Unexpected Early Delivery or C-section
A guide for expecting mothers

According to the Health Ministry, about 8% of babies are born prematurely in Malaysia. An unexpected early delivery may call for an emergency C-section, whether you've planned to deliver naturally or surgically.

This guide will tell you all the must-knows of C-sections and how to stay worry-free if the unexpected happens.

What is a C-section?
A caesarean section, commonly known as a C-section, is a surgical delivery method when a vaginal birth is unfeasible. The procedure is accomplished by making a 4 to 6-inch incision along the mother's abdomen.

A C-section poses more risk than a vaginal delivery, though can less painful and time-consuming.

When is a C-section needed?
A C-section is generally required in emergencies. For example, if the mother's body isn't ready to deliver vaginally or if the baby is in distress. However, it has become quite common for women to plan to undergo a C-section to bypass labour pain or for health reasons.

You might need a C-section if:

• Your baby is too large for a vaginal birth.
• You are carrying more than one baby.
• Your baby isn't in a head-down position in the womb.
• You have active infections in your vagina or cervix.
• There is a blockage in the passageway to the vagina, e.g., by the placenta.
• You have health conditions such as diabetes, hypertension, and heart problems.
• You've had a C-section before.
• You have excessive vaginal bleeding.

C-section risks
Post-delivery complications with C-section births are not uncommon, as all major surgeries carry risks. We compile a list of possible risks a C-section might bring to you and your baby.

Risks to the mother:

• You may experience infection and inflammation at the site of the incision, endometrium, or urinary tract.
• Surgical delivery results in more blood loss than a natural birth, leading to possible excessive bleeding during and after your delivery.
• A C-section increases the risk of developing blood clots in the legs or pelvis (deep vein thrombosis) in the first 24 hours after delivery.
• You may develop reactions to the anaesthesia given during the procedure.
• You might have complications with future pregnancies if you decide to deliver vaginally, as your uterine wound might tear. In addition, your placenta might develop unusually and cause placenta previa or preterm birth.

In the long run, women who undergo C-sections rather than vaginal deliveries are more likely to experience miscarriage and stillbirth in future pregnancies, respectively. Fortunately, these are not common occurrences.

Risks to the baby:
A C-section may also pose risks to the baby than to the mother. One of the few possible complications is breathing difficulties after the baby is born. This is because the labour process helps clear the baby's lungs of fluid to prepare for breathing. Thus, surgical delivery might not leave the baby enough time to drain or reabsorb the fluid before birth.

The surgery might also leave an accidental scrape or cut on the baby's skin.

C-section procedure - What to expect
If you're having a planned C-section, your doctor might advise you to run a few blood tests beforehand. A full blood profile will help medical professionals understand your blood type in the event of an emergency blood transfusion.

You may also want to discuss your medical conditions with your doctor to avoid adverse reactions with anaesthesia and antibiotics during the procedure.

Nonetheless, it is always a good idea to be prepared for the unexpected, even if you're planning to deliver vaginally. Talk to your doctor and discuss the possibility of an emergency C-section so you can be well-prepared. 

You can expect the following before, during, and after a C-section surgery.

Before the procedure

• You will need to shower with an antiseptic soap the night before or the morning of the surgery to rid your skin of bacteria. This step is to reduce the risk of an infection after the procedure.

• You should not shave your pubic area 24 hours before a C-section, as microscopic cuts or scrapes might invite infection to the surgical site.

• An IV line will provide you with fluids and drugs. A catheter will also be inserted into your bladder to drain urine.

• You will be given regional anaesthesia so you can still experience the delivery process. Sometimes, general anaesthesia will be required, and you'll be unconscious throughout the procedure.

• Your abdomen will be cleaned with an antiseptic.

• An initial incision, usually horizontal, will be made on your abdomen above the pubic bone (suprapubic transverse). Then, the cut is deepened into a uterine incision on the lower part of the uterus (low transverse).

• Your doctor will deliver the baby through the incisions. Then, the umbilical cord is clamped and cut before the placenta is removed.

• Lastly, your abdomen and uterus will be sutured to close the incisions.

During the procedure

• Your abdomen will be cleaned with an antiseptic.

• An initial incision, usually horizontal, will be made on your abdomen above the pubic bone (suprapubic transverse). Then, the cut is deepened into a uterine incision on the lower part of the uterus (low transverse).

• Your doctor will deliver the baby through the incisions. Then, the umbilical cord is clamped and cut before the placenta is removed.

• Lastly, your abdomen and uterus will be sutured to close the incisions.

After the procedure
The hospital stay after a C-section procedure is at least 2 to 3 days, during which you can start breastfeeding and get out of bed. You are encouraged to get adequate movement during this time to reduce constipation and prevent blood clots.

You can also discuss your pain management medication with your healthcare provider to understand the best option for you.

When you go home
Full recovery of your wounds may take 6 to 8 weeks, so try not to rush into things once you get home. There's no better time to rely on your loved ones and let them take the wheel for a few weeks. Some of the things you should do are:

• Rest while you can for the first few weeks.

