Also known as a caesarean section, or c-section, a caesarean birth is a way to deliver a baby without vaginal birth.
You will have surgery to your belly and womb. We make a cut, about 10 and 20cm long, along the bikini line. It takes about an hour but sometimes can take longer.
It can be done as an emergency (unplanned), or it can be planned ahead of time. Planned caesarean births are also called elective caesarean sections.
How do you plan a planned caesarean birth?
You and the doctor caring for you will talk about your choices. The doctor, who is an obstetrician (specialist in pregnancy and birth), will talk about your medical history and why a planned caesarean birth may be right for you. You will discuss:
- vaginal birth
- planned caesarean birth
The doctor will explain the benefits and risks of both choices to you. You can make an informed choice which is right for you.
What are the reasons to have a planned caesarean birth?
There are many reasons why a doctor may talk to you about having a planned caesarean birth or why you may choose to have one, including:
- If you have had a caesarean birth before
- Baby is in the breech position
- Baby is in a position not suitable for a vaginal delivery
- Baby’s growth is slowing – sometimes referred to as tailing growth
- Multiple pregnancy – such as twins or triplets
- Low lying placenta or a placenta praevia
- If you had a difficult normal delivery before
- If you had tummy (abdominal) surgery before
- Baby is measuring big on personalised growth charts
- Pre-eclampsia
- Certain infections such as genital herpes or HIV
- Personal choice
What are the risks of having a planned caesarean birth?
A caesarean is a major operation, but most women do not have problems. It is important to know the risks and how it may affect future pregnancies before making an informed choice. The doctors will talk about these risks, which include:
- Immediate risks
- Heavy or excessive bleeding
- Accidental injury to baby – such as cutting their skin
- Short-term breathing problems for your baby and admission to the neonatal unit. This most often affects babies born before 39 weeks of pregnancy. It usually improves after a few days of close monitoring in hospital
- Damage to nearby areas such as the bladder or the bowel
- Hysterectomy – removal of the uterus to stop heavy bleeding
- Early risks
- Pain and discomfort
- Wound infection
- Infection of the womb lining
- Need to return to hospital after discharge
- Need to return to theatre
- Blood clots in the legs or lungs
- Neonatal death and / or Maternal death
- Admission to Intensive care unit
- Late risks
- Not able to control pee (urinary incontinence)
- Not able to control poo (bowel incontinence)
- Long-term pain
- Scarring on and inside your tummy (abdomen)
- Childhood obesity
- Childhood asthma
- Increased risks in future pregnancies- such as placenta praevia (where the placenta covers the cervix)
- Need for repeat caesarean birth in a future pregnancy
What anaesthesia will be used for my planned caesarean birth?
There are 2 main types of anaesthetic for a caesarean birth. These are:
- Regional anaesthetic – including spinal and combined spinal-epidurals
- General anaesthetic
Regional anaesthesia: local anaesthetic is given into your back. It will numb your tummy and lower body. You will be awake during your caesarean. You can meet your baby as soon as they are born.
Spinal anaesthetic
This is the most common anaesthetic used for a caesarean birth. The nerves that carry feeling to your lower body are in a sack of fluid inside your back. We insert the local anaesthetic into this fluid using a fine needle.
Combined spinal-epidural
You have the benefits of both a spinal and an epidural. The spinal anaesthetic makes you go numb quickly. The epidural places a thin tube near to the nerves in your back. It is used to give local anaesthetic. This means more anaesthetic can be given if needed.
General anaesthetic (You are asleep. You do not feel anything during the surgery)
Sometimes you may need a general anaesthetic rather than a spinal or epidural such as:
- If you have medical conditions such as a high risk of bleeding or abnormalities in your back
- Sometimes a spinal or epidural anaesthetic may be not work fully to for surgery
If you have a general anaesthetic, you will be asleep during your caesarean. Your birth partner will not be able to be with you in theatre.
Risks with having anaesthetics
There can also be risks of having anaesthesia for your caesarean.
