A caesarean section may be recommended as the safest option for you and your baby. Find out why you might have a planned or emergency c-section, and what to expect during the birth.
What is a caesarean section?
A caesarean section is an operation to allow your baby to be born without going through the birth canal. Instead, your baby is born through a cut in your abdomen.
A caesarean birth can usually be done with a type of regional anaesthetic such as an epidural which allows you to remain awake.
Because it is a form of intervention that involves major abdominal surgery, recovery after a c-section generally takes longer than after a vaginal birth.
There are two kinds of caesarean sections:
- emergency c-section, also known as unplanned c-section or EMCS, and
- elective c-section, also known as planned c-section or ELCS.
An emergency c-section takes place after you’ve gone into labour, while an elective c-section happens before labour has started.
Caesarean births take place in surgery rooms on the labour ward.
Why might I have an emergency c-section?
Although it sounds alarming, not all unplanned c-sections have to happen quickly. For example, you may have a c-section if you are in labour for a long time but you don’t seem to be getting closer to giving birth. In this case, it may be hours between you and the consultant agreeing to do a caesarean section, and you going into surgery.
In other circumstances, the c-section needs to take place as soon as possible because an unexpected problem has arisen and your baby needs to be born urgently. If this happens, you’ll probably go into surgery within half an hour of the decision being made.
More than one in ten women have unplanned c-sections, so it’s worth thinking about what you’d like to happen if you do end up having a caesarean section birth. Discuss it with your midwife in advance and include this information when you’re writing your birth plan.
“I was induced at 12 days overdue, but after several days I’d only reached 6cm dilation and was whisked down the corridor for an emergency c-section. My healthy baby boy was born just fine and I made a speedy recovery, so all was well.”
Why might I have an elective c-section?
Elective sections can be planned for medical reasons, for example if your placenta covers your cervix so your baby wouldn’t be able to be born vaginally. Although it’s called elective, there is in reality little choice involved in this type of scenario.
There are other cases where the choice to have a planned c-section is a decision for you to make with your consultant. For example, many hospitals recommend that you give birth by a planned c-section if your baby is breech, as they feel that’s the safest way for your baby to be born, but you can still choose to have a vaginal delivery.
You can also request to have a planned caesarean section without any underlying medical reasons – find out more in our page on Choosing to have a c-section.
If you’re scheduled for an elective c-section, you’ll probably know the date of the birth in advance and it often takes place when you’re around 39 weeks pregnant, as babies are at a higher risk of breathing problems if born by planned c-section before then.
“I had a planned c-section because I was at risk of heart complications. The birth was a positive experience and I recovered fine. I really don’t like the term ‘elective c-section’ though – my decision was based on what I believed would be best medically, not to avoid a vaginal delivery.”
How likely am I to have a c-section?
A 2017 survey by the Care Quality Commission found that 15% of women who gave birth in January 2017 had an emergency c-section, and 11% had a planned c-section.
NHS maternity statistics show that the chances of having an unplanned caesarean differ between different groups of women:
- Older women are more likely to have an unplanned caesarean than younger women.
- First-time mothers are more likely to have an unplanned caesarean than women giving birth for the second or subsequent time.
What happens during a c-section?
Knowing what happens at the different stages of a caesarean section can help you feel more prepared, whether you’re hoping to have a vaginal birth or already have an elective c-section scheduled.
It’s only natural to find the idea of having major abdominal surgery while being awake daunting, especially if you don’t have a lot of experience of being in a hospital environment.
If you do have anything you’re wondering about when it comes to c-sections, you can always ask your midwife or doctor at any of your antenatal appointments.
Your midwife will have been present at c-sections as part of their training, so can help answer any questions or concerns you have.
Signing a consent form
Whether you’re having a planned or unplanned c-section, you’ll be asked to sign a form stating that you consent to the surgery you’re about to go through.
Your consultant doctor will explain to you why they think that you should have a caesarean section, and go through the risks and benefits with you, so you can give informed consent.
This can happen either at an antenatal appointment if you’re going to have a planned c-section, or right before the surgery if you need to have an emergency c-section.
