Overview – Caesarean section

If there’s time to plan the procedure, your midwife or doctor will discuss the benefits and risks of a caesarean compared with a vaginal birth.

Medical reasons for a c-section

A c-section (short for Cesarean birth) is surgery in which your baby is born through a cut that your doctor makes in your belly and uterus. For some women and babies, a c-section is safer than vaginal birth. If you have medical conditions that affect your pregnancy, you may need a c-section to protect the health of your baby.

A c-section may be planned (also called scheduled). This means you and your health care provider decide when to schedule the c-section based on your health condition and the condition of your baby. Or a c-section may be an emergency. An emergency c-section has to be done immediately because your health or your baby’s health is in danger.

If there are medical reasons to schedule your c-section, talk to your provider about waiting until at least 39 weeks of pregnancy. This gives your baby the time she needs to grow and develop before birth. Scheduling a c-section should be for medical reasons only.

What are medical reasons for a c-section?

You may need a c-section because of complications that make vaginal birth unsafe for you or your baby. For example:

Complications during pregnancy

• You’ve had a c-section in the past or you’ve had other surgeries on your uterus (womb). The more c-sections you have, the greater your risk for pregnancy complications. Some women can safely have a vaginal birth after they’ve had a c-section. This is called a VBAC. If you’ve had a c-section in the past, talk to your provider to see if VBAC may be possible in your next pregnancy.
• There are problems with the placenta, such as placenta previa, which can cause dangerous bleeding during vaginal birth. The placenta grows in your uterus and supplies the baby with food and oxygen through the umbilical cord.
• You have an infection, like HIV or genital herpes. You can pass these infections to your baby during vaginal birth. So a c-section is safer for your baby.
• You have a medical condition that may make vaginal birth risky, like diabetes or high blood pressure. Diabetes is when you have too much sugar in your blood. This can damage organs in your body, like blood vessels and nerves. High blood pressure is when the force of blood against the walls of the blood vessels is too high. It can stress your heart and cause problems during pregnancy.
• You’re having multiples (twins, triplets or more).

Complications that affect your baby and labor and birth

• Your labor doesn’t progress. This means it’s too slow or stops.
• Your baby is very large.
• Your baby isn’t in a head-down position for birth. If your baby is in a breech position, it means his bottom or feet are facing down. A transverse position is when your baby’s shoulder is facing down. Some babies can be turned in the womb to move into a head-down position. But a c-section may be safer for your baby.
• The umbilical cord is pinched or you have umbilical cord prolapse. This is when the umbilical cord slips into the vagina before the baby.
• Your baby is in distress. This means he isn’t getting enough oxygen or his heartbeat may not be regular.
• Your baby has certain birth defects, like severe hydrocephalus. This is when fluid builds up on your baby’s brain. It can cause a baby’s head to be very large. Birth defects are health conditions that are present at birth. They change the shape or function of one or more parts of the body. Birth defects can cause problems in overall health, how the body develops or how the body works.

What are the risks of scheduling a c-section for non-medical reasons?

Scheduling a c-section may cause problems for you and your baby because your due date may not be exactly right. Sometimes it’s hard to know exactly when you got pregnant. If you schedule a c-section and your due date is off by a week or 2, your baby may be born too early. Babies born early (called preterm babies) may have more health problems at birth and later in life than babies born on time. This is why it’s important to wait until at least 39 weeks for a scheduled c-section.

If your pregnancy is healthy, it’s best to let labor begin on its own. If your provider talks to you about scheduling a c-section, ask if you can wait until at least 39 weeks to have your baby. This gives your baby’s lungs and brain all the time they need to fully grow and develop before he’s born.

If there are problems with your pregnancy or your baby’s health, you may need to have your baby earlier than 39 weeks. In these cases, your provider may recommend an early birth because the benefits outweigh the risks. Having a c-section before 39 weeks of pregnancy is recommended only if there are health problems that affect you and your baby.

If your provider recommends scheduling a c-section, ask these questions:

• Why do I need to have a c-section?
• Is there a problem with my health or the health of my baby makes it necessary to have my baby before 39 weeks? Can I wait to have my baby closer to 39 weeks?
• What problems can a c-section cause for me and my baby?
• What will my recovery be like?
• Can I have a vaginal birth in future pregnancies?

