Caesarean section
Your health expert: Mr Yemi Kuponiyi, Consultant Obstetrician and Gynaecologist
Content editor review by Pippa Coulter, October 2023
Next review due November 2026
A caesarean section, or c-section, is an operation to deliver your baby through a cut in your tummy and womb. It’s usually carried out around 39 weeks of pregnancy, if it’s a planned caesarean. In some circumstances, a caesarean section can be the safest way to deliver your baby. But it’s a major operation that carries some risks, and it’s important to be aware of these.
About caesarean section
In England, more than one in three babies are delivered by caesarean section. Your doctor may recommend a caesarean section for medical reasons. This may be planned in advance (elective) or it may be unplanned, if it’s done as an emergency. In the UK, you also have the right to choose to have your baby by caesarean section.
Medical reasons for a caesarean section
Here are some of the reasons your doctor may recommend a planned caesarean.
- You have a ‘low-lying’ placenta. This means your placenta completely or partly covers the baby’s way out from your womb. The medical name for this is placenta praevia.
- Your baby is in the ‘breech’ position with their feet or bottom downwards, rather than their head.
- You’re expecting more than one baby and the first baby isn’t lying in the normal ‘head down’ position.
- You’ve had a caesarean section before. See our section on ‘future births after having a caesarean’ for more information about this.
- You have a viral infection you could pass to your baby during a vaginal delivery.
Reasons why you may need an unplanned or emergency caesarean include the following.
- There’s a complication which is putting you or your baby at risk.
- You start bleeding heavily from your vagina.
- Your labour has been going on for some time and isn't progressing.
Your doctor or midwife will only recommend a caesarean if it’s the best thing for you and your baby. You can ask them about the risks and benefits before you give your consent.
Choosing caesarean section
In the UK, you have the right to choose to have your baby by caesarean section. And all maternity units must offer this option.
There are many reasons women give for wanting a caesarean. They include having concerns or anxieties about a vaginal birth, and feeling that a caesarean gives a better sense of control.
You should tell your midwife or doctor that you’re considering a caesarean as early as possible. They’ll want to talk to you about the reasons why. They will also want to make sure you have accurate information to help you make a decision. You may be offered the chance to talk to a health professional trained in providing support. They’ll talk through your birth options with you, including what pain relief you can have.
Your doctor or midwife will go through the risks and benefits of choosing to have a caesarean section compared to a vaginal birth with you. These will be very individual to you. But some of the main ones are listed here.
Benefits of a planned caesarean
- You can plan when and where your baby is born. This may make you feel more in control.
- You reduce the chance of needing an assisted vaginal birth (with forceps or ventouse) or an emergency caesarean.
- You avoid the labour pain associated with vaginal childbirth. You are still likely to experience pain in the days following the operation.
- You avoid soreness and possible tears around your vagina and perineum (the skin between your vagina and anus) that can come with vaginal childbirth.
- You are less likely to develop urinary incontinence (where you leak urine) after caesarean than vaginal childbirth.
Risks of a planned caesarean
- After a caesarean, you may need to stay in hospital about one to two days longer than with a vaginal delivery. It can also take longer to recover and get back to your usual activities, like driving.
- Your wound is likely to be sore for the first few days and sometimes for months afterwards.
- A caesarean is a major operation. There are several possible complications, including infection, bleeding and injury to organs. Serious complications are more common with the number of caesareans you have. See the section on Complications for more information.
- Caesarean increases the risk of complications in future pregnancies, whether you go on to have a vaginal delivery or another caesarean. If you have any questions, ask your doctor or midwife. If you’re having a planned caesarean, you will need to sign a consent form before your operation.
Preparing for a caesarean section
If you’re having a planned caesarean, your healthcare team will give you information about how to prepare. A planned caesarean is usually carried out at around 39 weeks of pregnancy, unless there are reasons why your baby needs to be born earlier. It’s possible that you may go into labour before the date of your caesarean. Your healthcare team will discuss your preferences for birth should this happen.
Planning your caesarean
For a planned caesarean, you may have some choice over what happens during the operation and birth. This may include things like:
- who you would like with you at the birth (your birth partner)
- whether you would like to play music during the birth
- whether you would like to see your baby being born
- how soon you would like to hold your baby
You can decide on these things and share them with your midwife beforehand. It’s also a good idea to get things ready at home for your recovery. Arrange to have someone to help you in the first few weeks after you get home. You won’t be able to drive or lift anything heavy at first. Your midwife can give you advice on what you’ll need to bring to the hospital.
