Caesarean Birth

If you are considering a planned caesarean birth it is important to consider the risks and benefits to you and your baby. This information is not for you if you have already been offered a caesarean birth because of specific reasons in your pregnancy, as the benefits and risks will be different. 

The Royal College of Obstetricians and Gynaecologists have produced the following leaflet to help you in your decision making. 

Considering a caesarean birth | RCOG

This animation is designed to support the informed consent process for planned caesarean births by outlining the risks and benefits.

Animation - Informed consent in planned caesarean birth

You will have been given an approximate date for your Elective Caesarean Birth. You will receive a telephone call the week before with confirmation of the date of your Caesarean Birth and a date for your Pre-operative Assessment.

During your Pre-operative Assessment appointment, blood tests may be taken and you will be given information about eating and drinking and instructions about any regular medication prior to your Caesarean Birth.

You will be given some antacid medication (to reduce the acid in your stomach) and advised when to take them.

The Maternity Support Worker will confirm that your consent form has been signed.

The following information is a quick guide to preparing for your caesarean birth and will be discussed with you at your pre-operative assessment, however we recommend you read this leaflet in full.

We also recommend that you watch our video ‘Your Elective Caesarean Birth’ on this page.

What are the risks of a caesarean birth?

Serious risks:

• Emergency hysterectomy, 7 to 8 women in every 1000 (uncommon)
• Need for further surgery at a later date, 5 women in every 1000 (uncommon)
• Admission to intensive care unit, 9 women in every 1000 (uncommon)
• Increased risk of a tear in the womb in future pregnancies, 2 to 7 women in every 1000 (uncommon)
• Developing a blood clot, 4 to 16 women in every 10,000 (rare)
• Stillbirth in future pregnancies, 1 to 4 women in every 1000 (uncommon)
• In a future pregnancy, the placenta covers the entrance to the womb (placenta praevia), 4 to 8 women in every 1000 (uncommon)
• Injury to the urinary system, 1 woman in every 1000 (rare)
• Death, approximately 1 woman in every 12,000 (very rare)

Frequent Risks:

• Common: persistent wound and abdominal discomfort, repeat caesarean birth in subsequent pregnancies, readmission to hospital, minor cuts to the baby’s skin
• Less common: Haemorrhage, infection

How should I prepare for my caesarean birth?

• If your caesarean birth is in the morning, have no food after 3.00am and have only clear still fluids up to 7.00am on the day of your caesarean birth. It is a good idea to get up early to have a drink of water/dilute squash/black tea or coffee on the morning of your caesarean birth. This will help you feel less thirsty later.
• If your caesarean birth is in the afternoon, have no food after 7.00am and have only clear still fluids up to 11.00am on the day of your caesarean birth.
• If you have Diabetes the advice given may be different.
• Remove any nail varnish/ gel/ acrylic nails/make up/jewellery and piercings prior to coming to hospital. Any jewellery/piercings that cannot be removed can be covered with tape.
• Have a bath/shower on the morning of the caesarean birth or the night before, as this reduces the risk of surgical site infection.
• Information about the anaesthetic for your operation and the pain relief afterwards can be found on the website labourpains.com. Your anaesthetist will also explain this on the day.

What happens while I am in hospital?

• You will be kept informed of any delays or possible cancellations.
• The Anaesthetist and Obstetrician will see you before your operation.
• After your operation you will spend some time in the recovery room prior to being taken to the maternity ward.
• You will be given regular pain relief and an injection to prevent blood clots in your legs/lungs.
• Your catheter will be removed six hours following the operation and you will be encouraged to get out of bed and have a shower.
• Depending on how well you and your baby are, you may be able to go home the day after your operation.

To help you recover more quickly from your elective caesarean birth we recommend that you follow the advice below. It has been shown that knowing what will happen during your caesarean birth and early mobilisation will reduce the risk of complications and the length of your stay in hospital. It will also help you to return to normal daily life more quickly.

What happens on the day of admission?

