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What is a caesarean birth?

Caesarean birth is when a baby is born by abdominal surgery. Around a third of babies in the UK are born by caesarean (NHS Digital, 2021). Some are planned, while others are unplanned caesareans.

To find about more about when a planned or unplanned caesarean may be offered and the different things you might want to consider, read our article.

Planning for a caesarean birth

A planned or 'elective' caesarean usually takes place after 39 weeks of pregnancy, when a baby's lungs are developed, to reduce the chances of your baby having any breathing problems immediately after birth (NICE, 2021). However, there may still be health factors to consider that will mean your midwife or doctor may suggest a planned birth earlier than 39 weeks (NICE, 2021).

If you are carrying twins or triplets, your doctor or midwife will discuss your particular circumstances, and the type and timing of the birth with you. This may include a planned caesarean as early as 32 weeks for the most complicated situations (NICE, 2019).

What will happen before my planned caesarean?

If you are planning to have a caesarean birth, you will have the opportunity to discuss your decision and birth preferences with your midwife and doctor.

You will be offered an appointment about a week before the planned date to discuss the procedure and you will be given medication to take before the operation. This could include antibiotics, anti-sickness medication, or anti-acid medication (NHS, 2019a).

You will also be offered a blood test to check for anemia and determine your blood group (NICE, 2019, 2021a).

You will be asked to sign a written consent form. The information should always be presented to you in a way which you can understand (NICE, 2021; RCOG, 2015). This is your chance to ask any questions, and have time to consider the answers, before you sign the consent form (NHS, 2019a).

You'll be given a time to arrive at hospital and asked not to eat for a few hours before the surgery, although isotonic drinks may be recommended (NHS, 2019a; NICE, 2021). Surgery may not take place for several hours after your arrival time, depending on how many other planned and unplanned caesareans are being performed that day. Some parents take things to keep themselves entertained in this time, and this is also an opportunity to ask any more questions you might have.

When you arrive at hospital, a midwife will check you have taken the medication given to you at your pre-operative appointment and may recommend pressure stockings to reduce the risk of deep vein thrombosis and pulmonary embolism (when an artery in the lungs is blocked by a blood clot that has travelled from elsewhere in the body).

You'll often meet the anesthetist first to discuss your options. A regional (spinal) anesthetic is most common (OAA, 2022) but some caesareans are performed under general anesthetic.

What happens just before I go into theatre?

You will be given a gown to put on for theatre, and a name band for your wrist or ankle. Your birth partner will be invited to change into theatre scrubs as well.

Once in theatre, your blood pressure, pulse and temperature will be checked, and your baby's heartbeat will be monitored. You will be asked to confirm your name and date of birth (OAA, 2022).

Your birth partner may be directed where to sit and asked to avoid certain areas of the room to minimise the chance of infections (OAA, 2022).

Regional (spinal) anesthetic is most commonly used during caesarean birth. You will be invited to sit or lie on your side, curling your back. The anesthetist will spray the area with a sterilizing solution before administering a local anesthetic to numb the lower back. The spinal anesthetic is then administered, but it may take a few minutes to get it in the right place.

Some people describe the sensation as tingly or like a small electric shock, and as the drug takes effect the legs and lower body begin to feel very heavy and warm. The anesthetist will be monitoring how you are feeling and can provide treatment if you feel sick or dizzy (OAA, 2022).

Once the anaesthetic has been administered in theatre, a catheter will be inserted into your bladder to drain urine away and a drip will be put into your arm to provide fluids and any medication, such as antibiotics.

The incision for your caesarean birth will be made around the area where pubic hair grows. If there is any hair in this area, it will be shaved off before the birth (NHS, 2019; OAA, 2022). It is not recommended to do this yourself in advance, as research shows this leads to a higher chance of wound infection (Ng et al, 2013).

Caesarean under general anaesthetic

Around 9 in 100 caesarean births are performed under general anaesthetic (Bamber et al, 2020). Some women chose this due to an extreme fear of needles (OAA, 2022) while medical reasons could include allergies, clotting issues, or spinal problems (OAA, 2022; NHS, 2019a).

A general anaesthetic might also be used if your baby needs to be born quickly (OAA, 2022).

