Caesarean Section

A caesarean section, or c-section is an operation during which an obstetrician makes a cut through your abdomen and uterus (womb), to allow your baby to be born. It is the most common major surgery for women. In the UK, about one in four pregnant women has a baby by caesarean every year. 

Most caesareans are carried out with a local anaesthetic or epidural meaning you’ll be awake during the operation and aware of what’s going on around you. Around 10% of all caesareans happen under general anaesthetic. 

 

A caesarean section can be performed electively or in an emergency.

This page will give you the factual information about a caesarean from the NHS. As it is a major surgery, a lot of the information can sound very overwhelming and scary. However, it is important to fully understand the process and risks associated with this type of delivery so that you can make an informed choice about whether this type of birth it right for you. The term 'choice' was used because ultimately, you have to provide consent for a caesarean. The medical professionals will offer you advice if they think a caesarean is necessary, and you have the right to accept or decline that advice.

Women who truly believe and accept that a caesarean is necessary will hopefully have a more positive birthing experience, knowing that they have done what is best in the circumstances. For one such positive caesarean birthing story, check out our blog.

If you are feel like your wishes regarding the type of delivery are not being respected, check out AIMS.

Emergency Caesarean

Elective Caesarean

What are the risks?

Planning for your caesarean

The Procedure

After the Procedure

Recovery

VBAC (Vaginal Birth After Caesarean)

 

Emergency Caesarean

The term 'emergency' can be misleading as most unplanned caesareans are not immediately life-threatening. Occasions when this might happen include:

  • When a mother had planned a vaginal delivery but the labour has stalled so a caesarean if offered to allow the baby to be born quicker;

  • The baby is thought to be distressed

  • Placental bleeding

  • The site of previous uterine surgery may not be holding together well

  • ​You were planning a caesa rean, but your waters broke, or you went into labour before the operation.

Occasionally a caesarean is deemed urgent (about 10% of all caesareans are urgent). This might be because you or your baby has developed a serious complication during pregnancy or labour. In these cases, you and your medical team will have to make decisions quickly, but your midwife or obstetrician should be able to discuss these with you and your partner before and after the caesarean.

Although you may have less time to consider your options when an issue of this sort arises you still have the right to make an informed decision. In order to give or decline consent, you should still be provided with information about:

  • why it is being recommended?

  • what are the risks of surgery?

  • what the options are if you decline?

 

Elective Caesarean

An elective caesarean (or planned caesarean) may still be deemed medically necessary but is scheduled in advance. This may be the case if:

 

  • Your baby is in a transverse (sideways) position.

  • Your baby has an unstable lie and keeps changing position.

  • Your baby is in a bottom-down, or breech position.

  • You have a low-lying placenta (placenta praevia).

  • You have an infection that could be passed on to your baby if you give birth vaginally, such as Herpes or HIV.

  • You have another condition that would make it likely that would you have a severe tear.

  • You are expecting twins or other multiples.

  • You have had a previous caesarean.

With the exception of placenta previa, which usually (although not always) means that a caesarean is the safest way to give birth, none of the above situations means that a caesarean is inevitable, and you do have the option to decline. If you would prefer to explore your options, you are free to do so. The decision to accept the offer of a caesarean is always yours, and yours alone.

When a planned caesarean is recommended there is time to consider whether this is the best decision for you and your baby. This will be a very personal decision. Most women need not only to think about why the caesarean is being recommended, but also about the risk of the surgery and about what their personal priorities are for the birth of their baby. For some women a caesarean birth will be something they can accept happily, but for other they will need to explore every other option before they can agree to surgery.

 

Elective caesareans can also be offered for those mothers who feel unable to cope with a natural labour and vaginal birth due to physical and/or psychological needs. Usually the mothers will attend sessions with a counsellor who will recommend an elective caesarean in the best interests of the mother.

What are the risks?

When a caesarean is suggested or requested information about the risks must be provided in order that you can give consent for surgery, just as it would be for any other surgery. Signing a consent form without this information makes that consent invalid, and there could be legal case to answer from any surgeon who has not obtained valid consent to carry out surgery. People will consider different risks or benefit to be more or less important when making their decision.

