Can I choose to have a caesarean?
Yes, you no longer need to have a 'medical' reason. Some women who opt to have one have a phobia of birth, or other mental health needs that mean a vaginal delivery doesn't feel like an option for them.
If you feel this way, your midwife or doctor will explain all the benefits and risks of surgery, discuss the reasons behind your anxiety, and may offer you counselling. If, after that, you still feel that you want the procedure, you are entitled to have it. You'll also be offered extra support.
What are the risks and benefits of a c-section birth?
In an emergency, it can be life-saving for mothers and babies; sometimes it's are not just the better option, but the only option. Electing for the surgery has its pros too, in that it's planned in advance – so if there are any complications you'll be in a more controlled environment, with plenty of experts on hand.
There are practical plus points, too – you'll know when your baby is arriving and can prepare childcare and make sure your hospital bag is packed. And, of course, you avoid the more, erm, visceral bits of second stage labour.
However, it is still major surgery and does carry risks. These can include:
- The baby's skin being nicked as the operation is performed
- The baby having difficulty breathing at first
- Infection of the womb or womb lining
- Excessive bleeding
- Deep vein thrombosis
Most of these things are easily dealt with and it's worth remembering that the vast majority of women will not encounter any problems.
What's an elective c-section?
Elective (or planned) caesareans take place before labour begins and are booked in advance of your due date rather than going into labour naturally and delivering the baby vaginally.
Reasons for a planned caesarean include:
- A baby being breech (feet or bottom down)
- A baby being transverse (sideways)
- An infection in the mother, such as herpes or HIV, which could be passed to the baby in the birth canal
- An old injury or a bad tear from a previous birth
- Placenta praevia (when the placenta is covering the entrance to the womb)
- Antepartum haemorrhage (heavy bleeding in pregnancy)
- Pre-eclampsia or placenta dysfunction, meaning the baby is better out than in
- Having the surgery previously and it being safer to do so again
- The mother having fear of birth or similarly strong feelings against delivering vaginally for another reason
What is an emergency caesarean?
An emergency (or unplanned) caesarean is one that takes place during labour because of complications – although having a complicated delivery doesn't necessarily mean you'll suddenly be whisked into an operating room with alarms blaring.
For the most part you should have adequate time to weigh up the pros and cons of continuing with a vaginal birth or opting for surgery.
Reasons for an emergency operation include:
- The baby being in distress and needing to be delivered quickly.
- Labour failing to progress or progressing too slowly. Sometimes it can take an incredibly long time for the cervix to dilate – this can be completely exhausting for both mum and baby
- Placental abruption – the placenta is beginning to peel away from the uterus wall. This is potentially very dangerous because of the risk of haemorrhage (uncontrolled bleeding) and other complications
- An unsuccessful assisted delivery using forceps or ventouse
- The baby not moving into the birth canal – either because the baby's too big or because the pelvis is too small to deliver vaginally
- If you had been booked in for a planned caesarean, but then your waters broke or you went into labour early
What to expect before the operation
You'll be told not to eat anything on the day of surgery, but you can usually drink water up to two hours before.
You'll be given a rather fetching hospital gown, told to remove jewellery or tape over rings, remove nail varnish (including acrylics) and remove contact lenses and even braces. This is all to preserve the highest levels of hygiene possible.
Next you'll be prepped for surgery. You'll be lying on an operating table, which is often slightly tilted to one side to avoid the weight of the womb pushing down on your veins and lowering your blood pressure. The epidural or spinal anaesthetic will be sited in your back, a catheter inserted into your bladder, and a drip put into your arm or hand so you can have extra pain relief or fluids if necessary. You'll probably have electrodes on your chest or a finger monitor to measure heart and pulse rate, too.
They may also give you compression stockings to wear, shave some of your pubic hair where the cut will be made and give you a thorough wipe down with anaesthetic.
Be warned: they will shave the top couple of inches of your lady garden with a dry bic razor if you have not done it yourself.
What is having a caesarean like?
Don't expect this to be a private affair: there will be a whole host of people including the surgeon (obstetrician), an anaesthetist, various assistants, several nurses and a paediatrician in the operating theatre with you.
Most procedures are performed while conscious; only around 10% are done under general anaesthetic. Providing the operation is being carried out while conscious with an epidural or spinal block, your birth partner can usually be present, too.
What happens during a c-section?
A screen will be placed across your abdomen so you don't have to watch what's going on. In some hospitals, you can look up into an overhead mirror so that you can have a bird's eye view of proceedings if you want to. It's not for the squeamish, but it can be an extraordinary experience to watch your baby's birth. Alternatively, you can ask them to lower the screen a little as the baby is born.
If you don't want to see the section performed don’t look up into the mirrored lights!
