What is caesarean birth (C-section)?

A caesarean section (C-section or caesarean) is an operation to deliver a baby through a cut in the abdomen (tummy) and uterus (womb).

There are several reasons why you might plan for a caesarean, or your medical team might recommend you have a caesarean after labour begins.

Why might I need a C-section?

The most common reasons for having a caesarean are:

• concerns for the safety of you or your baby
• your baby is in the breech position (bottom first) and your doctor doesn’t recommend a vaginal breech birth
• your baby is transverse (lying sideways) and can’t be turned
• you have twins and the first one is in the breech position
• your placenta is covering the cervix (opening to the womb)
• you have had several previous caesareans
• there are complications such as severe bleeding
• your labour is not progressing

Around 1 in 3 babies in Australia are born by caesarean. This is higher than the rate in many other developed countries. This rate is also increasing, both in private and in public hospitals, although you are more likely to have a caesarean in the private sector.

A caesarean might be planned (elective) if there is a reason preventing your baby been born by a vaginal birth. Sometimes before or during your labour, complications develop, and a C-section delivery needs to be done quickly. This is called an emergency caesarean.

Your doctor will discuss the reason you may need a caesarean based on your individual situation and, in some cases, your preferences.

What to expect if you have a caesarean birth

You may be in the operating theatre for one hour or more. The operation takes about 30 to 40 minutes. The baby is usually born in the first 10 minutes. The doctors will talk to you during the operation and tell you what is happening.

In most cases your partner or support person can be with you. You will also usually have a midwife with you. They will look after you and your baby in the theatre and recovery area.

You will usually receive an epidural or spinal anaesthetic. This numbs the lower part of your body and lets you be awake throughout your caesarean birth. Sometimes emergency caesareans must be done under general anaesthetic which means you will be asleep during the birth.

A catheter (a thin flexible tube) will be placed into your bladder to collect urine. This is because you will not be able to get up to use the bathroom. You will have intravenous (IV) lines inserted into your arm to give you fluid and medicines.

Your tummy will be cleaned, and the obstetrician (doctor) will make a cut through the wall of your tummy near the pubic hair line. The doctor will cut through layers of fat and muscle and then through your uterus. Your baby is birthed through your tummy this way. If your baby needs to be delivered very quickly, the cut may be made from just below the belly button to above the pubic bone.

Diagram showing how a baby is born during a C-section

The doctor will remove the placenta and close the cut with stitches or staples. You will feel tugging and pulling if you are awake but not pain. You will also hear fluid being suctioned. A screen is usually put across your chest so you cannot see what is happening.

If you are awake, you can usually hold your baby straight after your caesarean birth and begin skin-to-skin contact and breastfeeding. Sometimes the baby’s nose and mouth need to be cleared of fluids or the baby may need additional treatment from the medical team.

Who will be in the room?

Your partner or support person will usually be able to be with you during your caesarean. There may also be a lot of medical staff, including:

• obstetrician — doctor who performs the operation and delivers the baby
• anaesthetist — doctor who administers the anaesthetic
• scrub nurse — passes instruments to the obstetrician
• scout nurse — assists the scrub nurse
• anaesthetic nurse — assists the anaesthetist
• paediatrician — doctor who looks after the baby after the birth
• midwife — nurse who looks after the baby until you return to the ward
• theatre technician — looks after the operating theatre and helps you on and off the table

What are the pain relief options?

The types of anaesthetic used in caesareans differ. Your doctor will choose the most appropriate for you.

Epidural

When you get an epidural, you receive a local anaesthetic then a hollow needle and a small, flexible tube (catheter) are inserted near the spinal cord in your back. The needle is removed, leaving the catheter in place. Anaesthetic medicine is injected through the catheter and can be topped up later.

Spinal block

Similar to an epidural, a spinal block injects a single dose of anaesthetic directly into the fluid around the spinal cord. You will go numb very quickly, but the amount of anaesthetic cannot be topped up.

General anaesthetic

You might be given a general anaesthetic if

• a spinal block or epidural anaesthetic doesn’t work
• there isn’t time for a spinal block or epidural anaesthetic to be used
• there are concerns for your health or your baby’s health
• you request a general anaesthetic

What are the risks and complications of C-sections?

A caesarean is major surgery. Complications are rare but they can be serious. The risks include:

• blood loss
• wound infection
• blood clots
• possible damage to organs near the operation site, such as your bladder
• risks from the anaesthetic

The risk of complications increases if you are overweight.

If you have a caesarean, your future pregnancies will be considered higher risk and there are more risks with future caesareans.

Sometimes babies born by C-section can have temporary trouble breathing. The midwife and paediatrician will take care of your baby. There is a very small chance your baby can be cut during the operation. This is usually a small cut that isn’t deep and will heal on its own.

What should I expect when recovering from a caesarean birth?

There is usually a slower recovery after a caesarean birth compared with vaginal birth. You may feel pain for a few days, but this can usually be treated with pain-relief medication. Usually, you will stay in hospital for three to five days.

Your obstetrician and midwife will provide advice about your recovery.