What is caesarean birth (C-section)?

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

You might plan for a caesarean, or your medical team might recommend you have a caesarean after labour begins.

Around 4 in every 10 babies born in Australia in 2023 were born by caesarean.

Why might I need a C-section?

A caesarean might be elective (planned) if there is a known reason that your baby can't be born by a vaginal birth, or if caesarean birth is your preference.

Sometimes complications develop before or during labour, and your doctor will recommend having a caesarean quickly. This is called an emergency caesarean.

Your doctor may recommend a caesarean if:

• there are concerns for your safety or your baby's safety
• your baby is in a breech position (bottom first) and vaginal birth is not recommended
• you are pregnant with twins and the first baby is in a breech position
• your placenta is covering the cervix (opening to the womb)
• you have had previous caesareans and vaginal birth is not recommended
• you have complications, such as severe bleeding
• your labour is not progressing

It's a good idea to think about how you would like to give birth before your labour begins. Discuss your birth plan, and the possibility of caesarean, with your doctor or midwife, as well as your birth partner.

In Australia, your healthcare rights mean that you can ask questions and make decisions about your labour and birth. Your healthcare team need to provide enough information for you to give informed consent about your care.

What should I expect if I have a caesarean?

If you have a caesarean birth you will usually be in the operating room for about an hour. The operation takes about 30 to 40 minutes. The baby is usually born in the first 10 minutes.

You will usually have an epidural (spinal anaesthetic). This numbs the lower part of your body and means you can be awake during the birth. Sometimes an emergency caesarean must be done under general anaesthetic. This means you will be asleep during the birth.

A catheter (a thin flexible tube) will be placed into your bladder to drain urine (wee). This is because you will not be able to get up to use the bathroom. You shouldn't feel it being inserted because of the anaesthetic medicines.

A screen is usually put across your chest so you can't see what is happening. The procedure usually follows these steps:

1. Your tummy will be cleaned.
2. The obstetrician (doctor) will make a cut through the skin of your abdomen (tummy) near the bikini line.
3. The doctor will cut through layers of fat and muscle and then through your uterus.
4. Your baby will be birthed through this cut in your tummy.
5. Your doctor will remove the placenta and close the cut with stitches or staples.

If your doctor needs to birth your baby very quickly, the cut may extend from just below your belly button.

During a caesarean you will feel tugging and pulling if you are awake. You will also hear fluid being suctioned. You should not feel any pain.

What happens to my baby during a caesarean section?

After your baby is born, the doctor will hand them to the midwife or paediatrician who will clean away the amniotic fluid and check their condition. If your baby is well, you will be able to have skin-to-skin contact with your baby while you are still on the operating table. There are many benefits of skin-to-skin contact for both you and your baby.

Sometimes your baby's nose and mouth need to be cleared of fluids to help them breathe. If your baby is having trouble breathing or there are any other worries, a paediatrician will care for them in the operating room.

Who will be in the operating room?

Your partner or support person will usually be able to be with you during your caesarean. The other people in the operating room could include:

• obstetrician — doctor who performs the operation and delivers your baby
• anaesthetist — doctor who gives you anaesthetic medicine
• scrub nurse — nurse who passes instruments to the obstetrician
• scout nurse — nurse who assists the scrub nurse and gathers any additional equipment
• anaesthetic nurse — nurse who assists the anaesthetist
• paediatrician — doctor who looks after your baby after the birth
• midwife — nurse who looks after the baby until you are moved to the postnatal ward
• operating room technician — staff member who prepares and maintains the operating room

Can I have my support person with me?

Usually you can have one support person, for example your partner, with you in the operating room. They will be given scrubs and a theatre hat to wear. They must wear closed in shoes.

If you need to have a general anaesthetic your partner will not be in the operating room because you will be asleep.

What are the pain relief options?

Your doctor will recommend the most appropriate pain relief for you. You can ask questions about the pain relief available.

Epidural

An epidural involves inserting a hollow needle and a small, flexible tube (catheter) near the spinal cord in your back. The needle is removed, leaving the catheter in place.

Anaesthetic medicine is injected through the catheter. The anaesthetic medicine can be topped up later if needed.

Spinal block

A spinal block is a single dose of anaesthetic medicine that is injected directly into the fluid around your spinal cord. You will go numb very quickly after a spinal block. The amount of anaesthetic cannot be topped up.

General anaesthetic

If you have a general anaesthetic, you will be asleep during the operation and when your baby is born.

Your doctor might give you a general anaesthetic if:

• a spinal block or epidural anaesthetic isn't working
• there isn't enough time for a spinal block or epidural anaesthetic to be used
• it isn't safe to give you an epidural or spinal anaesthetic
• you request a general anaesthetic

What are the risks and complications of a caesarean?

A caesarean is a major operation. Complications are rare but they can be serious.

Risks to you

Risks to you include:

• blood loss
• wound infection
• blood clots, in your legs or lungs
• damage to organs near the operation site, such as your bladder
• risks from the anaesthetic, such as low blood pressure and nausea
• hysterectomy (removing your uterus) — this is rare, and only occurs if the amount of bleeding is life threatening

The risk of complications is higher if you are living with overweight or obesity.

If you have a caesarean, your future pregnancies may be considered higher risk.

Risks to your baby

Risks to your baby include:

• temporary difficulty breathing
• a small cut during the operation, which usually heals on its own
• bruising, as your doctor may need to use forceps to birth your baby

If your baby has trouble breathing, the midwife and paediatrician will take care of them.

What should I expect when recovering from a caesarean birth?

After a caesarean section, midwives and nurses will look after you in the recovery room until you're ready to go to the postnatal ward. Usually, you will stay in the postnatal ward for 3 to 5 days. Before you go home you can learn more about looking after your new baby.

In most cases you can breastfeed your baby soon after a caesarean. Often within an hour. Here are some tips that may help:

• If you're sore from the operation, ask your midwife to help you position your baby.
• Ask your midwife to organise a visit with a lactation consultant if you would like extra support.
• Take your pain-relief medicines as advised, to help make breastfeeding more comfortable.
• If you and your baby are well, have skin-to-skin contact with your baby as soon as possible after birth.

Having a caesarean can cause a slight delay in your milk coming in. Don't be discouraged — often it just takes a little more time.

You may feel pain for a few days — your doctor will recommend a pain-relief medicine to help.

If your wound has been closed with staples, these will need to be removed around 7 days after your caesarean. If you have stitches, they will usually be dissolvable stitches. This means they will be gradually absorbed by your body.

Read more on recovery after a caesarean.

What are my birth options for future pregnancies?

It's often possible to have a vaginal birth after caesarean section (VBAC). This can be a safe choice for many women.

However, your chance of pregnancy complications increases with each caesarean you have. Complications can include:

• problems with the position of your placenta
• problems with your placenta detaching after the birth
• needing hysterectomy, which would prevent you from having any future pregnancies

Sometimes a planned caesarean for your next birth is a safer option than a vaginal birth.

Discuss your options with your midwife and doctor early in your next pregnancy, including:

• your birth preferences
• the risks and benefits of each option

In Australia you have the right to make a shared decision with your doctor about your care.

Resources and support

The Royal Australian College of Obstetricians and Gynaecologists offers information about what to expect during a caesarean birth.

Learn more about elective and emergency caesarean birth from the Queensland Government.

Languages other than English

Health Translations Victoria has fact sheets in multiple languages, including:

• managing your pain following a caesarean
• going home after a caesarean birth
• anaesthetic medicines used during a caesarean