Around 1 in 4-5 babies born in the UK are born by caesarean. A caesarean is an operation where an obstetrician makes a cut in your abdomen and womb, just above your bikini line, and lifts your baby out through this opening.
Elective caesareans (sometimes called planned caesareans) are usually performed after 39 weeks, to ensure that your baby has had time for their organs to fully develop. Elective caesareans are recommended for various reasons, such as having a low-lying placenta, or babies that are presenting in certain breech positions. These are babies that are presenting bottom first. Sometimes, a caesarean is planned before 39 weeks if there are concerns for mum or the baby.
Caesareans that are not planned are called emergency caesareans. These are usually performed when problems occur during labour – it might be that labour isn’t progressing, you start bleeding, or your baby isn’t responding well to contractions. In some cases, such as when a baby has restricted growth or reduced movements, an emergency caesarean may be done before labour has started.
Emergency caesareans are not always done straight away but there will be some urgency. When they need to be done quickly, your midwife needs help to prepare you for theatre, so try not to worry too much if several members of the team come into your room to help.
During a caesarean there will be quite a few people in the operating theatre. Each one will have a role in ensuring the safety for you and your baby:
- Midwife to look after you and your baby
- Anaesthetist and their assistant to administer anaesthetic, ensure you have adequate pain relief and other medications, and make that your body is coping well with the procedure
- Surgeon and their assistant to perform the operation
- Scrub nurse
- Theatre support worker who will support the scrub nurse and the rest of the team
- Paediatrician to ensure baby is well when born (not necessary in all cases)
- Both Dorset County Hospital and Poole Maternity Hospital are teaching hospitals and you may have students present (if you have any issues with this, please speak to your midwife
If you are having an elective caesarean, you will normally have a pre-op appointment. At this appointment you will usually see an anaesthetist, surgeon and midwife.
At this appointment, you will:
- Get a date and time to arrive at the hospital
- Be told when to stop eating and drinking
- Be asked about your regular medications, and told whether to stop taking them
- Receive pre-op medications and be told when to take them
- Find out what will happen and what to expect on the day
- Discuss the role of your birth partner on the day
- Receive an antenatal check (blood pressure, urine tests, examination)
- Have a blood test to check your iron levels
- Have methicillin-resistant Staphylococcus aureus (MRSA) swabs taken if these haven’t already been done
- Give your written consent for the surgery
- Be told about the risks of the surgery
- Discuss your medical history, experience of anaesthetics and any allergies
- Find out which type of anaesthetic you will have on the day
- Be able to ask any questions or voice any concerns about the procedure
Most caesareans in the United Kingdom (UK) are done using a type of anaesthetic called a spinal block. It’s used so often because it’s a safe and reliable form of anaesthesia, it enables you to stay awake for the birth, and it doesn’t impact the baby.
An emergency caesarean is one that is not planned in advance. The word “emergency” sounds very scary, but most emergency caesareans are not life-threatening for you or your baby. It just means that the team need to deliver your baby soon.
When there is enough time, the aim will be to get you ready quickly for a spinal block, which will enable you to stay awake for the procedure, and for your birth partner to be in theatre with you. If you already have an epidural in place, the anaesthetist can usually add stronger drugs to this for your operation. In order to get you ready for theatre quickly, extra staff may come into your room to help your midwife to prepare you for theatre, so don’t worry if your room suddenly fills with extra people – this doesn’t mean that your baby is in immediate danger.
In rare cases where it is necessary to get your baby out immediately, the quickest and safest way to deliver your baby will be to give you a general anaesthetic, which means you will be asleep for the procedure. If you need a general anaesthetic, your birth partner will not be able to go into the operating theatre with you. Once the operation is complete, you will be woken up and taken to the recovery room. This will be when you see your baby for the first time. If your baby is well, your birth partner will usually be able to hold the baby until you wake up. It can be upsetting to find out that you won’t be awake when your baby is born, but your consultant will only suggest a general anaesthetic if it is the best way to keep you and your baby safe.
Your midwife will get you ready for theatre, which will include:
- Giving you medicine or an injection to stop you being sick
- Putting on support tights to reduce blood clots
- Removing your jewellery
- Helping you into a hospital gown
- Placing a catheter (plastic tube) into your bladder (this is sometimes done in the theatre)
- Placing a small plastic tube called a cannula into a vein in your hand, which will be attached to a bag of fluids (a drip)
You will be taken to theatre and the anaesthetist will administer your anaesthetic. You may have a monitor on your stomach during this time so that they can make sure your baby is well. The team will also put a blood pressure cuff around your arm and stick some leads to your chest, so that they can monitor you throughout the procedure.
