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Caesarean delivery

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

To meet your individual needs, your care may differ from what is described here. It's important to discuss your caesarean delivery with your surgeon 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 operation is also sometimes called a caesarean section (or C-section).

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

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 is another problem putting his or her health 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 are expecting more than one baby, for example, twins or triplets.
  • Your baby is lying with his or her feet or bottom first rather than with his or her head downwards, which is the usual position for a vaginal birth. This is called a breech position. It makes giving birth vaginally more difficult or sometimes impossible.
  • There is a high risk that you may have heavy bleeding if you have a vaginal delivery.
  • You have a viral infection, such as HIV or genital herpes simplex.
  • You have had a previous caesarean delivery, although after one caesarean it's often possible to have a vaginal delivery in a subsequent 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 is 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 is less common nowadays. The cut through your abdomen may be vertical or a bikini line cut may be used. A cut is then made vertically down the middle of your womb. 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, if you have fibroids or if your baby is very premature.

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Details

  • Preparation Preparing for a caesarean delivery

    If you’re having a planned caesarean, your surgeon or midwife will arrange for you to have a blood test before the operation. This is to see whether 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 (about 300-500ml). If you’re already anaemic, or if you lose more blood than expected during the operation, you may need a blood transfusion.

    Planned caesareans are usually done using regional anaesthesia, either using an epidural, a spinal, or a combined epidural/spinal block. These types of anaesthesia completely block feeling from the waist down and you will 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 if you started a vaginal delivery. If so, this can be topped up with another dose if you then need a caesarean delivery. A spinal block takes effect more quickly, but is a one-off dose and only lasts for a set length of time.

    You may have a general anaesthetic if you need to have an emergency caesarean. This means you will be asleep during the operation. You may also have a general anaesthetic if you have a planned caesarean, for example, if you have a low-lying placenta (placenta praevia).

    Your surgeon or another healthcare professional will discuss with you what will happen before, during and after your operation, and any pain relief you might need. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the operation. This will help you to be informed, so you can give your consent for the operation to go ahead, which you may be asked to do by signing a consent form. If you’re having a caesarean delivery in an emergency situation, it may not be possible to ask you to sign a consent form, but you will be asked for verbal consent.

  • Alternatives What are the alternatives to caesarean delivery?

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

    For example, it's sometimes possible to give birth vaginally if you’re expecting twins, if your baby is in the breech position or if you have had a previous caesarean delivery.

    Your midwife or surgeon can give you more information about the specific risks and benefits of both options, which will depend on your situation.

  • The procedure What happens during a caesarean delivery?

    If you're having a planned caesarean delivery, you may be able to choose some aspects of the delivery. For example, you may be able to choose the music playing during the operation, whether you see your baby delivered or not, or how and when your baby is passed to you when he or she is born.

    You will have a drip 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.

    You will have a tube called a catheter put into your bladder to make sure it's empty. This is important because your surgeon will be operating very close to it. A catheter will also help you to feel more comfortable and to pass urine if you have an epidural or spinal anaesthetic. You won’t be able to pass urine without the 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. Your baby will then be carefully delivered. If you have had a regional anaesthetic, you may feel some pushing or pulling during the operation. However, you shouldn't feel any pain. Usually, you will be able to see and hold your baby immediately after he or she is born.

    As your baby is being delivered, you will be given an injection of Syntocinon into a vein. This is an artificial form of oxytocin, a hormone (a chemical found naturally in your body) that causes your womb to contract. As your womb contracts, your surgeon will deliver the placenta.

    He or she will then close the cuts in your womb with dissolvable stitches. Your surgeon will close your abdomen using stitches or clips and he or she will cover your wound with a dressing. The stitches in your womb don't need to be removed. Depending on the technique your surgeon uses, you may need to have the 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 lasts about 30 to 40 minutes if there are no complications. It often takes longer if you have had surgery before because of the scar tissue.

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  • Aftercare What to expect afterwards

    You will be given painkillers after your caesarean delivery. You may have these given to you through the needle used for your epidural or you may have the option of patient-controlled analgesia. For this, you will have a drip inserted into a vein in your arm. You can give yourself strong painkillers called opioids, such as diamorphine, when you need them by pressing a button.

    If there are no complications 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.

    Your dressing will be taken off after about 24 hours. After this, your wound will probably be left uncovered.

    You will be offered some ways to help prevent a blood clot (deep vein thrombosis or DVT) developing in your legs. If you’re at a low risk of DVT and have a planned caesarean, 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. Until you go home, you will also be given daily injections of anticoagulant medicine, such as heparin, to help prevent blood clots forming so easily.

    If you 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 be able to 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 to four days after having a caesarean delivery. However, if you’re making a good recovery 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

    You will be given medicines for pain relief while you’re in hospital and advice about what to use once you leave. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

    During the operation, you may have been given antibiotics. This is to prevent any infection of your wound, your womb or your urinary system (your bladder and the tubes that run to and from it). 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. You probably won't have a dressing on it unless your midwife or surgeon advise it.

    The length of time it takes to recover fully from a caesarean will vary 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, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

    Side-effects

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

    • pain and discomfort from your wound
    • scarring

    Complications

    This is when problems occur during or after the operation. Most women aren't affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or the development of a blood clot, usually in a deep vein in your leg (DVT).

    Specific complications of caesarean delivery include:

    • an infection in your womb, urinary system or the wound
    • injury to a nearby organ, such as your bladder or bowel – this is more likely if you have had surgery before
    • a small cut to your baby from when the surgeon enters your womb
    • 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

    Your midwife or surgeon can give you more information about these complications. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your surgeon to 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 the operation if you both want him or her 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 while the caesarean is taking place. Usually a screen will be placed over your chest so that you can't see what is happening while the surgeon is operating. Once your baby has been delivered, you will probably both be able to see and hold him or her straightaway.

