Caesarean section

A caesarean section, or c-section, is an operation to deliver your baby through a cut in your tummy (abdomen). If you have problems in your pregnancy, caesarean section can be the safest way to deliver your baby. But it’s a major operation that carries some risks. It’s important that you’re aware of these if you’ve been advised to have or are considering a caesarean.

Medical reasons for having a caesarean section

Your caesarean may be planned (elective) or may be done as an emergency. Here are some of the reasons your doctor may recommend a planned caesarean.

• You have a ‘low-lying’ placenta. This means your placenta completely or partly covers the baby’s way out from your womb. The medical name for this is placenta praevia.
• Your baby is in the ‘breech’ position with their feet or bottom downwards, rather than their head. You may first be offered a procedure to try and turn your baby around by pressing on your tummy. This is called external cephalic version.
• You’re expecting more than one baby and the first baby isn’t lying in the normal ‘head down’ position.
• You’ve had a caesarean section before. See our section on ‘future births after having a caesarean’ for more information about this.
• You have a viral infection you could pass to your baby during a vaginal delivery. These include HIV which isn’t well controlled, or where you have hepatitis C as well as HIV. Or, you may have a planned caesarean, if you have a first genital herpes infection late in pregnancy.

Reasons why you may need an unplanned or emergency caesarean include the following.

• There’s a complication during the birth, which is putting your baby at risk.
• You start bleeding heavily from your vagina.
• Your labour has been going on for some time and isn't progressing.

Remember, your doctor or midwife will only recommend a caesarean, if it’s the best thing for you and your baby. You can ask them about the risks and benefits before you give your consent.

Can I ask for a caesarean section?

Your doctor won’t recommend a caesarean section unless there’s a medical reason. However, any woman can choose to have her baby by caesarean section if she wishes.

It’s important that you understand exactly what’s involved if you’re considering this option. You should tell your midwife or doctor as early as possible. They’ll offer you the chance to talk to a health professional trained in providing support. You can talk through any concerns about vaginal birth with them. They’ll explain your birth options, including what pain relief you can have.

They’ll also explain the risks and benefits of a caesarean section compared to a vaginal birth. Some of the main ones are listed here.

Benefits of a caesarean

• You can plan when and where your baby is born, and it may make you feel more in control.
• You’re less likely to have the pain and soreness around your vagina that you may get with a vaginal birth.
• You’re less likely to have heavy bleeding in the first few days after a caesarean birth than a vaginal delivery.

Risks of a caesarean

• After a caesarean, you’re likely to need to stay in hospital for longer. It can also take longer to get back to your usual activities, like driving.
• It might take longer to have skin-to-skin contact with your baby straight after the birth.
• Your wound is likely to be sore for the first few days and sometimes for months afterwards.
• A caesarean is a major operation. There are several possible complications for you and your baby. See the section on Complications for more information.

If you have any questions, consult your doctor. 

Preparing for a caesarean section

If you’re having a planned caesarean, you’ll get information about how to prepare. It’s very important to follow any instructions your hospital gives you. This will include not eating or drinking for some hours before your operation.

You should arrange beforehand to have someone to help you in the first few weeks after you get home. It can take time to recover, and you won’t be able to drive or lift anything heavy at first.

You’ll have a blood test before your caesarean section to check for anaemia and to confirm your blood group. Swabs may be taken from areas of your skin to check for bacteria, like methicillin-resistant Staphylococcus aureus (MRSA), which are resistant to antibiotics.

You’ll be offered antibiotics to take on the day of your caesarean. This is to reduce your chance of getting an infection afterwards. You may also be offered anti-sickness drugs and antacids.

What type of anaesthetic will I have?

If you’re having a planned caesarean, it’s usual to have either a spinal or epidural anaesthetic. This means you’ll be awake, but numb from the chest down. You’ll have a thin tube (catheter) put into your bladder to help you pass urine (wee). See our video below, ‘How an epidural is given during childbirth’.

If you have an emergency or unplanned caesarean, you may need to have a general anaesthetic. This means you’ll be asleep during the operation.

What happens during a caesarean section?

Once the anaesthetic has taken effect, your surgeon will make a cut across your lower tummy. This area is sometimes called the ‘bikini line’. They’ll then make a cut in your womb to reach your baby. If you’ve had a regional anaesthetic, you won’t feel any pain but you may feel some pulling or pressure in your lower body.

After delivery of your baby and placenta, the cuts to your womb will be closed with dissolvable stitches. Your surgeon will close the wound in your abdomen using stitches or clips and cover it with a dressing.

What to expect afterwards

You’ll be encouraged to have skin-to-skin contact with your baby as soon as possible after the birth. You’ll also be offered support to start breastfeeding your baby if you choose to do so.

Your medical team will check that you’re recovering from your anaesthetic properly. And they’ll make sure that you have medicines to reduce any discomfort.

