Having the caesarean section operation

If you have a planned caesarean section, this should not normally be before the 39th week of pregnancy. This is because there is a chance your baby might have breathing problems soon after birth if born early. These problems are less likely if the baby is born after 39 weeks.

Your preferences for the birth (for example, lowering the screen to see the baby being born, silence so that the first voice the baby hears is yours, or music playing) should be accommodated if possible.

Questions about the operation

  • Can you explain why you have decided to offer me a caesarean section?

  • What does a caesarean section involve?

  • What type of stitches will I have? When will these be taken out?

  • Can my partner stay with me throughout the procedure?

  • How long will it take to recover after a caesarean section? Will I be able to look after my baby myself?

  • How long will I have to stay in hospital?

What happens immediately before a caesarean section

If you are having a caesarean section you should be offered a blood test to check whether you are anaemic.

Around 4–8 of every 100 women lose more than a litre of blood at the time of caesarean section. Some women have a high risk of this happening, if they have:

  • heavy bleeding before labour (known as antepartum haemorrhage)

  • placental abruption (where the placenta separates from the wall of the womb)

  • placenta praevia

  • uterine rupture (a tear in the womb, often along the scar of a previous caesarean section).

If you have any of these problems, you may need a blood transfusion and you should have the caesarean section at a maternity unit with blood transfusion services.

If you have been healthy during your pregnancy, you do not need to have:

  • screening tests for blood clotting

  • cross-matching of blood (this is when a sample of your blood is taken, the blood group is analysed and then the sample is saved in the hospital blood bank ready to be used to order a blood transfusion if you need one)

  • an ultrasound scan before the caesarean section; it does not cut down your risk of heavy blood loss or the risk of injury to the baby.

You should be offered antibiotics just before you have a caesarean section because they cut down your risk of getting an infection afterwards. There is no evidence that the antibiotics will affect the baby.

Anaesthetics for caesarean section

A caesarean section should usually be done using a regional anaesthetic (spinal or epidural), which numbs the lower part of the body and means you will be awake during the operation. This is safer for you and the baby than a general anaesthetic. You may be given the anaesthetic in the operating theatre or in a separate room next to the theatre.

You should be given information about the different kinds of pain relief that you can use after the operation, so that you can be prescribed whatever best suits your needs. If you have a regional anaesthetic for your operation, you should also be offered a pain killer called diamorphine, given by an injection into your spine at the same time that the anaesthetic is given. This reduces the need for other pain relief afterwards.

You will need to have a bladder catheter inserted to empty your bladder because, with a regional anaesthetic, you will not be able to tell if your bladder is full and needs to be emptied.

If you are having a regional anaesthetic, you should also be offered a drug called ephedrine or phenylephrine, which will be given through a drip to reduce your risk of low blood pressure during the operation.

You may need a general anaesthetic if you are having an unplanned caesarean section. Because of the anaesthetic, you are at risk of vomiting during the operation. If this happens, fluid and food particles from your stomach can get into your lungs (this is known as aspiration) and can cause potentially serious inflammation (known as aspiration pneumonitis). Eating during labour increases the amount of food and fluid in your stomach, and this may increase the risk of aspiration if you have a general anaesthetic. If you have foods such as toast, crackers or low-fat cheese during labour (known as low-residue foods) the risk of aspiration is uncertain. Having drinks with the same concentrations of salt and sugar as human body fluid (known as isotonic drinks) during labour gives you energy without giving you a full stomach.

If you have an unplanned caesarean section, your healthcare team should cut down the risk of vomiting and aspiration by:

  • offering you drugs or acupressure (which involves wearing wrist bands that apply pressure to special points in your wrists) to try to prevent nausea and vomiting

  • offering you antacids to reduce the acidity in your stomach and drugs to keep the amount of food in your stomach low, and reduce its acidity

  • using standard emergency procedures to prevent fluid and food particles going into your lungs.

During the operation

You have more risk of a blood clot in your lungs or in your legs if you have a caesarean section. To reduce the risk of this happening you may be offered for example, anti-embolism stockings, help to walk around soon after the caesarean section, or injections during and after the operation. Your doctor should assess your risks of blood clots when deciding which of these you need.

You should be given the drug oxytocin by slow injection into a vein once your baby is born to encourage your womb to contract and cut down blood loss.

Checking your baby's health

A trained practitioner who is skilled in resuscitating newborn babies should be present if your healthcare team thinks that your baby's health is at risk. If you have had a caesarean section because of suspected distress in the baby, your healthcare team should measure the pH balance (acidity) of the blood in the artery in the baby's umbilical cord. This will help them to confirm whether your baby was distressed and plan the baby's care.

Babies born by caesarean section are more likely to have a lower temperature than normal. Your healthcare team should follow accepted good practice for keeping babies warm (for example, having a higher temperature in the operating theatre, or wrapping the baby in blankets).

Your healthcare team should encourage you to have skin-to-skin contact with your baby as soon as possible. This tends to improve how women feel about their baby, their mothering skills and their chances of successfully breastfeeding. It also tends to reduce the amount a baby cries.

After the operation

Immediately after the operation you should be observed on a one-to-one basis by a properly trained member of staff until you are breathing normally and are able to talk and communicate clearly.

After you recover from the anaesthetic, the staff looking after you will check your breathing rate, heart rate, blood pressure and whether you are feeling pain or feeling sleepy every half hour for 2 hours, and then every hour. These observations will be done for a number of hours, depending on what type of anaesthetic and what type of pain relief you had during the operation. If you are not feeling well or if the observations are changing then a doctor will come and see you.

After a caesarean section, you may have more difficulty starting to breastfeed your baby. Therefore, you should be offered extra support and help to do this. Once you have started breastfeeding, you are as likely as other women to be able to carry on.

Unless you have an infection that needs treatment, you do not need to continue to have antibiotics after your caesarean section.

You should be offered pain relief that you can control yourself with drugs such as morphine (called patient-controlled analgesia or 'PCA'). However, these can make you drowsy and nauseous, so you should also be offered non-steroidal anti-inflammatory drugs (NSAIDs), such as diclofenac, if they are suitable for you. Taking NSAIDs can cut down the amount of morphine-like painkillers (such as diamorphine) that you might need.

If you are recovering well and you have no problems after your caesarean section, you should be able to eat and drink if you are thirsty or hungry.

If you have had a general anaesthetic, you do not need to be offered routine respiratory physiotherapy.

If you have had a regional anaesthetic, your bladder catheter will be removed once you are able to walk and at least 12 hours after the last 'top-up dose' of anaesthetic.

Your wound dressing will be removed after 24 hours. Wound drains do not cut down infection or the risk of bruises, so they should not be used in caesarean section.

Your healthcare team should give you the opportunity to discuss the reasons for your caesarean section at an appropriate time before you leave hospital, or later if you prefer. They should also provide you with information about your options for future pregnancies.

Current good practice for the care of your baby after a caesarean section should follow the accepted care for any newborn.

  • Information Standard