Giving birth by caesarean section

A caesarean section birth is when your baby is born through an incision (cut) into your lower abdomen (tummy). Usually the cut is made along the top of your bikini line on the edge of your pubic hair. Caesarean sections can either be done as an ‘elective’ (planned) or as an ‘emergency’ procedure.

Having a caesarean birth will not stop you from having skin to skin contact with your baby soon after birth, or from breastfeeding your baby.

This page aims to give you information about caesarean sections. If you have any questions, please ask your Consultant or Doctor at the hospital, GP or Midwife.

This is when the caesarean is planned in advance; there are many reasons for this. Your Obstetrician (doctor or surgeon specialising in pregnancy, childbirth and the postpartum period) at the hospital will discuss your options with you so that you can make an informed decision about the way you give birth to your baby.

Your Obstetrician will discuss the risks involved in having a caesarean and ask you to sign a consent form. This form is to say that you understand what is involved in the procedure and that you agree to have the caesarean section. This is an ideal time to ask any questions you have about the procedure.

If you choose to have a caesarean, you will be given a date for this to take place.

Usually planned caesareans are done from 39 weeks onwards as this reduces the risk of your baby having breathing difficulties. Breathing difficulties are more common with babies born by caesarean compared to normal births (see common risks).

If your caesarean is going to be done before you are 39 weeks pregnant for medical reasons then your Obstetrician will speak to you about you having steroid injections to reduce the risk of baby having breathing difficulties.

You will have a pre-operative assessment appointment before your caesarean section to check how fit and well you are; usually in antenatal clinic or on the ward. This will be around 1 to 2 weeks before your caesarean, however it sometimes needs to be planned within a shorter timeframe.

At your assessment

• A healthcare professional will take and record your blood pressure.
• Blood samples are arranged to be taken; usually 3 days before your caesarean section, and sent to the laboratories. This makes sure that if a blood transfusion is needed, suitable blood can be found quickly. Your haemoglobin (iron levels) will also be checked. It is very important to tell the Obstetrician or Midwife if you do not wish to have blood products used as part of your care.
• We will discuss the latest COVID19 screening guidance.
• Skin swabs will be taken from your nose and groin area for MRSA screening. MRSA is a type of bacteria that is resistant to many standard antibiotics. MRSA infections mainly affect people who are staying in hospital. Infections with MRSA can be harder to treat than other bacterial infections, but can usually be treated with antibiotics that work against MRSA.
• You will be given an anti-microbial body wash to take home with you and you will be asked to bathe or shower with this before your caesarean section. The wash helps to reduce bacteria on your skin.

You should use the body wash as follows:

• Day 1: use it on your body
• Day 2: use it on your body and hair
• Day 3: use it on your body
• Day 4: use it on your body and hair
• Day 5: use it on your body
• Day 6 is caesarean day: use it on your body and hair

Please bring the body wash with you into hospital and bathe or shower with this whilst you are in hospital. You can use your regular shampoo and body wash when you go home, as normal.

• We will test your urine to check that there are no concerns before surgery.
• The Midwife will check your baby’s wellbeing and ask if your baby is moving well.
• You may also be weighed, and your legs measured for anti-thrombotic (TED) stockings.
• You will be offered two antacid tablets and will be told when to take them.
• On the evening before and after you have had your baby we advise that you have a daily injection of a blood thinning agent called ‘Low Molecular Weight Heparin’ (LMWH), usually for at least 10 days, and in some cases up to 6 weeks. The healthcare professional in the clinic will let you know how and when to give yourself the injection of LMWH. This goes just under the skin and works with the TED stockings to reduce your risk of developing blood clots. If you are already taking LMWH during your pregnancy you should take the last one on the day before your caesarean at 6pm.

We would advise that the evening before your caesarean that you have a meal which is rich in carbohydrate such as rice, pasta or pizza.

Please note - If you have diabetes or gestational diabetes you should continue to have your diabetic meal choices on the evening before, to help maintain your blood sugars.

At 10pm take one of the antacid tablets.

Only eat a small amount until 2am (2 o’clock in the morning on the day of your operation).

DO NOT have anything to eat (this includes chewing gum, tea/coffee) after 2am on the morning of your operation until 6am.

At 6am take your remaining antacid tablet with water.

