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Caesarean Section Births

How long should mothers rest for ideally after a Caesarean birth? Why is such rest needed? Is five days ample rest?

A caesarean birth is a major operation. Rest after operation is important to allow the wound to heal. For the first 12-24 hours after the surgery, the woman usually requires bed rest. The woman will be given strong pain medication for pain relief. A drip will keep her hydrated, and a urinary catheter will keep the bladder empty.

She might also have to wear special stockings for the legs to prevent deep venous thrombosis (DVT - blood clots) in the legs. The woman can eat and drink after the operation if the observations are stable. After the initial 24 hours, if the operation has been without complications, the woman is encouraged to move. Mobilising is important to reduce the risks of DVT. The stay in hospital is normally 3-4 days. However, the recovery for the whole operation is at least 6 weeks. After hospital discharge, ample rest at home is still required for the wound to heal.

What kind of precautions can mothers take while they rest after a Caesarean birth?
Caesarean birth is generally very well tolerated, and most mothers recover and breast feed within a few days. Sometimes, complications can occur. It is important to report excessive vaginal bleeding or lower abdominal discomfort during the recovery period. This could mean an infection requiring antibiotics.

It is also important to report any urinary symptoms, as well as any calf tenderness, shortness of breath or cough due to the risks of DVT and blood clots in the lungs. The woman should not exercise and sex until full recovery. Driving is not advised until after 6 weeks, as the wound needs to be fully healed before being able to do an emergency brake drive safely.
What percentage of births are Caesarean births? Have there been an increase in the number of Caesarean births in the past five years? If so, what is the percentage increase?

Ministry of Health statistics report that 30.5% of deliveries were caesarean sections for the period 2001- 2003. These figures show an increase compared to twenty years ago, when the average caesarean section rate was 20%. At the National University Hospital, 26.5% of deliveries in 2008 were caesarean deliveries. The caesarean section rate at NUH had remained relatively constant over the last 5 years.

The increasing trend for caesarean births is similar in other Western developed countries. Women delay childbirth and have fewer children, variations in clinical practice, organisational factors (such as provision of one-to-one support in labour, women's choices about childbirth) are all important factors explaining this trend.
If there has been an increase, why have more mothers been requesting for Caesarean births?
It is not certain if the increase in Singapore rates is related to more mothers requesting for planned caesarean births without medical indications (maternal request). Maternal request on its own is not an indication for caesarean section and the specific reasons for the request should be discussed, as well as the benefits and risks of caesarean section compared with vaginal birth. Counselling should be offered to help address a potential fear of childbirth.
If there is no such increase, is there a preference for natural births?

All pregnant women without any medical indication for a caesarean delivery should be strongly encouraged to have a vaginal birth. Caesarean section should be reserved for medical reasons.

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