Giving birth by c-section

Pregnant woman prepares for caesarean section

Around one in four babies is delivered by caesarean section, rather than vaginally. A c-section may be “planned” due to a medical condition or an issue with the baby or its position. Or it might be a last-minute decision because labour isn't progressing as expected. Whether you're planning a caesarean or hoping to avoid one, it makes sense to know what they're all about.

Can I choose to have a caesarean?

Yes. You no longer need to have a “medical” reason to have a c-section. Some women who opt to have a caesarean 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 a c-section, discuss the reasons behind your anxiety, and may offer you counselling. If, after that, you still feel that you want a caesarean, you are entitled to have one. You'll also be offered extra support during pregnancy and labour.

What are the risks and benefits of a caesarean birth?

In an emergency, caesareans can be life-saving for mothers and babies and sometimes they are not just the better but the only option. Elective caesareans have their pros too, in that they are planned in advance – so if your pregnancy is complicated for any reason, you'll be giving birth in a more controlled environment, with plenty of experts on hand to help.

There are more practical plus points, too – because you'll know when your baby is arriving, you can be ready with any childcare sorted and your hospital bag packed. And, of course, you avoid the more, erm, visceral bits of second stage labour, which is not to be sniffed at.

However, caesareans are major surgery, and as such, do carry risks. These can include:

  • The baby's skin being nicked as the caesarean 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 caesarean?

Elective (or planned) caesareans take place before labour begins – it means that you and your carers chose to book you in for a caesarean in advance of your due date rather than go into labour naturally and try for a vaginal delivery.

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 had a caesarean 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.

We tend to think of caesareans as being either planned or unplanned, but medics put them into four categories. Firstly, there are completely planned operations, then there are three more categories that all fall under the umbrella of “unplanned”:

1. Where you weren't booked in for a caesarean but things don't progress quickly so there's a discussion about what to do next and you decide to go for a c-section rather than continue trying for a vaginal birth.

2. Where there is no immediate threat to life but the baby does need to be whipped out (they aim to have the baby out within 30-75 minutes of the decision being made).

3. Where either the mother or baby's life is at risk – they aim to deliver within 30 minutes in this case. Sometimes this is done under a general anaesthetic if there isn't time to site an epidural.

The last type is pretty uncommon. For the most part, even if you do have an unplanned caesarean, you may well have adequate time to weigh up the pros and cons of continuing with a vaginal birth, before deciding a caesarean is the most sensible route to take.

Reasons for an emergency Caesarean 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 a c-section

You'll be told not to eat anything on the day of surgery, but you can usually drink water up to two hours before the operation.

You'll be given a rather fetching hospital gown, told to remove any jewellery (best to leave this at home, really), tape over any rings you're wearing, remove nail varnish (including acrylics) and remove contact lenses and even braces. This is all simply to preserve the highest levels of hygiene possible.

Pregnant epidural

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.

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.

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. This is not date-night attire by any stretch of the imagination, but fear not – your birth partner will also be given scrubs to wear, including those shower cap things you wear over your shoes and a lovely hair-net-type hat. So you'll be in good company. Or at least have something to laugh at to take your mind off things in theatre.

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 c-sections are done with you awake but having had a spinal block or epidural. Only around 10% are done under general anaesthetic. Providing the operation is being carried out under an epidural or spinal block, your partner can usually be present, too.

operating theatre - surgeons pass forceps under lights

What happens during a caesarean section?

Caesareans take place in an operating theatre. 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 should want to. It's not for the squeamish, but it can be an extraordinary experience to watch your baby's birth. You can also just ask them to lower the screen a little as the baby is born if you want.

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 time – c-section babies tend to be “colder” straight after birth than those delivered vaginally, so they need keeping really warm.

Newborn baby wrapped up after caesarean

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.

Providing there are no complications, the whole thing usually takes around 40 minutes.

What happens after a caesarean?

Once you're stitched up and your baby is checked over, you'll be moved to a side ward where a midwife will attend to you and your baby. If you plan to breastfeed, now's a good time to have a go if you feel up to it.

You'll be given pain relief to have when the epidural wears off, and if you're at risk of developing a blood clot you may be given heparin injections to have at home.

How long will I stay in hospital after a caesarean?

If all goes well, some hospitals let you out the day after surgery. But around three to four days is an average stay.

What's the recovery time for a c-section?

Around six weeks. A caesarean is major abdominal surgery so you really do need to behave as you would if you'd had any other operation and rest up.

Whatever drugs they offer you – take them. Take them every time they are offered. If they ask if you would like something for pain, say yes. When these things start to wear off you will feel it.

You'll be advised to avoid doing anything that might re-open the wound – definitely no heavy lifting, strenuous exercise or things like vacuuming – not that you're likely to have time on your hands for a spring clean or trip to the gym anyway with a newborn to care for.

While you're recovering from a c-section, take extra care if you're lifting your baby and wear loose, comfortable clothing that sits above your tummy and won't rub on your wound. You'll also need to clean and dry the wound daily.

When can I drive after a caesarean?

There are no hard and fast rules but most doctors advise you to leave it six weeks before driving following a c-section.

Pregnancies after a c-section

You're advised to wait at least six months and preferably a year before becoming pregnant again. The smaller the gap between pregnancies, the greater the risk of a uterine rupture or placenta praevia in a subsequent pregnancy.

Having had one caesarean doesn’t mean you won't have a natural birth next time. Most women can have a VBAC (vaginal birth after caesarean) with no problems at all, but you may be given extra monitoring.

Why do I feel disappointed about having a caesarean?

Caesareans come in for a lot of critical press and there's concern among many midwives (and mums) that one in four births in the UK is by caesarean. 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.

Whatever the delivery, the main thing is to look after YOU so that you can enjoy as much of the experience as possible.

Whether you spent nine months planning a water birth at home and ended up having major abdominal surgery instead, or you chose a c-section for any of the other myriad and perfectly legitimate reasons, you've got enough complex emotions to handle as a new mother without feeling that, in some obscure way, you've failed.

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 end up having a caesarean and don't really understand why, 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.