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Caesarean section


Expert reviewer, Dr Samantha Wild, General Practitioner, Bupa UK
Next review due December 2021

A caesarean section or c-section is an operation to deliver your baby through a surgical cut in your abdomen (tummy). In the UK, more than one in four babies are delivered this way.

For some women who have complications in their pregnancy, caesarean section can be the safest way to deliver their baby. However, it is a major operation that carries its own risks. It’s important that you‘re aware of these if you’ve been advised to have or are considering a caesarean.

Pregnant woman with a nurse

Medical reasons for having a caesarean section

There are certain situations when it’s considered safer for you or your baby to have a caesarean section. Your caesarean may be planned in advance (a planned or elective caesarean). Or you may need an unplanned or emergency caesarean if problems develop during labour or before you go into labour.

Some of the reasons your doctor may recommend a planned caesarean include the following.

  • You have a ‘low-lying’ placenta, where your placenta completely or partially covers the entrance to your womb. The medical name for this is placenta praevia.
  • Your baby is lying with their feet or bottom downwards, rather than their head. This is called the breech position and makes giving birth vaginally more difficult or sometimes impossible. You may be offered a procedure called external cephalic version to try and manually turn your baby around. But this doesn’t work for everyone.
  • You’re expecting more than one baby, perhaps twins or triplets, and the first baby isn’t lying in the normal ‘head down’ position.
  • You have a viral infection that could be passed to your baby during a vaginal delivery. These include HIV which isn’t under control, hepatitis C and HIV together, or genital herpes which you’ve had for the first time in your final trimester.

Reasons why you may need an unplanned or emergency caesarean include the following.

  • There’s a complication during the birth, which is putting your baby at risk. This is called fetal compromise or fetal distress.
  • You start bleeding heavily from your vagina (haemorrhage).
  • Your labour has been going on for some time and isn't progressing.

You’ll always need to give your consent before having a caesarean. Remember, your doctor or midwife will only recommend one if it’s in the best interest of you and your baby.

Can I request a caesarean section?

If you don’t have any complications during your pregnancy, a vaginal birth is safer than having a caesarean. However, in the UK, all women are entitled to choose to have their babies by caesarean section even if there is no medical reason. There’s some debate over this because the World Health Organization recommends that caesarean sections should only be carried out when medically necessary. Because of this, some maternity units won’t offer caesarean sections on request, and you may be referred to a different unit.

It’s important that you understand exactly what’s involved if you’re considering this option. You should tell your midwife or doctor as early as possible that you’re thinking about having a caesarean. You’ll be offered the chance to discuss any questions or concerns you may have about vaginal birth with a health professional trained in providing support. They will talk to you about birth options and what pain relief is available. They’ll also explain the risks and benefits of a caesarean section compared to a vaginal birth. Some of the main ones are listed here.

Benefits of a caesarean

  • You can plan when and where your baby is born, and it may make you feel more in control.
  • You’re less likely to have the pain and soreness around your vagina that you may get with a vaginal birth.
  • You’re also less likely to have heavy bleeding in the first few days after a caesarean birth than you would with a vaginal delivery.

Risks of a caesarean

  • You’re likely to need to stay in hospital for longer, and it can take longer to get back to your usual activities like driving.
  • It might take longer to have skin-to-skin contact with your baby straight after the birth. This can make it harder to start breastfeeding if you’ve had a caesarean. And some women find it takes longer to bond with their baby.
  • Your wound is likely to be sore for the first few days and sometimes for months afterwards.
  • A caesarean is a major procedure – there are several possible complications for you and your baby. See the section on Complications for more information.

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 have any questions, be sure to ask your doctor or midwife to help you understand.

Preparing for a caesarean section

You’ll need to have someone to help you at home for at least the first couple of weeks after a caesarean. It can take time to recover, and you won’t be able to drive or lift anything heavy at first. If your caesarean is planned, make arrangements with your partner, a family member or friend if possible, to be around to help you.

Before your caesarean section, your obstetrician or midwife may ask you to have a blood test. This is to check if you have anaemia. Anaemia is a condition in which your blood can't carry enough oxygen to meet the needs of your body. If you’re anaemic and you lose more blood than expected during your caesarean, you may need to have a blood transfusion.

If you’re having a planned caesarean, you’ll usually be asked not to eat anything and only drink clear liquids beforehand. This may be for 12 hours before the procedure, but follow any advice you’re given by your hospital. On the day of your caesarean, you’ll be offered antibiotics to take. This is to reduce your chance of developing an infection after the procedure. You may also be offered anti-sickness drugs and antacids.

