A caesarean section (C-section) is an operation in which a cut is made through your tummy (puku) to your womb (wharetangata) to deliver your baby (pēpē).
- A caesarean section may be a planned (elective) caesarean or an emergency caesarean.
- A caesarean section is usually carried out using regional (spinal or epidural) anaesthetic.
- A caesarean section is a procedure that is frequently performed. However, like any other operation or surgery, it carries risks and can have complications.
- In the next pregnancy after a caesarean section, most women can have a natural vaginal birth.
What are the different types of caesarean section?
A caesarean section can be a planned (elective) caesarean section or an emergency caesarean section.
Planned or elective caesarean section
A planned or elective caesarean section is when your operation is planned before you go into labour. This is usually recommended by your doctor or obstetrician when they think that a caesarean is safer for you and/or your baby. An elective caesarean section does not mean that you have chosen to have a caesarean because you do not want to have a vaginal birth.
Emergency caesarean section
An emergency caesarean section is when your operation is carried out urgently or in a hurry, usually after labour has started, without being planned in advance. This can happen when delivery is needed immediately due to complications that happen during pregnancy or labour, and the safest option is to deliver your baby straight away. Sometimes a person who is planning an elective caesarean section needs an emergency caesarean if they go into labour before their elective caesarean section date.
Read more about the types of caesarean section.
What anaesthesia is needed for a caesarean section?
Most caesarean sections are carried out when you are awake, using an epidural or spinal anaesthetic (also called a spinal block) that will numb you from the chest down. This is called regional anaesthesia. Sometimes a general anaesthetic is required and you will be unconscious or asleep during your caesarean. Your anaesthetist will normally discuss these options with you before your operation so a decision can be made based on your situation. Sometimes, during an emergency situation, a long discussion may not be possible.
Read more about anaesthesia for caesarean section.
What happens during a caesarean section?
Before your caesarean section
If you are having a planned or elective caesarean section, you will have a preoperative appointment to discuss this. You will be asked questions about your health, pregnancy, medical history and home circumstances. Your options will be explained to you and you will be told why a caesarean section is recommended. Sometimes some investigations, such as blood tests, may be carried out.
Your anaesthetic options will be discussed and explained to you. You will receive information about what will happen on the day of your caesarean, including when to stop eating and drinking, and the time that you need to come to the hospital. You will likely be given some tablets to neutralise tummy acid to take the night before and on the morning of your caesarean.
This is an opportunity to find out as much as you can about what is involved in your caesarean. You might want your partner, whānau or a support person to come with you to your appointments. This is so they know what is happening and can support you. Ask questions about what to expect during or after your caesarean.
On the day of your caesarean section
You will be given a time to come to the hospital on the day of your caesarean section. You can bring a support person/partner with you to the hospital and they can stay with you throughout the procedure, including during the operation.
It is important to follow the instructions given to you at your preoperative appointment:
- Stop eating and drinking 6 hours before your caesarean section (except water).
- Stop drinking water 2 hours before your caesarean section.
You will be shown where to get changed and will be given somewhere to put your belongings. Your blood pressure and pulse will be checked and your pēpē's heart beat will be listened to.
Read more about what to expect on the day of your caesarean section.
After your caesarean section
After your operation, you and your baby will be transferred to the recovery area, also known as the post-anaesthesia care unit (PACU). Your support person can usually stay with you. You and your baby will be monitored closely in PACU by a nurse and / or midwife.
You will be provided with pain relief. The anaesthetists will have already put pain relief into your spinal or epidural, and that will continue to work after your caesarean has finished. You will also get different types of regular oral (by mouth) pain tablets to take. You may have a pump where you can press a button to deliver pain relief into your bloodstream when you need it (called patient controlled analgesia or ‘PCA’). When the nurse looking after you is satisfied that you are comfortable and your clinical observations are normal, you will usually be transferred to the postnatal ward.
In the postnatal ward there are steps you can take to speed up your recovery. These include:
- aiming to eat and drink as soon as you can
- getting out of bed 6–8 hours after your caesarean
- having your urinary catheter removed 8–12 hours after your caesarean, once you are able to get up out of bed and go to the toilet
- having regular prescribed pain relief
- breastfeeding your baby – your nurse or midwife will teach you about breastfeeding.
You and your baby will be monitored closely in the postnatal ward by your midwife, doctor or nurse. You or your baby's progress may affect how long you will stay in the hospital and when you can be discharged. Most people are able to go home 2–3 days after their caesarean section. Talk to your doctor, nurse or midwife if you have any questions.
What are the risks of a caesarean section?
A caesarean section is generally a safe procedure. However, like any other operation, a caesarean section carries risks and complications. There are also risks and complications with vaginal birth. The risks can happen to you, your baby and your future pregnancies.
Risks to you include:
- infection of your womb (uterus) or bladder
- blood clots (deep vein thrombosis)
- wound infection (infection of the cut made on your tummy)
- too much bleeding during the operation meaning you need a blood transfusion
- damage to internal organs, eg, bladder, bowel or ureter (the tubes between your kidneys and bladder).
Risks to your baby include:
- breathing difficulties – this is more common in babies born before 39 weeks. It is more common after planned caesarean sections without labour
- injury to your baby such as a small cut on your baby’s skin.
Risks to future pregnancies include:
- attachment of the placenta to the scar in your womb (placenta accreta). This can cause difficulties in delivering the placenta and can be associated with severe bleeding.
- the scar in your womb opening up during labour
Can I have a natural birth in future after a caesarean section?
Most women can have a natural birth in their next pregnancy after a caesarean section. Many people will be encouraged to have a vaginal birth after caesarean (VBAC). Some women may be advised to have a caesarean section in their next pregnancy.
After a caesarean section, it is recommended that you wait at least 1 year before getting pregnant again. This allows your womb to heal from your previous caesarean.
Talk to your doctor or midwife about contraception options after a caesarean section, and your plan for future pregnancies. The doctor and obstetric team who performed your caesarean will be the best people to talk to as they understand your condition well.
What support is available with a caesarean section?
Having a caesarean section can be stressful. It is also normal to have feelings of anxiety, failure or guilt. Talk through your feelings with your partner, family/whānau and friends to get the support you need. You can also talk to your doctor or midwife about the plan for future pregnancies and any questions that you have about your caesarean section.
Your physical recovery after a caesarean section is usually harder than after a vaginal birth because of the cut made into your puku and womb. Get your whānau, family and friends to help out with tasks around the home such as laundry and house work. Make sure you continue to take regular pain relief when you go home.
If you're feeling anxious and overwhelmed, or just need someone to talk to, free call or text 1737 anytime, 24 hours a day to speak to or text with a trained counsellor. You can also find a counsellor yourself to talk about how you are feeling.
Your caesarean section National Women's Health, ADHB, NZ
Inducing labour, pain relief, and help during birth Ministry of Health, NZ
Caesarean section NHS, UK
Caesarean section Patient Info, UK
|Dr Judy Ormandy is an obstetrician and gynaecologist at Capital & Coast District Health Board and a Senior Lecturer in Obstetrics & Gynaecology at the University of Otago, Wellington. Her areas of interest are medical education and maternal mental health.|