During a general anaesthetic your birth partner may not be allowed to be present in the operating theatre (OAA, 2022). They can wait in recovery and will be able to look after the baby and have skin to skin contact while you come out of theatre. If your baby needs to be taken to special care for any reason, your birth partner may be invited to join them.

What happens during a caesarean?

The procedure is similar whether the caesarean is planned or unplanned.

Don't be surprised if there are a lot of people in the operating theatre. Depending on the reason for your caesarean, staff might include:

midwife(ves)

two obstetricians

a theatre nurse and an assistant

an anaesthetist and an assistant

paediatrician (a doctor specialising in children)

If you're awake during the procedure, a screen is usually put up so you and your birth partner can't see the operation. If you prefer, you can ask to have the screen lowered when your baby is being born.

Your birth preferences, like playing music in theatre, or silence so your voice is the first your baby hears, should be accommodated where possible.

During the procedure you will be slightly tilted on to your side and may be aware of the sounds of the instruments being moved around, and of the suction of fluids from around the baby. This is completely normal.

You shouldn't feel any pain during the operation, but you might feel some pressure. You might also feel some mildly uncomfortable, rather than painful, sensations. Some women have said it feels like 'having someone doing the washing-up in my tummy'. Generally, the anaesthetist will talk to you during the operation and give you more pain relief if you need it.

If you've had a general anaesthetic, you won't be aware of anything until you're awake. This will usually be in the recovery room rather than the operating theatre.

When will I meet my baby for the first time?

If you're awake and your baby is well, you can cuddle and have skin-to-skin contact straight away. Your partner can also do this if you prefer.

You can also choose delayed or optimal cord clamping. Waiting to clamp the cord can provide the baby with a higher iron level after birth. If possible, it's good to discuss your preferences with your obstetrician before your operation.

If you have a general anaesthetic and your baby is well, they might be given to your birth partner for skin-to-skin contact in another room near the operating theatre.

Sometimes you will be able to have assisted skin-to-skin contact in the operating theatre, even if you're not awake. Your baby can be placed on your chest and supported by a midwife while your wound is stitched.

If your baby needs any help breathing, or has other problems, they may be taken to the special care baby unit (Labour Pains 2018).

Will happens if I need an unplanned caesarean?

An unplanned caesarean (sometimes called an emergency caesarean) takes place during labour, or before labour starts if an unexpected medical problem comes up.

If there are immediate concerns for you or your baby, an emergency caesarean will usually be performed within 20-30 minutes, although this only occurs in around 1 in 10 unplanned caesarean births (NICE, 2021; OAA, 2022).

If there are no immediate concerns, it could take up to 75 minutes from when the decision is made, and the preparation will be very similar to that of a planned caesarean (NICE, 2021). You will be asked to sign a written consent form, but in an emergency, verbal consent is sufficient (NICE, 2021; RCOG, 2015). Partners cannot sign the form instead of the woman, even if she is unconscious (Birthrights, No date).

If your caesarean is unplanned and you've already had an epidural during labour, this is usually topped up. Occasionally, an epidural alone is not sufficient, in which case other options include a combination epidural and spinal block, or a general anaesthetic (OAA, 2022).

What happens after a caesarean?

While you're staying in hospital you will be given pain relief. You should also be able to have close contact with your baby and start breastfeeding, if you would like to - some people even start doing this in theatre or the recovery room. You should be offered infant feeding support as soon as possible after the birth of your baby.

You'll be encouraged to get out of bed when you feel able to and to eat and drink as soon as you want to. You won't be able to drive for a few weeks, so you will need to arrange transport home.

You should receive advice on looking after your wound at home, and on taking any painkillers you may need during the recovery period.

You can read more about other aspects of caesarean birth in some of our related articles.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

For statistics on your local hospital's caesarean section rates, see which birth choice.

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Having a caesarean: what to expect | Labour & birth, Different types of birth articles & support | NCT

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Knowing what happens during a caesarean and immediately after can help you feel more prepared. Here, we explain what happens before the operation, the difference between planned and unplanned caesareans, the anaesthetic used, and what happens afterwards.

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Considering a caesarean birth patient information leaflet | RCOG

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This information is for you if you are considering a planned (elective) caesarean birth for your baby. It may also be helpful if you are a partner, relative or friend of someone who is considering a caesarean birth.

