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Caesarean delivery

Caesarean delivery is an operation to deliver your baby through your abdomen. You may have a caesarean delivery as a planned operation, or you may need one because of an emergency.

To meet your individual needs, your care may differ from what’s described here. It's important to discuss your caesarean delivery with your obstetrician and midwife.

If it's not possible for you to give birth to your baby vaginally, you will need an operation called a caesarean. This is also sometimes called a caesarean section or C-section.

You can plan in advance to have a caesarean delivery, which is called a planned or elective caesarean. Or, you may go into labour and then need an emergency caesarean because of complications that develop. It’s also possible that you may need an emergency caesarean before you go into labour.

Some of the reasons why you may have a caesarean delivery are listed below.

  • Your labour has been going on for some time and isn't progressing.
  • Your baby isn't getting enough oxygen, or there’s another problem putting them at risk. This is called fetal compromise or fetal distress.
  • The placenta partly or completely covers your cervix (the neck of your womb). This is called placenta praevia.
  • You’re expecting more than one baby, for example, twins or triplets.
  • Your baby is lying with their feet or bottom first rather than their head downwards. This is called breech position and makes giving birth vaginally more difficult or sometimes impossible.
  • You bleed heavily during a vaginal delivery.
  • You have a viral infection, such as HIV or genital herpes simplex.
  • You’ve previously had a caesarean delivery. Although it's often possible to have a vaginal delivery after a caesarean pregnancy.

In the UK, about one in four babies are delivered by caesarean. However, this varies between hospitals and with where you live.

Types of caesarean delivery

There are two main types of caesarean delivery.

  • Lower uterine segment caesarean is the most common type. A cut is made across the lower part of your abdomen and womb, usually parallel to your bikini line. There’s usually a smaller amount of blood lost with this type of caesarean and the scar that forms afterwards tends to be smaller and stronger.
  • A classical caesarean, which is less common nowadays. The cut to your womb is made vertically. It's likely that you will only need this type of caesarean delivery if there are reasons why a cut can't be made in the lower segment of your womb. For example, your placenta may be in the way at the front (placenta praevia) or your baby may be very premature.
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Details

  • Preparation Preparing for a caesarean delivery

    If you’re planning to have a caesarean delivery, your obstetrician or midwife will arrange for you to have a blood test before your operation. This will show if you have anaemia. Anaemia is a condition in which your blood can't carry enough oxygen to meet the needs of your body. All caesareans cause some blood loss and you may lose anything up to one litre of blood. If you’re already anaemic, or if you lose more blood than expected during the operation, you may need to have a blood transfusion.

    Planned caesareans are usually done using regional anaesthesia. This could be either using an epidural, a spinal, or a combined epidural/spinal block. These types of anaesthesia completely block the feeling from your waist down but you’ll stay awake during the operation.

    An epidural takes time to work, but it can be topped up regularly. You may have already had an epidural for pain relief if you were in labour. If so, this can be topped up with another dose. A spinal block takes effect more quickly, but it’s a one-off dose and only lasts for a set length of time.

    If your baby needs to be born immediately, for example because of fetal distress, you may require a general anaesthetic. This means you will be asleep during the operation.

    You may need to give your consent for the caesarean to take place. So speak to your obstetrician and ask any questions you’d like answers to. It’s important you understand the risks, benefits and any alternatives to the operation. If you’re having a caesarean delivery in an emergency situation, it may not be possible to ask you to sign a consent form. If this happens, you’ll be asked for verbal consent.

  • Alternatives What are the alternatives to caesarean delivery?

    If you’re considering a planned caesarean delivery, it's important to be aware of the possible alternatives.

    It's sometimes possible to give birth vaginally if you’ve had a previous caesarean delivery. And, if you’re expecting twins or if your baby is in the breech position. Your midwife or obstetrician can give you more information about the specific risks and benefits of your options.

  • The procedure What happens during a caesarean delivery?

    If you have a planned caesarean delivery, you may be able to choose some aspects of the delivery. You may be able to choose whether you see your baby delivered, or how and when your baby is passed to you. You may even be able to choose to have music playing during your operation.

    A drip will be inserted into a vein in your hand or arm to give you fluids and medicines. You will then be given either a regional or general anaesthetic. A tube, called a catheter, will be put into your bladder to make sure your bladder’s empty. This is important because your surgeon will be operating very close to it. A catheter will also help you feel more comfortable when passing urine if you have an epidural or spinal anaesthetic. You won’t be able to pass urine without a catheter until the spinal or epidural wears off because the nerves of your bladder will be numb.

