Caesarean Section

During a caesarean section, the baby is born through a cut or incision which is made through the mother’s abdomen and uterus. A caesarean section to deliver a baby may be planned (elective), or unplanned. An unplanned caesarean section is usually the result of complications before or during labour which necessitate a fast delivery of the baby for the good of its health or the mother’s. If you are pregnant, it’s a good idea to learn more about a caesarean section in case you are unable to have a vaginal birth.

An Elective Caesarean

Some women ask if they can have a caesarean section to deliver their baby instead of a vaginal birth. There are risks associated with any operation, and a caesarean section is major surgery. Mothers who want a caesarean for non-medical reasons need to be aware of the risks, including the effect a caesarean can have on future pregnancies. If you feel very strongly that you would like a caesarean, speak to your doctor or midwife about your reasons and your wishes.

An elective caesarean is usually offered to mothers if there is a reason that means their baby cannot be born by a normal vaginal delivery. This could be because:

You have a problem such as heart disease and labour could be dangerous for you.
You have an infection that you could pass to your baby if you have a vaginal birth.
Your baby is in a breech position. Breech refers to how your baby is lying in your womb. It means that your baby is lying with their bottom or feet are at the opening to the cervix instead of their head.
You are pregnant with twins, and one baby is in a breech position.
Your baby is lying sideways, or transverse, and cannot be turned by the doctor.
Your placenta is partly or completely covering the cervix.
You have already had caesarean sections with previous pregnancies.

Emergency Caesarean

You might need an emergency caesarean section if your doctor or midwife is concerned for your baby’s wellbeing, or your health, before or during labour. You might also need a caesarean if your labour isn’t progressing as it should, or there is a life-threatening emergency. In some cases, complications develop before labour, such as severe bleeding or pre-eclampsia and it is necessary to perform an emergency caesarean without delay.

What Happens During the Operation

Before you undergo a caesarean section, your doctor should explain why it is necessary and the chance of any associated complications or risks developing. You will be asked to sign a consent form, and as long you are not in a life-threatening situation which means there isn’t time, you will be able to ask any questions that you have.

The operation is performed by an obstetrician, and this is the medical professional that will deliver your baby. The procedure is similar whether your caesarean is an elective or emergency procedure.

As well as the obstetrician, also present in the theatre will be:

An anaesthetist and an anaesthetist nurse to administer anaesthetic and pain relief. You will be given the anaesthetic that is most appropriate for you and your baby depending on your circumstances.
A paediatrician to care for your baby when he or she is born.
A midwife to take over the care of your baby until you are well enough to return to the postnatal ward.
There will also be a surgical assistant, scrub nurse, nurse assistant and theatre technician who work as a team to ensure that your operation runs smoothly.

Usually, your partner or support person will be able to go into the theatre with you, but nobody else can be permitted.

Anti-Embolism Stockings

Before your operation, you will be fitted with special stockings until you can move around again after the operation. These TED stockings, or anti-embolism stockings, help to reduce the risk of blood clotting while you are inactive.

Also before your operation:

A cannula is put into the vein in the back of your hand or arm.
A catheter is inserted into your bladder to keep your bladder empty during the operation.
The operation site is shaved so that it is free of hair.

Anaesthesia for a Caesarean Section

Your anaesthetist will advise you whether an epidural, spinal block or general anaesthetic is best for your situation.

Epidural or Spinal Block

An epidural or spinal block is a procedure where a drug is injected into the small space in your back near your spinal cord. With an epidural, a needle is inserted into your lower back, and a catheter is threaded through the needle. The anaesthetist then removes the needle, leaving the catheter in place to administer the anaesthetic. A spinal block involves injecting the anaesthetic into the canal around your spinal cord. You will then be unable to feel any pain since the medication prevents the pain signals from being sent to the brain.

You will be awake, and you will be able to see your baby being born.
A screen will be placed across your chest so you cannot see the area that is being operated on.
The incision is usually made around the bikini line.
You may feel some tugging or pulling.
You may hear a sucking sound, which is the obstetrician removing the waters that surround your baby from your uterus.
The operation takes around 30 to 40 minutes.
The doctors will talk to you during the operation and let you know what is happening.
You will see your baby as soon as he or she is lifted out of your uterus and usually your baby is placed straight onto your chest.

With a general anaesthetic, you are asleep during the operation. You will see your baby when the operation is finished, and you will wake up in the recovery room.

Risks Associated with a Caesarean Section

Complications are rare, but they can have serious consequences, and you need to be aware of them. Some risks are associated with any surgery, and others apply specifically to a caesarean section. If you are overweight, the risks are greater.

Risks to the mother include:

Heavy blood loss.
Infection in or around the wound.
Blood clots, called deep vein thrombosis or DVT, usually in your legs
Pulmonary embolus.
The risk of damage to other organs, such as your bladder.
Risks associated with the anaesthetic.

A pulmonary embolus is a rare complication of a caesarean section, but it is a serious one. It involves a blood clot moving from your leg to your lungs. While you are in hospital, you may be given an injection every day to minimise the risk of developing clots in your legs and lungs.