Caesarean surgery has risks that would be expected of any surgery such as:

  • bleeding

  • infection

  • blood clots

  • problems with the anesthetic

  • accidental and sometimes unavoidable damage to tissues and organs

In addition, caesarean births have other risks specific to a baby being born this way. Common post surgical problems include wound infections and adhesions. Less common ones include permanent nerve damage, bladder damage and hysterectomy; it can affect future pregnancies.

When babies are born by caesarean they miss out on the journey through the birth canal. Often it is suggested that this is an advantage, but we now know that important things happen for the baby during this part of birth, including helping to prepare the baby to breathe and seeding the baby’s gut with beneficial bacteria. Research has confirmed that babies born by caesarean are at greater risk of:

  • asthma

  • eczema

  • respiratory problems

  • obesity in later life

All of these issues seem to be related to missing this part of the birth process.

You should be fully informed to weigh up the risks against the reasons the surgery was suggested. 

Planning for your caesarean

If your caesarean is elective/planned, you'll be given an approximate date for it to be carried out.

You'll also be asked to attend an appointment at the hospital in the week before the procedure is due to be performed.

During this appointment:

  • You can ask any questions you have about the procedure

  • You will go through the options for the anaesthetic

  • You can discuss your preferences for skin-to-skin where possible after the birth

  • They will scan to see the position of the baby and check the foetal movements

  • blood test will be carried out to check for a lack of red blood cells (anaemia) and you will have a urine test

  • You'll be given some medication to take before the procedure – this may include antibiotics, anti-sickness medication (anti-emetics) and medication to reduce the acidity of your stomach acid (antacids)

  • You'll be asked to sign a consent form.

 

You'll need to stop eating and drinking a few hours before the procedure – your doctor or midwife will tell you when. You may be given a carbohydrate drink to take to help with your recovery.

 

Most obstetricians are happy to work with women to make a caesarean birth a positive experience. It is usual for the baby’s father and/or a birth supporter to be in theatre for the birth and for the parents to be able to greet their baby and have skin to skin contact, providing the baby is well.

Other options for the birth might include:

  • lowering the screen so the mother can see her baby born

  • the baby to be passed straight to its mother for skin to skin and breastfeeding

  • delaying cord clamping (usually about a minute, so less than optimal cord clamping)

  • facilitating resuscitation of the baby, if required, at the side of the operating table without cutting the cord

  • lotus birth may be supported

For more on birth plans, see our page.

The Procedure

You'll be asked to change into a hospital gown when you arrive at the hospital on the day of the procedure.

A thin, flexible tube called a catheter will be inserted into your bladder to empty it while you're under the anaesthetic, and a small area of pubic hair will be trimmed if necessary.

You'll be given the anaesthetic in the operating room. This will usually be a spinal or epidural anaesthetic, which numbs the lower part of your body while you remain awake. This means you'll be awake during the delivery and can see and hold your baby straight away. It also means your birth partner can be with you.

 

General anaesthetic – where you're asleep – is used in some cases if you can't have a spinal or epidural anaesthetic.

During the procedure:

  • you lie down on an operating table, which may be slightly tilted to begin with

  • a screen is placed across your tummy so you can't see the operation being done

  • a 10-20cm cut is made in your tummy and womb – this will usually be a horizontal cut just below your bikini line, although sometimes a vertical cut below your bellybutton may be made

  • your baby is delivered through the opening – this usually takes 5-10 minutes and you may feel some tugging at this point

  • your baby will be lifted up for you to see as soon as they've been delivered, and they'll be brought over to you

  • you're given an injection of the hormone oxytocin once your baby is born to encourage your womb to contract and reduce blood loss

  • your womb is closed with dissolvable stitches, and the cut in your tummy is closed either with dissolvable stitches, or stitches or staples that need to be removed after a few days

 

The whole procedure usually takes around 40-50 minutes.

After the Procedure

You'll usually be moved from the operating room to a recovery room straight after the procedure.

