Caesarean section – why, when and how
Caesarean deliveries (also known as caesarean section and C-section) are when the baby is born through a surgical procedure. It requires the mother to have an incision in her abdomen, through to the womb, through which the baby will be delivered.
Such deliveries generally take place when complications have been identified prior to labour or if a situation arises during labour that necessitates prompt action. For some mums-to-be it may be also be a non-medical choice and this will need to be discussed thoroughly with the medical team with care.
Elective or planned caesarean for medical reasons
You may be offered a caesarean section if complications are identified prior to labour. This is called an ‘elective’ caesarean because the operation is planned and agreed in advance.
An elective caesarean is generally advised when it is considered to be the safest option for delivery of your baby as well as your own wellbeing.
The reasons why an elective caesarean might be advised include:
- The position of the baby in the womb – breech or transverse
- Placenta praevia – a low-lying placenta
- Maternal medical condition – such as diabetes or heart-disease
- A previous caesarean delivery
- Twin or multiple pregnancy
- Pre-eclampsia
- Previous stillbirth
Your midwife will be sure to discuss the procedure and risks with you. If you agree, a plan will be put in place for you to have the procedure in hospital at a pre-booked date and time.
Emergency caesarean
In some cases, the labour may have started normally, but if a problem arises which means quick action is needed for the safe delivery of the baby and/or for the health of the mother, the medical team will suggest an emergency caesarean is necessary.
Typically, an emergency caesarean will be take place when:
- The position of the baby is breech or transverse and cannot be manipulated or turned
- Pre-eclampsia is diagnosed and treatment is proving ineffective
- The baby is in fetal distress due to a lack of oxygen
- The labour fails to progress
- Excessive vaginal bleeding
If any of the above occur during your labour, the medical team’s recommendations will be explained to you. Consent will be required.
Not all situations are urgent and some time may be given to allow you to consider your options but should the labour become life threatening, to you or your baby, immediate action will need to be taken.
Choosing a caesarean section for non-medical reasons
Some pregnant women may wish to undergo a caesarean section for non-medical reasons.
You should discuss this option with your midwife to learn more about the risks and benefits of either a vaginal or a caesarean section delivery. It’s understandable that women, especially first-time mums, feel some anxiety about birth and labour, so it is important that you are fully informed and get the right support beforehand to help you make your decision.
The procedure
A caesarean section is a major operation that involves a surgical intervention to cut through your tummy and womb to access your baby.
You will be asked to wear a gown and you (and your birth partner if it’s a planned C-section) will be taken to a room designed for surgical procedures. A catheter will be inserted into your bladder to drain urine.
For planned C-sections, you will already have been given antibiotics to reduce the risk of infection. Anti-emetics (anti sickness medication) and antacids (to reduce stomach acids) may also be given to you.
An epidural anaesthetic will be administered to numb the lower half of your body. You will be awake for the birth of your baby.
As the anaesthetic takes effect the team will place a screen across your waist so that you can’t see the surgery. The surgeon will make a 10-20cm long incision across your lower abdomen and womb, through which your baby will be delivered. You are likely to feel some pulling and tugging as the baby is removed from your womb. You should not feel any pain.
As soon as your baby is born you will be able to hold him/her to enable that important first skin-to-skin contact.
An injection of oxytocin will be administered to encourage your womb to contract and control blood loss. The wound will be closed.
The whole procedure typically takes between 40 to 60 minutes.
Associated risks of caesarean section
In the UK, caesarean sections are a largely a safe procedure and most mums and babies will experience no complications.
However, as with all invasive procedures, there are associated risks. If you would like to choose a caesarean section but don’t have a medical reason to do so, it is a good idea to know what these are so that you can make an informed decision.
Generally, the associated risks include:
- Damage to nearby internal organs – bladder and urethra
- Wound and uterus infection
- Blood clots caused by deep vein thrombosis (DVT)
- Excessive bleeding
- Breathing problems for your baby
- Possible cuts to your baby during the operation
Post-operation and recovery
You will be required to stay in hospital for a few days following the surgery. As the anaesthetic wears off you may feel some aching and discomfort at the site of the incision. You will be given appropriate pain relief to help manage this. It is likely that you will also be asked to wear surgical stockings to avoid the risk of blood clots.
A scar will be visible around your pubic hairline. Over time this will fade and the scar will not be as noticeable.
When you go home, you can expect that it will also take longer to physically recover after the birth, when compared to a vaginal delivery. You may find that you won’t be able to be as active and will be advised not to drive for six weeks.
Giving birth again
While another pregnancy may not be on your mind just yet, having one caesarean does not preclude the possibility of vaginal delivery for subsequent babies, unless the conditions of that pregnancy indicate otherwise.
Your midwife will be able to guide you on the options available at the time.