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Your right to a caesarean birth - Birthrights

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What is a caesarean birth? A caesarean birth, or c-section, is an operation. In a caesarean birth, c-section, or caesarean section, the surgeon will deliver your baby through a cut in your stomach and uterus (womb). The operation normally happens under an anaesthetic given in your spine so that you…

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About Caesarean Birth

Caesarean surgery is lifesaving for some mothers and babies, and avoids problems for others. But in many cases it is not clear that the benefits outweigh the risks, particularly if the risks to any future pregnancies and births are taken into consideration. Across the country more than 1 in 4 babies are born by caesarean, and is some hospitals it is more like 1 in 3 women who will have surgery for the birth of their baby.

Most women do not want a caesarean unless it is clear that their baby really needs to be born that way, but other women know that a caesarean birth is best for them. Our national guidelines make it very clear that women's preferences need to be taken into account when a caesarean is being recommended to, or requested by, a pregnant woman.

What is the difference between a planned, elective and emergency caesarean?

Caesareans may be planned before labour starts and these can be referred to as planned or elective caesareans. Elective does not mean that the women has chosen or wants the caesarean; just that it is planned surgery.

Other caesareans may be unplanned. Unplanned caesarean are often also called emergency caesareans, this is because they had not been planned and the reason for them 'emerged' before or during labour. Only a small number of emergency caesareans are urgent and the term 'crash section' may be used to describe this urgent surgery. Most emergency caesarean are not urgent and there is time to agree what you want for the birth of your baby.

Can you make a caesarean birth plan?

As very few caesarean need to be done in a rush and many are planned well before the birth, there is usually time to consider what you want to happen when your baby is born. Most obstetricians are happy to work with women to make a caesarean birth a positive experience. It is usual for the baby's father and/or a birth supporter to be in theatre for the birth and for the parents to be able to greet their baby and have skin to skin contact, providing the baby is well.

Other options for the birth might include:

lowering the screen so the mother can see her baby born

the baby to be passed straight to its mother for skin to skin and breastfeeding

delaying cord clamping (usually about a minute, so less than optimal cord clamping)

facilitating resuscitation of the baby, if required, at the side of the operating table without cutting the cord

lotus birth may be supported

If you are having a planned caesarean and are not being supported with your birth plan you have a right to be referred to someone else who will. For more idea of what you might like for the birth see http://caesarean.org.uk/caesareanBirthPlan.html

Can you choose a caesarean birth?

Some women feel strongly that their baby should be born by caesarean and usually have a very good reason for why they feel this is best for them. Reasons may be psychological or physical, and both should be recognised as medical reasons for requesting the surgery. The NICE guidelines provide recommendations on how women who want a caesarean should be supported, including being referred for psychological support where there is a fear of birth, but ultimately being booked for a caesarean or referred to someone else who will. If you are struggling to get your needs for a caesarean respected then please see the page on {your right to specific treatment}, but you may also find this Birthrights fact sheet useful http://www.birthrights.org.uk/library/factsheets/Right-to-C-Section.pdf

Why might a planned caesarean be suggested?

Some reasons for caesarean to be suggested before labour are (and there are many others):

baby is in the breech position (bottom down)

twins or other multiples

previous caesarean(s)

placenta previa (placenta is over, or partly covering, the cervix at the end of pregnancy)

With the exception of placenta previa, which usually (although not always) means that a caesarean is the safest way to give birth, none of the above situations means that a caesarean is inevitable, and you do have the option to decline. This is the case for many situations where a caesarean is suggested. If you would prefer to explore your options, you are free to do so. The decision to accept the offer of a caesarean is always yours, and yours alone.

When a planned caesarean is recommended there is time to consider whether this is the best decision for you and your baby. This will be a very personal decision. Most women need not only to think about why the caesarean is being recommended, but also about the risk of the surgery and about what their personal priorities are for the birth of their baby. For some women a caesarean birth will be something they can accept happily, but for other they will need to explore every other option before they can agree to surgery.

Why might an unplanned caesarean be suggested?

A caesarean may be recommended before or during labour if an issue arises such as:

a baby is thought to be distressed

placental bleeding

the site of a previous uterine surgery may not be holding together well

Although you may have less time to consider your options when an issue of this sort arises you still have the right to make an informed decision. In order to give or decline consent, you should still be provided with information about:

why it is being recommended?

what are the risk of surgery?

what the options are if you decline?

