Introduction
You are planning an elective caesarean birth or have had an ‘unplanned’ (emergency) caesarean birth.
This information leaflet will provide you with information as to what to expect before, during and after your caesarean birth. Please talk with your midwife or obstetrician (doctor specialising in pregnancy and birth) if you have any additional questions that we have not covered for you within this leaflet.
What is a caesarean birth?
A caesarean birth is when a cut is made on your lower tummy and into the womb to allow your baby to be born. Your doctor will discuss with you the reasons why it is felt that you need a caesarean birth and answer all your questions.
Elective caesarean births are planned, and you will have had discussions with your midwife and doctor about the reason for this type of birth prior to the birth.
Emergency (unplanned) caesarean births may be needed either before or during labour. You should have been given explanations as to why this was recommended. It is usually because your baby needed to be born by caesarean because the risks to them of not being born within a specified time period were greater than the risks of a caesarean birth for either you, or your baby.
Birth plan
You can complete a written birth plan, and your community midwife will guide you through this process towards the end of your pregnancy.
If you have wishes for your caesarean birth experience, such as playing your own music, lowering the screen to see the baby being born, and early skin-to-skin contact, please discuss them with your midwifery and medical team.
You are also welcome to bring a camera if you want to take photos of your baby.
Planning for caesarean birth
When is the best time for a caesarean birth?
If you have a planned caesarean birth, it usually occurs no more than a week before your due date. This is because there is a chance your baby might have breathing problems soon after birth if they are born too early. These problems are less likely if your baby is born after 39 weeks. Your doctor will discuss and plan a date with you for your baby’s birth.
Sometimes there are medical reasons to do the caesarean before 39 weeks, such as in an emergency. If this applies, the reasons for this should be explained to you.
While we try to keep to the agreed date for your caesarean birth, it may sometimes be necessary to move your scheduled date, due to emergencies. This will be communicated with you as soon as possible and alternative date given. We apologise in advance if your caesarean birth date needs to be moved.
Antenatal steroids
If it is considered appropriate for you to be offered antenatal steroids, to help with your baby’s breathing after birth, this will be discussed with you and arranged if appropriate.
Your pre-operative appointment
Before your planned caesarean birth, you will have a pre-operative appointment to assess your current pregnancy, health, and any current medication you are taking. You will be seen by a midwife and maternity support worker to have the following:
- a set of observations, including your heart rate and blood pressure, and
- a urine sample check
- a listen-in to the baby’s heartbeat
- MRSA swabs, if these weren’t done when your planned caesarean birth was booked in antenatal clinic
- a set of bloods to check an up-to-date iron level and blood group
- a discussion to confirm what to expect during your admission and planned caesarean birth, as well as confirmation of fasting and arrival times
You will be given antacid tablets called omeprazole, to take on two occasions before you come into hospital, to reduce the acidity in your stomach.
When your operation is in the morning:
- Please take the first antacid tablet with a sip of water at 10:00pm the night before your operation.
- Please take the second antacid tablet at 6:00am on the morning of your operation with a sip of water.
- Please have nothing to eat after 10:30pm in the evening before your operation. You can continue to drink up to a pint of still water only until 6:30am. Do not have anything else to eat or drink after this time, including chewing gum.
- When you arrive on the ward, you will be able to ‘sip until send’, where you can drink no more than 170mls (approximately one small standard hospital glass) of water each hour, until you are called down for your operation.
When your operation is in the afternoon:
- Please take the first antacid tablet with a sip of water between 6.00am and 8.00am on the morning of your operation.
- Please take the second antacid tablet at 11:00am on the morning of your operation with a sip of water.
- You may eat a light breakfast on the morning of your operation, but please have nothing to eat after 7:00am. You can continue to drink up to a pint of still water only until 11:30am. Do not have anything else to eat or drink after this time, including chewing gum.
- When you arrive on the ward, you will be able to ‘sip until send’, where you can drink no more than 170mls (approx. one small standard hospital glass) of water each hour, until you are called down for your operation.
