Caesarean section

What is a C-section?

A C-section means that your baby is born via a cut made in your belly rather than through your vagina.

There are three types of C-section:

• Elective/non-medical – a C-section for reasons other than medical reasons
• Medically-necessary – a C-section undertaken for known medical issues
• Emergency – a C-section undertaken because of medical complications during a vaginal birth

Most C-sections are routine, straightforward and quick, and most women experience a little discomfort, but no pain. Risks for your baby are few, and rare, and long term consequences well understood, and relatively minor.

None of which changes the fundamental fact that a C-section is serious surgery, and not to be undertaken lightly.

So why might you want one? Why might your doctor propose one? And why might you end up having one whether you planned to or not?

Why have a C-section rather than giving birth naturally?

If you’re thinking about a C-section, it’s probably on the advice of your doctor.

A straightforward vaginal birth is always the ideal option, so if your doctor’s talking about a C-section it’ll be because they’re concerned about potential issues with a vaginal birth – issues which make a C-section, overall, the best, lowest-risk option, with the best possible chance of a happy, healthy outcome for you and your baby. Such issues might include:

• Your baby’s head is ‘too large for your pelvis’: the head is too large and/or your pelvis too small to allow for a safe, straightforward delivery.
• Your baby’s potential exit route through your cervix is blocked by a mislocated placenta (sometimes called ‘placenta previa’) or some other obstruction, such as a large uterine fibroid.
• A previous C-section. Having had one or more earlier C-sections sometimes – not always, but quite often – rules out a vaginal birth.
• Twins, triplets or more! Although twins can be delivered vaginally, multiple babies always make it more likely that a C-section will be the best, lowest-risk option.
• ‘Non-ideal’ positioning – your baby isn’t head-down and ready to go but lying sideways, or feet- or bottom-down. It may be possible to turn your baby to the correct position, but if not, you’ll probably need a C-section.
• A pre-existing health condition, such as heart disease or a pelvic fracture, which could make vaginal delivery risky and/or painful.

Can I choose a C-section for non-medical reasons?

If you ask for a C-section rather than having one suggested to you for medical reasons – sometimes called an ‘elective’ C-section – you may well find your doctor or midwife spending some time telling you about the potential risks of what is, when all’s said and done, a serious operation, and the advantages of a vaginal birth.

The ultimate decision, though, is yours and yours alone. And if you decide, after discussing the risks and other implications of the C-section option, that you still want to go ahead, they’ll make the necessary arrangements.

What happens during a C-section?

Most C-sections are planned, for medical reasons, so you’ll know well in advance when it’s going to take place, and will probably never go into labour.

You’ll be connected to a ‘drip’ or ‘IV’ – a tube to a vein in your arm which will be used to deliver necessary medicines and fluids during the procedure – and a catheter, a thin tube which will keep your bladder empty.

You’ll then probably be given local anaesthesia – an epidural or spinal block – which will leave you completely numb below the waist. A screen will be put in place, so you will not be able to see the procedure, but you will remain awake throughout, and will probably be aware of some tugging/pressure when your baby is born, though you should feel no pain.

All being well, your baby will be quickly delivered, and given for you to hold, and, if you want, perhaps breastfeed. If your baby isn’t given to you straightaway, don’t read anything into it. Many babies need a little initial help to begin breathing. But the chances of anything being significantly wrong are very slim.

Once your baby’s born, your doctor will remove your placenta and stitch you up.

The whole procedure typically takes anything from around 30-60 minutes from start to finish.

What if I have to have an emergency C-section?

You may end up having to have a C-section whether you wanted one or not. Such an ‘emergency’ C-section will happen if, during a planned vaginal birth, complications make an immediate birth necessary, for the good of you and your baby. Such complications might include:

• Your labour just isn’t progressing
• Monitoring of your baby detects an irregular heartbeat or other signs of distress
• The umbilical cord gets wrapped round your baby, or enters the birth canal first
• Your baby’s position is wrong, and cannot be corrected
• You begin to haemorrhage
• The placenta separates from your uterus
• You suffer a uterine rupture – tearing of a scar from a previous C-section

In such circumstances – or any others where the doctor decides that continuing with a vaginal birth may no longer be a safe option – you will probably progress to a C-section.

If so, it may all happen very quickly. Issues demanding an emergency C-section are often urgent, so your doctor will be keen to get your baby out and safe as soon as possible. You may be given a general rather than a local anaesthetic – so you’ll be unconscious throughout – and the entire procedure can be completed very quickly.

Is a C-section risky?