What are the risks of a caesarean?

When a caesarean is suggested or requested information about the risks must be provided in order that you can give consent for surgery, just as it would be for any other surgery. Signing a consent form without this information makes that consent invalid, and there could be legal case to answer from any surgeon who has not obtained valid consent to carry out surgery. People will consider different risks or benefit to be more or less important when making their decision.

Caesarean surgery has risks that would be expected of any surgery such as:

bleeding

infection

blood clots

problems with the anesthetic

accidental and sometimes unavoidable damage to tissues and organs

In addition, caesarean births have other risks specific to a baby being born this way. Common post surgical problems include wound infections and adhesions. Less common ones include permanent nerve damage, bladder damage and hysterectomy.

Do babies miss out on being born vaginally?

When babies are born by caesarean they miss out on the journey through the birth canal. Often it is suggested that this is an advantage, but we now know that important things happen for the baby during this part of birth, including helping to prepare the baby to breathe and seeding the baby's gut with beneficial bacteria. Research has confirmed that babies born by caesarean are at greater risk of:

All of these issues seem to be related to missing this part of the birth process.

Can a baby be injured at a caesarean?

Is is uncommon for babies to be injured, but about 1 in 100 babies will be cut during a caesarean birth. Most these cuts are minor, though rarely babies have been seriously injured.

Might future pregnancies be affected?

When a caesarean is carried out the uterus will be damaged. Usually a small incision is made which is extended by tearing as tissue that has been torn apart and is a bit ragged heals better than a straight cut when it is stitched back together.

The scar on the uterus does not cause a problem for the majority of women, but it does increase the chance of some problems. It has been shown that it takes women longer to conceive another baby than women who have had vaginal births, and that more women will fail to conceive another baby.

Pregnancies following a caesarean have higher rates of placental problems such as placenta previa and an abnormally adherent placenta (placenta accreta, percreta and increta). These are serious issue increasing the risk for the baby and the women, and if an abnormally adherent placenta occurs then a highly skilled medical team will be required in order to minimise risk of bleeding and to try to avoid the need for a hysterectomy.
Uterine rupture is extremely rare when a woman's uterus has not been damaged, but after a caesarean a rupture occurs in about 1 in 500 [VBAC] labours.
What sorts of anesthetic would be used?

It is very rare today for a caesarean to be carried out under general anaesthetic and most are done using an epidural or spinal, or a combination of the two. You should be provided with printed information by your hospital about these anesthetics and what to expect. The following page gives information from the Obstetric Anaesthetists' Association about anesthetics used for caesareans http://www.labourpains.com/UI/Content/Content.aspx?ID=44

What sort of stitches will be used?

There are several different sorts of stitches used to close skin wounds. Dissolving and removal stitches or staples may be used, but the most common way caesarean scars are closed is with a single running stitch with a bead at each end. This is easily removed, usually about 5 days after the operation, by cutting a bead off one and pulling the stitch out in one piece. A midwife should be checking your wound until the stitches are removed and for longer if it has not healed completely when the stitches are removed. You wound should gradually feel less painful, but if it should become more red, sore or oozing, then you may have an infection and need to contact a doctor, as infections after a caesarean can become serious quickly. The following page has a collection of caesarean scar pictures http://www.caesarean.org.uk/ScarPics.html

There will also be internal stitches that have been used to repair your uterus and the tissue around it, these will dissolve in time and rarely cause women a problem, although some women may find that a stitch comes out in the lochia.

How long will it take me to recover physically?

How quickly women recover from a caesarean varies enormously and you are going to be the best judge of what you are ready to do. This will include when you are ready to leave hospital. Many women are very keen to get home, but other feel that they are being rushed to free up a bed. If you do not feel ready to go home then make sure that the staff know this whether it is because you are still in pain, feel unwell or have no one to help you when you get home.

Over the weeks after a caesarean you should gradually find you have less pain and are able to do more. However, it is quite common to find that bleeding or pain may increase following a sudden increase in how much you are doing. If you do not feel you are recovering properly then you have a right to see the midwife or your obstetrician even if it is weeks or months after the birth.

