Caesarean Section

These may include:

A caesarean section is an operation in which a baby
is born through an incision (cut) made through the
• you have already had a number of caesarean sections.
mother’s abdomen and the uterus (womb). The cut is
usually made low and around the level of the bikini line.
• your baby is in a breech position (bottom or feet
first) and cannot be turned, or a vaginal breech birth is
Planned (elective) caesarean section involves the decision, between
not recommended.
you and your doctor, to have a caesarean birth prior to the onset of
either labour or unexpected complications requiring urgent delivery.
• your placenta is partly or completely covering the cervix
Unplanned (emergency) caesarean section may be required if
(opening to the womb).
complications develop and delivery needs to be quick, either during
or before your labour.
• your baby is lying sideways (transverse) and is not able
to be turned by the doctor.
There are several reasons why your obstetrician may recommend
an elective caesarean section. Your doctor will discuss the reason
• you have a twin pregnancy, with your first baby in a
for making this recommendation based on your particular
breech position.
situation and, in some cases, your preferences.

Whenever a caesarean section is recommended, your doctor

Caesarean section on maternal should explain why it is necessary and describe any important
complications. Relevant risks will be explained to you when you
request complete the consent form for the operation, whether for an
elective or emergency caesarean section. Do not hesitate to ask
A small number of pregnant women may prefer a caesarean questions. It is important to make an informed decision.
section to vaginal birth. Women considering elective caesarean
section should discuss this decision with their doctor or midwife.
Risks for your health
There are some risks and benefits to this decision for both mother
and baby. It is important to know that some risks may not be A caesarean section is major surgery. Major complications rarely
apparent until subsequent pregnancies. Your doctor and midwife occur, but may have serious consequences when they happen.
will respect your right to be involved in the decision-making Not all of these risks are unique for caesarean section but are
regarding the type of birth, considering your wishes, your different from those associated with a vaginal birth.
perception of the risks and plans for future pregnancies.
These consequences include:
• blood loss
• wound infection
• blood clots in your legs (known as a deep vein
thrombosis, or DVT). You may be given injections while in
hospital to minimise the risk of developing clots in your
legs and lungs.
• a blood clot that moves from your leg to your lungs
(known as a pulmonary embolus). This is a rare, but
serious complication of caesarean section.
• potential damage to organs near the operation site,
including your bladder. This might require further
surgery.
• anaesthetic risks such as low blood pressure, nausea
and vomiting and post-dural puncture headache. This
occurs when the epidural or spinal needle punctures the
dura (tissue which surrounds the spinal cord). When a
puncture occurs, it causes the spinal fluid to leak out of
the hole and it is this which causes a headache. Most
headaches will settle within a few days but some may
last longer. Information about the risks of anaesthesia
Emergency caesarean section during a caesarean section and for pain relief can be
found at https://www.anzca.edu.au/patient-information/
An emergency caesarean might occur for the following reasons: anaesthesia-information-for-patients-and-carers/pain-
relief-and-having-a-baby
• concern for your baby’s wellbeing prior to or during • slower recovery.
labour • after you have had one caesarean section, future
• your labour is not progressing pregnancies are deemed a high risk and the
• there are maternal complications, such as severe risk of complications increase with each subsequent
bleeding or severe pre-eclampsia caesarean.
• there is a life-threatening emergency for you or your • all of these risks are increased if you are overweight.
baby
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 Caesarean Section

