Caesarean Section

Planned c-sections are usually done from week 39 of pregnancy because babies born earlier than this may not be fully developed for life outside the womb. You may have your c-section earlier than this if there’s a medical reason for delivering the baby sooner, for example, if you’re expecting more than one baby.

If you need a planned c-section, you will see an obstetrician (a doctor who specialises in women’s care during pregnancy, labour and after birth). You will also see a midwife at each of your maternity appointments. The midwife or obstetrician will explain why they advise you to have a c-section. Possible reasons include:

• problems with the placenta, such as a low-lying placenta (placenta praevia)
• the baby is lying in a difficult position for labour, such as bottom down (breech)
• you are expecting twins – for example, if the babies share a placenta or if either
• baby is lying in a difficult position for labour
• you are expecting more than two babies.
• Some women with HIV or genital herpes may be offered a c-section in some cases to prevent passing the virus to the baby.

The obstetrician will explain the benefits and risks of a c-section and your other birth options. It is your decision; you don’t have to have a c-section if you don’t want one.

You may feel you want to have a c-section, even if you don’t need one for medical reasons. For example, you may feel you can’t cope with the pain involved with a vaginal birth. Or if you had a difficult vaginal delivery with your last baby, you may be worried about going through the same thing again.

But having a c-section is not risk-free. It is major abdominal surgery, which carries some risks for you and your baby. It is likely to take you longer to recover from the birth and you are likely to have some pain and discomfort for a few weeks afterwards.

Talk to your midwife about anything that is worrying you and about the reasons why you would like a c-section. They may be able to put your mind at rest. You can ask to see an obstetrician or anaesthetist to find out more about what having a c-section will involve.

Some women want a vaginal birth but are worried that they won’t be able to cope. If you feel this way, speak to your midwife as soon as you can. They may refer you to a specialist, who can offer you any emotional support you may need and give you more information about your options. This can help you make an informed decision about how you want to deliver your baby.

If you’re still sure you want a c-section after talking it through with your healthcare team, you should be able to have one. Some women may feel guilty or worried about asking for a c-section when they don’t have a medical need for one. But your healthcare team will not judge you and will want to help you have the best possible birth experience. If you feel your obstetrician doesn’t support your choice of birth, you can ask to see a different doctor. Some hospitals aren’t able to get funding for c-sections without a medical need. If this happens, you can ask to move to a hospital in a different area.

If your c-section has not been planned, it is called an emergency c-section. The word ‘emergency’ makes it sound last minute and rushed, but this is simply the medical term. It is often not an emergency and doesn’t in itself mean that you or your baby are in danger.

Possible reasons for having an emergency c-section include:

• your labour isn’t progressing
• you don’t go into labour after an induction and you are past your due date
• you have vaginal bleeding during pregnancy or labour
• there are concerns about your, or your baby’s, health
• you go into labour before a planned c-section

There is no strong evidence that the following actions affect your chances of needing a c-section:

• walking around during labour
• not lying on your back during labour
• being in water during labour
• drinking raspberry leaf tea
• the midwife or doctor breaking your waters early.
• There is no evidence that your height, or the size of your baby, can predict whether you will need a c-section. If you are short or you have a small pelvis or small feet, this doesn’t mean you can’t have a vaginal birth.

If there are no other complications, expecting a large baby doesn’t mean you will need a c-section.

If your caesarean section (c-section) is planned, your midwife will give you information about what to do on the day, including:

• date and time to arrive at the hospital
• when to stop eating and drinking – this is usually six to eight hours before your c-section
• having a shower before you leave home, to reduce the risk of infection
• whether you should take any medicines that you normally take
• whether you should take any medicine at home to stop you feeling or being sick during the c-section
• whether your birth partner can go into the operating theatre with you.
• You may also have a blood test to check whether you are anaemic, in case you lose blood during the c-section.
• You may be offered antibiotics before your c-section, to reduce your risk of infection.

The doctor or midwife will explain what will happen and ask you to sign a consent form. The consent form describes what happens before, during and after the c-section. It also explains the risks of the c-section and the anaesthetic.

If your c-section is planned, you will be asked to sign the consent form at an appointment before your operation. Ask your doctor to explain anything you don’t understand before you sign the form.