A straightforward C-section, though a serious operation, is very safe. Major surgery always involves risks, though, and it would be a mistake to think of a C-section as any kind of easy option. Compared to a vaginal birth, a C-section increases the risk of:

• Heavy bleeding
• Blood clots
• Infection
• Injury to other organs

And unsurprisingly, recovery afterwards is likely to involve more pain and discomfort – and to take longer – than with a vaginal birth. Many women go straight home after a vaginal birth; not with a C-section. You’ll definitely need to say in hospital for a day or two, to confirm your surgery’s gone well, and give it a chance to start healing.

There are also some increased risks to your baby, though these are relatively minor – typically fluid in the lungs, which clears naturally within a day or two, or minor nicks or scrapes from the surgery, which again are nothing to worry about, and will usually heal themselves quickly and completely.

What happens after the surgery?

In a typical case, where everything has gone as planned, you’ll probably find yourself in a recovery room feeling a bit battered and bruised. You may also be feeling sick, or groggy, or itchy, or otherwise uncomfortable, from the drugs used during the operation. Nurses will make sure you’re ok, checking your blood pressure, heartrate and breathing.

Over the next few days, you’ll probably experience one or more symptoms like:

• Vaginal discharge – probably for several weeks after delivery, starting out bright red, then pink, then brown, finally yellow or clear.
• Afterpains – feeling like menstrual cramps – over-the-counter pain meds may help.
• Breast swelling and soreness – breastfeeding, using a breast pump, and directly-applied cold washcloths can help ease tenderness. If you’re not breastfeeding, wear a firm, supportive bra. And don’t try to ease the discomfort by rubbing – this will just stimulate milk-production and make matters worse.
• Hair and skin changes – over the first few months you may notice your hair thinning, and/or red or purple stretch marks on your belly and breasts. Your hair should recover; stretch marks are permanent, but will fade over time.
• The blues – AKA the ‘baby blues’, more than likely including anxiety and extreme fatigue. It’s absolutely normal, and there’s really very little you can do but endure. Having said which, if it lasts more than a fortnight or so, you and your doctor might want to discuss therapy, or medication.

How should I look after myself after a C-section?

Your doctor or midwife will make sure you don’t go home without detailed instructions on looking after yourself and your baby after you leave hospital, most likely including tips on taking care of your healing incision, such as:

• Keep the surrounding area clean, to prevent infections. Itching/irritation should fade after a few days. If instead your incision stays red, swollen or hot to the touch, or leaks discharge, or you become feverish or otherwise start feeling worse rather than better, tell your doctor straightaway.
• You may be able to take showers, and letting water run over the wound can help with cleaning – but check with your doctor first.
• Use only water and mild soap, clean gently, pat dry.
• No baths or swimming until you have your doctor’s all-clear.

While looking after your wound, don’t forget to look after yourself. You’ve been through a major operation; you’re going to need time and support. And also:

• Take it easy. Don’t lift heavy stuff, don’t do anything strenuous, don’t be in too much of a hurry to start driving again. Spend plenty of time doing not a lot.
• Support your belly – hold it when you sneeze, or cough, or laugh.
• Use over-the-counter pain relievers such as ibuprofen if you need to (unless you’re explicitly advised against for some reason).
• Heating pads or warm washcloths can help ease local pain.
• Drink fluids – you’ll probably need more than usual, to replace fluids lost during the operation and those you’re passing on to your baby through breastfeeding.
• Eat less, more often, and favor fiber-rich foods that can help ease problems with constipation.
• Try doing some basic, easy exercises – anything from deep breathing to gentle stretching – and get out of bed for a walk around when you feel up to it. Basically, anything that gets/keeps you active – without overdoing it – will aid a quicker, better recovery.

Be aware that full recovery is likely to take a good while – four to six weeks is typical – and in the meantime, try not to let the inevitable mood swings get you down too much, and keep reminding yourself they’re normal, and temporary.

Will I be able to have a vaginal birth for my next baby?

You may, or you may not.

Many women do have vaginal births after they’ve had a C-section, without problems. But having said that, issues are more likely than if you hadn’t had one before – one of the reasons your doctor will generally question any preference for a non-medical, or ‘elective’, C-section.

If you do decide you want to go ahead with a VBAC (Vaginal Birth After C-section) and your doctor sees no compelling reasons why you shouldn’t, then go ahead. 70% of women who take this route end up having a successful vaginal birth. It’s certainly worth thinking about, given that VBACs, compared to another C-section, mean:

• No surgery
• Less blood loss
• Quicker recovery, with less pain/complications
• Less chance of infection
• Reduced likelihood of damage to your bladder or bowel
• Reduced risk of problems with future childbirths

And if it doesn’t work out for you, it’s not the end of the world – you’ll almost certainly end up proceeding to another C-section, without problems.