Risks associated with anaesthetic include:

Low blood pressure
Nausea and vomiting
Post-dural headache

A post-dural headache occurs when the epidural or spinal needle punctures the dura. The dura is a bag which contains fluid. Your brain and spinal cord are contained within the dura. The spinal fluid can leak out of the hole through the puncture, reducing the pressure in the rest of the fluid. The result is a headache which typically feels worse when sitting or standing. Most headaches settle within a few days, but the hole in the dura can take several weeks to heal, so some headaches can last longer.

Risks to your baby include:

Temporary breathing difficulty.
Need for special care in hospital.
A small risk of your baby being cut during the operation
Bruising on your baby’s head or body if forceps or vacuum are used.

Sometimes, in about one to two out of every 100 babies, the baby is cut when the obstetrician is operating. It is usually a small cut that isn’t deep, and thin adhesive strips are used to seal the wound. The cut usually heals without any further harm to the baby.

What Happens After Your Baby is Delivered by Caesarean

The environment of the recovery room will be cold for your newborn baby, so one of the medical team will likely put a bonnet on his or her head and warm blankets over your baby’s back.

It is important that a baby receives skin to skin contact as soon as they are born. As long as you are both well, your baby will be placed straight onto your chest. Your baby is likely to be wide awake after delivery, and this is the perfect time for mum and baby to bond. Having your baby placed straight onto your skin will also help to stabilise his or her temperature, provide reassurance, and help to initiate an instinctive feeding response that encourages successful breastfeeding. Your baby may be able to stay with you throughout your time in recovery to enhance the bonding process and to increase the likelihood of you being able to offer your baby their first feed.

How Mums are Likely to Feel Immediately After a Caesarean

A caesarean is major surgery, and you will normally need to stay in hospital for about three to five days after your operation, depending on the hospital and how well you recover. You will need to rest in bed at first, and you will feel uncomfortable for the first few days. If there are any problems with your recovery, you may need to stay in hospital longer.

You will be offered pain relief medication to help you manage the pain. It is important that you take the pain relief that you need to help you recover as quickly as possible; let the hospital staff know if you feel unwell, you are in pain, or you feel sick.

Moving Around After a Caesarean

It is very important for your health that you do deep breathing exercises and leg exercises regularly and you wear your TED stockings during the day and night. As soon as your catheter, drip and wound drain are removed, you will be able to take a gentle walk every day. Take things very gently at first, but try to move around and get your muscles working again. By being mobile and active, you reduce the chances of chest infections and blood clots in your legs and you help to prevent constipation. Ask your midwife about postnatal exercises.

Emotional Support

Straight after the birth of a baby, it’s normal to feel emotional. When you have had a caesarean, your feelings might be enhanced, especially if you didn’t plan on delivering your baby in this way. Try to remember that the most important thing is that you and your baby are well. Talk to your partner, family and medical staff about your feelings.

Your Wound

If your wound was closed with staples, these are usually removed within three to seven days.
Re-absorbable sutures or stitches will be absorbed by your body so you will not need to have them removed.
Keep your wound clean and dry.
Wear loose, comfortable clothing that won’t catch on the wound.
Keep an eye out for infection. Look out for any redness, swelling, pain or bad-smelling discharge. If you notice any of these symptoms, let your doctor or midwife know.
You may feel some pain or numbness in the skin around the incision site. This can last for several months.
Your wound will heal over the next few weeks.

Going Home after a Caesarean

Some hospitals will allow you to go home earlier than three to five days and have your follow-up care at home. If this is something you would like, ask your midwife what options are open to you.

Over the next few weeks, you may notice mild cramping, light bleeding or vaginal discharge. Looking after a new baby is hard for all women, but when you are recovering from a major operation, it can be even more difficult both mentally and physically.

Do not lift anything that is heavier than your baby.
If something causes you pain, don’t do it.
Get as much rest as you can.
Avoid strenuous activities for six weeks.
Ask family or friends for help or support if you feel unwell or feel that you are struggling to cope.

You may not be able to drive a car for six weeks after your operation. Your obstetrician will advise you when your wound has healed, and you are sufficiently recovered to drive again.

Avoid sex until you feel comfortable. It’s normal to take weeks or months after the birth of a baby to feel ready to have sex again.

By about six weeks, you are likely to be feeling much better, although it’s normal to experience aches and pains for several months after your operation.

Future Pregnancies after a Caesarean Section

When you have had a caesarean section, you are classed as high-risk for future pregnancies. This is because the risk of complications increases after each caesarean. Some women can have a vaginal delivery after a caesarean section, so talk to your healthcare professional about your options. This is called vaginal birth after caesarean (VBAC).

If you have three or more caesarean births, you are more likely to experience:

Placenta praevia: Problems with your placenta implanting low in the uterus if you become pregnant again. This is a condition called placenta praevia.

Placenta accreta: Problems when your placenta doesn’t come away as it should after your baby is delivered. This is a potentially serious complication called placenta accreta and can lead to severe bleeding after childbirth.

The need for a hysterectomy: The need for extra procedures such as a blood transfusion or an emergency hysterectomy. The risk is low, but with each subsequent pregnancy, the need for a hysterectomy when the baby is born increases. A hysterectomy means that you are unable to have any more children.

Whether your baby is born vaginally or by caesarean section, the most important thing is that both mother and baby are well. By considering the size of the family you want and talking to your healthcare professional, you and your family are more likely to enjoy a safe and rewarding experience.