Make-up, jewellery, and nail varnish
Please remove all makeup and nail varnish (including gel and acrylic nails) before coming into hospital as these may affect our safety monitoring equipment. We advise you to leave your jewellery at home, although wedding rings can be taped.
We do not recommend shaving your bikini line in advance of your operation, as shaving can increase the risk of infection.
What time will I have my operation?
It is not possible to give you an exact time for your operation. Emergency care on the labour ward/delivery suite may affect planned caesarean timing. We aim to perform your operation on the day it has been planned, but occasionally it may be rearranged because of unexpected situations that may occur. Our aim is to keep all mothers and babies on the unit safe. If this happens to you, please accept our apologies in advance.
Having your caesarean birth
Possible complications of caesarean birth for you
Caesarean births are safe. However, 16 women in every 100 will have some form of complication following a planned caesarean birth. This risk may be higher in the event of an unplanned caesarean birth.
Minor problems may include:
- Wound and abdominal discomfort in the first few months after surgery
- Readmission to hospital (5 in 100)
- Heavy bleeding (5 in 1000) which may result in anaemia
- Infection of the lining of the womb (8 in 100)
- Wound infection
- Difficulty with passing urine or urine infection
- Individual risks will be discussed with you by your doctor, but the following general risks and possible complications may include:
- Blood clots in your legs or lungs (4 to16 in 10,000)
- Damage to your bowel or bladder (1 in 1000 women) or ureters (the tube connecting the kidney to the bladder) (10 in 10,000 women)
- Return to theatre to stop ongoing bleeding (5 in 1000)
- Admission to intensive care unit (1 in 100)
- Pelvic infection or abscess (2 in 1000)
- Some extra procedures may become necessary during the caesarean birth such as a blood transfusion (5 in 1000) or emergency hysterectomy (8 in 1000), particularly if there is heavy bleeding at the time of your caesarean birth. A hysterectomy would mean you are unable to have any further children as the womb is removed. The risk of needing to undergo a hysterectomy at the end of a subsequent pregnancy increases with each caesarean birth but overall, the risk is still very low.
If you have had two caesarean births before and have a low placenta in your third pregnancy, you have a higher chance of a serious complication called placenta accreta. This is where the placenta does not come away as it should when your baby is delivered. Please talk to the doctor about your individual risks when you sign the consent form.
Possible complications of caesarean birth for your baby
Most babies born by caesarean birth are well after birth. However, a small number of babies may develop problems. If there are concerns about your baby, they will be seen by a baby doctor; most of the time your baby will be able to stay with you. However, a few babies will need to go to the neonatal unit.
Common problems of newborn babies are:
- Minor cuts to baby’s skin: There is a small chance (1 to 2 in 100) that a minor cut is made to baby’s skin during delivery. This is usually very superficial and heals well, but the baby doctor would be asked to review.
- Getting cold: Newborn babies are not good at keeping themselves warm and chill easily. To avoid this happening, your baby will be dried thoroughly after birth and either placed skin-to-skin with you or your birth partner or wrapped in blankets. A hat is very important as we know babies lose heat from their heads. Your baby’s temperature will be checked to ensure they are not getting cold.
- Breathing problems: Some babies have difficulty with their breathing after birth. A sign that a baby is having breathing difficulties is usually that they may breathe faster, or their breathing may be noisy called ‘grunting’. This can be for many reasons. The most common reason is that a small amount of fluid has remained in the baby’s lungs and has not fully cleared at birth; this happens to about 1 baby in 50 at 39 weeks, 1 in 25 at 38 weeks and 1 in 12 at 37 weeks, and is more likely to be seen in babies born before their mother has contractions (i.e. mothers having a planned caesarean birth). If your baby appears to have breathing difficulties, a member of the neonatal team will be asked to assess the baby. Mild problems often settle quickly. The baby doctor may leave your baby with you and come back later to check all is well. Babies who have more severe difficulties will be transferred to the neonatal unit where they can be given any special treatment that may be needed.
