What Happens During a Caesarean Section?


In the UK around 25% of babies are born via caesarean section. Around 10% are elective C-sections (i.e. chosen by the mother for personal, medical or sometimes psychological reasons, and planned ahead of time) and around 15% are emergency or unplanned C-sections (which may be necessary for many different reasons).

This C-section awareness month, registered midwife and co-founder of My Expert Midwife, Lesley Gilchrist, explains what happens during a C-section birth and how women can prepare for a more comfortable recovery:

A C-section is an operation that enables a baby to be born through an incision in the tummy and womb. There are lots of reasons why women may choose to have their baby by C-section and also medical reasons why some babies are born via an emergency or unplanned C-section.

Women who decide that a planned or elective caesarean section is their preferred way to give birth will have an appointment with an obstetrician who will discuss the pros and cons of giving birth this way. When the woman has confirmed her informed choice, the surgery will be booked and a date provided. Usually, this will be around 39-40 weeks into the pregnancy.

A few days before the surgery date, the woman will go to the hospital for assessment and blood tests. The night before the planned surgery, women are usually asked to fast overnight and are then  admitted to hospital in the morning.

When it is time for surgery the woman will be called into the anaesthetic room, and be helped into an upright sitting position in preparation for a spinal anaesthetic, which will numb the body from the waist down. This enables the mother to be awake for the operation and to meet her baby as soon as they are born. The woman will need a cannula inserted into a vein, usually in the hand - and a catheter fitted to empty the bladder to avoid any damage during the operation. An anaesthetist will use a cold spray to make sure that the body is numbed.

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In the operating theatre, the woman will be covered in sterile drapes, with a screen so she can’t see the operation taking place. The birth partner can also be present throughout, sitting next to her.

The surgeons will apply cleaning fluid to the abdomen, then make a 10 to 20 cm incision at the bikini line. The bladder will be moved away, the abdominal muscles parted, and another incision made into the uterus. A suction device may be needed to clear away the waters once they are broken. It is normal to feel some pushing and pulling sensations - some women describe it as feeling like washing up is being done in their tummy - and then the baby will be born. So long as your baby doesn’t need any intervention it may be passed to the mother or birth partner for skin-to-skin contact. The surgeon will then close the wound, this may take some time as there are several layers to stitch.

Emergency c-sections may be needed for different reasons, and the reasons determine the urgency by which the procedure needs to take place. There are three 3 categories which define how urgently baby needs to be born: 

  • A Category 3 emergency C-section has no strict time limit and may be needed if, for example, if a woman is booked in for an elective C-section and her waters break or she goes into labour earlier.
  • A Category 2 emergency C-section allows up to 90 minutes from decision to birth of baby and reasons for requiring one could include a compromise to the health of the mother (for example, in the case of severe pre-eclampsia or other conditions) or to the baby (e.g., if labour is not progressing and there are signs that your baby may be distressed).
  • A Category 1 emergency C-section indicates that baby needs to be born as soon as possible and no longer than 30 minutes from the time the decision is made. Reasons for needing one include evidence that your baby is severely distressed, heavy bleeding from your vagina, or cord prolapse.

Emergency C-sections are very similar to elective C-sections, although there are some differences. Consent for the procedure may need to be given when the woman is in labour or very tired. Doctors should talk to the woman in between contractions to ensure she understands and is informed about what is going to take place. In some circumstances, the consent might need to be verbal. A neonatal doctor may be present in theatre to check over the baby when it is born, depending on the circumstances.

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In most cases, the woman will be able to have a spinal anaesthetic but in the rare event that the baby needs to be born very quickly she may need to be given a general anaesthetic. In this case the baby can be given to a birth partner for skin-to-skin contact and a cuddle until the woman is out of theatre or if the baby needs treatment in the special care baby unit, the birth partner will be able to join them as soon as the baby’s condition is stable.

From theatre, the woman will be taken to a recovery area until she is well enough to be transferred to the postnatal ward. On the ward, midwives and other staff will help with baby cares and feeding. Women should try to take things slowly and take regular pain relief to help manage their recovery.

How long the mother and baby stay on the postnatal ward depends on how well they are, but the average hospital stay for a woman who has had a planned c-section is 1 or 2 days. 

When packing the hospital bag, it's useful to include underwear that will cover but not rub the incision and short-sleeved, button-up tops that might make dressing with a drip or cannula easier. A small cushion can be useful to hold over the wound when moving and to help support the baby when breastfeeding. Women who have C-sections tend to have longer stays in hospital than women who have vaginal births, so consider packing some extra clothes, pads and nappies for you and baby.

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