Caesarean section

A caesarean section, or C-section, is an operation to deliver your baby through a cut in your tummy and womb. It is major surgery. It may be planned in advance or done as an emergency.

A caesarean may be advised if a vaginal birth could be risky for you or your baby. Reasons include a baby lying feet first or crosswise, a low-lying placenta covering the opening of the womb (placenta praevia), pre-eclampsia, labour that stalls, or a worrying heartbeat in the baby. It can save lives when needed. The World Health Organization advises caesareans only when medically necessary, so ask your doctor why it is advised for you.

If the caesarean is planned, you see the team in the week before, and a blood test checks for anaemia.

On the day you change into a gown, and a drip and a bladder tube (catheter) are put in. You may be given antibiotics beforehand.

1. A spinal or epidural injection numbs your lower body. You stay awake, and your birth partner can usually be with you.
2. A screen across your tummy hides the operation.
3. The surgeon cuts your tummy and womb, usually low across the tummy.
4. Your baby is delivered within 5 to 10 minutes. You may feel tugging but not pain.
5. You are given medicines to help the womb contract and prevent heavy bleeding.
6. The womb and tummy are stitched, often with dissolving stitches. The whole operation takes about 40 to 50 minutes.

In some cases a general anaesthetic is used, so you are asleep, and your birth partner usually cannot be present.

You rest in a recovery room, where staff check on you often. You are offered painkillers, help to prevent blood clots, and help with breastfeeding, and you are encouraged to move soon. The catheter comes out after about 12 to 18 hours, and most women go home after 1 to 3 days. Clean and dry the wound daily and wear loose cotton clothes. Use pads, not tampons, for the bleeding. You cannot drive for a few weeks.

Contact your midwife or doctor straight away for:

• Severe pain or heavy vaginal bleeding
• A wound that is more red, painful or swollen, or leaks pus
• Pain when passing urine, or leaking urine
• A cough or shortness of breath
• Swelling or pain in your lower leg

A caesarean is generally very safe, but it is major surgery. Risks to the mother include:

• Infection of the wound or womb lining, which is common
• Heavy bleeding, sometimes needing a transfusion or more surgery
• A blood clot in the leg, which is rare
• Damage to the bladder or the tubes from the kidneys, which is rare

The baby may get a small cut to the skin, or breathing difficulties, mostly in babies born before 39 weeks, which usually improve in a few days. A past caesarean uncommonly raises the risk, in a later pregnancy, of the womb scar opening.

Most mothers and babies do well. The scar may be red at first, then fades. Most women who have had a caesarean can safely try a vaginal birth next time, though another caesarean is sometimes advised, so talk to your doctor early. Restart exercise, heavy lifting and sex when you feel able, often after about 6 weeks.