Caesarean Section

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Introduction

Caesarean Section

A caesarean section, or C-section, is an operation to deliver your baby through a cut made in your tummy and womb.

The cut is usually made across your tummy, just below your bikini line.

A caesarean is a major operation that carries a number of risks, so it's usually only done if it's the safest option for you and your baby.

Around one in every four to five pregnant women in the UK has a caesarean.

This page covers:

Why they're carried out

Asking for one

What happens

Recovery

Risks and complications

Future pregnancies

Why caesareans are carried out

A caesarean may be recommended as a planned (elective) procedure or done in an emergency if it's thought a vaginal birth is too risky.

Planned caesareans aren't usually done before the 39th week of pregnancy.

A caesarean may be carried out because:

  • your baby is in the breech position (feet first) and your doctor has been unable to turn them by applying gentle pressure to your tummy, or you would prefer they didn't try this
  • you have a low-lying placenta (placenta praevia)
  • you have pregnancy-related high blood pressure (pre-eclampsia)
  • you have certain infections, such as a first genital herpes infection occurring late in pregnancy or untreated HIV
  • your baby isn't getting enough oxygen and nutrients - sometimes this may mean the baby needs to be delivered immediately
  • your labour isn't progressing or there's excessive vaginal bleeding

If there's time to plan the procedure, your midwife or doctor will discuss the benefits and risks of a caesarean compared with a vaginal birth.

Asking for a caesarean

Some women choose to have a caesarean for non-medical reasons. If you ask your midwife or doctor for a caesarean when there aren't medical reasons, they will explain the overall benefits and risks of a caesarean compared with a vaginal birth.

If you're anxious about giving birth, you should be offered the chance to discuss your anxiety with a healthcare professional who can offer support during your pregnancy and labour.

If after discussion and support you still feel that a vaginal birth isn't an acceptable option, you're entitled to have a planned caesarean.

What happens during a caesarean

Most caesareans are carried out under spinal or epidural anaesthetic. This mean you'll be awake, but the lower part of your body is numbed so you won't feel any pain.

During the procedure:

  • a screen is placed across your body so you can't see what's being done - the doctors and nurses will let you know what's happening
  • a cut about 10-20cm long will usually be made across your lower tummy and womb so your baby can be delivered
  • you may feel some tugging and pulling during the procedure
  • you and you birth partner will be able to see and hold your baby as soon as they've been delivered

The whole operation normally takes about 40-50 minutes.

Occasionally a general anaesthetic, where you're asleep, may be used, particularly if the baby needs to be delivered more quickly.

Read more about how a caesarean is carried out.

Recovering from a caesarean

Recovering from a caesarean usually takes longer than recovering from a vaginal delivery. You might need to stay in hospital for three or four days, compared with one or two days for a vaginal birth.

You may experience some discomfort in your tummy for the first few days, and you'll be offered painkillers to help with this.

When you go home, you'll need to take things easy at first. You may need to avoid some activities such as driving for six weeks or so.

The wound in your tummy will eventually form a scar. This may be red and obvious at first, but it should fade with time and will often be hidden in your pubic hair.

Read more about recovering from a caesarean.

Risks of a caesarean

A caesarean is generally a very safe procedure, but like any type of surgery it carries a certain amount of risk.

It's important to be aware of the possible complications, particularly if you're considering having a caesarean for non-medical reasons.

Possible complications include:

  • infection of the wound or womb lining
  • blood clots
  • excessive bleeding
  • damage to nearby areas, such as the bladder or the tubes that connect the kidneys and bladder (ureter)
  • temporary breathing difficulties in your baby
  • accidentally cutting your baby when your womb is opened

Read more about the risks of a caesarean.

Future pregnancies after a caesarean

If you have a baby by caesarean, it doesn't necessarily mean that any babies you have in the future will also have to be delivered this way.

Most women who have had a caesarean section can safely have a vaginal delivery for their next baby, known as vaginal birth after caesarean (VBAC).

However, you may need some extra monitoring during labour just to make sure everything is progressing well.

Some women may be advised to have another caesarean if they have another baby. This depends on whether a caesarean is still the safest option for them and their baby.

For more information, the Royal College of Obstetricians and Gynaecologists has a leaflet on birth options after previous caesarean section (PDF, 357kb).

Abdomen

The abdomen is the part of the body between the chest and the hips.

How-is-it-performed

What happens

Caesarean sections are carried out in hospital. You may be asked to come in for an appointment a few days beforehand, and you might need to stay in hospital for a few days afterwards.