Regional anaesthetic
- Headache
- Most can be treated with simple pain relief. 1 in 200 spinal anaesthetics can cause a severe headache to occur which need specific treatment
- Not enough or too much pain relief
- Sometimes the anaesthetic may not work well enough. The anaesthetist will give you extra pain relief or may need to change to a general anaesthetic
- Short-term nerve damage
- Rare complication which can cause short-term loss of feeling, pins and needles and sometimes weakness can last for a few days or weeks before a full recovery
- Permanent nerve damage
- A very rare complication (about 1 in 50,000 spinals)
General anaesthetic
- Common problems
- Feeling sick and being sick
- Sore throat
- Shivering
- Itching
- Uncommon complications
- Breathing difficulties after anaesthetic
- Damage to lips or teeth
- Accidental awareness during anaesthesia. You may have memories of events in the operating theatre
- Rare complications
- Severe allergic reaction
- Very rare complications
- Brain damage
- Death directly due to anaesthesia
How will the planned caesarean birth be booked?
Once you decide on a planned caesarean birth, your doctor or midwife will fill out a referral form. The hospital team will book a date for your surgery. This tends not to be before 39 weeks unless needed earlier for your and your baby’s health.
Where and when do planned caesarean births happen?
Leicester Royal Infirmary: planned caesarean birth lists are Monday to Friday. They happen in a separate maternity theatre. It is away from Delivery Suite.
Leicester General Hospital: planned caesarean birth lists run on Tuesdays, Wednesdays, and Thursdays. They are done in theatre alongside Delivery suite.
Where possible, attempts will be made to book your caesarean birth for the hospital you are booked in to. Sometimes this is not possible due to demand on maternity services.
When do you find out the date for your planned caesarean birth?
The theatre co-ordinator will contact you to tell you when the caesarean is booked. They will tell you the date and time of when to attend the hospital for your surgery.
The aim is to contact you at least one week before your planned caesarean, but ideally two weeks before. This depends on workloads at the time.
You will also get a date for an appointment before your surgery (pre-op appointment).
Who can be with me during my planned caesarean birth?
You can have one birth partner with you. Due to safety in theatre, it is not possible to swap and change birth partners.
Your birth partner will wait with you for your planned caesarean birth. They will be able to support you in recovery and on the postnatal ward.
If you are awake for your operation, your birth partner can be in theatre with you for the birth of your baby.
If you need a general anaesthetic, your birth partner will join you and your baby in the recovery room afterwards.
No other visitors are allowed in until after your recovery is complete. This is for safety reasons.
Please ask staff about visiting times on the wards for other visitors.
Can my planned caesarean birth be cancelled?
Sometimes the hospital may need to cancel your caesarean on the day. This will be due to unexpected emergencies. They may need to change the date or location of your caesarean due to service demands for example, it could be changed from Leicester Royal Infirmary to Leicester General Hospital.
The hospital will keep you up to date and will share any concerns with you. If your caesarean is cancelled, the hospital will look to rebook you as soon as possible. They will try to prioritise you on the date you are rebooked.
What will I need for my planned caesarean birth?
Bring a small bag with you which has:
- Dressing gown
- Slippers or shoes to wear to walk into theatre
- Contact lens case or glasses case (if applicable)
- Camera or mobile phone
- Snacks
- £1 coin for use of lockers
- Hat and a nappy for baby if you wish
- One vest and one baby grow for in recovery
What will I need on the ward?
Keep another bag in your car which your birth partner can collect for you later. This should have items you will need for the ward including:
- Night clothes
- Wash bag and toiletries
- Maternity pads
- Towel
- Clothes for going home
- Phone and phone charger
What does my baby need?
Your baby bag should include:
- Vests
- Baby grows
- Hat
- Nappies (about 6 a day)
- Cotton wool or baby wipes based on your preference
- If you are planning to bottle feed, bring baby milk with you. It must be readymade formula. Do not bring powdered formula in as we cannot make up the milk. Starter packs of milk are good, but these can be expensive.
What happens during the pre-op clinic appointment?
This appointment will be 2 days before your surgery. It will get you ready for your planned caesarean birth. During this appointment:
- You will have blood tests taken. This is to check your blood group before your caesarean and to check your iron level. This is done to keep you safe during your caesarean. If your bloods are not taken before coming to hospital for your planned caesarean section, it may be cancelled
- You will have swabs taken to screen for infections which can happen in hospital before you come into the hospital
- You will be given 2 pre op drinks. If you are diabetic – Type 1, 2 or gestational diabetic, you do not need to have these drinks. They can cause high sugars which are not good for you or your baby. Hospital staff will tell you when you need to take these drinks
- You will be given 3 omeprazole tablets. These are special antacid tablets. You take two at 12:00 the day before your operation. You take one at 6:00am on the morning of the operation
- You will be advised to take all other medications as you would normally unless told not to by the pre op team
- Nurses will give you an antibacterial wash called Stellisept. They will also give you a tube of antibiotic cream for your nose called Mupirocin. These will reduce the amount of germs on your skin and in your nose. It helps reduce your risk of infection. You should shower with the Stellisept wash once a day. Use the Mupirocin cream 3 times a day leading up to your caesarean section. You should start this the day before your caesarean and continue until you go home after baby is born.