• Follow pain relief instructions given by your doctor.

• Avoid sex for at least 6 weeks.

• Drink plenty of water.

Talk to your healthcare provider if:

• Your incision is swollen, red, or leaking discharge.

• You have a fever with breast tenderness.

• You're experiencing unusual vaginal discharge and heavy bleeding.

• You're showing signs of postpartum depression.

How much does an emergency C-section cost?
The difference between an emergency C-section and a planned one is the time you have to prepare for it.

The estimated price range of an emergency C-section in Malaysia is around RM200 to RM4,000 in public hospitals and RM8,000 to RM20,000 in private hospitals.

Note that additional charges like ultrasound, nursery fees, and cases of complications may incur additional costs.

Insurance for C-section
A C-section surgery might be a financial burden to some families, especially if this mode of delivery is needed unexpectedly due to medical reasons. In such cases, it might be a good idea to take up relevant insurance to be well-prepared.

PRUMy Child Plus, offered by PRUWith You, is a coverage plan that protects your child from womb to adulthood. Protection starts as early as week 13 into your pregnancy. This plan can be flexibly attached with extra riders to enhance the benefits.

This comprehensive plan ensures you and your child are cared for with protection from pregnancy complications, emergency C-sections, congenital conditions, and more.

C-section FAQs
Like any other major surgery, mothers who plan to give birth via a C-section might have many queries about what it's like. So we answer some frequently asked questions about caesarean births so you can be prepared no matter what.

Sleeping positions after a C-section
After a C-section, sleeping on your back is the best way to take pressure off your wound and help align your spine. Elevating your legs with pillows may also help you feel more comfortable in this position.

You can also try sleeping at a 45-degree incline with the help of pillows.

Breastfeeding positions after a C-section
Classic breastfeeding positions like the cradle might not be comfortable in the first few weeks as holding your baby that way may irritate your healing wound.

Instead, you can try lying in bed on your side with your baby facing you in the same position. Another method you can try is to sit up and wrap your baby under your arm, with their belly facing your body. These positions help them latch easily and reduce strain on your wound.

How painful is a C-section delivery?
You will most likely be given regional anaesthesia, like an epidural or a spinal block, before the procedure to numb your body from the waist down. Thus, though awake, you won't feel any pain throughout the surgery, only a tugging sensation or some pressure.

How long does a C-section take to heal?
Your wound will take around 6 to 8 weeks to fully heal. Soreness around the abdominal incision site is normal for the first few days. Your doctor might suggest a few pain relief options depending on your condition.

You should avoid placing anything into your vagina (e.g., tampons) for the first 6 weeks after a C-section, as the cuts and wounds in and around the area may invite infection. You may also experience heavy bleeding in the first week of post-surgery, after breastfeeding, and after getting up from bed.

When to wear an abdominal belt after a C-section?
The perfect time to start wearing a postpartum support band is 2 to 4 weeks after your C-section. Any time before that is too soon, as the belt might irritate your healing incision wound.

Nonetheless, it's best to consult your healthcare professional before deciding to wrap your postpartum tummy to make sure it's safe for you to start.

What to wear after a C-section?
After a C-section, you should wear loose-fitting clothing to reduce irritation and allow ample airflow to facilitate healing. It might also be more comfortable for you to wear high-waisted underwear that doesn't restrict the wound area.

What to eat after a C-section for fast recovery?
Your body needs plenty of nutrition to recover postpartum. The best foods to enhance the healing process are:

• Fibre-rich foods, e.g., leafy greens, whole grains, fruits

• Iron-rich foods, e.g., spinach, liver,

• Proteins, e.g., lean red meats, fish, chicken

• Vitamin C, e.g., red peppers,

• Healthy fats, e.g., avocado, nuts, seeds

Avoid fermented, fried, spicy food and carbonated drinks, as they can cause bloating and indigestion.

How to lose weight after a C-section?
You might be keen to lose some pregnancy weight after your delivery, but it's not a good idea to rush into it. However, going on a diet or reducing your carbohydrate intake is also not recommended. Restricting your nutritional intake is not a healthy way to lose postpartum belly fat.

What you can do is fulfil your dietary needs without sacrificing nutrition. If you're breastfeeding, a daily calorie intake of 2300 to 2500 is recommended; if you're not, you should consume at least 1800 calories a day.

Try to avoid processed foods like canned food, snacks, and candy as they contain empty calories with no nutritional benefit.

When can I exercise after a C-section?
Excessive range of motion too early after your surgery might cause your wound to reopen. You can start doing light exercises 6 weeks into recovery or high-impact activities 12 weeks after.  To be safe, consult your doctor before you start exercising postpartum.

Conclusion
Whether you're planning to deliver vaginally or surgically, it's good to know what happens before, during, and after a caesarean birth in case of an unexpected circumstance.

In these times, Prudential offers comprehensive coverage plans to protect you and your baby throughout your delivery journey.

We're always happy to help if you need help understanding more about the terms to build a plan tailored to your needs. Feel free to contact our Customer Service line at 03-2116 0228 or write us at customer.mys@prudential.com.my.