You may drink water only, up until the time of your elective caesarean.

Please ignore the following information if you have diabetes or gestational diabetes or know that you are having a general anaesthetic (being put to sleep) for your caesarean.

Also at 6am have ONE of the following:

a small carton of clear apple juice (400mls max)
OR
a small carton of Ribena (400mls max)
OR
a small cup of tea/coffee with 2 sugars and NO milk (400mls max)

Do not have anything else to eat - including chewing gum.

You will usually be asked to attend the Maternity Unit or the Day Surgery Centre at 7.30am on the morning of your caesarean. You and your birth partner will meet the Midwife who will care for you during, and immediately after your caesarean. The Midwife will check you over again, ask if you have any concerns, and make sure you are ready to go to theatre. The theatre in which your caesarean will take place is in the Delivery Suite on Labour Ward or in the Day Surgery Unit.

Sometimes, planned caesareans may need to be delayed or the date changed if emergencies happen. If this happens we would let you know what the new plan for you is.

Please bring one of the carton drinks described above with you in case this happens, but do not have it unless a doctor or midwife tells you it is safe to drink it.

Planned caesarean sections are usually planned from 9am onwards. A definite time cannot be given, as Delivery Suite/Labour Ward have to be flexible for emergencies. 

Before going to theatre

• Remove nail varnish, false nails (gel and acrylic), jewellery, and false lashes. Please do this at home before coming in. You can remove any contact lenses just before theatre.
• Your wedding ring, which may be worn, or rings that cannot be removed, will be covered with tape.
• Please leave valuables at home where possible.
• An identity bracelet, TED stockings, and theatre gown will be provided for you to wear. The identity bracelet must be worn throughout your stay in hospital.
• It may be necessary for the Surgeon to trim the top of your pubic hair, you do not need to do this yourself.

You will meet the anaesthetist, and the surgeon who will be performing the caesarean. An anaesthetist is a specially trained doctor responsible for the anaesthetic (pain relief) you will need for your caesarean.

It is usually recommended for you to have a spinal or epidural, for planned caesareans. This means you will be numb from the waist down. You can stay awake, and your birth partner can stay with you to share the birth of your baby.

If you do not want to be awake, or if for a medical or obstetric reason you are unable to have a spinal or epidural, you will be offered a general anaesthetic. This is when you go to sleep. Your birth partner cannot stay with you in the theatre if you have a general anaesthetic, but can be very close by.

Your birth partner will be able to see the baby as soon as they are born. If your baby has been in a breech position (bottom down) you will have a scan before theatre to check that baby is still breech. If baby has turned to head first, in most cases a caesarean will not be needed and further plans will be discussed with you.

When in theatre, you will have a drip in your hand (this is to replace the fluid you lose during surgery). A catheter (tube) will be placed in your bladder; this keeps your bladder empty during surgery, and staff can monitor your urine more closely. The anaesthetist may give you a small drink of sodium citrate. This works with the antacid tablets to neutralise any remaining stomach contents.

When you are ready, the anaesthetist will give you either a spinal, epidural or a general anaesthetic. When the anaesthetist is happy that you are pain-free, the obstetrician will start the caesarean. Further information can be found on the Labour Pains website. 

This is when the caesarean is done either before, or during labour, when there are concerns about either your, or more frequently your baby’s wellbeing.

This can be a very worrying time for you and your birth partner. The midwives and obstetricians caring for you will explain what is going on as things happen. After your caesarean, you will be given the opportunity to discuss what happened with an obstetrician and your midwife.

You are prepared in a similar way to an elective caesarean, but this is done much more quickly. The surgeon who will be performing your caesarean will make sure you know the reasons for needing the caesarean, and will ask you to sign a consent form.

The anaesthetist will see you, and if you already have an epidural, it may be possible for you to have a ‘top-up’ with some strong local anaesthetic. If you have not got an epidural, the obstetrician and anaesthetist will discuss with you whether a spinal or general anaesthetic will be the best option.