The surgeon makes an incision of about 20cm across your lower abdomen, and then parts your tummy muscles and makes a second cut into your womb. They may need to move your kidneys, bladder and other organs out the way to reach the womb. You'll probably hear lots of “slurping” noises as the amniotic fluid is sucked out, then you'll feel a bit of tugging and pushing on your belly as your baby is lifted out. The whole thing takes about 10 minutes.
The paediatrician will quickly check your baby over and then, providing all's well, hand him over to you or your partner for skin-to-skin contact – your baby will be 'colder' than one delivered vaginally, so they'll need keeping warm.
While all this is going on, you'll be given syntocinon to deliver the placenta – known as the third stage of labour in a vaginal delivery. Then the surgeon will close the incision, using dissolving stitches or staples. Any tearing caused by attempts to deliver vaginally will also be stitched up now.
Provided that there are no complications, the whole thing takes around 40 minutes.
What happens afterwards?
Once you're stitched up and your baby is checked over, you'll be moved to a ward where a midwife will attend to you and your baby. If you plan to breastfeed, now's a good time to try.
How long does it take to recover from a c-section?
The average time taken to recover is six to eight weeks, but it can vary from woman to woman. Some bounce back quickly, others take longer.
Giving birth is pretty exhausting at the best of times (and that's before they send you home with a completely dependent nocturnal animal to care for). But you really do need to behave as you would if you'd gone into hospital to have any other type of surgery.
Take it easy, ask for help whenever you need it and follow any advice the doctors and midwives give you.
How long will I stay in hospital?
The average hospital stay is three to four days; however, if all goes well and the medical team are happy, you may be able to go home the day after your surgery. Equally, if there are any complications from the birth itself or afterwards, or if your baby needs special care, they may want to keep you in a little longer.
Your midwifery team will be keen to get you out of bed as soon as possible (usually within the first 12 hours) even if you don't feel like it, as it's important to try to get up and walk – or stagger – around a bit. This helps your circulation, speeds up recovery and also reduces the risk of getting a blood clot.
What pain relief will I be given after my c-section?
If you had an epidural or spinal block during the procedure, it's likely this won't be removed for a few hours or so after your baby's birth. During this time, you should be able to have “top-ups” so you'll be virtually pain-free. The only downside is you won't be able to move much, but then it's unlikely this will be high on your wish list.
Once the epidural is removed, you may be quite shocked by how hard it is to move around. And how it feels like you've been kicked in the stomach by a Shire horse.
You'll be sent home with plenty of painkillers to see you through but if you're finding it too much to cope with, speak up. It may be that there's something which needs checking out.
What should I do once I get home?
Back home, regardless of how well you feel, it's important to take things easy for six to eight weeks.
Lifting heavy items (and that includes small children and shopping), doing the vacuuming or anything else that puts particular pressure on your tummy muscles is to be completely avoided: you do not want your wound to tear.
Remember, treating yourself kindly is not being lazy – it's common sense. Overdo things and your recovery could end up taking a lot longer.
Tips for recovering after a c-section
- Don't lift anything heavier than your baby for the first few weeks.
- Try not to move too suddenly, particularly when standing up from a sitting or lying position.
- Put one hand on your wound when you're sneezing, coughing or getting up – and don't let anyone tell you any good jokes. The palm of your hand helps to supports the area a bit.
- Make sure you wear really big “Bridget Jones” style knickers – you don't want the waistband rubbing against your scar.
- Take things easy. Definitely no vigorous exercise, but also best to give the household chores a miss for a couple of weeks, too.
- It's also important to keep mobile as this can help prevent you getting a blood clot in the days after surgery, so try to do some VERY gentle exercise, as recommended by your doctor, and a bit of gentle walking in the days after surgery.
- Get plenty of fluids and fibre-rich foods to prevent constipation. Surgery foods can slow down your digestive system and the last thing you need after abdominal surgery is to be straining on the loo.
Accept all offers of help and ask for more if you need it.
Do you still bleed after a c-section?
Yes, though the bleeding may be a bit lighter than if you'd had a vaginal birth. This post-birth bleeding is known as “lochia”. It can go on for up to six weeks but is much less heavy after the first couple of weeks. As with a vaginal birth you'll need to use sanitary pads rather than tampons during this time to guard against infection.
Is it harder to breastfeed after a c-section?
Mums who have undergone surgery have exactly the same chances as those who had a vaginal birth of breastfeeding successfully, though you may not feel up to it immediately.
I found it much easier to breastfeed my daughter – who was born by elective c-section – than my son who was born through a vaginal birth. She just took to it like a duck to water; I used the lying down on my side method for quite a while and it was fine.
If you decide to go for it right after the birth, you might want to ask for help to breastfeed. Your partner or a midwife can help you hold your baby to the breast and position them.