On the day of your caesarean birth please arrive at Ward 23 at 7.30am (for planned for the morning) and 11am (for births planned for the afternoon). Please do not arrive any earlier than your scheduled time as you will not be able to access the ward before your scheduled time. You will be greeted by a staff member who will show you into the waiting room. Soon after admission you will be shown to a bay and advised of the time you should expect to be taken to theatre.

The Midwife will go through a checklist to ensure you are ready to go to theatre.  This will include attaching a wristband and ensuring any nail varnish and jewellery are removed. You will be given a gown to put on. Your blood pressure, pulse and temperature will be taken and you will be asked for a urine sample.

The Midwife will check the position of your baby and will listen to your baby’s heartbeat.

The Anaesthetist and Obstetrician will visit you prior to your procedure. You will be asked about your medical history and options for anaesthesia will be discussed.

In some circumstances your caesarean birth may be delayed if staff are required to attend to emergencies on the Labour Ward. You will be kept fully informed by the Midwife of any delays and the reasons for this. If your surgery is delayed it is recommended you drink a non-fizzy isotonic drink e.g. Lucozade.

When the theatre staff are ready, you will be taken to the operating theatre for your caesarean birth.

In the operating theatre you will have a small plastic tube called a cannula put into your arm/hand and an intravenous drip will be attached to keep you hydrated. In most cases you will receive a spinal anaesthetic, an injection in your back to stop you feeling any pain during the surgery, as this is usually the safest option for you and your baby. Occasionally, you may need to go to sleep with a general anaesthetic. A catheter will be inserted into your bladder to drain urine. Following the caesarean birth you may have a tube inserted into your abdomen to drain excess fluid, however this is rare.

What will happen after my caesarean birth?

Once you have had your caesarean birth you will be taken into the recovery room where the Midwife will carry out your observations (blood pressure, pulse, temperature, oxygen levels, breathing rate, urine output and pain assessment).

You will be offered drinks and a light meal. It is recommended that you eat the meal provided as it will enhance your recovery and the level of your nausea will be reduced. If you do feel nauseous after your caesarean birth, anti-sickness medication can be given.

Once your observations are stable you will be taken to the Maternity Ward. The Midwife on the Maternity Ward will discuss with you the frequency of your observations following your caesarean birth. The Midwife will also check your abdominal wound and your vaginal loss.  This is done regularly to ensure that you not bleeding heavily. Your intravenous fluids will be discontinued when you are able to drink normally. You will be given a dose of intravenous antibiotics during the operation to reduce the risk of getting an infection.

You will be given the call bell and advised to ring anytime if you require assistance.

What pain relief will I receive?

A spinal anaesthetic injection includes both a pain killer and local anaesthetic. If you have a general anaesthetic, you will be given some strong pain relief during your Caesarean Birth, and you may be given a local anaesthetic injection around your incision site.

You will be given regular pain relief such as paracetamol and ibuprofen and we encourage you to ask if you require more. You may also be given a pain killing diclofenac suppository (into your bottom) after your caesarean birth has been performed, this is only if it is safe for you to take nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen. This offers good pain relief and lasts longer than a tablet. In addition, you may also be given stronger pain relief such as a dihydrocodeine tablet or liquid morphine when needed. All these tablets are safe to take if you are breast feeding.

To help to prevent blood clots in your legs and lungs you will be prescribed a daily injection which will work alongside the Flowtrons™ (material wraps around your calves which inflate and deflate) until you are up and mobile. In some cases you will need to continue these blood thinning injections at home.

Please ensure that you have paracetamol and ibuprofen (if it is safe for you to take) for when you get home. It is best to take these regularly for the first few days. If you need extra pain relief and have been prescribed dihydrocodeine to take home, take these as directed on the pack, but only when you need them.

When can I move around?

After spinal anaesthesia the movement of your legs should begin to return after a few hours. The precise time varies from person to person. Once you have sufficient strength in your legs to stand up and walk to a chair you can do so. After a general anaesthetic you can mobilise once you can comfortably walk to a chair.

A member of staff will assist you the first time you get out of bed. Getting out of bed and moving around helps to prevent any chest infections and blood clots developing.