- Low blood sugars: Babies have stores of energy to use in the hours after birth. Sometimes, this energy may be used up during delivery or if the baby is cold, they may not use it properly. If the midwife is worried, they will test your baby’s blood sugar level by taking a drop of blood from the baby’s heel. Feeding your baby usually resolves a low sugar level. If the level is very low or your baby appears unwell in any way, they will be seen by a member of the neonatal team.
Anaesthesia for caesarean birth
Most of our caesarean births are completed using a regional anaesthesia, which involves an injection in your back. It may be either as a spinal anaesthetic or epidural or a combination of both.
Regional anaesthetic allows you to remain awake during your birth, without feeling any pain in your lower body. This is usually safer for you and your baby and allows you and your birth partner to experience the birth together.
Sometimes, it is necessary to give you a general anaesthetic (that sends you to sleep) for your caesarean birth. If you have a general anaesthetic, your birth partner will wait outside the operating theatre and your baby is taken to them after birth until you are awake. They are welcome to have skin-to-skin contact with your baby.
Your anaesthetist for your caesarean birth will discuss the type of anaesthetic that will be used in advance, discuss the pain relief available after your caesarean birth and answer any questions that you may have prior to going to theatre.
You can find out more at
https://www.labourpains.org/caesarean-birth/caesarean-birth-advice-and-information
Before your caesarean birth
You should take a nappy and choice of baby clothes with you to theatre and, if you plan to bottle feed, please bring the first bottle with you.
Before the anaesthetic is started, a drip will be put into the back of your hand.
After regional anaesthesia, a catheter (a thin, soft tube) will be placed in your bladder to empty it before the operation starts; if you have a general anaesthetic this is inserted prior to being put to sleep. An antibiotic is given into your drip to prevent wound infection.
Inflating and deflating stockings are worn around your legs during, and for few hours after your operation to improve circulation.
What happens during your caesarean birth?
A caesarean birth involves major abdominal surgery and a ‘bikini line cut’, approximately 12-15 cm long and about 2.5 cm above your pubic bone. It takes time for the surgeon to deliver your baby, as there are several layers of the body surrounding the uterus (womb).
The womb is opened, and the surgeon puts their hand into the womb around the lowest part of the baby (usually the head but may be the bottom if breech presentation). When the lowest part of the baby has been lifted to the opening, the assistant pushes on the top of your tummy to help your baby be born. If you are awake for the procedure, you may feel a pulling or tugging sensation at this point during the operation, but you shouldn’t feel pain.
Once your baby is born, the cord is clamped and cut before they are taken by the midwife, who checks and dries your baby before passing them to you. Delayed cord clamping of one minute is offered as standard, unless there are concerns regarding their condition at birth. Skin-to-skin can also be offered in theatre if you wish, and your baby is well. All babies are labelled with their mother’s details before they leave theatre.
The baby doctor may be present before your baby is born to give additional support following birth. If your baby is unwell, they will tell you and your birth partner about any concerns and explain what care is advised.
Following your baby’s birth, a medication is given to you via the drip in your hand to help your placenta separate from the wall of your womb and minimise blood loss. The placenta and membranes are delivered, and inside your womb is checked to ensure it is empty. The incision is then stitched, which takes more time than it does to deliver your baby. Your skin is usually closed with dissolvable stitches but occasionally stitches that need to be removed are used. You will be informed after your operation as to which have been used. Your wound will be covered by a dressing, which remains in place for five to seven days.
You will be offered a pain-relieving suppository to be given at the end of the operation into your back passage.
The whole operation lasts about one hour.
Care immediately after your caesarean birth
When you leave theatre, you will go back to a recovery room to be looked after by a nurse for approximately 30 minutes. Regular observation of your blood pressure, pulse and vaginal blood loss will be made. You will be given sips of water to drink. If you have any pain, we will give you pain relief drugs to help.
We aim to continue skin-to-skin contact with the baby in the recovery area and you will be given help to feed baby as required. Your baby will also be weighed whilst you are in recovery and will have Vitamin K if you have opted for this.