Last reviewed: October, 2018

Overview – Caesarean section

The cut is usually made across your tummy, just below your bikini line.

A caesarean is a major operation that carries a number of risks, so it’s usually only done if it’s the safest option for you and your baby.

Around 1 in 4 pregnant women in the UK has a caesarean birth.

Why caesareans are carried out

A caesarean may be recommended as a planned (elective) procedure or done in an emergency if it’s thought a vaginal birth is too risky.

Planned caesareans are usually done from the 39th week of pregnancy.

A caesarean may be carried out because:

• your baby is in the breech position (feet first) and your doctor or midwife has been unable to turn them by applying gentle pressure to your tummy, or you’d prefer they did not try this
• you have a low-lying placenta (placenta praevia)
• you have pregnancy-related high blood pressure (pre-eclampsia)
• you have certain infections, such as a first genital herpes infection occurring late in pregnancy or untreated HIV
• your baby is not getting enough oxygen and nutrients – sometimes this may mean the baby needs to be delivered immediately
• your labour is not progressing or there’s excessive vaginal bleeding

If there’s time to plan the procedure, your midwife or doctor will discuss the benefits and risks of a caesarean compared with a vaginal birth.

Asking for a caesarean

Some women choose to have a caesarean for non-medical reasons.

If you ask your midwife or doctor for a caesarean when there are not medical reasons, they’ll explain the overall benefits and risks of a caesarean to you and your baby compared with a vaginal birth.

If you’re anxious about giving birth, you should be offered the chance to discuss your anxiety with a healthcare professional who can offer support during your pregnancy and labour.

If after discussing all the risks and hearing about all the support on offer you still feel that a vaginal birth is not an acceptable option, you should be offered a planned caesarean. If your doctor is unwilling to perform the operation, they should refer you to a doctor who will.

What happens during a caesarean

Most caesareans are carried out under spinal or epidural anaesthetic.

This mean you’ll be awake, but the lower part of your body is numbed so you will not feel any pain.

During the procedure:

• a screen is placed across your body so you cannot see what’s being done – the doctors and nurses will let you know what’s happening
• a cut about 10 to 20cm long will usually be made across your lower tummy and womb so your baby can be delivered
• you may feel some tugging and pulling during the procedure
• you and your birth partner will be able to see and hold your baby as soon as they have been delivered if they’re well – a baby born by emergency caesarean because of foetal distress may be taken straight to a paediatrician for resuscitation

The whole operation normally takes about 40 to 50 minutes.

Occasionally, a general anaesthetic (where you’re asleep) may be used, particularly if the baby needs to be delivered more quickly.

Recovering from a caesarean

Recovering from a caesarean usually takes longer than recovering from a vaginal delivery.

Providing there are no complications, most women can go home 1 to 2 days after having a caesarean.

You may experience some discomfort in your tummy for the first few days. You’ll be offered painkillers to help with this.

When you go home, you’ll need to take things easy at first. You may need to avoid some activities, such as driving, until you have had your postnatal check-up with the doctor at 6 weeks.

The wound in your tummy will eventually form a scar. This may be obvious at first, but it should fade with time and will often be hidden in your pubic hair.

Risks of a caesarean

A caesarean is generally a very safe procedure, but like any type of surgery it carries a certain amount of risk.

It’s important to be aware of the possible complications, particularly if you’re considering having a caesarean for non-medical reasons.

Possible complications include:

• infection of the wound or womb lining
• blood clots
• excessive bleeding
• damage to nearby areas, such as the bladder or the tubes that connect the kidneys and bladder
• temporary breathing difficulties in your baby
• accidentally cutting your baby when your womb is opened

Future pregnancies after a caesarean

If you have a baby by caesarean, it does not necessarily mean that any babies you have in the future will also have to be delivered this way.

Most women who have had a caesarean section can safely have a vaginal delivery for their next baby, known as vaginal birth after caesarean (VBAC).

But you may need some extra monitoring during labour just to make sure everything is progressing well.

Some women may be advised to have another caesarean if they have another baby.

This depends on whether a caesarean is still the safest option for them and their baby.

Page last reviewed: 04 January 2023
Next review due: 04 January 2026

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