Caesarean Section: What to Expect

A caesarean section, commonly known as a C-section, is a surgical procedure used to deliver a baby through incisions in the mother's abdomen and uterus. Whether you're planning for a C-section or just want to be informed about all birth possibilities, understanding what this procedure involves can help ease anxiety and prepare you for what to expect.

Understanding Caesarean Sections

A caesarean section is a major surgical procedure where your baby is delivered through an incision in your abdomen and womb rather than through the vaginal canal. The cut is typically made horizontally across your lower abdomen, just below your bikini line, leaving what's often called a "bikini line scar."

In the UK, approximately 1 in 4 pregnant women deliver their babies via caesarean section. While it's a common procedure, it's important to understand that it's still major surgery and carries certain risks and recovery implications.

Why Might You Need a Caesarean?

There are many reasons why a caesarean section might be recommended. These can be broadly categorised as planned (elective) or emergency procedures.

A planned caesarean is typically scheduled from the 39th week of pregnancy and might be recommended for reasons such as:

• Your baby is in the breech position (feet first) and attempts to turn them have been unsuccessful or declined
• You have a low-lying placenta (placenta praevia)
• You're experiencing pregnancy-related high blood pressure (pre-eclampsia)
• You have certain infections that could be transmitted to the baby during vaginal birth, such as genital herpes or untreated HIV

Emergency caesareans may be necessary when:

• Your baby is not receiving enough oxygen or nutrients
• Your labour is not progressing as expected
• There is excessive vaginal bleeding during labour

What Happens During a Caesarean Section?

Preparing for a Caesarean Section

If you're having a planned caesarean, there are several preparations to be aware of:

• You'll have pre-operative appointments to discuss the procedure and complete necessary health checks
• Blood tests will be taken to check your blood type and haemoglobin levels
• You'll be advised not to eat for 6-8 hours before the procedure (though clear fluids may be allowed up to 2 hours before)
• You'll need to remove jewelry, nail polish, and contact lenses before surgery
• An intravenous (IV) line will be placed to administer fluids and medications
• A urinary catheter will be inserted to keep your bladder empty during surgery
• The surgical area will be cleaned and possibly shaved

Your birth partner can usually be present during the procedure, and they will typically be provided with surgical scrubs to wear.

What Happens During a Caesarean Section

Understanding the procedure itself can help reduce anxiety if you need or choose to have a caesarean section.

• Most caesareans are performed under spinal or epidural anaesthesia, meaning you'll be awake but won't feel any pain in the lower part of your body
• A privacy screen is placed across your body so you won't see the surgical procedure
• The medical team will make an incision about 10-20cm long across your lower abdomen and womb
• After the first incision through your skin, several layers of tissue and muscle will be carefully separated
• Once your uterus is reached, a second incision will be made to access the amniotic sac and your baby
• You might feel some tugging or pulling sensations, but no pain
• After your baby is delivered, the umbilical cord is cut and the placenta is removed
• The surgeon will then carefully close each layer with dissolvable stitches or staples for the skin
• In most cases, you and your birth partner can see and hold your baby immediately after delivery
• The entire procedure typically takes 40-50 minutes

In some emergency situations, general anaesthesia (where you're asleep) might be necessary, particularly if your baby needs to be delivered very quickly.

Recovery After a Caesarean

Recovery from a caesarean section generally takes longer than recovery from a vaginal delivery. Here's a comprehensive guide to your recovery timeline:

Immediate Post-Operative Period (First 24 Hours)

• You'll be monitored closely in a recovery area before moving to a postnatal ward
• Pain relief will be administered regularly to keep you comfortable
• The urinary catheter will remain in place for at least 12-24 hours
• You'll be encouraged to move your legs while in bed to prevent blood clots
• Healthcare staff will help you with your first attempts at breastfeeding if desired

Early Recovery (Hospital Stay: 1-2 Days)

• Most women stay in hospital for 1-2 days after the procedure
• You'll be encouraged to get out of bed and walk within 24 hours of surgery
• Pain medication will be adjusted as needed to manage discomfort
• Your wound dressing will be checked and possibly changed
• Hospital staff will provide support with baby care and breastfeeding

At Home Recovery (First Six Weeks)

• You'll likely experience some discomfort in your abdomen for the first few weeks
• Take prescribed pain relief as directed by your healthcare provider
• Keep your wound clean and dry; watch for signs of infection (redness, increasing pain, discharge)
• Avoid lifting anything heavier than your baby for at least six weeks
• Gradually increase your activity level, but listen to your body
• You'll need to avoid driving until you can perform an emergency stop without pain (usually 4-6 weeks)
• Avoid strenuous exercise and sexual intercourse until after your postnatal check-up
• The wound in your abdomen will form a scar that will likely fade over time

Understanding the Risks

Like any surgical procedure, a caesarean section carries certain risks. It's important to be aware of these, particularly if you're considering a caesarean for non-medical reasons:

• Infection of the wound or womb lining
• Blood clots
• Excessive bleeding
• Potential damage to surrounding organs, such as the bladder
• Temporary breathing difficulties in your baby
• Rare risks of accidental injury to the baby during the procedure

Your healthcare team will take precautions to minimize these risks and will discuss them with you before the procedure.

Planning for Future Pregnancies

Having one caesarean section doesn't necessarily mean all future deliveries must be via caesarean. Many women who have had a caesarean can safely have a vaginal delivery in subsequent pregnancies, known as a vaginal birth after caesarean (VBAC).

However, this depends on various factors, including why the first caesarean was necessary and your overall health. Your healthcare provider will discuss your options with you in any future pregnancies.