- You will be advised to remove all jewellery, piercings, makeup, nail polish or false nails before you come into hospital for your caesarean.
The pre-op team will tell you what time to come to the hospital on the day of your caesarean birth.
Who will care for me and my baby on the day of my planned caesarean birth?
Lots of professionals will care for you during your caesarean birth. These include:
- Midwives – caring for you and your baby from admission to hospital, in theatre and recovery
- Obstetricians – the doctor doing the operation
- Anaesthetists – the doctor who will give you your anaesthetic
- Theatre team – to support you in theatre and manage the theatre environment
- Recovery nurses – monitoring you in recovery to make sure you are well after your surgery
- Neonatal doctors –medical team who care for babies in hospital. Sometimes they may be present or asked to review your baby, if the midwife have any concerns about your baby’s health or wellbeing
Male and female members of the team may care for you whilst you are having a planned caesarean birth.
What happens on the day of my planned caesarean birth?
A member of the team will have told you what time to arrive at the hospital.
- If you are told to arrive at 7am – you are on the morning list
- If you are told to arrive at 10:30am – you are on the afternoon list
If your caesarean is booked at the Leicester Royal Infirmary, please go to the Kensington building main reception. They will direct you to level 1 Theatre Arrivals Area.
If your caesarean is booked at the Leicester General Hospital, please go to the Maternity Unit and go to Delivery Suite. The staff will then show you to the waiting room.
The midwives will admit you when you arrive at the hospital. They will:
- Do some checks such as blood pressure, heart rate and temperature
- Check the position of your baby and listen to their heart rate
- Ask questions about baby’s movements
- Check if you take regular medicines – such as for diabetes or blood pressure
- Ask questions such as when you last had something to eat and drink
- Measure your calf size for anti-embolic stockings (compression stockings). You will wear these for the length of your stay in hospital. They increase blood flow and lower the risk of developing blood clots
- Put on two name bands – one to each wrist
- Give you two hospital gowns to change into. One covers your front. One covers your back. When changing, you need to take off all clothing and underwear.
- Make sure all jewellery, make up and nail polish is taken off. All piercings should be removed
- Ask you what you would like to happen in theatre – such as skin to skin contact with baby, music, if your birth partner would like to cut the umbilical cord
- Talk about Vitamin K for your baby. You may have spoken to your community midwife before, but the midwife must ask for your consent on the day
The midwifery team will encourage you to have regular sips of plain water whilst you wait for your caesarean to make sure you stay hydrated – no more than one cup per hour, unless you are advised otherwise by an anaesthetist.
What happens next?
A member of the obstetric team and the anaesthetic team will see you.
- The obstetric doctor will do the caesarean. They will talk to you about the potential risks of this operation and check you understand. You will be able to ask questions and sign your consent form.
- The anaesthetist will talk to you about which anaesthesia is the right one for you and your baby. They will talk about how they will give you the anaesthetic.
What happens after I have seen the doctors?
When everyone booked for caesarean has been seen by the doctors, the team have a meeting. They will discuss each of you one by one to make sure all members of the team know why you are having a caesarean. They will see if any more support or equipment is needed. The team decides on the list order. They will update you about this. It is important to be aware that this order can change based on clinical need. The theatre team will always keep you updated.
What happens when I go into theatre?
When you first arrive in theatre, the team do a safety check. This is to check who you are, your understanding of the operation you will be having. They also do safety checks for the theatre team to make sure everything is ready for your operation. The theatre team will apply some monitoring for your blood pressure, heart rate and oxygen level.
How will the anaesthetic be given? And what happens when it is given?
You will have a cannula (a thin plastic tube) put into a vein in your hand or arm to give you fluids and medicines.
If you are having a regional anaesthesia:
- The procedure usually takes a few minutes. It may be longer if it is difficult to find the small spaces in your back
- You will be asked to sit up. The theatre team will support you to be in a good position to insert the anaesthesia.
