Articles

Key takeaways

• A caesarean birth is a surgical procedure to deliver your baby.
• It can be planned in advance or happen in an emergency.
• Recovery often takes longer than a vaginal birth.
• Most women can have a vaginal birth after a caesarean (VBAC).

What is a caesarean birth?

A caesarean birth, also called a C-section, is an operation. It delivers your baby through a cut made in your tummy and womb. The cut is usually made across your tummy, just below your bikini line.

While it's a common procedure, a caesarean is a major operation. It carries some risks, so it is usually only done if it is the safest choice for you and your baby. Around 1 in 4 pregnant women in the UK have a caesarean birth. In Scotland, about 1 in 3 babies are born this way.

The operation normally takes about 40 to 50 minutes. It usually happens under an anaesthetic given in your spine, so you stay awake. Sometimes, a general anaesthetic is needed when medically necessary.

A caesarean may be recommended for several reasons:

• Baby's position – your baby is in a feet-first position (breech).
• Placenta position – you have a placenta that is low down in your womb (placenta praevia).
• Maternal health concerns – you have high blood pressure caused by your pregnancy (pre-eclampsia).
• Infections – you have certain infections, such as a first genital herpes infection late in pregnancy or untreated HIV.
• Baby's wellbeing – your baby is not getting enough oxygen and nutrients, or is small or premature.
• Multiple babies – you are expecting twins, triplets, or more.
• Labour progression – your labour is not progressing as expected.
• Vaginal bleeding – you have heavy vaginal bleeding during pregnancy or labour.

Planned versus emergency caesareans

A caesarean section can be planned in advance. This is known as an elective caesarean.

An emergency caesarean is one that is carried out when unexpected concerns for you or your baby arise. This is also known as an emergency caesarean.

Planned (elective) caesarean

You may have a planned caesarean if you know you will need one before you go into labour. Your appointment will probably be before your baby's due date. This helps to make sure you have your baby before labour starts on its own.

Planned caesareans are usually done from the 39th week of pregnancy. Your doctor or midwife may offer you a planned caesarean if:

• There are problems with the placenta, such as it being low down in your womb (placenta praevia).
• Your baby is lying in a difficult position for labour, such as bottom down (breech).
• You are carrying twins who share a placenta, or if either baby is in a difficult position.
• You are expecting more than two babies.
• You have HIV or genital herpes, to reduce the risk of passing the virus to your baby.
• You have other health issues that make a caesarean safer for you.

Unplanned (emergency) caesarean

You may go into labour expecting to give birth vaginally, then find you need a caesarean section. This is called an emergency caesarean section. Often, it is not as dramatic or last-minute as the name suggests.

You may need an unplanned emergency caesarean if your baby needs to be delivered quickly. This may happen if:

• There is concern about your health or your baby's health.
• Your labour is not moving along, or progressing, as expected.
• You have vaginal bleeding during pregnancy or labour.
• You go into labour before the date of your planned caesarean section.
• Your baby is not getting enough oxygen and nutrients.

The benefits and risks of a caesarean birth

A caesarean is a major operation, but it may be the safest option for you and your baby. Your doctor or midwife will only suggest a caesarean if it is the safest choice for you and your baby. This is due to certain health issues or concerns with the pregnancy.

Benefits of a planned caesarean

A planned caesarean can reduce the risk of:

• Needing an assisted vaginal birth or an emergency caesarean birth.
• Pain during the birth.
• Injury to the vagina or perineum.
• Losing control of your bladder (urinary incontinence).
• Pelvic organ prolapse, where organs like the womb or bladder push against the vagina.
• Uncertainties of going into labour naturally, as you have a planned date for the birth.

Risks of a planned caesarean

There are risks for both you and your baby with a planned caesarean. It may take longer to recover after your baby is born.

• Pain – You should not feel pain during the caesarean due to the anaesthetic. However, the wound will be painful during recovery.
• Recovery time – The recovery period is usually about 6 weeks, but this can vary.
• Infection – Infection of the womb can take several weeks to heal. You will be offered antibiotics through a drip at the start of your caesarean to reduce this risk.
• Scar tissue – As you heal, you might develop scar tissue (adhesions) inside your tummy. This can be painful and make future operations more difficult. The risk of complications is higher if you have had previous tummy operations, such as other caesarean births.

Recovery and future pregnancies

Recovering from a caesarean usually takes longer than recovering from a vaginal delivery. You will probably be in hospital for 1 or 2 days after the operation. You may need to take things easy for several weeks.

Recovering from a caesarean

• Pain management – You may feel discomfort for the first few days and will be offered painkillers. Ensure you have regular painkillers like paracetamol or ibuprofen for home use.
• Medication advice – Do not take codeine or co-codamol if you are breastfeeding.
• Hospital stay – You will have regular contact with your baby, can start breastfeeding, and will be encouraged to move around as soon as possible. A catheter will stay in place for at least 12 hours.
• Wound dressing – Your wound will be covered with a dressing for at least 24 hours.
• Cleaning and clothing – Your midwife will advise on wound care; gently clean and dry it daily. Wear loose, comfortable clothes and cotton underwear.
• Stitch removal – Non-dissolvable stitches or staples are usually removed by your midwife after 5 to 7 days.
• Activity – Take things easy at home and avoid activities like driving until your 6-week postnatal check-up. Staying active and hydrated helps lower the risk of blood clots, such as DVT.
• Scar appearance – The wound will form a horizontal scar, about 10-20cm long and usually below your bikini line. This scar will initially be red and obvious. However, it should fade over time and is often hidden by pubic hair.
• Scar colour – On darker skin, the scar may fade to a brown or white mark.
• Sensation – You may lose feeling around the wound area, which can return over time.

Impact on future pregnancies

Having a caesarean does not mean all future babies must be delivered this way. Most women who have had one caesarean can safely have a vaginal delivery for their next baby (a vaginal birth after a caesarean, or VBAC). You may need some extra monitoring during labour.

Some women may be advised to have another planned caesarean (an elective repeat caesarean section, or ERCS). This depends on whether a caesarean is still the safest option for them and their baby.

If you are fit and healthy, both VBAC and ERCS are safe choices with very small risks. Your midwife or obstetrician will discuss your birth options with you.

Choosing a VBAC has several benefits:

• After one caesarean, about 3 out of 4 women with a straightforward pregnancy who go into labour naturally give birth vaginally. Your chance of a vaginal birth is even higher if you've had a previous vaginal birth. About 9 out of 10 women in this situation achieve it.
• If successful, a VBAC means you avoid the risks of another major operation.
• Your recovery is likely to be quicker.
• Your hospital stay may be shorter.
• You are also less likely to have problems from scar tissue in future pregnancies.

The main risk of attempting a VBAC is that you may need an emergency caesarean during labour, which happens to about 1 in 4 women. An emergency caesarean has a slightly higher risk of complications and a potentially longer recovery than a planned one.

An ERCS is usually performed after 39 weeks of pregnancy. Babies born earlier by caesarean can sometimes need extra breathing support or a short stay in a special care baby unit.

Although uncommon, a caesarean can increase the risk of problems like uterine rupture or placenta accreta spectrum in future pregnancies. These risks increase with each caesarean section.