If you’re having an emergency c-section and your baby needs to be delivered quickly, you may be asked to sign a consent form or you may be able to give verbal consent. If there’s time, your midwife or doctor can answer any questions you or your birth partner have about the operation before you give consent.

Most women have a spinal or an epidural anaesthetic. Both types of anaesthetic are given as an injection in your spine that numbs the lower part of your body. You may have the anaesthetic in the operating theatre or in a side room. You will either lie on your side or sit leaning forward, curving your back, while the anaesthetist inserts a very fine needle into your spine.

A spinal anaesthetic is the most common type used for planned and emergency c-sections because it starts to work quickly. If you are having an emergency c-section and you have already got an epidural in place, the anaesthetist can top it up with a stronger anaesthetic for the c-section.

You may have a painkiller called diamorphine injected into your spine at the same time as your spinal or epidural anaesthetic. This relieves pain for 12-18 hours and so reduces the amount of pain relief you need after the operation.

You will be awake throughout the operation. You won’t feel any pain but you may feel some pressure or tugging sensations.

If you can’t have a spinal or epidural anaesthetic, or if your baby needs to be delivered very quickly, you may need a general anaesthetic. This means you will be asleep for the operation. Your birth partner won’t usually be able to go into the operating theatre but they should be able to be with you in the recovery room.

If you are having a planned c-section, you will be asked to put on a hospital gown and walk to the operating theatre.

Your birth partner can usually stay with you throughout a planned or emergency c-section. The midwife or operating assistant will give them a top, trousers and hat to wear in the theatre for hygiene reasons.

There will be lots of people in the operating theatre, including two obstetricians (who will do the operation), an anaesthetist, a midwife and other support staff.

You will lie on your back on the operating table, which will be tilted so you’re leaning on to your left side. This reduces the risk of your blood pressure dropping during the operation.

You will have:

• fluids through a needle in your arm (a drip), to stop you getting dehydrated and to reduce the risk of low blood pressure during the operation
• anti-sickness medicine to stop you feeling or being sick
• a small tube (catheter) into your bladder to drain urine – this will stay in place for at least 12 hours and until you feel able to walk to the toilet.
• The top part of your pubic hair may be shaved or clipped. Do not do this yourself at home in case it causes an infection.

The doctor makes a cut along the top of your bikini line and womb. Your baby is then lifted out. There will be a screen between your head and lower body so you can’t see the operation but you can ask for it to be lowered so you can see your baby being born. You may want to ask your birth partner or one of the theatre staff to take some photos of this moment.

If you don’t want to have a screen up during the operation, speak to your doctor in advance to find out if this is possible.

Your baby may be placed on your chest while the doctor removes the placenta and closes your wound using stitches or clips. This early skin-to-skin contact helps you bond with your baby and can help you start to breastfeed.

Unless your baby needs help to breathe, the doctor should wait a few minutes before clamping the cord, to increase the amount of blood your baby gets from the placenta. This is called delayed or optimal cord clamping. Not all hospitals do this routinely, so you may want to include this in your birth plan.

The midwife will then check the baby and dry them to help them stay warm, before placing them on your chest. If you plan to breastfeed, you can start trying while you’re in the theatre.

If you’re not able to hold your baby in the operating theatre, you can usually have skin-to-skin contact after the operation. Your birth partner can also have skin-to-skin contact with your baby.

The whole operation takes about an hour.

After your caesarean section (c-section) operation you will be moved from the operating table onto a bed. You and your baby will be taken to a small ward, which is sometimes called the recovery room.

You can continue having skin-to-skin contact with your baby while you’re in the recovery room. Your midwife will help you find a comfortable position for putting your baby to the breast.

If you and your baby are well, you will move to the postnatal ward after a few hours.

In the recovery area and on the postnatal ward, you will have:

• regular checks to make sure the anaesthetic is wearing off – your midwife will also check your breathing, heart rate, blood pressure, wound dressing and pain relief for the first few hours
• regular checks on the amount of vaginal bleeding you have – the midwife will also make sure you’re changing your maternity pads regularly
• a catheter to drain urine from your bladder – your midwife will check you have passed enough urine within six hours and will take the catheter out about 12 hours after the operation, once you are up and moving around
• compression stockings to reduce your risk of blood clots
• a needle in your arm (drip) to give you fluids until you’re eating and drinking again – you can usually eat and drink as soon as you feel ready.

