What is a Caesarean birth?
A Caesarean birth is a means of delivering your baby through the abdomen (tummy). It’s performed by a doctor, through a horizontal incision around your public hair line. The reason for this operation being offered to you will have been discussed with you by your doctor in the antenatal clinic, who will ask you sign a consent form for the operation.
Giving your consent
Your doctor will explain the operation, its procedure and the risks to you, as well as answering any questions you may have. They will then ask you to sign a consent form.
Most Caesarean births are straightforward and carried out by a senior doctor. However, it is important that you are aware of any potential risks. These include:
- Thrombosis (blood clothes in the leg and chest) – although this is uncommon
- Infection – particularly wound, bladder, and chest infections – affect between 10 and 20 women in every 100
- Major bleeding or damage to the structures in your pelvis close to your womb, such as your bladder, ureters (the tubes which carry urine from your kidneys to the bladder) and your bowel. This only affects one in every 1,000 women.
- Haemorrhage – which may require a blood transfusion or hysterectomy
Complications of Caesarean sections do not happen often but you should be aware of them. Please feel free to discuss the risks with your midwife, obstetrician, or anaesthetist.
What anaesthetic is required?
If your Caesarean is planned, in most cases, it is safer for you to have a spinal anaesthetic – an injection in your spine which numbs you from the top of your womb down.
Your recovery from this type of anaesthetic is quicker, with fewer side effects than a general anaesthetic (when you’re asleep). You’ll be able to discuss your options with the Anaesthetist just prior to your operation.
Preparing for a Caesarean birth
You will be given an appointment to attend the Antenatal Day Unit between 24 and 48 hours prior to your procedure, for a pre-operative assessment and to further discuss your Caesarean.
At this point, any queries you may have will be answered and the following will be undertaken:
- If you have not already signed it in clinic, you will be asked to sign your consent form for the operation
- You’ll be given medication to be take home with you that will reduce the acid in your stomach and prevent sickness. You’ll be asked to take one tablet in the evening before the operation – at around 10pm – and the second on the morning of your operation – at around 7am.
- You’ll be asked questions about any recent hospital admissions, for the purpose of Infection Control Screening (CPE)
- A sample of your blood will be taken to store, in case you need a blood transfusion during, or after the delivery
- A swab will be taken from your nostril to check if you are a carrier of MRSA bacteria or Covid-19
- A full antenatal check may be carried out, including taking your blood pressure, a urine test, taking your temperature, checking your pulse and measuring your weight
What happens on the day of a Caesarean birth?
You’ll usually be asked to come to the hospital for around 8am on the morning of your operation. This may vary on occasions, but the midwife will discuss this with you individually and you will be told where you need to come.
- Bring your maternity notes with you
- Have a bath or shower before you come to hospital
- Remove any nail polish on your toe and fingernails – including gels and false nails
- Remove any contact lenses
- Leave your valuables and jewellery at home
- Remove any body piercings
Please do not:
- Have anything to drink or eat after midnight – including chewing gum
- Wear aby makeup on the day of admission – including false eyelashes
Your wedding ring may be taped until after your operation and you will also be asked if you have any loose teeth, caps, or crowns.
If your operation is in the morning:
Please don’t have anything to drink or eat after midnight the night before. If you are diabetic, a plan of care and management of your diabetes will be discussed with the medical doctor prior to admission.
You can take your antacid medication, as prescribed, on the morning of your operation, with a small sip of water.
How long does the operation last?
An elective Caesarean usually takes between 30 and 45 minutes to complete, once your anaesthetic is in place.
Can my partner/ birth partner be there?
We’re asking every birth partner to take a self-administered Lateral Flow test. The result returns within 30 minutes. They will also be asked to wear a mask in theatre.
If you have a spinal anaesthetic, your partner can be in theatre with you and, because you are awake, you may be able to hold your baby immediately.
Partners are usually asked to wait outside whilst the epidural or spinal anaesthetic is being put in. This can take up to 45 minutes, so please don’t worry during this time.
Your partner will be asked to change into theatre clothing on entry to the theatre. Please note, we cannot be responsible for valuables left in the changing room.
If you are having a general anaesthetic (when you go to sleep), your partner may accompany you to the theatre entrance but will not be allowed to stay with you throughout the operation. They will be shown where to wait.
In this situation, any requests regarding the giving of specific information – such as the time of birth, or sex of your baby, must be identified to your midwife prior to your operation.
What happens when I arrive at the hospital on the day of my operation?