Your birth partner can be with you during your stay in recovery; however, we cannot allow other visitors in this area. After you have been cared for in recovery, you will be transferred to either the postnatal ward or to delivery suite, depending on your clinical needs at this time.
Recovering after your caesarean birth
Care on the postnatal ward
After your stay in recovery, you will be transferred to the postnatal ward. However, some women may need to be cared for on delivery suite with further monitoring.
Visitors are welcome on the postnatal ward; please speak to the midwife caring for you about specific visiting arrangements as these are currently subject to change.
- There are several ways to give you pain relief after a caesarean birth:
- If you have had a spinal or epidural, a long-acting painkiller will be used.
- Pain relieving suppositories (capsules) are often given at the end of the operation into your back passage.
- You will be given tablets of paracetamol and ibuprofen to take at regular intervals.
- If you need more pain relief, dihydrocodeine or liquid morphine (Oramorph) is available.
- Wind pain is common and can be very uncomfortable after an operation. Please tell a midwife if you are having problems, as we can give you something to ease the discomfort. It may take a few days to get back to your normal bowel habit; walking about, drinking plenty of water, and a healthy diet will help prevent constipation (the midwife or your GP can provide a mild laxative if this is a problem). Ensuring your diet is high in fibre prior to admission can also aid bowel function post birth.
Eating and drinking
If you feel that you would like something to eat and drink, start off with something light, such as water, a couple of plain biscuits and maybe a sandwich. Avoid fizzy drinks, fruit, or a heavy meal initially.
Moving about while in hospital
The ward staff will offer you help and assistance with baby care, feeding and helping you to move around. We advise you to ask for assistance the first time you get out of bed, but please feel free to ask for help whenever you need it.
If you have been awake for your caesarean birth, the feeling and movement in your legs will return within six hours and you will be able to get out of bed as soon as your legs feel strong enough. Please ensure that you move your ankles and calves whilst you are in bed to prevent blood clots forming in the backs of your legs (this is known as deep vein thrombosis, or DVT). It is important to be getting out of bed and moving around gently as soon as you feel able, to reduce the risk of both DVT and chest infections delaying your recovery.
The urinary catheter (tube in the bladder) will be removed once you are mobile following the operation and the ‘drip’ in your arm will be removed prior to going home. The staff will ask you to measure how much urine you are able to pass when you use the bathroom, and the first three will be measured by a member of staff.
Personal care
When you feel ready, you can get up and have a wash or a shower. Your birth partner will be of great help during this time, helping you to and from the shower or looking after the baby while you are in the shower. We encourage you to get out of bed as soon as your legs are strong enough (if you have had a spinal or epidural); however, please do not do this without assistance.
It is advisable to wear loose, comfortable clothes and cotton underwear after your operation.
Blood loss
After a caesarean birth, you will have some vaginal blood loss. Usually, the blood loss lasts for several weeks. Your midwife will ask you about your blood loss – they will also feel your tummy to check that your womb is returning to its normal size. The bleeding is normally heaviest for the first week but can take a few weeks to completely stop. You should tell your midwife if you pass large clots, or your discharge starts to smell unpleasant.
We advise using sanitary pads (not tampons or menstrual cups). Washing your hands before and after changing your pad and changing your sanitary pad every time you go to the bathroom will reduce the risk of infection.
Caring for your baby
You may need extra help to feed and care for your baby initially. We will help you and your birth partner with the care and attention you require while in hospital.
It is important to keep your baby warm after delivery, so we
suggest that your baby is appropriately dressed, whenever they are not in skin-to-skin contact. Please speak to the midwife if you are unsure.
Preventing blood clots
Deep breathing exercises and leg exercises are encouraged as soon as possible, to reduce the risk of blood clots. You will be helped to move around as soon as you can. Some people are asked to wear special stockings. An injection (anticoagulant) is given daily for some women to prevent blood clots (from ten days, up to six weeks). You or your partner will be taught how to give this injection if it is required.
A physiotherapist may come and see you to give specialist advice on postnatal exercise, how to get out of bed, and pelvic floor exercises.