The speed of recovery from a c-section varies from woman to woman. There are many things that can affect your recovery, such as the type of c-section you had. But all c-sections are major surgery, and you will need help with lifting your baby and getting out of bed for at least the first day.

You will need to stay in bed until the anaesthetic wears off. If you had a spinal or epidural anaesthetic, this usually takes a few hours. It will take longer if you had a general anaesthetic. While you’re in bed, you won’t be able to pick up your baby and so you’ll need help with feeding and nappy changing. If you need help, you can press a call button attached to your bed.

You’ll need help to sit up in bed while you’re recovering from the anaesthetic. You may need help for longer than this if you have a lot of pain or tenderness in your abdomen (tummy area). Your hospital bed will have controls, which you can use to raise and lower the head of the bed and move the bed higher or lower off the floor.

Your wound is likely to feel sore and bruised for a few days or weeks. Your midwife may give you paracetamol or a non-steroidal anti-inflammatory drug (NSAID), such as ibuprofen or diclofenac, to relieve pain. NSAIDS may cause stomach problems but taking them with food should help. Tell your midwife if you think your pain relief is causing any side effects.

If you are still having pain, your midwife may offer you a more powerful (opioid) painkiller, such as morphine. These painkillers can make some people feel drowsy and sick. If this happens, your midwife will give you a different type of pain relief.

To help control any pain:

• take your pain relief regularly and on time, even if you don’t have pain at the moment
• tell the midwife straight away if you are still having pain.

The amount of pain relief recommended by your midwife or doctor should be safe for you to take while you’re breastfeeding. Small amounts of any medicine you take may pass into your milk but they are unlikely to harm your baby if you take them as instructed. However, codeine or co-codamol (which contains codeine) may be harmful for your baby. Always check with your doctor, midwife or pharmacist before taking any medicines. Your midwife may give you painkillers to take at home, such as paracetamol or ibuprofen.

You will have a waterproof dressing covering your wound. Your midwife may ask you to take the dressing off 24 hours after your c-section so they can check your wound. Many women find it easiest to do this in the shower because the warm water helps to reduce any discomfort.

You may not need another dressing, but if you do, your midwife will remove it when they visit you at home.

Once your dressing has been removed, keep your wound clean using plain water. Avoid using soap and pat the area dry gently with a soft towel, rather than rubbing.

You may find it more comfortable to wear loose clothes and cotton pants that sit above your wound.

Your wound is closed with either stitches or clips. Some women have stitches that dissolve once the wound has healed. Otherwise, your midwife will remove the stitches or clips when they visit you at home, about five to seven days after your c-section.

Once the anaesthetic has worn off, you’ll be able to stand up and go for a short walk. You are likely to feel wobbly the first time you get up and you will still have your catheter, so you will need the midwife to help you. Your abdomen (tummy area) may feel tender and heavy. Your midwife can give you some pain relief beforehand to make you more comfortable.

It’s important to move around soon after your c-section to reduce the risk of blood clots. Other ways of reducing this risk include:

• drinking plenty of fluids
• wearing compression stockings
• having a daily injection of a blood-thinning drug after surgery – your midwife
• will tell you if you need this and for how long.

Only use medical compression stockings that your midwife has given you. They will measure your lower legs to make sure the stockings fit you properly. You’ll need to wear the stockings day and night for as long as your midwife advises, only taking them off to shower. You will normally only have one pair so you may want to wear slippers to stop them getting dirty.

Your catheter will be taken out about 12 hours after your operation, as long as you’ve been able to get out of bed. This feels uncomfortable but it isn’t painful. Once your catheter is out, you will be able to walk to the toilet and have a shower. It can be a good idea to ask someone to walk to the bathroom with you the first time in case you feel unsteady on your feet.

Your midwife will encourage you to drink plenty of fluids after your catheter is removed. They may ask you to measure the amount of urine you pass the first couple of times you go to the toilet, to check you don’t have any bladder problems. Tell your midwife if you have any discomfort when you pass urine.