What are the emotional effects of a caesarean birth?

Most women struggle a bit emotionally after a caesarean even if they are very happy to have had a caesarean birth, but many women are left struggling with trauma or grief about the birth which can be very hard to reconcile with the delight with their new baby. Understanding what happened, why it happened to them, and what they might or might not have been able to do differently are often key to recovering. Postnatal depression is more common after a caesarean, and some {women suffer with PTSD}. You have a right to help from your health professionals, but women often find the women's support group are helpful in their recovery.

Women who have had an unplanned caesarean or a problem during the surgery may want talk to someone about what happened. You can make an appointment to see your obstetrician or one of the senior midwives. You may want to get a copy of your notes and if you are unhappy with your care then it is probably a good idea to do this before arranging a meeting. Some women prefer to talk through their birth with someone from outside the Trust, perhaps an independent midwife. AIMS will help to support you if you wish.

Articles that may be of interest
Journal Vol. 22, No. 2 Caesarean Birth
Further Reading
AIMS Birth after Caesarean Caesarean Birth: Your Questions Answered
Written by Debbie Chippington Derrick

Date: 19/08/2017

Reviewed by Emma Ashworth

Review needed: 08/2019

AIMS supports all maternity service users to navigate the system as it exists, and campaigns for a system which truly meets the needs of all. AIMS does not give medical advice, but instead we focus on helping women to find the information that they need to make informed decisions about what is right for them, and support them to have their decisions respected by their health care providers. The AIMS Helpline volunteers will be happy to provide further information and support. Please email helpline@aims.org.uk or ring 0300 365 0663.

Published on 26th July 2017

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Caesarean surgery is lifesaving for some mothers and babies, and avoids problems for others. But in many cases it is not clear that the benefits outweigh the risks, particularly if the risks to any future pregnancies and births are taken into consideration.

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NHS site supporting shared decision-making and using BRAN.

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Shared Decision Making (SDM) is a collaborative process in which doctors and patients work together to select tests, treatments and care management or support packages, based on clinical evidence and patients' informed preferences and values. It explicitly acknowledges the fact that there is usually more than one way to treat a problem, including 'no treatment' and patients may require help to weigh up the benefits and harms of the options in order to determine the best choice for them.

There is good evidence that SDM benefits patients, improving the quality and appropriateness of clinical decision making. A Cochrane Review of 115 randomised control trials found that use of patient decision aids leads to improved knowledge and more accurate risk perceptions among patients, greater participation in decision-making, and more appropriate treatment decisions. This will include reduced demand for some screening procedures, such as PSA tests and surgical procedures, such as hysterectomies and knee replacement operations.

It is also an effective strategy for tackling overdiagnosis and overtreatment. For example, interventions to promote SDM, including SDM skills training, have been shown to lead to reductions in inappropriate antibiotic use in acute respiratory infections and better understanding of the risk of over-detection in breast screening.

A fundamental aim of Choosing Wisely is to use the shared decision making approach to reduce unnecessary tests and treatments. Therefore, many of the recommendations have links to decision aids, which will support you to have the necessary conversations with your patients.

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Shared decision making - Choosing Wisely UK

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Shared Decision Making (SDM) is a collaborative process in which doctors and patients work together to select tests, treatments and care management or support packages, based on clinical evidence and patients' informed preferences and values.

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Patient and public attitudes towards consent and decision making,

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What were the key findings?

The research explored patient and public attitudes towards roles in decision making and consent, including good communication and how to support patient decision making.

Participants made some practical suggestions to help doctors improve shared decision making during appointments and consultations, including:

involve the patient: discuss a small number of options, offer the patient choice, provide a steer

tailor communications: check the patient's communication needs, adapt communication and amount of information to suit the patient, make patients aware of option of interpreters

risks and benefits: use real life examples, discuss side effects

involving others: help explain information, provide practical and emotional support, but confirm the person's role

information provision: use good visual aids, diagrams, pictures and models, avoid medical jargon, give patients information to take away such as leaflets

friendly approach: make eye contact, speak slowly, provide reassurance, invite questions.

Why did we commission this research?