- They will ask you to curl up over your bump
- The anaesthetist will feel the spaces in your back. They will put some local anaesthetic in your lower back to numb the skin
- From this point, it is common to feel pushing on your back
- If you feel tingling or pain, you must tell the anaesthetist. It will help them to find the right space
- When the injection is finished, they will help you to lie down. They will tilt the bed will slightly to one side
- Your skin will start to feel warm. You may feel pins and needles before becoming numb to the touch
- Your legs will become heavy. It will be difficult to move
- The anaesthetic will be working fully when you are not able to lift your legs or are not able to feel pain in the lower part of your body
- The midwife will monitor baby’s heartbeat.
- The midwife or a member of the theatre team will insert a plastic tube into your bladder. It is called a catheter. It drains your pee (urine) during the operation.
- The anaesthetist will check the anaesthetic is working. These checks include asking you to lift your legs and touching your skin with something soft, sharp, or cold and asking what you can feel
- When the anaesthetic is working as it should, the anaesthetist will let you and the team know that the operation can begin.
If you are having a general anaesthetic:
- You may be asked to drink an antacid medicine to reduce the acid in your stomach
- The anaesthetist will give you some oxygen to breathe through a facemask for a few minutes
- During this time, the midwife may insert a plastic tube into your bladder. It is called a catheter. It drains your pee (urine) during the operation. The doctor will clean your tummy before your caesarean section
- You are given the anaesthetic through a drip
- When you are asleep, the anaesthetist will place a breathing tube into your throat
- You will be monitored closely whilst you are asleep
- The midwife and baby doctor will care for your baby at first. When the team have checked your baby, if there are no concerns, your birth partner can come to meet your baby
What happens now?
It is nearly time to meet your baby! The doctors will clean your skin around the bikini line to reduce risk of any infection. They will then cover you with blue sterile drapes. They will create a screen between you and the operation site.
If you have a regional anaesthetic, your birth partner will come into theatre to support you during the operation.
If you have a general anaesthetic, your birth partner will stay outside the theatre for the delivery. When your baby is born safely, your birth partner will be invited in to come and meet your baby.
What happens during the operation?
It may feel strange during your caesarean. If you have a spinal or combined spinal epidural, you may still feel some sensations such as movement, pressure and stretching. Your anaesthetist will be with you during the surgery so you can speak to them if you are worried about anything you are feeling. They can reassure you and treat discomforts as needed.
Just before your baby will be born, you will hear a suction sound. This is when the doctors break the waters surrounding baby. Then you will feel more pressure on your stomach as the doctors try to push the baby out. This is to replicate the squeezing action baby’s experience when born vaginally. Sometimes the doctor may use forceps to assist with the delivery of baby’s head.
What happens when baby is born?
Once baby’s head has been born, the screen between you and the doctors can be lowered to let you and your birth partner watch your baby be born. Some women enjoy this, and others do not, so that is up to you. If you do not want this, the doctors will deliver you baby and can lift them over the screen so you can see them right away. This is a lovely photo opportunity. The team is happy for you to bring your phones into theatre to take photos and to play music. Do not video in theatre or make any phone calls.
The doctors will wrap your baby in a warm towel and lay them on your legs. This is to allow one minute of delayed cord clamping. It is standard procedure in a planned caesarean birth. When one minute has passed, the doctor will cut your baby’s umbilical cord and place them into the cot.
What happens now baby is born?
The midwife will do some checks for baby including:
- Drying baby will a fresh towel
- Inviting your birth partner to help in cutting baby’s umbilical cord
- Top to toe check, such as checking for any birth marks
- Temperature checks
- Weighing baby
- Putting on a warm wool hat
- Putting on a nappy
- Applying two ID bands with baby’s details – one on the ankle and one on the wrist
- Giving the dose of Vitamin K
Skin to skin will be offered in theatre by the midwife if there are no concerns with you or your baby. This will help for bonding between you and your baby. If you choose not to, or do not feel ready for skin to skin in theatre, this can be offered to your birth partner.
What happens when the caesarean is finished?
When the caesarean is almost complete, the midwife will take baby and your birth partner into the recovery room. If your baby needs more checks, these are done whilst you are in theatre. If that is the case, the midwife caring for you will explain this to you. Your birth partner and baby will be taken into the recovery room. A ward bed will then be taken into theatre.
If you have had a general anaesthetic, the anaesthetist will wake you up slowly in theatre. The team will move you from the theatre bed onto the ward bed. Then you will be taken into the recovery room to join your baby and birth partner.