Your catheter will be removed approximately six hours following your caesarean birth. Once your catheter has been removed the Midwife will ask you to use liners provided so your urine output can be measured until you have passed at least 300mls at one time. This is to make sure that your bladder function has returned to normal.

What will happen on the first day following my caesarean birth?

On the first day following your caesarean birth it is normal to feel uncomfortable and a little unsteady due to the pain relief you have been given, this will vary from person to person. Please discuss your pain relief requirements with your Midwife regularly to ensure your individual needs are met and your pain is well controlled.

If you need any prescribed medications to take home, such as the injection to prevent blood clots, these will be given to you and the Midwife will start to plan your discharge.

When you feel ready, you will be offered assistance to the shower, and may be asked to remove your wound dressing at this time, whilst in the shower depending on the type of dressing you have.

You may also have a blood test taken to check your iron count.  If this is low, you may be prescribed some iron tablets. If your iron count has fallen significantly, we may discuss the option of a blood transfusion with you.

You should be eating and drinking as normal.  Do not worry if you have not had your bowels opened prior to going home, as this usually happens once your diet returns to normal.

How long will I stay in hospital following my caesarean birth?

Your Midwife will keep you informed of your progress throughout your stay in hospital and please feel free to ask any questions at any time about your treatment and care.

When you feel ready to go home you will be discharged by the Midwife following any routine checks on you and your baby. Discharge usually occurs on the first day after your caesarean birth, however this can depend on how you and your baby recover.

How do I care for my wound?

You should gently clean your wound with water and dry the wound with a towel every day. It is advisable to wear loose, comfortable clothes and cotton underwear. If your wound becomes more red, painful and swollen seek advice from your midwife. If there is a discharge of pus or foul-smelling fluid from your wound, you may have an infection so you must contact your midwife or GP as soon as possible so that a swab can be taken and antibiotics started if required.

What does having a caesarean birth mean for my next pregnancy?

Although it is not the first thing you are thinking about at the moment, requiring a caesarean birth for the birth of this baby this has implications for your next pregnancy.

What are my choices for birth after a caesarean birth?

More than one in five women (20%) in the UK currently give birth by caesarean birth. Many women have more than one caesarean birth. If you have had one or more caesarean births, you may be thinking about how to give birth next time. Whether you choose to have a vaginal birth or a caesarean birth in a future pregnancy, either choice is safe with different risks and benefits. Overall, both are safe choices with only very small risks. In your next pregnancy, you will have a chance to discuss which choice is the right one for you.

Contact numbers

Should you require any additional information or help, please contact Antenatal Clinic Midwives on 01270 612171

Congratulations on the birth of your baby. As you were not planning to have a caesarean birth, you may have a few questions about what it means for you and what is going to happen next.

What pain relief will I receive?

A spinal anaesthetic injection incudes both a pain killer and local anaesthetic. If you have a general anaesthetic, you will be given some strong pain relief during your caesarean birth, and you may be given a local anaesthetic injection around your incision site.

You will be given regular pain relief such as paracetamol and ibuprofen and we encourage you to ask if you require more. You may also be given a pain killing diclofenac suppository (into your bottom) after your caesarean birth has been performed, this is only if it is safe for you to take nonsteroidal anti-inflammatory drugs (NSAIDS), such as ibuprofen. This offers good pain relief and lasts longer than a tablet. In addition, you may also be given stronger pain relief such as a dihydrocodeine tablet or liquid morphine when needed. All these tablets are safe to take if you are breast feeding.

To help to prevent blood clots in your legs and lungs you will be prescribed a daily injection which will work alongside the Flowtrons™ (material wraps around your calves which inflate and deflate) until you are up and mobile. In some cases you will need to continue these blood thinning injections at home.

Please ensure that you have paracetamol and ibuprofen (if it is safe for you to take) for when you get home. It is best to take these regularly for the first few days. If you need extra pain relief and have been prescribed dihydrocodeine on discharge, take these as directed on the pack, but only when you need them.

When can I move around?