This work supports the wider consultation on the GMC's Decision making and consent guidance which is being reviewed and updated. We wanted to explore patient and public attitudes towards consent and decision making with individuals from seldom-heard groups who may be less likely to engage in the wider consultation but may have specific issues around decision making and consent.

What did the research involve?

The research was qualitative and involved face-to-face in depth interviews and face-to-face and online group discussions with 100 people across England, Northern Ireland , Scotland and Wales.

Have we carried out similar research with doctors?

At the beginning of the review we commissioned research exploring doctors' attitudes to consent and the challenges they face when following our guidance in practice. Read the final report on doctors' attitudes to consent and shared decision making.

Download research

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Patient and public attitudes towards consent and decision making

# data[].attributes.attachment_link.description
The research explored patient and public attitudes towards roles in decision making and consent, including good communication and how to support patient decision making.

# data[].attributes.body
Patient and public attitudes towards consent and decision making,

# data[].attributes.attachment_link.readable_text
What were the key findings?

The research explored patient and public attitudes towards roles in decision making and consent, including good communication and how to support patient decision making.

Participants made some practical suggestions to help doctors improve shared decision making during appointments and consultations, including:

involve the patient: discuss a small number of options, offer the patient choice, provide a steer

tailor communications: check the patient's communication needs, adapt communication and amount of information to suit the patient, make patients aware of option of interpreters

risks and benefits: use real life examples, discuss side effects

involving others: help explain information, provide practical and emotional support, but confirm the person's role

information provision: use good visual aids, diagrams, pictures and models, avoid medical jargon, give patients information to take away such as leaflets

friendly approach: make eye contact, speak slowly, provide reassurance, invite questions.

Why did we commission this research?

This work supports the wider consultation on the GMC's Decision making and consent guidance which is being reviewed and updated. We wanted to explore patient and public attitudes towards consent and decision making with individuals from seldom-heard groups who may be less likely to engage in the wider consultation but may have specific issues around decision making and consent.

What did the research involve?

The research was qualitative and involved face-to-face in depth interviews and face-to-face and online group discussions with 100 people across England, Northern Ireland , Scotland and Wales.

Have we carried out similar research with doctors?

At the beginning of the review we commissioned research exploring doctors' attitudes to consent and the challenges they face when following our guidance in practice. Read the final report on doctors' attitudes to consent and shared decision making.

Download research

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Patient and public attitudes towards consent and decision making

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The research explored patient and public attitudes towards roles in decision making and consent, including good communication and how to support patient decision making.

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What is consent?

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Rebecca Schiller: Why human rights in childbirth matters

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Rebecca Schiller: Why human rights in childbirth matters

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Pinter & Martin is an independent publishing company specialising in pregnancy, birth, parenting, breastfeeding, yoga and psychology books

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1. The doctor and patient make an assessment of the patient's condition, taking into account the patient's medical history, views, experience and knowledge.

2. The doctor uses specialist knowledge and experience and clinical judgement, and the patient's views and understanding of their condition, to identify which investigations or treatments are likely to result in overall benefit for the patient. The doctor explains the options to the patient, setting out the potential benefits, risks, burdens and side effects of each option, including the option to have no treatment. The doctor may recommend a particular option which they believe to be best for the patient, but they must not put pressure on the patient to accept their advice.

3. The patient weighs up the potential benefits, risks and burdens of the various options as well as any non-clinical issues that are relevant to them. The patient decides whether to accept any of the options and, if so, which one. They also have the right to accept or refuse an option for a reason that may seem irrational to the doctor, or for no reason at all.

4. If the patient asks for a treatment that the doctor considers would not be of overall benefit to them, the doctor should discuss the issues with the patient and explore the reasons for their request. If, after discussion, the doctor still considers that the treatment would not be of overall benefit to the patient, they do not have to provide the treatment. But they should explain their reasons to the patient, and explain any other options that are available, including the option to seek a second opinion.

Mental health laws across the UK set out the circumstances in which an individual may be compulsorily assessed and treated for a mental disorder, without their consent. See the legal annex for more information about the legislation across the UK.

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The doctor and patient make an assessment of the patient's condition, taking into account the patient's medical history, views, experience and knowledge. The doctor uses specialist knowledge and experience and clinical judgement, and the patient's views and understanding of their condition, to identify which investigations or treatments are likely to result in overall benefit for the patient.