Caesarean delivery

Published by Bupa's Health Information Team, May 2010.

This factsheet is for women who are having a caesarean delivery, or who would like information about it.

Caesarean delivery is an operation to deliver a baby through the abdomen (tummy). A caesarean delivery can be a planned operation or it may be needed 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 doctor and midwife.

About caesarean delivery

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.

You may plan in advance to have a caesarean delivery, which is called an elective caesarean. Or, you may start giving birth vaginally and then need to have an emergency caesarean because of complications during labour. You may also need to have an emergency caesarean before you go into labour.

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

• 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 first or bottom first, rather than with the 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 an infection such as HIV or genital herpes simplex virus.
• You have had a previous caesarean delivery, although after one child it's often possible to have a vaginal delivery afterwards.

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

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 rarely performed nowadays. A cut is made vertically down the middle of your womb. The cut through your abdomen may also be vertical or a bikini line cut may be used. 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.

What are the alternatives?

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

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

Your midwife or doctor can give you more information about the risks and benefits of both options.

Preparing for a caesarean delivery

If you are having an elective 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 when there are too few red blood cells or not enough haemoglobin in the blood.

Planned caesareans are usually done using local anaesthesia, either an epidural or a 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. If you need to have an emergency caesarean, you may not have much time to prepare for your operation. However, even if this happens, your surgeon will try to explain the reasons why you need to have a caesarean delivery.

You may need a general anaesthetic if you need to have an emergency caesarean. This means you will be asleep during the operation. You may also need 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 usually ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

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 be put on a drip so that during the operation you can be given medicines and fluids to keep you hydrated. You will then be given either a local or general anaesthetic.

You may have a tube called a catheter inserted into your bladder to make sure that 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 pass urine if you have an epidural or spinal anaesthetic.

Once the anaesthetic has taken effect, your abdomen will be cleaned with antiseptic. Your surgeon will make a cut through your abdomen. Your baby will then be carefully removed. If you have had a local 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 delivery.

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. When your womb has contracted (after a minute or two) 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 put a dressing over your wound. 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 scar tissue.

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 a device called patient-controlled analgesia. This is a machine that allows you to give yourself painkilling medicines when you need them, by pressing a button. Strong painkillers called opioids, for example diamorphine, are given this way.

If there are no complications during your operation and you are recovering well, you can eat or drink when you feel like it.

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 are able to walk around.

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

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 are making a good recovery with no signs of fever or infection and have support at home, you may be able to leave hospital sooner.

Recovering from a caesarean delivery

You will be given medicines for pain relief while you are 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 advises 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 are 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.

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 (deep vein thrombosis, 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 the womb
• 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. The exact risks are specific to you and differ for every person, so we haven't included statistics here. Ask your surgeon to explain how these risks apply to you.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.