    Once the anaesthetic has taken effect, your abdomen will be cleaned with antiseptic. Your surgeon will make a cut through your abdomen and your womb. And your baby will be carefully delivered. If you’ve had a regional anaesthetic, you won’t feel any pain but you may feel some pushing or pulling. Usually, you’ll be able to see and hold your baby immediately after they are born.

    As your baby is being delivered, you’ll be given an injection of syntocinon into a vein. This is an artificial form of oxytocin, a hormone that causes your womb to contract. As your womb contracts, your surgeon will deliver the placenta.

    The cuts in your womb will then be closed with dissolvable stitches. Your surgeon will close your abdomen using stitches or clips and cover your wound with a dressing. Depending on the technique your surgeon uses, you may need to have your abdominal stitches taken out, or they may dissolve.

    It usually takes about five to 10 minutes to deliver your baby. From start to finish, the operation can last up to an hour. It can take longer if you’ve had surgery before because of any scar tissue you may have.

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  • Aftercare What to expect afterwards

    After having a caesarean delivery, you’ll be given painkillers to help ease any discomfort. They may be given to you through the tube used for your epidural or you may have the option of patient-controlled analgesia. If you’re controlling your painkiller, you’ll have a drip inserted into a vein in your arm. You can give yourself strong painkillers called opioids, such as diamorphine, by pressing a button.

    If no complications arise during your operation and you’re recovering well, you can eat or drink when you feel ready.

    If you have an epidural, the catheter that drains your urine usually stays in place for at least 12 hours after the last top-up. If you have a spinal block, your catheter can be removed once you’re able to walk around.

    The dressing on your wound will be taken off after about 24 hours.

    You will be offered some ways to help prevent deep vein thrombosis or DVT (a blood clot) developing in your legs. This may be just help getting out of bed to keep you mobile and ensuring you’re well hydrated. If you have a more complex caesarean or you have other risk factors, you will be given compression stockings to wear. You will also be given daily injections of anticoagulant medicine, such as heparin, to help prevent blood clots forming so easily.

    If you’ve had an unplanned caesarean, you should have the chance to talk to your surgeon and midwife about why you needed to have the operation. They will explain the reasons for your caesarean and give you information about any possible consequences the operation may have for you and your baby.

    It's usual to stay in hospital for about three or four days after having a caesarean delivery. However, if you’re recovering well with no signs of fever or infection and have support at home, you may be able to leave hospital sooner.

  • Recovery Recovering from a caesarean delivery

    To help you recover from a caesarean delivery, you’ll be given medicines for pain relief while you’re in hospital. You’ll also be given advice about what to use once you leave. Make sure you read the patient information leaflet that comes with your medicine. And if you have any questions, have a chat with your pharmacist.

    During your operation, you may have been given antibiotics. This is to help prevent any infection of your wound, your womb or your urinary system. Usually it’s a single injection given before your operation. However, if there’s any sign of infection, you may need to take a course of antibiotics. It's important that you complete any course of antibiotics even if you don't have any signs of infection.

    Your wound will heal best if you wear loose, cotton clothes and clean and dry it carefully every day.

    The length of time it takes to recover fully from a caesarean will be different for every woman. It's important that you don't try to do too much before you’re ready. This includes lifting and carrying heavy objects, doing vigorous exercise and driving. You can have sex once you have fully recovered from your operation.

  • Risks What are the risks?

    Caesarean deliveries are commonly performed and generally safe. However, it’s important to be aware of the possible side-effects and the risk of complications.

    Side-effects

    Side-effects are unwanted but mostly temporary effects you may get after having a procedure. Side-effects for a caesarean delivery include:

    • pain and discomfort from your wound
    • scarring

    Complications

    Complications are problems that occur during or after your operation. Most women who have a caesarean delivery aren't affected. The possible complications of any operation include:

    • an unexpected reaction to the anaesthetic
    • excessive bleeding
    • the development of a blood clot, usually in your leg (DVT)

    Specific complications of caesarean delivery include: 

    • an infection in your womb, urinary system or the wound
    • needing a hysterectomy – an operation to remove your womb (uterus)
    • injury to a nearby organ, such as your bladder or bowel – this is more likely if you’ve had surgery before
    • a small cut to your baby from when the surgeon enters your womb
    • breathing problems for your baby after birth
    • large blood loss (haemorrhage), either at the time of surgery requiring blood transfusion, or after the caesarean needing further surgery to stop it
    • possible complications in future pregnancies, including a slightly increased risk of having a stillbirth or difficulty conceiving

    We haven’t included the chance of these complications happening as they are specific to you and differ for every person. Your surgeon or midwife can explain how these risks apply to you.