The bathrooms are usually large enough for you to take your baby’s cot in with you, if you don’t have someone to look after your baby while you wash. Some hospital showers have seats, which can be helpful if you find it difficult to stand for very long. Don’t worry about getting your wound dressing wet – they are waterproof so your wound will stay dry.

‘The day of the surgery, I stayed in bed with a catheter in place. The next morning, the midwife helped me to get out of bed and have a shower. There was a pulling feeling in my abdomen that was very uncomfortable but they advised me to keep my hand pressed against it, which helped.’ Laura

Vaginal bleeding after a c-section is normal. It lasts for two to six weeks after the birth and mainly comes from where the placenta was attached to the womb.

It can take a few hours or days after your c-section for your bowel to start working again. In some women, this can cause painful trapped wind and constipation. Some pain medicines can also cause constipation.

Chewing gum may help to get your bowel working and help you feel more comfortable. Some women say that peppermint tea helps to relieve trapped wind. Drinking prune juice may help with constipation.

To help you manage constipation:

• drink 6-8 cups of water a day
• eat regular meals
• don’t put off going to the toilet and give yourself plenty of time to go
• when you’re sitting on the toilet, put your feet on a footstool or a pile of books
  move around as much as you can.

As long as you are both well, you and your baby will stay together on the postnatal ward after your c-section. This is an important time for you, and your partner, to bond with your baby, for example, by having skin-to-skin contact.

Your baby may cough up mucus in the first few days after your c-section. Mucus is usually pushed out of the baby’s lungs during a vaginal delivery, but this doesn’t happen during a c-section. The mucus can make it harder for your baby to feed and it can be worrying for you but it is normal and should get better after a few days.

You will usually stay in hospital for between two and four days. If you and your baby are well, and you have someone to help you at home, you may be able to go home after 24 hours.

You may not feel ready to go home, especially if this is your first baby or if you or your baby have needed extra help. Your hospital midwife will help you with any problems you may be having and may be able to put your mind at rest.

Once you are home, you’ll have support from your community midwife and your health visitor. The midwife will visit you the day after you get home. They will visit again five to seven days after your c-section, to remove your stitches or clips and check how you and your baby are doing. They will let you know how often they will visit and when they expect to discharge you from their care.

You will also have support from your health visitor. They may visit you at home to begin with, then you will usually visit them at a regular clinic. Your midwife or health visitor can put you in touch with other parents and local support groups.

When you leave the hospital with your baby, someone else should drive you home. If you don’t have any family or friends who can take you, book a taxi. You shouldn’t drive until you have recovered.

Don’t forget your baby’s car seat.

Before you leave hospital, your midwife may give you a supply of a blood-thinning drug to reduce your risk of blood clots. You may have had injections of this drug each day since your c-section.

The midwife will show you how to inject yourself. You will need to have the injections once a day for about a week after your c-section. If you have a higher risk of blood clots, you may need to have the injections for up to six weeks.

If you’re worried about doing the injections yourself, you can ask a family member or friend to do it for you. But they’ll need to be available to give you the injection at the same time each day.

It may take about six weeks to recover from your caesarean section (c-section). If you had any problems during or after your c-section, or if you are looking after other children at home, you may feel you need more time to recover.

Speak to your GP if you are still having pain or you don’t feel you have recovered after six weeks.

Gentle exercise, such as walking, will help you recover from your c-section. But avoid anything more active until you have no pain and you feel ready. For example, avoid driving, carrying anything heavy, doing heavy housework, such as vacuuming, or having sex until you feel able to. You will need help with carrying your baby in their car seat and with lifting their pram. Check with your insurance company when you will be covered for driving after a c-section.

Your midwife and health visitor will visit you at home for the first few weeks to check how you and your baby are getting on. After that, you can see your health visitor at a local clinic if you’d like your baby to be weighed or if you want to talk about any problems you’re having. You will need to make an appointment with your GP for your postnatal check six to eight weeks after your c-section. This is to check how you are recovering.

Your midwife will visit you at home to check your wound and remove your dressing, if you still have one. They will also remove the stitches or clips after about five days, unless you have dissolvable stitches. This does not hurt but it may feel uncomfortable.