Risks for your baby Anaesthesia

The most common problem affecting babies born by caesarean The anaesthetist will provide the most appropriate form of
section is temporary breathing difficulty. There is also a small risk anaesthesia suited to you during the operation. This may be an
of your baby being cut during the operation. This is usually a small epidural, spinal block or general anaesthetic.
cut that isn’t deep. This happens in 1 to 2 out of every 100 babies
delivered by caesarean section, but usually heals without any An epidural and a spinal block are a similar procedure where
further harm. an anaesthetic, (a drug that gives either partial or total loss of
sensation) is injected by the anaesthetist into the small space in
Thin adhesive strips may be needed to seal the wound while it your back near your spinal cord.
heals. It is important to note that some babies are still difficult to
deliver during a caesarean and forceps or vacuum may be used. The medication can then act directly on the nerves to stop the pain
They therefore may still have bruising around their head or body. signals from being sent to the brain. If you have a spinal block or
epidural anaesthetic, you will be awake throughout the operation,
but you will feel no pain. If you have a general anaesthetic, you
In the operating theatre will be asleep during the operation. Information about the use of
anaesthesia during a caesarean section and for pain relief can be
The procedures for a caesarean section are very similar whether found at https://www.anzca.edu.au/patient-information/anaesthesia-
the operation is elective or an emergency. information-for-patients-and-carers/pain-relief-and-having-a-baby

When you arrive in the operating theatre, there will be a number If you are awake during the operation, you will still feel tugging
of people present. All of them have an important role to play to and pulling, but you won’t feel pain or sharpness. Some women
ensure the safety of you and your baby. describe the feeling as though “someone is doing the washing up
in their stomach”. A screen will be put across your chest so that
Anaesthetist – will provide your anaesthetic and pain relief you cannot see what is being done. You will hear the sucking of
Obstetrician – will perform the operation and deliver your baby the waters that surrounded the baby until just before the baby is
Surgical assistant – assists the obstetrician lifted out.
Scrub nurse – coordinates the theatre and passes the instruments to
the doctor The operation usually takes about 30 to 40 minutes and the
Scout nurse – assists the scrub nurse and gathers additional doctors will talk to you during the operation and let you know what
equipment that is required is happening. One advantage of an epidural or spinal anaesthetic
Anaesthetic nurse – assists the anaesthetist is that you are awake at the moment of delivery and can see your
Paediatrician – receives the baby and cares for it at birth baby immediately.
Midwife – receives the baby and cares for it until you return to the
postnatal ward
Theatre technician – helps move you on and off the operating
table, positions lights and equipment.
Support people – Due to the large number of people present and
the sterile environment of the operating theatre, the number of
support people who are able to be with you will be limited.

Attendance of anyone other than your immediate partner or

support person may not be possible, and your preference for any
additional people will need to be discussed with your doctor or
midwife.

There will be a buzz of activity happening at this time, before the

operation starts. A plastic cannula (thin tube) will be put into the
vein in the back of your hand or arm so that fluids and medication
can be given to you. A catheter (a soft, plastic tube) will be
inserted into your bladder to keep your bladder empty during the
operation.

You will receive a shave of any hair covering the operation site.
You will be wearing special stockings known as ‘TED’ stockings
during the surgery until you are moving around after the operation.
The purpose of these stockings is to reduce the risk of blood clots
forming in the legs during inactivity.

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Caesarean Section

Care of your wound

Recovery after a caesarean Your caesarean incision may have been closed with staples which
section are usually removed within three to seven days of delivery.

If you have stitches, they are usually, reabsorbable sutures,

Supporting breastfeeding
meaning they are absorbed by the body and do not need to be
Assuming your baby doesn’t require additional resuscitation or removed. Keep your wound clean and dry. Wear loose clothing
support from the paediatric team, skin to skin contact is important and look for signs of infection (such as redness, pain, swelling of
as soon as possible after birth. Your baby should have warmed the wound or bad-smelling discharge). Report these to the
blankets placed over their back and a bonnet on their head. This doctor or midwife.
is because it is quite cold in theatre and in the recovery room. The
rest of your baby’s body should be in direct contact with your skin. The incision will heal over the next few weeks. During this time,
This will help stabilise their temperature and start to initiate an there may be mild cramping, light bleeding or vaginal discharge,
instinctive feeding response that will enhance bonding and help as well as pain and numbness in the skin around the incision site.
with establishing breastfeeding. Some hospitals will allow your
baby to stay with you in recovery and to have skin to skin contact
Most women will feel well by six weeks postpartum, but numbness
during this time to increase those responses and the likelihood that
around the incision and occasional aches and pains can last for
baby will attach and feed well at the breast.
several months.
Pain relief
Pain is common after surgery. After a caesarean birth you will be
uncomfortable for a few days but this can usually be managed
well with medications. The anaesthetist will provide you with a
number of options to help control your pain. Taking regular pain
relief is very important to your recovery. Let your midwife know if
you require any pain relief or anti-sickness medication.

