Caesarean section Heather Welford A very few women choose to give birth by caesarean, but for others it's a decision taken when a vaginal delivery stops progressing as it should, or when problems are anticipated. But what are the implications?

In this article

Elective and emergency caesareans How it's done

Recovery How you'll feel

Can I choose to have a caesarean?

Babies born by caesarean (C-section) come out through incisions in your uterus and abdomen. If you decide to have a caesarean, or, more likely, you're advised to have one in advance of labour, it's called an 'elective' caesarean.

One that takes place after you've already gone into labour is called an emergency caesarean.

In your notes, you may see it written as CS, LSCS (lower segment caesarean section) or LUSCS (lower uterine segment caesarean section).

Reasons you might need a caesarean include:

• Your baby's head is too large to fit through your pelvis
• The shape or size of your pelvis makes a vaginal birth more difficult
• The placenta is lying low in the uterus (placenta praevia), blocking your baby's exit
• You're expecting twins or triplets (one of whom may be in a difficult position)
• Your baby's lying across the uterus, or is breech (bottom or feet first)
• Once labour has begun, your baby becomes distressed (suffering from a lack of oxygen) and isn't far enough down the birth canal for forceps or ventouse
• You have eclampsia or severe pre-eclampsia
• You're ill, have high blood pressure, or become exhausted in labour

You'll be given an anaesthetic (if you haven't had one already). The anaesthetic used is almost always given as an epidural, which allows you to stay awake. Occasionally, a general anaesthetic is used.

If you're conscious, you can have someone with you in the operating theatre. Neither you nor your companion will be able to see what's going on, as a screen will be placed across your abdomen.

The surgeon makes an incision in your abdomen, just above your pubic hairline, and cuts through the uterus. The baby is then helped out. You might feel quite a bit of tugging and pulling when this happens.

Once the baby is delivered, the cord is clamped and cut. If everything's all right, you can hold him. The placenta and the membranes are then delivered and you are stitched up. The whole thing takes about 45 minutes.

It's normal to feel very tired for a few days after a caesarean and you may experience some pain, just as you would with any abdominal operation. You can take pain relief to help with this. Trapped wind is a common problem, too.

Recovery after a caesarean can take longer than a vaginal birth. There may also be after-effects, such as infection, which is why you'll probably be advised to take antibiotics.

In the first day or so, you may be attached to a tube that collects any blood pooling under the scar. A drip in your arm makes sure you remain hydrated. At the very beginning, you may also need a catheter or bedpan to help you urinate.

Ask what sort of stitches you have. They may dissolve or need removing later, or you may have clips that will need removing once you've healed.

Some women feel disappointed at having an emergency caesarean. If you feel like this, talk to the medical staff about the reasons why a caesarean was necessary. Understanding this can sometimes help you come to terms with it.

You may have no negative feelings at all about your caesarean. This, too, is fine.

Next time

You may be able to have a vaginal birth in the future, depending on the underlying cause of your caesarean.

There's no evidence that 'once a caesarean always a caesarean'. There's a very small risk that the scar on your uterus might start to rupture when you go into labour, but with proper care this can be spotted before it becomes a problem.

Too many caesareans?

There's some controversy about the number of caesarean performed: the total is rising year on year. The climate of 'over-medicalisation' of childbirth and fear of litigation if a vaginal birth goes wrong are thought to be among the reasons for the rising trend.

Statistics from the Department of Health show that one in four babies is born by caesarean in England, with many regional variations. In 1980, the number of caesareans in England was much lower, at nine per cent.

You won't automatically be given a caesarean on request, at least not on the NHS. But your doctor should listen to your reasoning. If your doctor and midwife are reluctant to grant your request, it may be because they feel there's no medical reason for it.

Understanding what happens during birth might be one way of coping with any anxieties you have about vaginal birth.

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