  • FAQs FAQs

    Can my birthing partner be with me while I'm having a caesarean?

    Answer

    Yes, it's very likely that your birthing partner will be able to stay with you during your operation if you both want them to be present.

    Explanation

    If you have an epidural or a spinal block, your birthing partner is likely to be able to stay with you in the operating theatre. Usually a screen will be placed over your chest so that you can't see what’s happening while your surgeon is operating.

    However, if you need to have a general anaesthetic, your birthing partner is less likely to be able to be with you. They may be able to see your baby shortly after the delivery. Arrangements for general anaesthesia vary depending on the hospital and the reason why you need to have a general anaesthetic. The team at the hospital will be able to explain to you what to expect.

    If I get pregnant again, will I need to have another caesarean delivery?

    Answer

    No, not necessarily. Many women are able to give birth vaginally after a caesarean.

    Explanation

    There are many reasons why you may have a caesarean delivery and this can affect whether you will need another one with another pregnancy. Many women are still able to have a vaginal delivery if they’ve had a caesarean delivery before. If you give birth vaginally after having a caesarean delivery, this is known as a vaginal birth after caesarean (VBAC). It's not known whether the benefits outweigh the risks of aiming for a VBAC rather than having a planned caesarean. The risks and benefits of VBAC and repeat caesarean are different for every woman. Your surgeon and midwife will help you make a decision about what’s right for you.

    Some studies have shown the following advantages of having a vaginal birth.

    • You have a greater chance of having an uncomplicated vaginal birth in future pregnancies.
    • You’re less likely to have a wound infection, which can cause pain after birth.
    • You’re likely to have a shorter stay in hospital and reduced recovery time at home.
    • There’s a slightly lower risk of your baby having breathing problems after birth.

    However, there are also risks associated with trying for a vaginal birth after a caesarean delivery.

    • There’s a slightly increased risk of your baby dying during labour. However, this risk is still extremely small, and is the same as if you were having your first baby.
    • Uterine rupture is a very rare complication. This is when the scar on your womb from your previous caesarean tears open. It’s more likely with a VBAC attempt (happening to two to seven in 1000 women) than with a planned caesarean delivery (happening to virtually no women).
    • There’s a slightly higher chance that you will need a blood transfusion.
    • There’s a slightly higher risk that you will get an infection in your womb.

    If you try for a vaginal delivery after a previous caesarean delivery, you and your baby will be closely monitored while you’re in labour. It’s recommended that you have your baby at a hospital where you can have a caesarean quickly if you need one.

    Ask your midwife or surgeon for more information about having a VBAC.

    Is there a limit to the number of caesarean deliveries I can have?

    Answer

    No, there’s no limit to the number of caesarean deliveries you can have. However, with each caesarean, your risk of certain complications during pregnancy and birth increases.

    Explanation

    Having a caesarean leaves a scar on your womb and the other tissues inside your abdomen. This means that the risk of certain problems during pregnancy is increased. It's important that you're aware of possible problems. Some of the main complications of repeat caesarean deliveries include:

    • injury to your bladder or bowel
    • problems with your wound, such as poor healing or infection
    • a large loss of blood (haemorrhage)
    • needing to have a hysterectomy – an operation to remove your womb (uterus)
    • placenta praevia – this means the placenta is attached on or near your cervix (the neck of your womb)
    • placenta accreta – this is when the placenta grows through the wall of your womb and into its muscular layer
    • uterine rupture – this is a very rare complication that means the scar on your womb from your previous caesarean tears open
    • a slightly increased risk of having a stillbirth in other pregnancies

    Your midwife or surgeon can give you more information about having repeated caesarean deliveries.

    Can I drive after having a caesarean?

    Answer

    Yes, you can, but you’re unlikely to feel well enough to drive straightaway. You will probably be advised to wait for four to six weeks.

    Explanation

    There’s no specific time that you must wait after having a caesarean delivery before you can drive. The Driver and Vehicle Licensing Agency (DVLA) states that you should consult with your doctor about when it's safe to start driving again after surgery.

    You're likely to have pain and discomfort for some weeks after the operation. You may find that wearing a seatbelt puts pressure on your wound. Any tenderness or soreness may distract you while you’re driving, or prevent you from stopping in an emergency. You will probably be advised to wait four to six weeks before driving.

    General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 48 hours after a caesarean. If you're in any doubt about driving, contact your motor insurer. And always follow the advice of your doctor or surgeon.

    Can I opt to have a caesarean delivery even if I could have my baby vaginally?