If your baby needs to be delivered immediately, there may not be enough time to go through everything or for you to sign the form, but you should still be kept informed of what’s happening and give verbal consent.
Find out more about informed consent during birth.
Because a c-section is major abdominal surgery, there are a few preparations that the hospital staff will do to minimise the risk of infection and make sure you’re comfortable during the surgery.
- Fitting a catheter. Because of the anaesthetic, you won’t be able to feel your bladder for hours after the surgery, so a catheter is recommended. This can be fitted on the ward before the birth if you’re having an elective c-section, or in the surgery room if you’re having an emergency c-section.
- Inserting a cannula. A cannula allows you to be given fluids and anti-sickness medication through a tube. This can either be fitted in your hand or in your arm.
- Shaving your pubic hair. The top line of your pubic hair may be shaved. It’s important that you don’t do this at home if you’re having a planned c-section, but instead leave it to the staff at the hospital.
- Changing your clothes. You’ll be asked to wear a hospital gown for the surgery, and sometimes also surgical stockings to minimise the risk of blood clots.
Unless it’s a hasty emergency, you should have the opportunity to talk to the anaesthetist about your options in advance.
- Spinal block: a single, fast-acting dose of medication injected into your back, to numb you below the chest.
- Epidural: also injected into your back and removes feeling from your chest down. This can be less effective but will act as pain relief for longer.
- General anaesthetic: only given if you can’t have a spinal or epidural for medical reasons, or if your emergency c-section needs to happen urgently. Under general anaesthetic, you’ll be asleep during the birth and will wake up in the recovery room afterwards.
Your c-section birth partner
If you have a general anaesthetic, your birth partner can’t be in the room during the surgery, but the baby can be brought out for them to hold until you’re awake.
If you have a spinal or epidural anaesthetic, you can have a birth partner with you in the operating theatre. They’ll be asked to change into scrubs, which are provided by the hospital, before the surgery starts and they can sit by your head during the birth.
Unlike other types of birth, you can only have one birth partner in the surgery room, but it can be any person of your choosing, for example:
- your partner
- the father of the baby
- your mum, sister or a close friend
- an independent midwife or doula.
Have a look at our tips on being a birth partner during a c-section.
In the operating theatre
When you’re taken into theatre, there will be up to ten people present to help at the birth. These are some of the people you can expect to see:
Read more about the people who will look after you during the birth.
The birth of your baby
You’ll be lying on a table and there will be a sheet in front of your belly so you don’t see the actual surgery – but if you want, it can be lowered to allow you to see your baby being born.
Once the anaesthetic is administered you can’t feel anything below your chest. You may feel some tugging or pulling when the surgery is going on, but it won’t be painful, the surgeon will make sure the anaesthetic is working before they make the incision in your lower stomach.
When your baby is born, they’ll be held up for you to see, before being taken over to the resuscitation table so the paediatrician can check them over. In the vast majority of cases, this is just a precaution.
As long as all is well with your baby you should be able to have skin-to-skin contact in the theatre while you’re being stitched up. Some babies even start to breastfeed in the theatre.
If you can’t hold your baby, your birth partner may be able to hold them instead.
Suturing and your hospital stay
After your baby’s born, the surgeon will deliver the placenta and then suture you up, either with dissoluble stitches or ones that will be taken out by a midwife around five days after the birth.
If the c-section is straightforward, the whole surgery usually only takes around one and a half hours.
Afterwards, you, your baby and your birth partner will be taken to a recovery room for a couple of hours, before being taken to the postnatal ward where you’ll stay for at least one night before going home.
Read more about your recovery after a c-section.
More from Which?
- Requesting a c-section: we guide you through the pros and cons of elective caesareans and explain how to arrange one on the NHS or privately.
- Read our advice on NHS and private ultrasound scans with information on when they occur and what to expect.
- Watch mums talking about their experiences of giving birth at home, on the labour ward and in a birth centre.
These are the sources of information used in this article:
Health and Social Care Information Centre, Hospital Maternity Activity 2015-16, NHS
Care Quality Commission, Maternity Services Survey 2017 (2017)