Planned caesareans are usually done using regional anaesthesia with either a spinal or epidural block. These types of anaesthesia completely block the feeling from your waist down but you’ll stay awake during the operation. You’ll usually be given painkillers too – either as an injection into your spine, or as an epidural, to reduce pain during and after the procedure. If you’re having a regional anaesthetic, you’ll need to have a tube called a catheter inserted into your bladder, as the anaesthetic interferes with your normal bladder function.

If your baby needs to be born immediately, for example because of a complication affecting the baby, you may need to have a general anaesthetic. This means you’ll be asleep during the operation.

What happens during a caesarean section?

If you have a planned caesarean section, you should be able to have some say over what happens when your baby is delivered. 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.

Usually a screen is placed over your chest so that you can't see what’s happening while your surgeon is operating. Often you can request to have this lowered if you’d like to see the moment your baby is born.

Before the surgery begins, your surgeon will clean your skin with an antiseptic solution. Once the anaesthetic has taken effect, your surgeon will make a cut to your abdomen, a few centimetres above your pubic bone (your bikini line). They will move apart layers of tissue beneath your skin to reach your womb, and then cut into your womb to reach your baby. If you’ve had a regional anaesthetic, you won’t feel any pain but you may feel some pulling or pressure in your lower body.

As your baby is being delivered, you’ll be given an injection of a hormone called oxytocin into your vein. This encourages your womb to contract, reducing blood loss. As your womb contracts, your surgeon will remove the placenta.

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

What to expect afterwards

You’ll be encouraged to have lots of skin-to-skin contact with your baby, as soon as possible after the birth. You’ll also be offered support to start breastfeeding your baby, if you choose to do so.

You’ll be closely monitored after the operation to check that your blood pressure and heart rate are stable, and that you’re not in any pain. You may be given a drip with strong painkillers called opioids that you can control yourself. You can use this once the painkillers that you’ve had during your procedure start to wear off.

If you don’t have any complications and you’re recovering well, you can eat or drink as soon as you feel ready. You’ll be encouraged to get up and start walking because this can help to prevent blood clots forming in your legs (deep vein thrombosis). You may be offered compression stockings to wear or an injection of an anticlotting medicine called heparin.

If you’ve had a catheter, it can be taken out once you’re up and moving around, as long as it’s been at least 12 hours since your last epidural dose. The dressing on your wound will be taken off after about 24 hours.

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 your options for any future pregnancies.

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, you may be able to go home sooner. Before you leave hospital, your nurse will give you advice about your recovery. This will include what painkillers you’ll need, any complications to watch out for, and how to look after your healing wound.

Recovering from a caesarean delivery

The length of time it takes to recover fully from a caesarean is different for every woman. You’ll need plenty of help and support from family and friends when you first get home. When you’re discharged, the hospital will give you some advice to follow, which is likely to include some of the following.

  • Make sure you take any painkillers and antibiotics that you’ve been prescribed.
  • Clean and dry your wound carefully every day, and wear loose, cotton clothes and underwear to help it heal.
  • Don’t lift anything heavy or do any vigorous exercise until you feel you’ve fully recovered. This can be up to 8 weeks or more.
  • You can usually drive when you feel comfortable and physically able to do so, but check with your insurance company first. See our FAQ about driving for more information.
  • You can have sex once you feel ready and comfortable to do so. Make sure you have arranged your contraception first.

It can take time to get back to normal after having a caesarean section, both physically and emotionally. You may feel some disappointment over the birth and have ‘flashbacks’, particularly if you didn’t plan to have a caesarean. Talk to your midwife or health visitor about how you’re feeling. They can answer any questions you have, and may be able to put you in touch with a support group.

Complications

Most women who have a caesarean recover well and have healthy babies. However, a caesarean is a major operation and it’s important to be aware of the possible risks to you and your baby.

Possible complications of caesarean section include the following.

  • You might develop an infection in your womb, a urinary tract infection or infection of your wound. Infections are common after a caesarean, but you’ll be offered antibiotics to reduce your risk.
  • You may get a blood clot in your leg (deep vein thrombosis), which can travel up to your lungs. Your healthcare team will take measures to prevent this, but it’s important not to ignore symptoms such as pain and swelling in your legs.
  • Heavy blood loss during the surgery. This isn’t common but if it happens, you might need a blood transfusion or further surgery to stop the bleeding.
  • Damage to a nearby organ, such as your bladder or bowel – this is more likely if you’ve had caesareans before.
  • Your baby might have temporary breathing problems after the birth. This is more common in babies born via caesarean than in babies born vaginally. Your baby might need care on a neonatal unit if this happens.
  • Your baby may receive a small cut during the operation. This happens in about 1 to 2 in 100 caesareans. It usually heals by itself.
  • A caesarean can cause possible complications in future pregnancies. For more information, see our FAQ, Is there a limit to the number of caesarean deliveries I can have?

