What is caesarean birth (C-section)?

A caesarean section (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.

More than 1 in 3 babies in Australia are born by caesarean. This is higher than the rate in many other developed countries and the rate in Australia is increasing.

Why might I need a C-section?

A caesarean might be planned (elective) if there is a reason that your baby can’t be born by a vaginal birth, or if that is your birth preference. Sometimes before or during your labour, complications develop, and you need to have a C-section birth quickly. This is called an emergency caesarean. Your doctor will discuss the reason you may need a caesarean based on your individual situation and consider your preferences.

Some reasons for having a caesarean are:

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

What to expect if you have a caesarean birth

You may be in the operating room 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 can 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 also have a midwife with you. They will look after you and your baby in the operating room and recovery area.

You will usually have an epidural (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 drain urine. 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. You will have intravenous (IV) lines placed into your arm to give you fluid and medicines.

A screen is usually put across your chest so you cannot see what is happening. Your tummy will be cleaned, and the obstetrician (doctor) will make a cut through the wall of your abdomen (tummy) near the bikini 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 doctor needs to birth your baby very quickly, they may cut from just below the belly button to above the pubic bone.

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.

If you are awake, you can usually hold your baby straight after birth and begin skin-to-skin contact and breastfeeding.

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 dry your baby from the amniotic fluid and check them over. If your baby is well, you will be able to have skin-to-skin with your baby while you are still on the operating table.

Sometimes the baby’s nose and mouth need to be cleared of fluids or the baby may need to be checked by the medical team.

If your baby is having trouble breathing or there are any other worries, then the paediatrician will care for them in the operating room.

Who will be in the room?

Your partner or support person will usually be able to be with you during your caesarean.

• obstetrician — doctor who performs the operation and delivers the baby
• anaesthetist — doctor who give you 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 your baby after the birth
• midwife — nurse who looks after the baby until you return to the ward
• operating room technician — looks after the operating room and helps you on and off the operating room bed

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. 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.

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 and can be topped up later.

Spinal block

Similar to an epidural, a spinal block is a single dose of anaesthetic medicine that is injected 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

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 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 C-sections?

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

Risks to you

Risks to your baby 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
• hysterectomy (removing your uterus) — this rare complication is only if the amount of bleeding is life threatening

The risk of complications are higher if you are living with overweight or obesity. If you have a caesarean, your future pregnancies will be considered higher risk and there are more risks from the operation with future caesareans.

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 to your baby’s head or body as forceps may need to be used to help 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?

There is usually a slower recovery after a caesarean birth compared with vaginal birth. You may feel pain for a few days, but your doctor will recommend a pain-relief medicine to help. Always check with your doctor or pharmacist before taking any medicine while you’re breastfeeding.

Usually, you will stay in hospital for 3 to 5 days. Your obstetrician and midwife will provide advice about your recovery.

In most cases you can breastfeed your baby soon after a C-section. If you’re sore from the operation, ask your midwife to help you position your baby. You can also ask your midwife to organise a visit with a lactation consultant if you’d like extra support.

What are my birth options for future pregnancies?

You may be able have a vaginal birth after caesarean section (VBAC). You can speak to your midwife and doctor about the risks and benefits and check if this is an option for you.

You may prefer to have another caesarean birth. Keep in mind that the risks of complications of C-sections increase with each caesarean section that you have.

Resources and support

The Royal Australian College of Obstetricians and Gynaecologists has a detailed information page about caesarean section.

The Royal Women’s Hospital has a website all about caesarean birth.