    Answer

    Yes, you can make this decision even if there are no clear medical reasons why you couldn’t give birth vaginally. The National Iinstitute for Health and Care Excellence (NICE) guidelines on caesarean delivery state that women who request a planned caesarean will be supported. At present, there’s no evidence that supports or rejects caesarean delivery over vaginal delivery when there’s no medical reason for a caesarean.

    Explanation

    When you’re talking to your GP or midwife about your options for giving birth, you can ask them about having a planned caesarean. They will discuss with you the factors that can help you to decide whether you plan a vaginal delivery or a caesarean delivery. Some women have a severe fear of giving birth. This could be because they’ve never done it before or because of a traumatic previous labour and birth. Your antenatal care team may be able to help ease any fears you might be having. They can explain more about birth options, how you can help yourself in labour and what pain relief is available. They can also help you set up a visit to your planned place of birth and offer you a referral to a birth counsellor.

    It’s worth taking time to consider the advantages and disadvantages for both delivery options.

    Advantages of a vaginal birth include:

    • a shorter stay in hospital
    • being able to breastfeed more easily 
    • less chance of your baby having breathing difficulties
    • quicker bonding with your baby

    Disadvantages of a vaginal birth may depend on the state of your health and your baby’s health. The following situations may make a vaginal birth more difficult for you and your baby. In these situations, your antenatal care team may recommend a planned caesarean delivery.

    • If your baby is breech (feet or bottom first instead of head) after 37 weeks pregnancy.
    • If you’re expecting more than one baby. Although if they’re both coming head-first the risk of a vaginal birth may be lower.
    • If you have placenta praevia (your placenta lying low in your womb) or other placenta disorders. 
    • If you have a blood disorder or certain infections, such as HIV.

    Advantages of a planned caesarean delivery include:

    • being able to plan when and where your baby is born
    • lower risk of bleeding soon after delivery
    • a quicker delivery

    There are possible disadvantages, which are listed below.

    • There could be damage to your organs, such as your bowel or bladder.
    • Your baby could get a small cut during the delivery.
    • You may have pain or infection in your wound.
    • You may have an increased risk of developing a blood clot (thrombosis).
    • There is more chance of your baby needing breathing assistance or being admitted to the neonatal intensive care unit (NICU).
    • You may have a longer stay in hospital and a longer recovery time at home.
    • Caesarean delivery has also been associated with more complications in future pregnancies. This can include difficulties in getting pregnant, having a placenta praevia, a uterine rupture before or during labour and stillbirth.
    • Caesarean delivery is also linked with a higher risk of your child developing asthma or diabetes, although this risk is still low.

    It’s important to look at all the options for your baby’s birth and to understand how the different choices may affect you and your baby. If you decide to have a vaginal birth, it’s possible that you may need an emergency caesarean. Understanding this delivery option before you go into labour will help you to give your informed consent, if you need to.

  • Resources Resources

    Further information

    Sources

    • Caesarean section. National Institute for Health and Care Excellence (NICE), November 2011. www.nice.org.uk
    • Map of Medicine. Caesarean section. International View. London: Map of Medicine; 2014 (Issue 1)
    • Cesarean delivery. Medscape. www.emedicine.medscape.com, published 13 March 2014
    • Caesarean section. PatientPlus. www.patient.co.uk/patientplus.asp, published 19 January 2012
    • Breech presentation. PatientPlus. www.patient.co.uk/patientplus.asp,  published 11 March 2013
    • Epidural nerve block. Medscape. www.emedicine.medscape.com, published 6 May 2013
    • Subarachnoid spinal block. Medscape. www.emedicine.medscape.com, published 5 August 2013
    • Reducing the risk of venous thromboembolism (deep vein thrombosis and pulmonary embolism) in patients admitted to hospital. National Institute for Health and Care Excellence (NICE), January 2010. www.nice.org.uk
    • Consent advice no. 7 caesarean section. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published October 2009
    • What happens during a planned or emergency caesarean section? National Childbirth Trust. www.nct.org.uk, accessed 01 August 2014
    • Crowther CA, Dodd JM, Hiller JE, et al. Planned vaginal birth or elective repeat caesarean: patient preference restricted cohort with nested randomised trial. PLoS Med 2012; 9(3):e1001192. doi:10.1371/journal.pmed.1001192
    • Caesarean section – full guideline. National Collaborating Centre for Women’s and Children’s Health. Commissioned by National Institute for Health and Care Excellence (NICE), September 2011. www.nice.org.uk
    • What is a straightforward birth? National Childbirth Trust. www.nct.org.uk, accessed 8 August 2014
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    Reviewed by Dylan Merkett, Bupa Health Information Team, November 2014.

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