After spinal anaesthesia the movement of your legs should begin to return after a few hours. The precise time varies from person to person. Once you have sufficient strength in your legs to stand up and walk to a chair you can do so. After a general anaesthetic you can mobilise once you can comfortably walk to a chair.

A member of staff will assist you the first time you get out of bed. Getting out of bed and moving around helps to prevent any chest infections and blood clots developing. 

Your catheter will be removed approximately six hours following your caesarean birth. Once your catheter has been removed the Midwife will ask you to use liners provided so your urine output can be measured until you have passed at least 300mls at one time. This is to make sure that your bladder function has returned to normal.

What will happen on the first day following my caesarean birth?

On the first day following your caesarean birth you it is normal to feel uncomfortable and a little unsteady due to the pain relief you have been given, this will vary from person to person. Please discuss your pain relief requirements with your Midwife regularly to ensure your individual needs are met and your pain is well controlled.

If you need any prescribed medications to take home, such as the injection to prevent blood clots, these will be given to you and the Midwife will start to plan your discharge.

When you feel ready, you will be offered assistance to the shower, and may be asked to remove your wound dressing at this time, whilst in the shower depending on the type of dressing you have.

You may also have a blood test taken to check your iron count.  If this is low, you may be prescribed some iron tablets. If your iron count has fallen significantly, we may discuss the option of a blood transfusion with you.

You should be eating and drinking as normal.  Do not worry if you have not had your bowels opened prior to going home, as this usually happens once your diet returns to normal.

How long will I stay in hospital following my caesarean birth?

Your Midwife will keep you informed of your progress throughout your stay in hospital. Please feel free to ask any questions at any time about your treatment and care.

When you feel ready to go home you will be discharged by the Midwife following any routine checks on you and your baby. Discharge usually occurs on the first day after your caesarean birth, however this can depend on how you and your baby recover.

How do I care for my wound?

You should gently clean your wound with water and dry the wound with a towel every day. It is advisable to wear loose, comfortable clothes and cotton underwear. If your wound becomes more red, painful and swollen seek advice from your midwife. If there is a discharge of pus or foul-smelling fluid from your wound, you may have an infection so you must contact your midwife or GP as soon as possible so that a swab can be taken and antibiotics started, if required.

What does having a caesarean mean for my next pregnancy?

Although it is not the first thing you are thinking about at the moment, requiring a caesarean birth for the birth of this baby this has implications for your next pregnancy.

What are my choices for birth after a caesarean delivery?

More than one in five women (20%) in the UK currently give birth by caesarean birth Many women have more than one caesarean birth. If you have had one or more caesarean births, you may be thinking about how to give birth next time. Whether you choose to have a vaginal birth or a caesarean birth in a future pregnancy, either choice is safe with different risks and benefits. Overall, both are safe choices with only very small risks. In your next pregnancy, you will have a chance to discuss which choice is the right one for you.

Following your Caesarean birth it is normal to feel some discomfort and require pain relief.

In order to help you manage your post-operative pain within the first week, it is important that you take pain relief at regular intervals, regardless of your level of pain. This will keep you comfortable, and enable you to move around, which will help with your recovery but will also mean you get to enjoy your first few weeks with your new baby.

Gentle activity e.g. walking short distances after a caesarean may also help to reduce pain.

Regular pain relief, such as paracetamol and ibuprofen (if you are able) can be bought over the counter. You may need to take pain relief for 7-14 days.

Paracetamol can be taken every 4-6 hours, no more than four doses in 24 hours. Ibuprofen can be taken every 8 hours, no more than three doses in 24 hours. Follow instructions on both packets for correct dose.

If you require further pain relief, in addition to paracetamol and ibuprofen you can also take dihydrocodeine tablets. These will be given to you on your discharge from the ward. Doses are every 6 hours, no more than four in 24 hours. Follow instructions on the packet for correct dose.

All these medicines are safe to take if breastfeeding.

If you are struggling with increased pain at home, please telephone Ward 23 on 01270 612287.

Example of when to take pain relief at home: