Caesarean birth

A caesarean section is a major surgical operation in which your baby is born through a cut in your abdomen and uterus. It is usually performed under a spinal or epidural anaesthesia. In some cases it is necessary to use a general anaesthetic so that you are asleep throughout.  

Some caesarean births are planned in advance (elective caesarean) because of existing problems with your pregnancy. In other cases, the decision to perform a caesarean is made during the course of labour. This is called an emergency caesarean.

An emergency caesarean is recommended for the following reasons:

• concern for your baby’s wellbeing  
• your labour is not progressing
• there are maternal complications, such as severe bleeding or severe pre-eclampsia
• there is a life-threatening emergency for you or your baby.

What to expect if you need an emergency caesarean

• You may be in the operating theatre for an hour or more. 
• Unless you are having a general anaesthetic, in most cases, your partner can be with you in the operating theatre.
• Most hospitals will have a midwife stay and look after you and your baby in the theatre and the recovery area.
• Unless you have had a general anaesthetic, skin-to-skin contact with your baby will be encouraged immediately after the birth, otherwise you are likely to have skin-to-skin as soon as you are able.
• The midwife will help you with breastfeeding.
• If your baby is unwell or needs to be monitored they may need to go to special or intensive care. In some cases they may need to go to a different hospital, which has a higher level of care for babies who are very sick.
• After surgery you will be offered a number of different pain-relieving medications as you need them.
• You will be encouraged to express breast milk if your baby is unable to feed from the breast. This will start as soon as possible after the birth and you will need to express about 8 to 10 times every 24 hours.

Risks with a caesarean birth:

• Side effects and complications from anaesthesia including, nausea, drowsiness, dizziness, short-term memory loss and, in rare circumstances, an allergic reaction.
• Pain is very common after surgery. There are several layers of body tissue that are cut and then repaired during a caesarean, so post-surgical pain is to be expected. This can usually be managed well with medications.
• Infection of the wound and bladder will affect a small number of women. This can be treated with antibiotics.
• You may have fever, which will usually be due to an infection.
• Blood clots can form after surgery. If it is in the lung (pulmonary embolus) it can be very serious.
• You may not be able to hold or feed your baby immediately after the birth, which may have implications for breastfeeding. This is only likely to be a problem if you have had a general anaesthetic. However, you should be able to hold and feed your baby as soon as you are more alert.
• Adhesions or scar tissue can form in your abdomen, which can cause ongoing pain and have implications for future abdominal surgery.
• Hysterectomy is a possible complication with any birth option.

After you have had one caesarean section the risk of complications increases with each caesarean after that. For example, there is an increased chance of the placenta implanting into or over the scar in future pregnancies.

This condition is referred to as placenta praevia or placenta accreta.

Vaginal birth after a previous caesarean

If you have had a caesarean section it may affect your future pregnancies and births. For future births, you will need to make a choice about whether to have another caesarean section or attempt a vaginal birth. This is called a Vaginal Birth After Caesarean Section (VBAC). Both options carry a level of risk. Having another caesarean carries all of the risks of a normal caesarean section. The main risk for VBAC is that the scar on the uterus will rupture, which can be very painful and, in some cases, life threatening. Between one and two in 200 women who attempt a VBAC will suffer a ruptured scar.

Most women who attempt a vaginal birth after a caesarean will succeed (70 per cent). Thirty per cent of women who attempt a vaginal birth will, for any number of reasons, end up having an emergency caesarean.

Many women who have had a previous caesarean section find the prospect of a vaginal birth healing, particularly if the first caesarean was unplanned or traumatic. Unless there are particular health reasons why you would be advised to have another caesarean, the decision is ultimately yours. Your midwife or doctor will usually discuss this with when you are around 26 weeks pregnant. It’s a good idea to ask about the specific risks and benefits for you. 

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