Once you've started to recover from the anaesthetic, the medical staff will make sure you're well and continue to observe you every few hours.

You'll be offered:

  • painkillers to relieve any discomfort

  • treatment to reduce the risk of blood clots – this may include compression stockings or injections of blood-thinning medication, or both 

  • food and water as soon you as you feel hungry or thirsty

  • help with breastfeeding your baby if you want it

 

The catheter will usually be removed from your bladder around 12-18 hours after the procedure, once you're able to walk around.

Recovery

The average stay in hospital after a caesarean is around three or four days. You may be able to go home sooner than this if both you and your baby are well.

While in hospital:

  • you'll be given painkillers to reduce any discomfort

  • you'll have regular close contact with your baby and can start breastfeeding

  • you'll be encouraged to get out of bed and move around as soon as possible

  • you can eat and drink as soon as you feel hungry or thirsty

  • a thin, flexible tube called a catheter will remain in your bladder for at least 12 hours

  • your wound will be covered with a dressing for at least 24 hours

 

When you're well enough to go home, you'll need to arrange for someone to give you a lift as you won't be able to drive for a few weeks.

Your midwife should also advise you on how to look after your wound. You'll usually be advised to:

  • gently clean and dry the wound every day

  • wear loose, comfortable clothes and cotton underwear

  • take painkillers if the wound is sore

  • watch out for signs of infection 

 

Non-dissolvable stitches or staples will usually be taken out by your midwife after five to seven days.

The wound in your tummy will eventually form a scar. This will usually be a horizontal scar about 10-20cm long, just below your bikini line. In rare cases, you may have a vertical scar just below your belly button. The scar will probably be red and obvious at first, but it should fade with time and will often be hidden in your pubic hair.

You may also have some vaginal bleeding. Use sanitary pads rather than tampons to reduce the risk of spreading infection into the vagina, and get medical advice if the bleeding is heavy.

Try to stay mobile and do gentle activities, such as going for a daily walk, while you're recovering to reduce the risk of blood clots. Be careful not to overexert yourself. You should be able to hold and carry your baby once you get home. But you may not be able to do some activities straight away, such as:

  • driving

  • exercising

  • carrying anything heavier than your baby

  • having sex

 

Only start to do these things again when you feel able to do so and don't find them uncomfortable. This may not be for six weeks or so. Ask your midwife for advice if you're unsure when it's safe to start returning to your normal activities. You can also ask your GP at your six-week postnatal check. 

VBAC

It is possible to have a vaginal birth after a caesarean.

VBAC can be safer for a woman than a repeat caesarean, because a caesarean itself carries extra risks. For example, there is an increased risk of infection and a longer stay in hospital.

There are implications for future pregnancies too, including risks of placental problems, which increase with the number of caesareans a woman has, and a greater risk of needing an emergency hysterectomy (removal of the uterus).

As long as there isn’t a particular medical reason not to have a vaginal birth; VBAC can be a good option for you and your baby.

There are a number of things you can do to maximise your chances of having a vaginal birth and these are exactly the same as for any woman giving birth:

  • Choose carers and a birthplace with which you are comfortable.

  • Discuss with your midwife a birth plan, which sets out your requests for support in the choices below.

  • Allow labour to start naturally without induction (which also avoids increasing the risk of scar problems).

  • Stay at home for as long as you feel comfortable and confident.

  • Wait till your waters break spontaneously.

  • Choose to have the baby’s heartbeat listened to with a stethoscope or a handheld Sonicaid (a ‘Doppler’) rather than being strapped to an electronic fetal heart rate monitor.

  • Avoid having an oxytocin drip to ‘speed up’ labour.

  • As long as your labour is progressing, tell your midwife you do not be tied to strict time limits on how long the first or second stage of labour should be.

  • Keep moving around, changing position, being upright – follow your instincts.

  • If you have one-to-one support throughout your labour, this will also reduce the chance of your having a caesarean. 

Source: NHS, www.aims.org.uk, NCT.org.uk

Information accurate at the time of publication.

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