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Caesarean delivery

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

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.

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 (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.

What are the alternatives?

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.

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.

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.

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.

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.

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.



Produced by Louise Abbott, Bupa Health Information Team, April 2012.

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

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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