Before the operation:
- You will have routine observations carried out, including taking your temperature, pulse and blood pressure
- A name band and allergy band will be placed on your wrist
- You may need to have your bikini line trimmed
- You will be given a hospital gown and paper hat to wear
- If you’re able to walk to theatre, please bring a dressing gown and a pair of well-fitting slippers
Equipment will be attached to you to measure your blood pressure, heart rate and the amount of oxygen in your blood.
The anaesthetist will also set up a drip. This allows us to give you fluid and drugs throughout the operation. You will also be given antibiotics during the operation.
A catheter will be inserted into your bladder prior to the operation and removed as soon as you’re mobile after the operation.
What will happen during a Caesarean where you’re awake?
The anaesthetic is given with a spinal injection and you will be asked to sit or lie on your side, curling your back. Your back will then be sprayed with some very cold antiseptic.
The anaesthetist will examine your back to find the best place to give you your injection. Local anaesthetic is given so that you do not feel the injection. This sometimes stings for a moment.
The spinal anaesthetic works very quickly. First you may notice a warm feeling in your bottom and very soon your legs will begin to feel heavy and warm – they may start to tingle. Numbness will spread gradually up your body.
You will be helped to lie down on the operating table by clinical staff. You may notice that the table is tilted sideways slightly. Don’t worry – this is to help you maintain your blood pressure.
The anaesthetist will check how far the anaesthetic has spread by using something cold or a light touch on your tummy. This is to make sure you’re ready for the operation.
If you don’t already have a catheter (a plastic tube into your bladder), one will be inserted at this stage to ensure that your bladder remains empty during the operation. This will usually be removed after 12 to 24 hours.
There will be a screen between you and your tummy so you may not be able to see what is going on. If you wish to see what is happening, please discuss this with the team caring for you.
During the operation, it’s normal to feel some strange sensations, such as pushing and pulling, but there shouldn’t be any pain. Your blood pressure may drop and this can me you feel lightheaded and sick. If this happens, you can be given medication through your drip to help make you feel better.
The anaesthetist will assess you throughout the operation and give you pain relief if required.
From the start of the operation, it will take about ten minutes before your baby is delivered. Immediately after the birth, the midwife will dry and examine your baby. A paediatrician may also be present. After this, you and your partner will be able to hold your baby and have your baby skin to skin.
After your baby has been born, a drug called Syntocinon may be put into your drip to help you deliver the placenta. The remainder of the operation takes about 30 minutes. At the end of the operation, you will be given a wash and offered a suppository (which is administered anally) to relieve pain after the anaesthetic has worn off.
After the operation, you will be transferred onto a bed and helped to sit up slightly. You will then be taken to the recovery area, if you’re in Scunthorpe, or to your room if you’re in Grimsby. You will be under observation for a while and this will include checking your pulse, blood pressure and wound. Your partner and baby can usually be with you.
Are there any risks or side effects?
If the spinal anaesthetic is not successful in making you numb, then the injection can be repeated. However, this is rare. If it still doesn’t work adequately, you will be offered a general anaesthetic instead.
Numbness from a spinal anaesthetic usually lasts between two and three hours.
As well as local anaesthetic, the spinal injection contains a painkiller which will keep your comfortable after the numbness has worn off. A side effect of the pain killing injection is that it can make you itch – but if this becomes a problem, you will be offered something to help relieve this.
What happens during a Caesarean birth when you’re asleep?
Once shown to the theatre, where your delivery will take place, you will be asked to lie down on the theatre table, which is tilted. In theatre, equipment will be attached to you to measure your blood pressure, heart rate, and the amount of oxygen in your blood.
The anaesthetist will set up a drip. This allows us to give you fluid and drugs throughout the operation. Before the operation, you will be given a small drink of antacid medicine.
The anaesthetist will give you oxygen to breathe through a face mask for a few minutes and anaesthetic will be given to you via the drip, to send you to sleep. This works very quickly. As you are given your anaesthetic, the anaesthetist’s assistant will press on the front of your neck. This is normal, and is to stop anything coming up from your stomach and interfering with the anaesthetic.
Whilst you are asleep, you will have a tube inserted into your mouth, which goes into your windpipe. This is attached to a breathing machine to breathe for you. Your heartbeat, blood pressure and pulse are measured at intervals whilst you are asleep. When you wake up, your throat may feel a little uncomfortable and sore.
You will be given a strong, painkilling injection into your drip and suppository to make you comfortable when you wake up. It’s common to feel drowsy and sick for a few hours afterwards but medication can be given for the sickness.