You should tell your midwife or doctor if you develop a cough or shortness of breath, or swelling and pain in your legs, so that they can make sure that these symptoms are not caused by a blood clot.
Your wound
The midwives will advise you on how to care for your wound.
You will have a dressing across your wound, and this will remain in place for five to seven days. If your BMI (body mass index) is over 35, a negative pressure dressing will be used. This has been shown to reduce wound infections for women with a higher BMI and consists of a small battery-operated device attached to the dressing, providing gentle pressure to aid healing. You will be provided with spare batteries to take home. This dressing stays on for seven days.
You may have a very small tube coming from your tummy. This is a drain, and it will be removed the day after your operation.
You will have some stitches across the wound. Most are dissolvable, but your hospital or community midwife will let you know if the stitches need removing.
The wound site may be bruised and sore in the first few days. It is common to still feel sore and tender around the wound for several weeks. However, this discomfort will get better over three to four weeks. Some women also complain of a feeling of numbness around the wound. This is normal and will gradually get better.
New patches of redness, oozing from the stitches or increasing discomfort may be signs of infection, so do tell your midwife or doctor if you notice these signs. Your community midwife will check your wound and your abdomen to make sure there are no signs of infection.
To try to prevent a wound infection, it is recommended:
- After a shower, dry the surrounding area carefully using your own towel. Do not share towels.
- It is normal to see some staining on the dressing, but if it is becoming soaked, please inform your midwife.
- Make sure your underwear does not rub against the wound or cause any unnecessary friction or pressure on it.
- Once the dressing is removed gentle cleaning and drying of the wound daily will be required.
- If your wound becomes hot to touch, looks red, or there is a discharge, or you feel unwell with a temperature; you must contact your GP in the first instance for advice as you may have an infection.
Going home
Most women go home on the first day after caesarean birth. Occasionally you may need to stay in longer for medical reasons, either for you or your baby. A community midwife will contact you and arrange to see you the day after you go home.
You will still feel some pain and discomfort once home. You should make sure you have a supply of paracetamol and ibuprofen at home to use once you have left hospital, as we do not dispense this on discharge.
If you have been prescribed injections to prevent clots forming, please continue with these until your supply runs out.
If you need any other medication on discharge, such as antibiotics or iron tablets, your midwife will provide you with these.
Travel and driving
Babies must be taken home from hospital using a car seat. Please be aware that you are required by law to wear a seatbelt when travelling by car, even if your tummy is sore.
Most insurance companies do not provide cover for mothers who drive within six weeks of a caesarean birth. Please check with your insurance company about the cover they provide for you.
Moving about and exercise
Once home, you will begin to feel better and find moving around easier. You may even feel well enough to go for a short walk. Your community midwife can advise you about exercise after discharge.
You should not go swimming or start pre-pregnancy levels of exercise until six weeks after your caesarean birth.
It is still important to rest as much as possible. For at least two weeks following your operation, it is a good idea to arrange for help at home from your partner, a relative or friend. Somebody to do the shopping and housework is especially helpful. It will probably take several weeks for you to return to all your normal activities. If you have any concerns about this, please discuss them with your community midwife.
Sex after a caesarean
It will take up to six weeks for your internal stitches to heal completely. It is advised that you do not have sexual intercourse before your postnatal check with your GP at six weeks.
Contraception choices will be discussed with you before you are discharged, as it can be possible to get pregnant in the first month after the birth. It is recommended to wait at least one year following a caesarean birth before considering a future pregnancy.
Next birth
The doctor who delivered your baby will have written in your records whether your next baby could be born normally, or whether you should be advised to have a repeat caesarean. This information will be included on your discharge letter, a copy of which will be sent to your GP.
Most mothers who have had a single caesarean can safely have their next baby vaginally. You can discuss your own situation with your doctor, midwife or at our ‘Birth After Caesarean Midwife Clinic’ in your next pregnancy.
Date of publication: 01/07/2025
Reference code: PIL223/IND059
Review date: 01/07/2028