1. Why?

A caesarean may be recommended by an obstetrician which is planned (elective) procedure or done in an emergency if risks arise normally in labour that mean its safer for mum or baby to proceed with an emergency caesarean.

Planned caesareans are usually done from the 39th week of pregnancy.

A caesarean may be carried out because:

• your baby is in the breech position (bottom first) and your doctor or midwife has been unable to turn the baby by external cephalic version (ECV), or if you declined this.
• you have a low-lying placenta (placenta praevia)
• Cord prolapse Active
• Pre-eclampsia- pregnancy related high blood pressure
• Active Genital herpes infection occurring late in pregnancy or untreated HIV
• Placental deficiencies which mean your baby is not getting enough oxygen and nutrients.
• Your labour is not progressing.
• Thick Meconium Stained Liquor- Baby opens its bowels in the uterus.
• APH (ante-partum haemorrhage)- excessive vaginal bleeding.

If you have been booked in for an elective c/section you will probably be given an appointment to speak to the obstetrician/Midwife/Anaesthetic Team about the procedure and what it involves, risk and benefits, recovery time. This is called a reassessment clinic.

If you end up in an emergency situation- the consenting/explaining is generally very rushed as time is of the essence however if you are ever unsure your Midwife will be able to explain everything to you as the emergency is happening.

2. When?

Planned caesareans are usually done from about the 39th week of pregnancy. This allows baby lungs to properly develop and reduce the risk of respiratory distress syndrome (RDS). 

There will be some medical conditions which mean that an elective c/section may be recommended earlier for example poorly controlled gestational diabetes. 

Emergency caesareans are done whenever the emergency arises- these are generally done to save either mum or baby’s life. 

3. How?

Most caesareans are carried out under spinal or epidural anaesthetic. 

This mean you’ll be awake, but the lower part of your body is numbed so you will not feel any pain. This will be tested before the first incision is made. Please be aware that you will be touch – but you should not feel pain. Women have likened it to feeling like someone is washing up inside their tummy. 

During the procedure:

• a screen is placed across your body so you cannot see what’s being done – the doctors and nurses will let you know what’s happening
• a cut about 10 to 20cm long will usually be made across your lower tummy and womb so your baby can be delivered
• you may feel some tugging and pulling during the procedure
• you and your birth partner will be able to see and hold your baby as soon as they have been delivered if they’re well – a baby born by emergency caesarean because of fetal distress may be taken straight to a paediatrician for resuscitation. 

The whole operation normally takes about 40 to 50 minutes. But to get the baby out generally takes less than 5 minutes from the first incision. 

Occasionally, a general anaesthetic (where you’re asleep) may be used. This is generally done when the situation is time critical. 

Asking for a caesarean.

Some women choose to have a caesarean for non-medical reasons.

If you ask your midwife or doctor for a caesarean when there are not medical reasons, they’ll explain the overall benefits and risks of a caesarean to you and your baby compared with a vaginal birth.

If you’re anxious about giving birth, you should be offered the chance to discuss your anxiety with a healthcare professional who can offer support during your pregnancy and labour. This is sometimes called ‘birth options clinic’.

If after discussing all the risks and hearing about all the support on offer you still feel that a vaginal birth is not an acceptable option, you should be offered a planned caesarean. If your doctor is unwilling to perform the operation, they should refer you to a doctor who will. As women you have the ability to make an informed choice on your method of delivery once you have all the facts.

Risks.

A caesarean is generally a very safe procedure, but like any type of surgery it carries risks.

Possible complications include:

• infection of the wound or womb lining
• blood clots
• excessive bleeding
• damage to nearby areas, such as the bladder or the tubes that connect the kidneys and bladder
• temporary breathing difficulties in your baby
• accidentally cutting your baby when your womb is opened

Read these risk about having a caesarean

Recovery.

Recovering from a caesarean generally takes longer than recovering from a vaginal delivery.

The average stay in hospital after a caesarean is around 3-4 days, compared with an average of 1 or 2 days for a
vaginal birth. However, if the c/section has been smooth and baby has been fine- it is possible to be discharged from hospital within 24 hours. In the trust where i work this has been happening for over 3 years with great success. If you are keen to go home sooner please discuss this with your Obstetrician or Midwife.

You may experience some discomfort in your tummy for the first few days. You’ll be offered painkillers to help with this.

You will also be discharged with pain killers and blood thinning injections to help reduce the risk of clots in your legs. 

When you go home, you’ll need to take things easy at first. You may need to avoid some activities, such as driving, until you have had your postnatal check-up with the doctor at 6 weeks. Some insurers will not cover you to drive for the first 6 week after a c/section so please check this before driving. 

When having a bath or shower please gently pat the area dry. The wound on your tummy will eventually form a scar. This may be obvious at first, but it should fade with time and will often be hidden in your pubic hair. Why not try our bath salts which are excellent for relaxation in the bath. Postpartum belly wraps are also known to help c/section mums feel a bit more supported around the abdominal area. Read this blog post from Dr Amal on the belly wraps. Note: If considering belly wraps please do not use them as waist trainers. You need to allow the body time to heal. 

Read these tips about recovering from a caesarean

Future pregnancies after a caesarean.

If you have a baby by caesarean, it does not necessarily mean that any babies you have in the future will also have to
be delivered this way.

Most women who have had a caesarean section can safely have a vaginal delivery for their next baby, known as vaginal birth after caesarean (VBAC).

The Royal College of Obstetricians and Gynaecologists has a great leaflet on birth options after previous caesarean section (PDF, 357kb) and about choosing to have caesarean section.