You will be taken to the recovery area, where you will meet up with your partner and baby. At Grimsby you will return to your room.
Are there any risks or side effects?
There is a small risk of acid from your stomach finding its way into your lungs during your anaesthetic. Every effort is made to minimise this happening by having nothing to eat prior to the operation and taking antacid tablets as prescribed. Acid from the stomach in the lungs can result in a severe form of pneumonia, but this is very rare.
You may have a sore throat if you have had a general anaesthetic and a drink of water may help to ease this. You can drink water to quench your thirst as soon as you like, or possibly a cup of tea if you have not had a spinal anaesthetic.
Even through you have had a Caesarean birth, the lining of your uterus (womb) still needs to be shed, so expect a fairly heavy period-type loss for the first few days.
Sometimes after a Caesarean birth you may feel ‘chesty’, especially if you have a general anaesthetic or you’re a smoker. A physiotherapist will be called if the doctor considers this necessary.
It is important that your breathe deeply and support your wound when coughing – either with your hands or a cushion.
Feeding and care of your baby
You and your partner will be given support with caring for your baby. You will be given help to find a comfortable position in which to feed your baby.
Pain relief following the operation
There are several ways to give you pain relief after a Caesarean birth. These include:
- Suppositories after often given at the end of the operation
- A morphine or similar painkilling injection into a muscle
- A morphine or similar drug is fed into a drip – which you can control. This is called patient controlled analgesia (PCA) and is used occasionally at Scunthorpe – usually after a general anaesthetic.
- By mouth – a midwife can give you tablets such as Voltarol or Paracetamol as regularly as needed
- Once you’re home, you can take Paracetamol and/ or ibuprofen. These will have no effect on breast feeding. If you require stronger pain relief, please discuss this with your midwife, as some drugs cannot be used if you’re breastfeeding.
Day of birth
Your midwife will examine you to ensure you are progressing normally. If all is well, your intravenous infusion can be discontinued and you can have something to eat.
At this point, your catheter can be removed – although we will need to know when you pass urine to measure your first void.
You will be able to sit out of bed and walk to the toilet, and your wound dressing will be removed, as well as any wound drains that are no longer required.
You will be offered a bed bath around eight hours after the birth.
After 24 hours, if you feel you would like a shower or a bath, our staff will assist you. Your wound dressing will be removed and you should try and walk as upright as you can.
The wound area should be kept clean and dry and will normally heal within a few days of the birth.
Your wound can either be sutured with stitches or closed with staples. Some stitches are dissolvable, while others will need removing. Your midwife will discuss this with you and put a plan in place. The midwife will also check your wound at each post-natal visit, to ensure that healing is taking place.
A lot of women suffer from post-operative wind pains. You may relieve this a little by keeping yourself as mobile as possible and walking upright. If you cannot get relief, ask your midwife for medication.
Your blood pressure, temperature, pulse and fluid balance will be monitored for at least 48 hours to ensure that everything is progressing normally.
These are worn for six weeks after your operation to reduce the risk of thrombosis (a blood clot). You may also be given a small injection each day, for at least ten days, which helps prevent blood clots from developing.
At the Diana, Princess of Wales Hospital, Grimsby, you will also wear compression boots for the first 24 hours, to further reduce the risks of clots forming in your legs.
You can be discharged home between 24 and 48 hours after the birth of your baby, depending on how you’re feeling.
If you meet certain criteria, you can have an enhanced recovery and go home after 24 hours if you wish. Please discuss this with your midwife.
To prepare you for this, you will be encouraged to make sure you drink plenty of clear fluids and eat a carbohydrate rich supper, no later than eight hours prior to the birth. After the birth, you will be encouraged to drink and have a light meal within the hour after the birth. Regular pain killers should be taken to help you with walking and with feeding your baby.
Recovery does take time and you should take things easy at first, gradually building up activities as your body allows.
When can I start to do housework?
As soon as you feel able. Avoid hoovering and ironing for four to six weeks. Avoid lifting or carrying anything heavier than your baby for at least 12 weeks.
How much rest should I take?
It is advisable to rest on your bed at least once a day to avoid getting over tired. Remember, you tire very easily caring for yourself and your baby. Accept all the offers of help – only you will know when you are ready to do all the work yourself again.
When can I start driving again?
We advise you wait four to six weeks following the birth of your baby. Make sure you check with your insurance company before you start to drive again.
Date of issue – March, 2022.
Review period – March 2025