If you develop a complication, it may take longer to recover. You’ll need to stay in hospital for longer or, if you’ve already gone home, you may need to be readmitted. The risk of complications tends to be greater if you’re overweight and if you have repeated caesarean sections.

Remember that in an emergency situation, a caesarean section might be the safest option to deliver your baby, despite the risk of complications. But if you’re considering a planned caesarean, you’ll need to weigh up the pros and cons of having the procedure against having a vaginal birth. Your midwife or doctor will provide you with detailed information about the risks and benefits of both options, to help you to make a decision.

Frequently asked questions

  • Yes, if you’re having a planned caesarean, your birthing partner will usually be able to stay with you in the operating theatre. They will be able to stay next to you and talk to you the whole time.

    If you need to have a general anaesthetic or it is an emergency situation, your birthing partner may not be able to be with you. Instead, they’ll usually 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.

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

    There are many reasons why you may have had your first caesarean section and this can affect whether you will need another one with another pregnancy. For instance, if you needed to have a caesarean previously because of a complication during your pregnancy, your doctor may recommend that it’s safer to have a caesarean again. Most 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). Some women who plan to have a VBAC may end up needing an emergency caesarean. While a successful VBAC is associated with the fewest complications, an emergency caesarean in these circumstances is associated with the most complications. The risks and benefits of VBAC and repeat caesarean are different for every woman. Your surgeon and midwife will talk to you about your options and help you make a decision that’s right for you.

    If you do decide to try for a VBAC, 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.

  • No, there’s no limit to the number of caesarean deliveries you can have. If you’ve had fewer than four caesarean sections, your risk of complications doesn’t seem to change whatever mode of birth you have next. But if you’ve had four or more caesareans, your risk of certain complications increases. These include:

    • injury to your bladder or bowel
    • the need to have a hysterectomy – an operation to remove your womb (uterus)
    • placenta praevia – this means the placenta completely covers your cervix (the opening to your womb)
    • placenta accreta – this is when the placenta grows into the muscle of your womb, and doesn’t come away as it should when the baby is born

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

  • You should wait until you’re fully recovered from your caesarean before driving. This is so that you’re physically able to drive and are not at risk of being distracted by pain. This may take around six weeks.

    You don’t need to notify the Driver and Vehicle Licensing Agency (DVLA) if you’ve had a caesarean. The DVLA states that after surgery such as a caesarean, 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. Your doctor will normally advise to wait until you feel comfortable and are in full control of the car. You should be able to perform an emergency stop safely, without feeling any pain.


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Related information

    • Caesarean section. Consent advice No 7. Royal College of Obstetricians and Gynaecologists, October 2009. www.rcog.org.uk
    • NHS maternity statistics, England 2017–18. NHS Digital, published 25 October 2018. digital.nhs.uk
    • Caesarean section. National Institute for Health and Care Excellence (NICE), November 2011. www.nice.org.uk
    • Choosing to have a caesarean section. Royal College of Obstetricians and Gynaecologists, July 2015. www.rcog.org.uk
    • Caesarean section. PatientPlus. patient.info/patientplus, last checked 9 February 2016
    • Placenta praevia, placenta accreta and vasa praevia. Royal College of Obstetricians and Gynaecologists, September 2018. www.rcog.org.uk
    • Obtaining valid consent. Clinical Governance Advice No. 6. Royal College of Obstetricians and Gynaecologists, January 2015. www.rcog.org.uk
    • WHO statement on caesarean section rates. World Health Organization, 2015. who.int
    • Personal communication, Dr Samantha Wild, General Practitioner, Bupa UK
    • Caesarean section. National Institute for Health and Care Excellence (NICE), last updated August 2012. www.nice.org.uk
    • Cesarean delivery. Medscape. emedicine.medscape.com, updated 16 August 2017
    • Hofmeyr GJ, Mshweshwe NT, Gülmezoglu AM. Controlled cord traction for the third stage of labour. Cochrane Database of Systematic Reviews 2015, Issue 1.doi:10.1002/14651858.CD008020.pub2
    • Rowlands IJ and Redshaw M. Mode of birth and women’s psychological and physical wellbeing in the postnatal period. BMC Pregnancy Childbirth. 2012:12 138
    • Birth after previous caesarean birth. Royal College of Obstetricians and Gynaecologists, October 2015. www.rcog.org.uk
    • Driver and Vehicle Licensing Agency (DVLA). Miscellaneous conditions: assessing fitness to drive. www.gov.uk, last updated 1 January 2018
  • Reviewed by Pippa Coulter, Freelance Health Editor, December 2018
    Expert reviewer, Dr Samantha Wild, General Practitioner, Bupa UK
    Next review due December 2021



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