Before your caesarean
It’s very important to follow any instructions your hospital gives you. This will include when to stop eating or drinking. This is usually six to eight hours before your operation. They may ask you to shower before you leave home to reduce the risk of infection.
You’ll have a blood test before your caesarean section to check for anaemia and to confirm your blood group. Your doctor may also ask you to do a screening test for MRSA (antibiotic-resistant bacteria) before your procedure.
You’ll be offered antibiotics to take on the day of your caesarean. This is to reduce your chance of getting an infection afterwards. You may also be offered anti-sickness and antacid medicines. You may be offered compression stockings to wear before your caesarean or an injection of an anticlotting medicine called heparin afterwards. These all help prevent blood clots forming in your legs (deep vein thrombosis or DVT).
Anaesthesia
Most people having a planned caesarean will have either a spinal or epidural anaesthetic. This means you’ll be awake, but numb from the chest down. You’ll have a thin tube (catheter) put into your bladder to help you pass urine. See our video below, ‘How an epidural is given during childbirth’.
If you have an emergency caesarean, you may need to have a general anaesthetic. You may also need to have a general anaesthetic if you are unable to have an epidural or spinal for any reason. A general anaesthetic means you’ll be asleep during the operation.
How an epidural is given
What is an epidural? | the procedure - watch in 1 minute 37 seconds
An epidural is an injection into your lower back to temporarily block pain from your waist down. This video describes how an epidural is given.
An epidural is an injection into your lower back that temporarily blocks pain from your waist down.
You'll be asked either to lie on your side with your knees tucked into your chest, or to sit upright and lean forward.
This opens up the space between the bones in your spine.
Your anaesthetist will carry out your epidural in two parts.
Firstly, a small amount of local anaesthetic is injected into your skin to completely numb the area.
Then, a hollow epidural needle is given into your epidural space.
This is the space just outside the membranes that surround your spinal cord.
When the epidural needle reaches the correct spot, your anaesthetist will thread a very thin plastic tube through the centre of the hollow needle.
They'll then remove the epidural needle, leaving just the tube in place.
The tube will run from inside your epidural space to the outside of your body.
It's secured using adhesive tape and used by your anaesthetist to give you medicines for pain relief when you need them.
Your anaesthetist may also attach a pump to the tube so you can top up your pain relief when needed, and sometimes you'll be able to control this yourself.
When you no longer need pain relief, the tube will be carefully removed and the area covered with a plaster.
Caesarean section procedure
You have a caesarean in an operating theatre. If you’re having a spinal or epidural anaesthetic, you may be able to have a birth partner in the theatre with you. If you’re having a general anaesthetic, this won’t be possible.
Once you have been prepared for surgery and the anaesthetic has taken effect, your surgeon will begin the operation. There will be a screen across your body so that you can’t see what’s happening. But you can ask to have this lowered when your baby is being born.
Your surgeon will first make a cut across your lower tummy. This is sometimes called the ‘bikini line’. They will then make a cut in your womb to reach your baby. Your surgeon will also remove the placenta. If you’ve had a spinal or epidural anaesthetic, you will stay awake throughout the operation. You won’t feel any pain but you may feel some pulling or pressure sensations in your lower body.
There’s a small chance of your baby getting a small cut during the operation. This happens in about one or two in 100 caesareans. It usually heals by itself.
After delivery of your baby and placenta, your surgeon will close the cuts to your womb with dissolvable stitches. They will then close the wound in your abdomen using stitches or staples and cover it with a dressing.
What to expect afterwards
You will be encouraged to have skin-to-skin contact with your baby as soon as possible after the birth. You’ll also be offered support to start breastfeeding your baby, if you choose to do so.
Your healthcare team will monitor you while you recover. You’ll be offered medicines to control your pain. If you don’t have any complications and you’re recovering well, you can eat or drink as soon as you feel ready. You’ll be encouraged to get up and start walking once the anaesthetic has worn off. This usually takes a few hours. You can have your catheter taken out, once you’re up and about, if it’s been at least 12 hours since your last epidural dose.
If you’re recovering well with no complications, you may be able to go home around 24 hours after your caesarean. But you may stay longer if you or your baby needs to. Before you leave hospital, your nurse will give you advice about your recovery. This will include what painkillers you’ll need, any complications to watch out for, and how to look after your healing wound.
If you’ve had an unplanned caesarean, you should have the chance to talk to your surgeon and midwife about why this was needed. They’ll also give you information about your options for any future pregnancies.