A nurse may need to shave a small area around your bikini line to prevent infection, and a screen will be put up so that you can’t see the surgical area. Your birth partner will be able to go straight into theatre with you if you are having an elective caesarean. Your partner will not be able to present if you have a general anaesthetic – they will wait in the recovery area and will be able to hold the baby until you wake up.
It’s normal to feel worried that the spinal anaesthetic isn’t working, but the team will check carefully to make sure it’s working properly before they start. The incision will usually be made in your bikini area and will be covered by your underwear or swimwear in future. In rare cases, the surgeon might need to make a vertical incision (down the length of your bump) – the surgeon will explain to you if this is necessary. Most women say that having a caesarean feels quite strange, a bit like someone doing the washing up in their abdomen! You will feel some pulling and tugging but you shouldn’t feel any pain – tell the anaesthetist right away if you do.
The anaesthetist will monitor you during the operation, to make sure you are coping well with the surgery. They will be checking your blood pressure using the cuff on your arm, and your heart rate using the leads stuck to your chest. You might find that you feel sick or dizzy during the operation – if you suddenly feel sick, or you feel any pain, tell the anaesthetist right away so that they can help you.
Once the baby is born, the surgeon will close your wound, and the midwife, paediatrician or neonatologist will closely check your baby. If your baby is doing well, they will bring your baby over to you and your partner. You may be able to have skin-to-skin contact with your baby at this point. Although it will only take about ten minutes for your baby to be born, you will be in theatre for about an hour while the placenta is removed, and the incision is closed.
If your baby needs extra care, you might not be able to hold them right away, and they may need to be taken to the Neonatal Unit for monitoring or treatment. The staff will keep you fully informed of what is happening with your baby. Once your baby is stable, your partner will be able to go and see them and take some photos for you. As soon as you are both well enough, you will be taken to the Neonatal Unit to visit your baby.
Once the operation is finished, you will be taken to the recovery area (Poole Maternity Hospital) or back to your room (Dorset County Hospital), where you will be monitored for a short while to ensure that you are coping well. Your midwife will check your blood pressure, pulse and temperature regularly. They’ll also make sure that you are tolerating fluids.
As long as your baby is well, they will stay with you. Skin-to-skin contact with your baby is encouraged. Your team midwife will support you with your choice of feeding within an hour of your baby being born. Your midwife will also do an initial assessment of your baby, weigh them and give them vitamin K if you consent to this. If your baby is in the Neonatal Unit, your midwife can help you to express some colostrum that can be given to your baby once they are able to feed.
You will be prescribed regular pain relief. If you require more pain relief, please let the midwife know as there are various options. If you have a spinal anaesthetic, you will slowly regain the feeling in your lower part of your body. Speak to the midwife when you start to feel pain so that you can receive effective pain relief. If you have decided to breastfeed, it is still safe for you to do this after receiving pain relief – please discuss this with your midwife if you have any concerns.
You may experience some shoulder pain, which is caused by air that is trapped in your abdomen during the surgery. Moving around is the best way to improve this, even though it can be difficult. You can have medicine to help to relieve this.
You can eat or drink as soon as you are hungry or thirsty. When you are able to tolerate fluids and you are stable, your cannula will be removed. If it’s necessary to keep the cannula in, your midwife will explain this to you.
You will be supported to get out of bed and try a few steps a few hours after your caesarean. This can seem hard at the time but moving around early helps to reduce your risk of clots in your legs. Continuing to wear your support stockings for a week to reduce your risk of blood clots. You’ll also be advised to have regular injections of anti-coagulants into your tummy for 10 days. You will be shown how to administer the injection at home and provided with a supply on discharge from hospital – it’s a very small needle so nothing to worry about.
Your urinary catheter will usually be removed 12 hours after your baby is born, unless there are medical reasons that mean it will need to stay in for a bit longer. If so, this will be explained to you. Once your catheter is removed, the postnatal staff will ask you to measure your first wee to make sure that your bladder is working properly.
The midwife will check your dressing regularly, and it will be removed after 48 hours. You can shower with the dressing on. The midwife will also check your blood loss regularly.
In most cases, if your caesarean is uncomplicated you may be able to go home the next day. If you need to stay a bit longer, your midwife will explain this to you.
