A caesarean section is a significant abdominal surgery. The anaesthesia carries separate risks, and a surgical delivery can require more time in the hospital and recovery than other methods. In the majority of cases, it is chosen simply because it's considered the safest way for birth to happen. There are two types of caesarean delivery: elective (or scheduled) and emergency. An emergency caesarean can be life-saving. Your situation will usually be explained to you calmly, and your consent will always be required.

What are the risks involved in a caesarean section?

Some of the risks involved with the surgery may be specific to your pregnancy and medical case. General risks include infection, blood clots in your legs or lungs, prolonged pelvic pain, excessive bleeding, and damage to nearby areas like your bladder. About two in 100 babies may have a nick on their head or bottom as a result of their position when the incision in your womb is made, though this will typically heal with no long-term problems. In some cases, a caesarean can cause problems for future pregnancies, such as a low-lying placenta. Bear in mind, however, that this is one of the most commonly performed abdominal operations in the world and is widely considered safe. You will have a scar and experience pain for weeks (potentially months around the scar) after the procedure.

Can I choose to have a caesarean section?

Yes, some women choose to have a caesarean for non-medical reasons. If you ask your midwife or doctor for a caesarean when there are no medical reasons, they'll explain the benefits and risks of a caesarean compared with a vaginal birth in your case. An elective caesarean happens when the decision to have surgery is made before labour starts. The term “elective selection” does imply choice, but this isn’t always why a caesarean happens. Often, there’s a clear medical reason why it’s the best option, such as a breech baby or a low-lying placenta. Elective caesareans typically happen between weeks 39 and 41 of pregnancy.

What happens if I need an emergency caesarean?

An emergency caesarean is when the decision to have surgery is unplanned. This can happen as quickly as in 20 minutes, but in other cases, it can be the same day. Although those looking after you will be keen not to waste time, the atmosphere is usually calm, and you’ll have the reason for surgery explained to you in full. Your consent will be required before you’re moved to an operating theatre. If you’ve had an epidural, this can be topped up through the catheter for the surgery; otherwise, you may be given a spinal block to numb you quickly.

Why might I need an emergency caesarean?

The most common reasons are your baby being distressed and what your doctor or midwife might call “failure to progress,” which means your cervix isn’t dilated enough to give birth. However, there are many other possible reasons. It’s important to remember that the decision to recommend a caesarean is not one that doctors take lightly and that they will discuss with you to make sure it’s the best option for you.

What happens before an elective caesarean?

If you’ve elected to have a caesarean, the pre-birth prep can vary between hospitals. You should have the date and time confirmed by a midwife in advance, as well as a call to remind you to stop shaving, waxing, or applying cream or talc to your vagina. They’ll also provide you with stomach-acid reduction tablets to take the night before. You may also have been given anti-sickness medication or antibiotics to help you prepare. You’ll be advised when to stop eating and drinking, as well as other dietary rules to follow. You’ll also have a scheduled blood test before surgery to check your iron level. On the day, you’ll be asked to change into a hospital gown, and a catheter will be inserted for when you need to urinate during surgery. You’ll be given an epidural or spinal anaesthetic. The surgeon performing your operation will usually come and see you beforehand to introduce themselves and answer any questions you may have.

What happens during a caesarean surgery?

You’ll usually be awake, and if it’s a planned caesarean section, you’ll have your partner there, and the baby will be delivered to your chest. The surgeon may chat with you while they’re working, and you may be able to have music on it if you’d like. You’ll lie on an operating table, which is a firm, narrow bed, and have a screen placed over your tummy. You’ll be strapped to the bed to keep you from falling off. Your partner will sit next to you at the head end. The surgeon makes a 10–20 cm horizontal incision within or above your bikini line. A vertical incision might be required if your baby is breech or sideways, or if your uterus is somehow irregular. You won’t usually get to pick the incision’s direction; it’s what the surgeon thinks will achieve the best outcome. Once the incision is made, they’ll dissect your tissues carefully until we get to your baby and the amniotic sac. You may be able to hear them using suction to remove your amniotic fluid safely, and in some cases, you might consider it intro music because your baby is just about to be delivered. If you have an epidural, you may feel some pulling and tugging. Some women describe this as feeling like someone’s doing laundry by hand in there, but it shouldn’t hurt. If you asked for delayed cord clamping and your baby is well enough, there will be a delay of at least a minute before cutting and clamping the umbilical cord. This delayed cord clamping allows time for extra blood to flow to your baby and may improve their health. You can usually have it, whether your surgery was elective or an emergency. He or she will then be lifted up for you to see and delivered to your chest. You will have skin-to-skin time while still in the operating theatre. You’ll be given an oxytocin injection (usually in your thigh, so you won’t feel it) to reduce blood loss and encourage your womb to contract. The surgeon will remove your placenta from the wall of your womb before stitching it up with dissolvable stitches. You are allowed to keep your placenta and/or umbilical cord for personal reasons; otherwise, they will be disposed of as hospital waste. Then your abdomen will be sewn up, either with dissolvable stitches or stitches or staples that need to be removed a few days later. The whole process takes less than an hour, but in a serious emergency, it can be done in under thirty minutes.

How long will it take me to recover?

Recovery time is different for everyone but will be longer than after vaginal birth. After surgery, you’ll be moved to a recovery room and monitored while your pain relief wears off. This takes longer if it’s a spinal anaesthetic than if you’d had an epidural. Your catheter will be removed about 12–18 hours post-surgery, and you’ll usually be able to walk around. You’ll be offered painkillers and blood-clotting treatments to aid your recovery. You’ll have to follow some rules to support the weeks-long healing process (e.g., not lifting anything heavier than your baby, including their older siblings). Your midwife will talk to you about signs of infection and how to prevent them, as well as other postoperative care. Top tip: We know this seems like an odd time to think about contraception, but if you use an IUD, it can be inserted at the time of the caesarean section after the placenta has been delivered, or vaginally in the first 48 hours. This preference can be added to your birth plan. It is possible to get pregnant again even before your first postpartum period, and the risks associated with a brief interval between pregnancies (for both mum and baby) mean postpartum contraception is important to consider no matter how you give birth.

What do I need to know about caesarean section?

Unii explains what elective and emergency C-sections are like.