This page covers:

Preoperative appointment

The procedure

Afterwards

Preoperative appointment

If there's time to plan your caesarean, 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
  • a blood test will be carried out to check for a lack of red blood cells (anaemia)
  • 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.

The procedure

Preparation

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.

What happens

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.

Afterwards

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 - read more about the first few days of breastfeeding

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

Read more about recovering from a caesarean.

Anaesthetic
Anaesthetic is a drug used to either numb a part of the body (local) or to put a patient to sleep (general) during surgery.
Epidural
An epidural is an anaesthetic injection given into the epidural space that surrounds the spinal cord, especially during labour, to numb the lower half of the body. 
Local anaesthetic
A local anaesthetic is a drug that is injected by needle or applied as a cream. It causes a loss of feeling in a specific area of the body.
Spine
The spine supports the skeleton and surrounds and protects the delicate spinal cord and nerves. It is made up of 33 bones called the vertebrae.

Recovery

Recovery

You may be in hospital for a few days after a caesarean section, and may need to take things easy for several weeks.

This page covers:

Recovering in hospital

Looking after your wound

Your scar

Controlling pain and bleeding

Returning to your normal activities

When to get medical advice

Recovering in hospital

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.

Looking after your wound

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 - see controlling pain
  • watch out for signs of infection - see when to get medical advice

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

Your scar

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 bellybutton.

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.

Controlling pain and bleeding

Most women experience some discomfort for the first few days after a caesarean, and for some women the pain can last several weeks.

You should be given regular painkillers to take at home, for as long as you need them.

Paracetamol is usually recommended for mild pain, co-codamol for moderate pain, and a combination of co-codamol and ibuprofen for more severe pain.

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.

Returning to your normal activities

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.

When to get medical advice

Contact your midwife or GP straight away if you have any of the following symptoms after a caesarean:

  • severe pain
  • leaking urine
  • pain when peeing
  • heavy vaginal bleeding
  • your wound becomes more red, painful and swollen
  • a discharge of pus or foul-smelling fluid from your wound
  • cough or shortness of breath
  • swelling or pain in your lower leg

These symptoms may be the sign of an infection or blood clot, which should be treated as soon as possible.

Risks

Risks

A caesarean section is generally a very safe procedure, but like any type of surgery it does carry a risk of complications.

The level of risk will depend on things such as whether the procedure is planned or carried out as an emergency, and your general health.

If there's time to plan your caesarean, your doctor or midwife will talk to you about the potential risks and benefits of the procedure.

This page covers:

Risks to you

Risks to your baby

Risks to future pregnancies

Risks to you

Some of the main risks to you of having a caesarean include:

  • infection of the wound (common) - causing redness, swelling, increasing pain and discharge from the wound
  • infection of the womb lining (common) - symptoms include a fever, tummy pain, abnormal vaginal discharge and heavy vaginal bleeding
  • excessive bleeding (uncommon) - this may require a blood transfusion in severe cases or possibly further surgery to stop the bleeding
  • deep vein thrombosis (DVT) (rare) - a blood clot in your leg, which can cause pain and swelling and could be very dangerous if it travels to the lungs (pulmonary embolism) 
  • damage to your bladder or the tubes that connect the kidneys and bladder (rare) - this may require further surgery

Women are now given antibiotics before having a caesarean, which should mean infections become much less common.

Risks to your baby

A caesarean doesn't affect the risk of some of the rarest and most serious birth complications, such as an injury to the nerves in the neck and arms, bleeding inside the skull, or death.

But a caesarean can sometimes cause the following problems in babies:

  • a cut in the skin (common) - this may happen accidentally as your womb is opened, but it's usually minor and heals without any problems
  • breathing difficulties (common) - this most often affects babies born before 39 weeks of pregnancy; it will usually improve after a few days and your baby will be closely monitored in hospital

If you think your baby is experiencing breathing difficulties after you've left hospital, contact your GP or call NHS 111 straight away. 

Risks to future pregnancies

Women who have a caesarean will usually have no problems with future pregnancies.

Most women who have had a caesarean section can safely have a vaginal delivery for their next baby - known as vaginal birth after caesarean (VBAC). But sometimes another caesarean may be necessary.

Although uncommon, having a caesarean can increase the risk of certain problems in future pregnancies, including:

  • the scar in your womb opening up
  • the placenta being abnormally attached to the wall of the womb, leading to difficulties delivering the placenta
  • stillbirth

Speak to your doctor or midwife if you have any concerns.

For more information, the Royal College of Obstetricians and Gynaecologists has a leaflet on birth after previous caesarean (PDF, 494kb).