Sometimes it's harder to get breastfeeding started because your milk is slower to come in. If that's the case, you can try feeding your baby some colostrum using a syringe in the early days. Skin-to-skin contact will also help.
While you're in hospital you may want to feed lying down, but once home you can try lots of other positions that make things less tricky with your scar. Lying on your side is often helpful.
Some mums swear by a position called “the rugby ball” where you kind of grab your baby under your arm so they aren't lying on your scar. A nursing cushion can also help to take the pressure off your tummy area.
If you're breastfeeding twins, there are yet more positions you might find useful.
When can I drive after a c-section?
I went to see the GP at 4 weeks and got signed off to drive again. Driving was easy! The only difficult part was being a bit sleepy (from disrupted sleep) and lifting the baby in the infant carrier.
A common misconception is that you have to wait six weeks before you can drive again, but actually there's no law to say you can't drive yourself home from hospital – although you'd be a numpty to try.
You need to be fully in control of your vehicle – and able to do an emergency stop – without any hesitation that pain or fear of pain might bring.
There's no point rushing things, but if you do make a timely recovery there's no reason why you shouldn't drive earlier than six weeks – just make sure your motoring insurance isn't affected. In most cases it won't be, but you might be asked to provide written confirmation from your doctor that you are fit to drive.
When can I exercise after a c-section?
It can take several months for your stomach muscles to knit back together – and even then you may feel numb around the scar area for years to come. It's perfectly normal to not instantly ping back to your pre-birth shape so try not to get dispirited if things don't look how they used to.
Time – and then exercise – will help strengthen your tummy muscles, but don't hit the gym before you're ready as you can end up doing more harm than good. A gentle walk and a few pelvic floor exercises will suffice until you're fighting fit again.
When can I have sex after a c-section?
Everybody heals differently and this one really does depend on when you feel like it, but many women will wait between four and six weeks before resuming intercourse. Although you will experience less bleeding, it will still take about six weeks for your cervix to close completely. You may feel ready to resume sexual intercourse sooner than this (and we salute you if you do), but you should get the all clear from your health visitor before getting down to business.
C-section scars and looking after your wound
What will my c-section scar look like?
The scar is usually a horizontal line of about 8-10cm just below your bikini line. Occasionally, the cut is made vertically instead but this is unusual these days.
At first it will look quite red and sore but within a few days it will look much less angry, eventually fading to a silvery line.
How do I look after my caesarean wound?
Your wound will have a dressing on it for the first day. After that you'll need to very carefully wash and dry the area to keep it super clean. If you use a flannel for this make sure it's fresh out of the wash each time so it definitely isn't harbouring any germs.
C-section scar infection
You also need to inspect the wound every day to check for any signs of infection, such as redness or swelling. If you can't see it properly, get your partner to look for you. If you spot it getting redder, more swollen or oozing any pus, tell your midwives or GP straight away as this can be a sign of infection and needs treating quickly.
C-section scar removal
Sometimes a mum is left with a scar that causes considerable discomfort or that she feels unhappy with. In these cases, it's possible to undergo a caesarean scar revision to improve upon the original. In many cases this can be performed under local anaesthetic. Depending on the reason for the revision, it may be possible to get this operation done on the NHS – however, if the cause is purely cosmetic you should be prepared to have to pay to go privately.
Alternatively, if you have to have an elective caesarean with a subsequent pregnancy, you should flag up any problems with your old scar as your consultant can try to address them during the delivery.
Recovering emotionally from a c-section
How will I feel after a c-section?
If your surgery was planned and all went as hoped you'll probably feel absolutely fine, though it can be hard to get enough rest with a newborn to care for. Being overtired and overwrought never left anyone feeling well-balanced.
Women who have undergone an emergency procedure, though, can feel quite traumatised by the experience. This is perfectly normal and you shouldn't feel ashamed if this is how you feel. It can help to talk through what happened with your midwife and obstetrician – and this can usually be arranged very simply by contacting your hospital.
Why do I feel disappointed about having a caesarean?
Some women feel disappointed or that they didn't “get birth right”. It’s a very common way to feel but try not to let these thoughts take over. Caesareans come in for a lot of critical press; but that's not something you need to let upset you personally. Whatever option was best for you and your baby was the right one.
You've got enough complex emotions to handle as a new mother without feeling that, in some obscure way, you've failed.
Whatever the delivery, the main thing is to look after YOU so that you can enjoy as much of the experience as possible.
As one Mumsnetter on our Talk boards put it: “Being a mum is difficult enough without being made to feel like you have to justify your birthing method.”
If you still don't understand why you had to have the surgery, make sure you get someone to explain. There's no point feeling you didn't push hard enough, or somehow didn't make the grade, if actually it would have been a physical impossibility for you to give birth vaginally anyway.
There are plenty of occasions for maternal guilt, but this isn't one of them. You gave birth. Congratulations. The really hard work starts here.