To prevent infection, you’ll be advised to clean and dry your wound very gently every day. It’s best to wear loose clothes and cotton underwear. If you find that your wound is oozing or smelly, it’s important to call Labour Line (0300 369 0388) right away.
It’s best to take painkillers if you are struggling with the pain. Once you are discharged, you should only need paracetamol and ibuprofen. If this is not sufficient to manage your pain, speak to your midwife or GP.
You will usually have dissolvable stitches, which will dissolve on their own and don’t need to be removed. If you have non-dissolvable stitches or staples, these will need to be removed after 5-7 days. Your midwife will give you advice on this.
Staying mobile and doing gentle activities will help your recovery and reduce the risk of blood clots, but make sure you don’t try to do too much too soon. You’ll usually need to wait around six weeks to resume driving, exercise, carrying heavy things or having sex. You can always ask your midwife or maternity support worker for advice on anything specific during your postnatal appointments.
Contact Labour Line on 0300 369 0388 immediately if you have any of the following symptoms:
- Heavy vaginal bleeding
- Severe pain
- Pain when having a wee, or leaking wee
- Your wound is oozing pus / discharge or has a bad smell
- Your wound becomes very red, swollen or painful
- You develop a cough or feel short of breath
- You have swelling, redness or pain in your lower leg
These symptoms can be signs of a medical emergency such as an infection or blood clot, so it’s important to be assessed right away.
Vaginal birth after Caesarean (VBAC)
If you’ve had a previous caesarean, you might be feeling unsure about your birth options. There’s lots of myths and misinformation around vaginal birth after caesarean (also known as VBAC).
You might be sure that you want a VBAC this time, or anxious about the idea of it. You might feel that you don’t want to try a VBAC at all. If you’ve had a traumatic birth experience previously, it’s understandable that you might be feeling scared and anxious.
Whether a VBAC will be recommended will depend on lots of factors. Women have caesareans for all sorts of reasons – some of these are unlikely to recur in future pregnancies, while in others the team may think it’s safest for you to have another caesarean. The obstetric team will help you to understand the circumstances around your caesarean, why it was necessary, and whether your caesarean and any other issues will affect your birth options.
For example, if you had a caesarean because your baby was breech, it’s unlikely that you will need another caesarean. Women who’ve had one previous caesarean and are having a straightforward pregnancy have a 75% chance of a successful vaginal birth. If you had a vaginal birth before your caesarean, you have an even higher chance of success – about 80-90% of women in this situation are able to have a vaginal birth.
There’s lots to think about when considering your options for your next birth. Your booking appointment is a good opportunity to discuss these issues. If you feel you need further information and support, your midwife can refer you to the Birth Choices clinic at Poole, or to see an obstetrician if you are having your baby in Dorchester.
Due to the risk of complications, women who’ve had a previous caesarean will be advised to have their baby in a hospital, so that there is access to specialist equipment and to operating theatres if they are needed. If you have decided you want a homebirth this time, ask your midwife to refer you to the Birth Choices clinic at Poole, or to a senior midwife in Dorchester.
When you start having contractions or your waters break, call Labour Line on 0300 369 0388 for assessment. They will tell you when you need to go to hospital.
When you arrive, you will be closely monitored for signs of any complications. You will be advised to have continuous monitoring of your baby’s heart throughout labour. This will allow the midwife or obstetrician to spot early signs of distress or problems with your scar. The midwife will regularly examine your scar and uterus for tenderness or pain during the first and second stages of labour in addition to normal observations and monitoring.
Telemetry, a wireless form of continuous monitoring, may be used if you choose to labour in water or want more freedom of movement – ask the midwife caring for you whether this could be a safe option for you.
In most cases, your pain relief options will be the same as any other woman in labour. In some cases, there are concerns that an epidural could mask problems with your scar and this will be discussed with you. You can have an epidural during a VBAC at Poole or Dorchester.
If you haven’t gone into labour spontaneously by 40 weeks, your consultant will discuss the options available to you, which may be induction or an elective caesarean depending on your circumstances and preferences.
There’s lots to consider when weighing up the risks and benefits of VBAC. Many of these are very individual and based on your heath, your baby’s health, your medical history and the reason for your previous caesarean(s). Your team will discuss your individual case with you, but if you would like more general information on advantages, disadvantages and statistics, you can read the RCOG leaflet on VBAC.
It’s important to remember that you are an individual and not a statistic, so this information should form part of a much wider personal discussion about your own case and risk factors.