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Caesarean delivery

Published by Bupa's health information team, February 2008.

This factsheet is for people who would like information about having a caesarean delivery.

Caesarean delivery is an operation to deliver your baby through your abdomen (tummy). You may need to have an emergency caesarean delivery or you may plan to give birth to your baby this way, for example because you have had previous abdominal surgery.

Your care will be adapted to meet your individual needs and may differ from what is described here. It's important to follow your doctor's advice.

About caesarean delivery

If it's not possible for you to give birth to your baby vaginally, you will need an operation called a caesarean. There are a number of reasons why this may be necessary. You may plan in advance to have a caesarean delivery. This is called an elective caesarean. It's possible that you will start giving birth vaginally and then need to have an emergency caesarean because of complications during labour. You may also need to have an emergency caesarean before you go into labour.

Some of the reasons why you may have a caesarean delivery include the following.

  • Labour has been going on for some time and isn't progressing quickly enough.
    • Your baby isn't getting enough oxygen, or there is another problem putting his/her health at risk - this is called fetal distress.
  • The placenta is attached on or near your cervix (the neck of your womb) - this is called placenta previa.
  • The placenta grows through the wall of your womb and into its muscular layer - this is called placenta accreta.
  • You are expecting twins or triplets (or other multiple pregnancy).
  • Your baby isn't in a head downwards position - he/she may be in a breech position (bottom first) or lying sideways across your womb. This makes giving birth vaginally more difficult or sometimes impossible.
  • There is a high risk that you may have heavy bleeding if you have a vaginal delivery.
  • You have had a previous caesarean delivery, although it's usually possible to have a vaginal delivery afterwards.

The number of women in developed countries who have a caesarean delivery has been steadily increasing. In the UK, about one in five babies are delivered by caesarean. However, this varies between hospitals and by where you live.

Types of caesarean delivery

There are a number of possible ways that a caesarean can be done. You are most likely to have a lower uterine segment caesarean section (LUSCS or LSCS). A cut is made across the lower part of your abdomen and womb, usually parallel to your bikini line. This type of caesarean tends to form a smaller, stronger scar than if the classical technique is used.

If you have a classical caesarean, a cut will be made vertically down the middle of your womb. The cut through your abdomen may also be vertical or a bikini line cut may be used. However, the classical procedure is rarely used now. It's likely that you will only need this type of caesarean delivery if your baby is lying sideways and can't be moved, or if your baby is very premature.

Preparing for your operation

If you need to have an emergency caesarean, you may not have much time to prepare for your operation. However, even if this happens, your surgeon will try to explain the reasons why you need to have a caesarean delivery.

Caesareans are done using local anaesthesia, either an epidural or a spinal block. An epidural blocks the feeling from your lower body, although you can often still feel your legs and feet. You will stay awake during the procedure. You may have already had an epidural if you began vaginal delivery and so this can be topped up with another dose if you then need a caesarean delivery. It can also be topped up if the operation takes longer than expected.

A spinal block also stops you feeling anything from your waist downwards, but as with an epidural you may be able to feel your legs and feet. This type of anaesthesia takes effect more quickly but only lasts for a set length of time.

There is a possibility that you may need a general anaesthetic if there are serious problems and an epidural will take too long to have an effect. This means you will be asleep during the operation and feel no pain.

Your surgeon will ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

What are the alternatives?

If you are considering an elective caesarean, it's important that you are aware of any possible alternatives. For example, it's often possible to give birth vaginally if you are expecting twins, if your baby is in the breech position in your womb or if you have had a previous caesarean delivery. Your midwife or surgeon can give you more information about the risks and benefits associated with both options.

About the operation

You will be put on a drip so that during the operation you can be given medicines and fluids to keep you hydrated. You will then be given either a local or general anaesthetic.

A catheter will be inserted into your bladder to make sure that it's empty. This is important because your surgeon will be operating very close to it.

Once the anaesthetic has taken effect, your abdomen will be cleaned with antiseptic. Your surgeon will make a cut through your abdomen. Your baby will then be carefully removed. If you have had a local anaesthetic, you may feel some pushing or pulling during the operation. However, you should not feel any pain. Usually you will be able to see and hold your baby immediately after delivery.