    If you need to have a general anaesthetic, your birthing partner is less likely to be able to be with you until you wake up. However, he or she 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 a subsequent pregnancy. Many women will be able to have a vaginal delivery if they have had a caesarean delivery before. If you give birth vaginally after having had a previous 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. Your surgeon and midwife will help you to make a decision.

    There are a number of advantages of having a vaginal birth, which are listed below.

    • You have a greater chance of having an uncomplicated vaginal birth in future pregnancies.
    • You’re likely to have less abdominal pain after birth.
    • You have a lower risk of developing a blood clot.
    • You’re likely to have a shorter stay in hospital and reduced recovery time at home.

    However, there are also risks associated with trying for a vaginal birth after a caesarean delivery. The main ones are listed below.

    • There is a slightly increased risk of your baby dying either before or during labour. However, this risk is still extremely small.
    • Uterine rupture is a very rare complication. This is when the scar on your womb from your previous caesarean tears open. This is more likely with a VBAC attempt (happening to two in 1000 women) than with a planned caesarean delivery (happening to one in 1000 women).

    If you try for a vaginal delivery after a previous caesarean delivery, your baby will be closely monitored while you’re in labour. You will also 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 is no limit to the number of caesarean deliveries you can have. However, with each caesarean you have, 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 (tummy). 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 repeated caesarean deliveries include:

    • injury to your bladder or bowel
    • a large loss of blood (haemorrhage)
    • needing to have a hysterectomy
    • 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 subsequent 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 four to six weeks.

    Explanation

    There is 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. It's best not to drive until you are confident that any tenderness or soreness won't 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.

    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 so that you're aware of their recommendations, 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, the National Institute for Health and Clinical Excellence (NICE) includes in their guidelines on caesarean delivery that women who request to have a planned caesarean delivery are supported in their decision. You can make this decision even if there are no clear medical reasons why you couldn’t give birth vaginally. At present, there is no evidence that supports or rejects caesarean delivery over vaginal delivery when there is no medical indication for a caesarean.

    Explanation

    When you’re talking to your GP or midwife in one of your later antenatal appointments about your options for giving birth, you can ask them about having a planned caesarean. He or she will be able to discuss with you the factors that may help you to decide whether you plan a vaginal delivery or opt for a planned caesarean delivery. Some women have a severe fear of giving birth, perhaps because they have never done it before or because of a traumatic previous labour and birth. Your antenatal care team may be able to help ease your fears by explaining more about birth options, how you can help yourself in labour, what pain relief is available, enabling you to visit your planned place of birth and offering you a referral to a counsellor trained in the speciality of birth.

    There are advantages and disadvantages for both delivery options that you may wish to consider.

    Advantages of a vaginal birth may include a shorter stay in hospital, being able to breastfeed more easily, less chance of your baby having breathing difficulties and quicker bonding with your baby.

    Disadvantages of a vaginal birth may depend on the state of your health and that of your baby. The following situations may make a vaginal birth more difficult, painful and dangerous 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 first after 37 weeks pregnancy).
    • If you’re expecting more than one baby, although if they are 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, requiring less pain relief in labour and a quicker delivery.

    There are disadvantages, which are listed below.

    • An increased risk of you losing a large amount of blood, which may require a blood transfusion.
    • 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, which may include difficulties in getting pregnant, having a placenta praevia, a uterine rupture before or during labour and stillbirth.

    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 opt for a vaginal birth, it’s possible that you may need an emergency caesarean, so understanding this delivery option before you go into labour will help you to be able to give your informed consent, if this situation happens.

  • Resources Resources

    Further information

    Sources

    • Arulkumaran S, Symonds I, Fowlie A. Oxford handbook of obstetrics and gynaecology. 1st ed. Oxford: Oxford University Press; 2004
    • Placenta praevia, placenta praevia accreta and vasa praevia: diagnosis and management. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published January 2011
    • Caesarean section. National Institute for Health and Clinical Excellence (NICE), November 2011. www.nice.org.uk
    • The management of breech presentation. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published December 2006
    • Management of HIV in Pregnancy. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published June 2010
    • Management of genital herpes in pregnancy. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published September 2007
    • Birth after previous caesarean birth. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published February 2007
    • Maternity data 2010–11. HESonline. www.hesonline.nhs.uk, published 2011
    • Blott M. The day-by-day pregnancy book. 1st ed. London: Dorling Kindersley; 2009
    • Allman K, Wilson I. Oxford handbook of anaesthesia. 2nd ed. Oxford: Oxford University Press; 2007
    • Cesarean delivery. eMedicine. www.emedicine.medscape.com, published 1 July 2011
    • What happens during a planned or emergency caesarean section? NCT. www.nct.org.uk, accessed 23 February 2012
    • Venous thromboembolism: reducing the risk. National Institute for Health and Clinical Excellence (NICE), January 2010. www.nice.org.uk
    • Caesarean section: consent advice no.7. Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk, published October 2009
    • Buhimschi C, Buhimschi I. Advantages of vaginal delivery. Clin Obstet Gynecol 2006; 49(1):167–83. www.journals.lww.com
    • 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
    • Lavender T, Hofmeyr G, Neilson J, et al. Caesarean section for non-medical reasons at term. Cochrane Database of Systematic Reviews 2006, Issue 3. doi:10.1002/14651858.CD004660.pub2
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