Recovering from a caesarean delivery
It usually takes around six weeks to fully recover from a caesarean. But this is different for everyone. You’ll need plenty of help and support when you first get home. When you’re discharged, the hospital will tell you what to expect and give you some advice to follow. This is likely to include the following.
- Clean and dry your wound carefully every day. It will take about six weeks to heal. You will have a scar, but this should fade over time.
- Wear loose, comfortable clothes and cotton underwear while you are healing.
- You will have some bleeding from your vagina for about two to six weeks after your caesarean. Contact your midwife, health visitor or GP if it suddenly gets heavier or you are passing large clots after the first 24 hours.
- Trapped wind and constipation are common after a caesarean. Making sure you are eating regular meals and keeping hydrated can help. If you’re taking opioid pain medicines, your midwife may offer you laxatives to prevent constipation.
- It’s important to keep active with gentle exercise, like walking. But don’t lift anything heavy or do any more vigorous exercise until you feel you’ve fully recovered.
- You can usually drive when you feel comfortable and physically able to do so. It’s best to check with your insurance company first.
- You can have sex once you feel ready and comfortable to do so. Make sure you have arranged contraception first. You can still get pregnant, even if you’re breastfeeding.
It can take time to get back to normal after having a caesarean section, both physically and emotionally. Talk to your midwife or health visitor about how you’re feeling. They can give you support and answer any questions you have.
Complications of caesarean section
Most women who have a caesarean recover well and have healthy babies. But a caesarean is a major operation and it’s important to be aware of the possible risks to you and your baby.
Possible complications of caesarean section include the following.
- Infection of your womb, urinary tract or wound. You’ll be offered antibiotics to reduce your risk.
- A blood clot in your leg (DVT), which can travel up to your lungs. Your healthcare team will take measures to prevent this. But seek medical help if you have symptoms, such as pain and swelling in your legs.
- Heavy blood loss during the surgery. This isn’t common but if it happens, you might need a blood transfusion. Some women (around one in 670) may need a hysterectomy (removal of the womb) if this happens.
- Damage to a nearby organ, such as your bladder or bowel. You may need surgery to repair this.
- Increased risk of complications in future pregnancies.
The risks associated with having surgery increase with the number of caesareans you have. Scar tissue from your caesarean may make future surgery more difficult.
Future births after having a caesarean
If you’re planning another baby after your caesarean, you will need to think about your birth options. You may be able to have:
- a vaginal birth – also known as a vaginal birth after caesarean (VBAC)
- another planned caesarean – also known as an elective repeat caesarean section (ERCS)
You should be able to have a VBAC if you’ve only had one caesarean before, and there are no complications with your pregnancy. It’s important to be aware that around one in four women trying for a VBAC end up needing an emergency caesarean. A VBAC is more likely to be successful if you’ve had a previous vaginal birth. A repeat caesarean can be the safest option for some women.
Which option you have will be very individual to you and depends on many factors. These include the reason why you had your original caesarean and any problems you had afterwards. You should discuss this with your midwife or doctor.
A caesarean section means that your baby is delivered by a doctor making a cut in your tummy. You’ll be given an anaesthetic so that you don’t feel pain. A caesarean may be planned beforehand, or may be done as an emergency. To find out what happens, see our caesarean section procedure section above.
If you’re having a caesarean under spinal or epidural anaesthesia, your birth partner will usually be allowed to be with you. This won’t be possible if you’re having a general anaesthetic. Find out more in our caesarean section procedure section.
No, not necessarily. You may be able to give birth vaginally. This will depend on many factors. You’re more likely to have a successful vaginal delivery after caesarean if you’ve had a previous vaginal birth. For more information, see our section on future births after having a caesarean above.
You should wait until you’re fully recovered from your caesarean before driving. This is so that you’re physically able to drive and not at risk of being distracted by pain. This may take around six weeks. If you’re not sure, check with your doctor. See our recovering from a caesarean delivery section for more information.
You may not have labour pain associated with vaginal childbirth if you have a caesarean. And the operation is performed under anaesthesia, which means you won’t feel any pain. You will have some post-operative pain after a caesarean section though. This may continue for several months. Talk to your midwife about your options for pain relief.
Recovery time will be different for everyone, but it usually takes around six weeks to fully recover. It takes longer to recover from a caesarean than from a vaginal birth. This is because a caesarean section is major surgery. For more information, see our section on recovering from a caesarean delivery above.
Childbirth - vaginal delivery
Epidurals for surgery and pain relief
An epidural is an injection of a local anaesthetic and/or other pain-relieving medicine into a space that surrounds your spinal cord
Other helpful websites
Discover other helpful health information websites.
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