Your birth plan is your chance to tell us what you would want for your birth. You can still make choices if you are having a caesarean. For example, you may like to think about:

• If you want staff to tell you what is going on during the operation or if you would prefer the room is quiet.
• Whether you would like music on during the birth. A radio / CD player is available in theatre.
• During the operation there is a screen (curtain) so you cannot see what is going on, but if you wish, you can ask for this to be lowered at the time of the birth.
• Would you want delayed cord clamping after your baby is born if possible? This is when your obstetrician will wait for at least one minute after your baby is born to cut the umbilical cord. This allows your baby to receive extra oxygenated blood from your placenta, which has important health benefits.
• Unfortunately it is not possible for a birth partner to cut baby’s cord. It may be possible for the length of the cord to be longer so that it can be cut at a later time by your birth partner, if you wish.
• Do you want skin to skin contact as soon as possible after the birth? This is encouraged, but you might prefer that your birth partner has skin to skin contact with baby.

You can usually expect to meet a minimum of seven staff in theatre. These consist of:

• Obstetricians - doctors who do the operation
• Anaesthetists - doctor who gives the anaesthetic
• Operating Department Assistant - helps the anaesthetist
• Paediatrician - doctor who looks after baby if needed
• Midwives - look after you and support you and our birth partner
• Nurses - provide support for the obstetricians and anaesthetists

The skin on your stomach area will be cleaned and you will be covered with a sterile sheet to help reduce the risk of infection. You and your partner should not touch this sheet.

Once the operation has started you will feel some pushing and movement. You should not feel pain. Please let the Anaesthetist know if you feel unwell or are uncomfortable.

Your baby is usually born within 5-10 minutes of starting the operation providing there are no problems encountered e.g. from previous caesareans.

Your baby will be dried and checked by the midwife / obstetrician, and can usually come straight to you or your birth partner.

The day of your caesarean section

After your caesarean you usually stay on the Delivery Suite for a few hours, unless you need closer observation. If so, you may stay on the Delivery Suite either overnight, or for a couple of days.

During the first 30 minutes after your operation only your birth partner will be allowed to stay with you in the recovery area. The obstetrician and midwives will be keeping a close check on you.

In the time immediately after your caesarean, you can still have skin to skin contact with your baby. If you and your baby are both well, your baby can often be placed skin to skin on your chest while still in theatre. Once out of theatre, skin to skin can continue until baby’s first feed. This helps baby feed well.

If you are well and have had a spinal/epidural you should be offered something to eat and drink in recovery within an hour to help you recover.

You will be offered pain relief as you need it and this will not affect breastfeeding. You can always ask for help with feeding or care of your baby. You may find it difficult to hold your baby while you still have a drip in place. Staff will be on hand to support you with your baby’s care until you can move as normal.

It is important to move about as soon as possible after your operation even if your catheter is still in, to help prevent blood clots forming. The staff will help you decide when is best to do this and you must not get out of bed the first time without staff around to help. Usually your drip and catheter can be removed, but they may have to stay in for a while if you have any complications.

Day one after your caesarean section

It is important to start to move about as soon as you are well enough. The staff on the ward will help you care for your baby. You should be able to eat and drink normally. You should be able to have a bath or shower.

A blood test will be done to check your iron level; you may have to take iron tablets if this is low.

Most people who are well are able to go home on the first day after a caesarean, at most by day 2. This will depend on how well you are and your situation. Your community midwife will continue your care at home, and make sure you make a good recovery. You will be given information about moving, rest and exercise after caesarean section before you are discharged home.

Common risks when having a caesarean section include:

• Infection

There is a risk of wound, urinary or pelvic infection. To help reduce the chance of getting an infection, you will receive a dose of antibiotic straight into your drip just before your caesarean. You may also be prescribed a course of antibiotics, if there are any signs of infection.

Your wound dressing will usually be taken off on day 2 after your caesarean section and your community midwife will check your wound for the next 7-10 days to look for any signs of infection. Some dressings are designed to stay on longer and your obstetrician or midwife will discuss the care of your dressing and wound with you during your care.

The wound will then be left without a dressing. We advise you to keep your wound clean and dry by taking a daily bath or shower and drying gently.

Try not to touch your wound to avoid infection. Always wash your hands before and after going to the toilet, changing pads or if you have to touch your wound. Do not use products such as talc and creams on the area until the wound is well healed.

Please contact your Midwife or GP if:

• you feel unwell
• you have a temperature
• you have increasing pain in your wound
• your wound becomes red or weepy
• your vaginal or wound discharge becomes smelly
• you have signs of a water infection
• you have any other increase in pain

If you feel that your concerns are urgent, you can contact NHS 111 or attend Urgent and Emergency Care (UECC).