Once your dressing has been removed, clean and dry your wound carefully every day. You may find it more comfortable to wear cotton high-waisted pants and loose clothes.

Tell your midwife or GP straight away if:

• you have a high temperature
• you feel generally unwell – for example, an upset stomach
• your wound becomes red, swollen, painful or has a discharge.
• These can be signs of infection.

Your wound will continue to feel sore and bruised for a few weeks and you will need to take pain relief for at least 7-10 days after your c-section, so you may want to make sure you have some paracetamol and ibuprofen at home.

To help control the pain take your pain relief regularly and on time, even if you don’t have pain at the moment. If you are still having pain with the painkillers, speak to your midwife, pharmacist or GP.

The amount of pain relief recommended by your midwife or doctor should be safe for you to take while you’re breastfeeding. Small amounts of any medicine you take may pass into your breastmilk but they are unlikely to harm your baby if you take them as instructed. However, codeine or co-codamol (which contains codeine) may be harmful for your baby. Always check with your doctor, midwife or pharmacist before taking any medicines. Your midwife may give you painkillers to take at home, such as paracetamol or ibuprofen.

Getting in and out of bed can be difficult or uncomfortable while you’re recovering from your c-section. Most people don’t have beds that you can raise and lower, as you do in hospital.

You may find it easier to get out of bed by rolling on to your side, dropping both legs over the side of the bed and then pushing yourself up sideways into a sitting position. Try to stand up as straight as you can. You can do the opposite to get back into bed.

Your wound will take about six weeks to heal. You will have a scar but this will fade over time.

You may lose feeling in the area of your wound, which may come back over time.

‘I had no feeling around my wound for nearly five months. I just had a strange feeling of pins and needles when I touched the area.’ Sarah

Your midwife may advise you to massage your scar to break up the scar tissue and stop any itching. There isn’t much evidence to show how well this works, but some women find it helpful. Only do this once your wound has fully healed. To massage your scar:

• lie on your back
• using a non-perfumed cream or lotion, make 20-30 small circular motions with your fingertips over your scar
• repeat two or three times a day.

You may have been given a supply of a blood-thinning drug to reduce your risk of blood clots. If so they will show you how to inject yourself. You will need to have the injections once a day for about a week after your c-section. If you have a higher risk of blood clots, you may need to have the injections for up to six weeks.

If you’re worried about doing the injections yourself, you can ask your partner, a family member or friend to do it for you. But they’ll need to be available to give you the injection at the same time each day.

Physical recovery from a c-section takes up to six weeks. However, everyone recovers differently, so when you can start having sex again will depend on how you feeling physically and emotionally. Talking about it might help to reduce any anxiety you are both feeling.

There is no hard and fast rule or legal requirement about when you can start driving again after a c-section.

However:

• you must be insured – check with your insurance company whether this operation affects their coverage. Anecdotal evidence suggests that most insurance companies will ask you to check with your doctor or midwife to make sure you have recovered sufficiently.
• you must be in control of the car
• you must be well enough to be able to perform an emergency stop.

If you meet the guidance above, you are free to drive. For most women anecdotal evidence suggests that this will be around week 4-6 after the birth.

Read DVLA guidance here Can you drive after a c-section? (mocktheorytest.com)

If you have any of the following symptoms contact your GP or call 111 straight away:

• you have pain when you pass urine or if you leak urine when you don’t mean to
• your pain relief is not keeping your pain under control, or your pain is getting worse
• your abdomen (tummy area) feels sore or tender, or you have an upset stomach
• your wound is red, swollen or painful
• your wound has a discharge or you are worried it is not healing properly
• you have a high temperature
• vaginal bleeding is still heavy after a week or gets heavier – get help straight away
• if you also feel faint or dizzy, or your heartbeat is fast or ‘pounding’
• you are worried about the smell or colour of your vaginal blood
• you have a cough, chest pain or you’re short of breath
• you have a headache together with either vision problems or sickness (nausea or vomiting)
• you have pain, redness or swelling in the calf muscle of one leg
• you are worried about your baby’s breathing – call 999 if your baby is having problems breathing.