Having a C-section

What is a C-section?

A caesarean, or C-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.

It can usually be done with a type of regional anaesthetic such as an epidural which allows you to remain awake. Caesarean births take place in surgery rooms on the labour ward. 

Because it 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.

A 2017 survey by the Care Quality Commission found that 15% of women who gave birth in January 2017 had an emergency Csection, and 11% had a planned C-section.

Why might I have a C-section?

Your doctor may recommend that you have a caesarean section if they think that it is safer than a vaginal birth for either you or your baby.

There are many different scenarios where you could be recommended a C-section and, unless it’s a hasty emergency, you should have the chance to talk through your circumstances and options before consenting to the surgery.

Emergency or unplanned C-section

Not all unplanned C-sections happen quickly - for example, you might have one if you are in labour for a long time but 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 happens as soon as possible because an unexpected problem means 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.

Elective or planned 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.

If you're planning to have an elective C-section, don't forget to pack useful extras in your hospital bag for a C-section delivery. Download our C-section hospital bag checklist to ensure you have everything you need.

Can I request to have an elective C-section?

Yes, you can ask to have one on the NHS without having any medical reason. This is known as a ‘maternal request C-section’.

Often, C-sections for non-medical reasons are requested by women who have birth anxiety, perhaps because of a previous traumatic birth, or who have suffered sexual abuse in the past. But there are many reasons for choosing to have a C-section, and your request should be considered in any case.

How do I arrange a C-section?

If you’re considering a planned C-section, bring it up at one of your antenatal appointments. Your midwife or doctor will refer you to an obstetrician, who’ll go through the risks and benefits with you.

You should be offered a referral to a health professional who can help you cope with your anxiety in a supportive way if your reason for asking for a C-section is that you’re worried about vaginal birth.

If, after talking things through with the necessary professionals, you decide that you would like to have a caesarean, official guidelines state that you should be offered a planned C-section. Your doctor you see should refer you to another doctor who will do the C-section if they’re unwilling to do it themselves.

If you’re having problems arranging a C-section through your consultant, a good first step is writing to the hospital. The organisation Caesarean Birth has useful tips on what to include in the letter.

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.

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 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.

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.

C-section preparations

A C-section is major abdominal surgery so 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.

Anaesthetic options

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.

In the operating theatre

When you’re taken into theatre, there will be up to ten people present to help at the birth (more if it's a multiple birth). These are some of the people you can expect to see:

• Surgeon
• Anaesthetist
• Midwife
• Nurses
• Paediatrician

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 as 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 precautionary.

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 should 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.

What is the recovery like after a C-section?

After a C-section, you’ll be recovering from abdominal surgery as well as looking after your new baby, so it’s important that you get the right pain relief and support.

While you’ll probably find that you’re in a lot less pain after a week or two, it may take many weeks, and in some cases months, for you to get back to normal activities like driving or exercise.

Some factors that may affect how quickly you recover are:

• If it’s your first or second C-section: When you have a second caesarean, the scar from your first section is opened up. The healing afterwards can be a bit more painful because of the scar tissue that’s there from the first time around.
• If you have a planned C-section: With an emergency caesarean, you have been through labour, possibly for days and with interventions. The C-section itself may also have been performed faster and under more stress than a planned section. All of this can mean it takes longer for you to feel better afterwards.

Pain relief after a C-section

Immediately after your C-section birth, hospital staff will help you out with the pain relief you need. Don’t be afraid to ask for more or a different kind of pain relief if you find you’re in a lot of discomfort – everyone’s experience of pain is different.

After a couple of days, most women find that they cope well with just over-the-counter pain relief. It can be a good idea to stock up on paracetamol and ibuprofen before the birth so you have it ready at home.

Previously, many women were prescribed co-codamol for the pain, but this is no longer recommended because in rare cases if can cause breathing issues for your baby if you’re breastfeeding.

If you’re experiencing more severe pain, or it lasts for longer than you think is normal, it can be a good idea to see your GP who can check that your wound is healing as expected and refer you for an investigation to rule out any internal issues.

Your C-section wound and scar

After surgery, your wound will be covered with a dressing, which can be removed after 24 hours. Wear loose, comfortable clothes and cotton underwear to let the wound heal, and gently clean and dry it daily.

After your wound has healed, you’ll be left with a red scar on your stomach, which will fade in time. In most cases, the scar will be low down on your stomach, under your bikini line.

Although you shouldn’t feel any pain from the scar in the future, it’s normal to lose some sensation around the scar area after a C-section.

Bleeding after a C-section

Just as after a vaginal delivery, you’ll experience afterpains and vaginal bleeding (lochia) following a C-section birth as your womb contracts back to its normal state. 

Use maternity pads, rather than tampons or a menstrual cup, to minimise the risk of infection.

Breastfeeding after a C-section

You can breastfeed straight after your C-section – some women even start breastfeeding in the operating theatre (the drugs used when you have your section are all safe for breastfeeding).

After the anaesthetic wears off, you may find it painful to have your baby on top of you when breastfeeding. A lot of women find it easier to breastfeed lying on their sides or holding their baby under their arm (‘rugby hold’) as that doesn’t put any pressure on the wound.

Breastfeeding positions after a C-section:

1. Rugby hold
2. Side-lying hold
3. Laid-back hold after C-section

Driving after a C-section

You won’t be able to drive for a few weeks after your C-section, so take that into account when planning how you’ll get home from hospital after birth and if you need to get around in the early days. It’s also important to check with your car insurer to find out how soon you’ll be covered before you get behind the wheel.

Heavy lifting

Stay away from lifting anything other than your baby for the first few weeks. This can be easier said than done, especially if you have an older child at home, so accept offers of help where possible.

After the first month, if you experience pain during or after lifting something, take it as your body’s signal to slow down for a bit longer.

Exercise after a C-section

You’re fine to start going for short walks as soon as you feel able to, but it’s recommended that you wait at least 12 weeks before you start any more vigorous exercise to make sure you’re not putting too much strain on your scar. Even if you feel fine, you’re still healing on the inside.

Recovering emotionally

As well as leaving a physical scar, birth can also have a deep psychological impact. This is especially common after a distressing birth experience – for example, if you felt that your or your baby’s safety was at risk at any point during the birth.

As well as talking to your midwife, health visitor or GP if you’re struggling emotionally, you can also find information and support through these organisations:

• The Birth Trauma Association has peer support groups for people affected by birth trauma and post-traumatic stress disorder.
• Make Birth Better have resources for women and their partners after a difficult birth.
• PANDAS has a helpline and peer support groups for parents with antenatal and postnatal depression.