• Your baby can be ‘scratched’ (with a scalpel blade) during the operation. This usually heals itself and will be monitored by your midwife or health visitor.
• Persistent wound or abdominal (tummy) discomfort or pain.
• Babies born by caesarean section are more likely to have temporary breathing problems and sometimes may need to be admitted to the Special Care Baby Unit for help with their breathing. This happens in every 2 out of a 100 babies born by caesarean at 39 weeks or later. It is more common the earlier your caesarean is done. 

Uncommon risks when having a caesarean section include:

Needing extra procedures that become necessary during the caesarean section. This could include:

• Blood transfusions
• Procedures to control bleeding
• A balloon insertion into your womb during caesarean section
• Compression sutures on your womb
• Emergency hysterectomy (particularly if there is heavy bleeding at the time of your caesarean section). A hysterectomy would mean you are unable to carry any further children. The risk of needing to undergo a hysterectomy at the end of a subsequent pregnancy increases with each caesarean section but overall is still very low. (7-8 in 1,000).
• Risk of return to theatre after your caesarean section to control bleeding or to deal with any other complication

Rare risks when having a caesarean section include:

• Damage to your bowel or bladder (1 in 1,000) or ureter (the tube connecting the kidney to the bladder) (3 in 10,000).
• Thrombosis (blood clots) - being pregnant increases your risk of developing a blood clot. This risk increases again when you have a caesarean, because you cannot move as much as usual. You are given an injection of blood thinning medication (LMWH), pressure stockings, and encouraged to move around as soon as possible. The midwife will explain how long you need this treatment for. It is very important that you take all of your injections, keep moving and wear your stockings for the length of time that you are advised. Clots are rare with all of this in place but if you have any pain in your calf, chest or have shortness of breath, you should go straight to UECC.
• 9 in 1,000 people are admitted to the intensive care unit after caesarean section.

Very rare risks when having a caesarean section include:

• the risk of death in caesarean section is very rare with 1 per 12,000 cases.

If you have had two caesarean sections before and have a low placenta in your third pregnancy, you have a higher chance of a serious complication called placenta accreta. This is where the placenta does not come away as it should when your baby is born. If this is the case, you may lose a lot of blood and need a blood transfusion, and you are likely to need a hysterectomy. The risk of placenta accreta increases with each caesarean section.

For reasons we don’t yet understand, the chance of experiencing a stillbirth in a future pregnancy is higher if you have had a caesarean section (4 in 1000, rare) compared with a vaginal birth (2 in 1000, uncommon).

These are rare complications. If the obstetrician noticed a problem at the time of the caesarean, you would told about this, and followed up very closely.

The stitches used can vary, but usually they are sub-cutaneous (under the skin). They may be dissolvable. Sometimes, one long sub-cutaneous stitch is used, which is held in by two beads. This does not dissolve, and is removed about five days after the caesarean by a Midwife. Metal clips can also be used. Occasionally, the Obstetrician will insert a ‘drain’ at the time of the caesarean. This prevents blood ‘pooling’ in the tissue layers under the skin and is usually removed within 24 hours after the caesarean.

No. This depends on why the caesarean was performed. In future pregnancies, you will be able to discuss your options with your obstetrician at the hospital. When you are discharged home you should receive information on choices for birth after caesarean, if you do not get this please contact us and we can send you one, or this is available from our website.

You must check with your insurance company when you will be covered to drive after your caesarean. Most companies say not until 6 weeks after your caesarean. It is better to avoid driving for a few weeks, as your wound will be very tender. You must be absolutely sure you would be able to do an emergency stop. This means you must be able to respond quickly enough, and not damage your wound.

You will be seen by your community midwife the day after you go home, and regularly until 7-10 days after giving birth. Unless you are given an appointment to attend the hospital for your postnatal check, you should see your GP at 6 weeks. It is really important that you have this postnatal check. By 6 weeks, you should be more or less back to normal. Your GP will be able to advise you about going back to work, and other matters such as contraception and family planning.

When you feel ready, but don’t forget you will need to use contraception as it is important to not get pregnant again for 18 to 24 months after a caesarean section. Get your contraception before day 21 after giving birth from your GP or family planning clinic.