What happens in recovery?
A recovery nurse will welcome you. They will check you regularly including your blood pressure, heart rate, blood loss, and wound.
These checks will be done:
- Every 5 minutes for the first 45 minutes
- Then every 30 minutes until you reach 2 hours of recovery care
- Then hourly until a total of 4 hours
If your caesarean section was straight forward, the nurses will offer you food and drink in the recovery area. If you have brought your own snacks, you can have these in the recovery area.
You will be advised to have some oral pain relief, such as paracetamol, unless you have an allergy or are unable to take this medication. This helps pain management now that your baby has been born.
In recovery, the midwives will also support with baby’s first feed – breastfeeding or bottle feeding depending on your choice. They will check baby’s temperature and make sure it remains within normal limits.
If your baby was born before 39 weeks of pregnancy, the midwife will need to complete extra checks for them. This will include checking their heart rate, oxygen levels, breathing rate and temperature. These checks will be written on a chart called a NEWTT2 chart. If you had diabetes in your pregnancy, your baby may also need blood sugars checks. Your midwife will explain to you why your baby may need these extra checks.
When do I go to the ward?
The midwife will take you to the ward after about 45 minutes or up to one hour after your surgery. Sometimes this may take longer if there are no beds available. You will continue your recovery care on the ward until 4 hours is complete. You can only have one birth partner with you on the ward until you have finished your total recovery care.
What happens on the ward?
A team of midwives, nurses, and maternity care assistants will care for you on the ward. They will complete final recovery checks. They will make sure you have normal leg movements to check that the anaesthetic is wearing off correctly.
You will be given you a medicine called enoxaparin. It is an injection given into your tummy. It lowers your risk of developing blood clots by thinning the blood. It is usually given one per day for 7 days. Your midwife will explain why you may need this for a longer period.
6 hours after your baby has been born, the ward staff will be ready to help you move out of bed. They will make sure you can stand and walk comfortably. They will remove your catheter. When the catheter is removed, you will be given 3 pots. This is to measure the amount of pee you pass for the first 3 times. You are expected to pee within 6 hours of removing the catheter. The ward staff will check the times of the first 3 times you pee.
The ward staff will also give you regular pain relief to keep you as comfortable as possible. It is normal to feel some level of discomfort. You have had a big operation. Regular pain relief should make things easier for you. Your midwife will talk to you about your pain relief needs. You may have differing needs, including drug allergies. The common pain relief choices used in maternity after a caesarean section are:
- Paracetamol
- Ibuprofen
- Dihydrocodeine
- Oramorph
- Tramadol
The midwives and nurses will advise you to take pain relief at regular intervals for the first few days to make sure you are comfortable. It will make it easier for you to move around and to care for your baby. It is important to take pain relief regularly. They can take 20 to 30 minutes to work. You will be sent home with pain relief to help you when recovering at home. The midwives will explain all medicines to you.
When can my family and friends come to visit me?
Visiting hours on the wards are subject to change. Your midwife can tell you the correct arrangements and numbers of visitors allowed on the wards. During the first part of your recovery care, only one birth partner can be with you.
What happens the next day?
The day after your caesarean will be all about preparing you to go home. The midwives:
- Will check your observations every 4 hours to make sure you are stable – including blood pressure, heart rate and temperature
- May ask to take a blood sample to check your iron level based on your blood loss at delivery
- Arrange for baby to have a hearing screening whilst in the hospital
- Arrange for baby to have a Newborn Infant Physical Examination (NIPE) in the hospital to make sure referrals needed are completed before you go home
- Full postnatal check for you and for your baby. This includes taking off your wound dressing to check the wound is clean and dry
- Check baby is feeding well – either breast, bottle, or mixed feeding
When do I go home from hospital?
The aim is to send you home 24 hours after baby’s delivery, once all checks are complete and the midwives have no concerns about you or your baby.
The midwife will send you home with:
- your notes
- information leaflets
- medicine such as pain relief and blood thinning injections. The midwife will talk to you about your medicines. They will check that you know what it is for, and how and when to take it.
The midwives will arrange for a community midwife to see you at home the day after your discharge. They will continue your routine postnatal care.
Useful links
- LabourPains- Caesarean birth advice and information
- LabourPains- What to expect when you have an elective caesarean birth
Contact details for further support
Theatre Co-ordinator (Monday to Friday 9am to 4pm): 07960 883 606