If you don’t have any complications and you’re recovering well, you can eat or drink as soon as you feel ready.

You’ll be encouraged to get up and start walking soon. You may be offered compression stockings to wear before your caesarean or an injection of an anticlotting medicine called heparin afterwards. These all help prevent blood clots forming in your legs (deep vein thrombosis).

Your catheter can come out, once you’re up and about, if it’s been at least 12 hours since your last epidural dose.

It's usual to stay in hospital for two to three days after having a caesarean delivery. If you’re recovering well with no signs of fever or infection, you may be able to go home sooner. Or you may be advised to stay longer if you or your baby needs to. Before you leave hospital, your nurse will give you advice about your recovery. This will include what painkillers you’ll need, any complications to watch out for, and how to look after your healing wound.

If you’ve had an unplanned caesarean, you should have the chance to talk to your surgeon and midwife about why this was needed. They’ll also give you information about your options for any future pregnancies.

Recovering from a caesarean delivery

How long it takes to recover fully from a caesarean is different for every woman. You’ll need plenty of help and support from family and friends when you first get home. When you’re discharged, the hospital will give you some advice to follow. This is likely to include some of the following.

• Clean and dry your wound carefully every day.
• Wear loose, cotton clothes and underwear to help it heal.
• Don’t lift anything heavy or do any vigorous exercise until you feel you’ve fully recovered. This can be up to six weeks or more.
• You can usually drive when you feel comfortable and physically able to do so. It’s best to check with your insurance company first.
• You can have sex once you feel ready and comfortable to do so. Make sure you have arranged your contraception first. You can still get pregnant, even if you’re breastfeeding.

It can take time to get back to normal after having a caesarean section, both physically and emotionally. Talk to your midwife or health visitor about how you’re feeling. They can give you support and answer any questions you have. And if you’d like to talk to others with similar experiences, they may be able to put you in touch with a support group.

Complications

Most women who have a caesarean recover well and have healthy babies. But a caesarean is a major operation and it’s important to be aware of the possible risks to you and your baby.

Possible complications of caesarean section which might affect you include the following.

• Infection in your womb, bladder or wound. Some infections are fairly common after a caesarean. You’ll be offered antibiotics to reduce your risk.
• A blood clot in your leg, which can travel up to your lungs. Your healthcare team will take measures to prevent this. But it’s important not to ignore symptoms such as pain and swelling in your legs.
• Heavy blood loss during the surgery. This isn’t common but if it happens, you might need a blood transfusion or further surgery to stop the bleeding.
• Damage to a nearby organ, such as your bladder or bowel.
• A caesarean can cause possible complications in future pregnancies. For more information about delivery after a caesarean, see our section on ‘Future births’.

The risk of complications tends to be greater if you’re overweight. You’re also more likely to have complications in repeat caesarean sections.

There are some complications of caesarean section which might affect your baby.

• Your baby might have temporary breathing problems after the birth. This is more common in babies born by caesarean than in babies born vaginally. They might need care on a neonatal unit if this happens.
• Your baby may get a small cut during the operation. This happens in about 1 or 2 in 100 caesareans. It usually heals by itself.

If you want to know more about the possible complications of a caesarean, talk to your doctor or midwife.

Future births after having a caesarean

If you’ve had a caesarean, you may wonder how you’ll give birth to your next baby. You may hope for a vaginal birth or prefer a planned caesarean section.

When thinking about your future birth options, there are some things to take into account.

• The reason for your caesarean section.
• Whether you’ve ever had a vaginal birth.
• Any complications or problems you had during the caesarean, or afterwards.
• The type of cut your doctor made in your womb.
• How you felt about having a caesarean.
• Whether you have any problems during your current pregnancy.
• How many babies you’re hoping to have in the future.

The risks and benefits of a vaginal birth or another caesarean are different for every woman. Talk to your midwife or doctor about your options at an antenatal visit. It’s best to do this before 28 weeks.

Having a vaginal birth after a caesarean

Around seven in 10 women go on to have their next baby vaginally after having had a caesarean. This is known as a vaginal birth after caesarean (VBAC). You’re more likely to have a successful VBAC if you’ve had a previous vaginal birth.

If you plan to have a vaginal birth, you and your baby will be very closely monitored while you’re in labour. Be aware that some women trying for a vaginal birth end up needing an emergency caesarean.

Having a planned repeat caesarean

If you plan to have another caesarean, this is known as an ‘elective repeat caesarean section’ (ERCS). If you’ve had three or more previous caesareans, this will be the safest option. Or there may be problems with your pregnancy which make a vaginal birth more risky. Your doctor or midwife can talk to you about these.

You can have repeated caesarean sections. If you have four or more caesareans, your risk of certain complications increases. These include injury to your bladder or bowel, and problems with your placenta.