As your baby is being delivered, you will be given Syntocinon - this is an artificial form of oxytocin. Oxytocin is a hormone (a chemical found naturally in your body) that causes your womb to contract. When this happens (after about two minutes) your surgeon will deliver the placenta. He or she will then close the cuts in your womb and abdomen using stitches or clips and put a dressing over the wound. The stitches in your womb don't need to be removed. Depending on the technique your surgeon used, you may need to have the abdominal stitches taken out or they may dissolve.

It usually takes about five to 10 minutes to deliver your baby. In all, the procedure lasts about 30 to 40 minutes if there are no complications.

What to expect afterwards

You will be given pain relief medicine after a caesarean delivery. This is usually diamorphine.

If there were no complications during the procedure and you are recovering well, you can eat or drink when you feel like it.

If you had an epidural, your catheter won't usually be removed until at least 12 hours after your last top-up. If you had a spinal block, your catheter can be removed once you are able to walk around.

The dressing will be taken off after about 24 hours. After this, your wound will probably be left uncovered.

You should have the chance to talk to your surgeon and midwife about why you needed to have a caesarean. They will be able to explain the reasons and also give you information about any possible consequences the operation may have for the future health of you and your baby.

It's usual to stay in hospital for about three to four days after having a caesarean delivery. However, if you are making a good recovery with no signs of fever or infection and have support at home, you may be able to leave hospital sooner.

Recovering from a caesarean delivery

You will be given medicines for pain relief while you are in hospital and advice about what to use once you leave. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

During the operation you will probably have been given antibiotics. This is to try to prevent any infection of the wound, your womb or your urinary system (your bladder and the tubes that run to and from it). It's important that you complete the course of antibiotics even if you don't have any signs of infection.

Your wound will heal best if you wear loose, cotton clothes and clean and dry it carefully every day. You probably won't have a dressing on it unless your midwife or doctor advises it.

The length of time it takes to recover fully from a caesarean will vary for every woman. It's important that you don't try to do too much before you are ready. This includes lifting and carrying heavy objects, doing vigorous exercise and driving.

What are the risks?

Caesarean deliveries are commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications from the procedure.

Side-effects

These are the unwanted but mostly temporary effects of a successful procedure, for example feeling sick as a result of a general anaesthetic. Side-effects for a caesarean delivery include:

  • soreness around your wound
  • scarring

Complications

This is when problems occur during or after the operation. Most women aren't affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or the development of a blood clot, usually in a deep vein in your leg (deep vein thrombosis, DVT).

Specific complications of caesarean delivery include:

  • an infection occurring in your womb, urinary system or the wound
  • possible complications in future pregnancies, including a slightly increased risk of having a stillbirth

Your midwife or surgeon can give you more information about these. The exact risks of having a caesarean delivery are specific to you and differ for every woman, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.

Further information

 

Related topics

Sources

  • Oats J, Abraham S. Fundamentals of Obstetrics and Gynaecology. 8th ed. Elsevier Mosby, 2005
  • Chamberlain G, Steer P. Turnbull's Obstetrics. 3rd ed. Churchill Livingstone: London, 2001
  • Greer I. Pregnancy. The Inside Guide. 1st ed. Collins: London, 2003
  • Caesarean deliveries in NHS hospitals: social trends 34. Office for National Statistics. www.statistics.gov.uk, accessed 15 November 2007
  • Chamberlain G. ABC of Labour Care. 1st ed. BMJ Books: London, 1999
  • British National Formulary (BNF). Prostaglandins and oxytocics. BMJ Publishing Group, 2007. 54: 414-415
  • Caesarean section. National Institute for Health and Clinical Excellence (NICE), 2004. www.nice.org.uk, accessed 15 November 2007
  • CG13 Caesarean section: information for the public. National Institute for Clinical Excellence (NICE), 2004. www.nice.org.uk, accessed 9 January 2008

This information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr Helen Fox MBChB, Clinical Research Fellow in the Department of Reproductive and Maternal Medicine, University of Glasgow and by Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional.

Publication date: February 2008.

 

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