Emotional support
Some women feel very positive about having a caesarean, while
others feel disappointed or sad, particularly if it was unexpected. It
can be very helpful to talk through your feelings with your partner,
family, or carers. The doctor or midwife can also discuss the birth
experience with you.

Mobility and exercise

Initially after your operation you will be resting in bed. During
this time it is important to do deep breathing and leg exercises
regularly. Your catheter, drip and wound drain (if you have one)
will be removed in the first one to two days depending upon your
recovery. Once these have been removed, it is important to take a
gentle walk every day.

This will reduce the likelihood of chest infections and blood clots
in your legs. Postnatal exercises are especially important after a
caesarean section to get your muscles working again, but take
things at a gentle pace. The midwife or physiotherapist will tell you
when you should begin them.

RANZCOG © 07|2021
Caesarean Section

These include:
The first few weeks
After a caesarean section, women usually stay in hospital for • Problems with your placenta implanting low in the
about three to five days. This can vary between hospitals or if uterus, near your scar, in future pregnancies.
there are problems with your recovery. In some hospitals, you can This condition is referred to as placenta praevia.
choose to go home early and have your follow-up care at home.
The midwife will explain what your hospital offers and will discuss • Problems when your placenta does not come away as
what best suits your needs. it should when your baby is delivered. This condition is
known as placenta accreta and the risk of it increases
Looking after a new baby is hard for all women. Be kind to with each caesarean section. It is a potentially serious
yourself. It may take a few weeks or even longer to recover, complication you should discuss with your doctor.
particularly if you have had complications. Get as much rest as
you can. If you feel that you need extra help and support, ask • Extra procedures that may become necessary during
family or friends to help. the caesarean section such as a blood transfusion or
emergency hysterectomy, particularly if there is heavy
Be careful of your back when you lift and don’t lift anything that bleeding at the time of your caesarean section. A
causes you pain. hysterectomy would mean you are unable to have any
further children. The risk of needing to undergo a
You should not drive a car until you have fully recovered, and hysterectomy at the end of a subsequent pregnancy
your wound has healed. This may take up to 6 weeks. Your increases with each caesarean section, but overall is
obstetrician can provide advice about when it is safe to drive still very low.
again.
3. Other pregnancy complications following caesarean section
Avoid sex until you feel comfortable. After birth of any kind, it is These include the rare occasion of caesarean scar pregnancy, a type
quite normal to take weeks, even months, before you are ready to of ectopic pregnancy where the fertilised egg implants into the scar
have sex. from a prior caesarean section in the front wall of the uterus. This
most often results in a recommendation to remove the early
What about the effect on future pregnancy tissue, due to risks to the mother of the pregnancy
continuing.
pregnancies and births?
Think about all of your options carefully. If a caesarean section is
1. If you plan to have a vaginal birth next time recommended, your obstetrician or midwife is available to discuss
Information about vaginal birth after a previous caesarean any questions that you may have.
section can be found on the RANZCOG website under patient
information. Whether your baby is born vaginally or by caesarean section, the
aim is for a safe, rewarding and satisfying experience for you and
2. If you plan to have another caesarean section your family.
As the number of previous caesarean sections increases, so does
the risk of rare but serious complications. You should consider the Other RANZCOG resources - Caesarean section video
size of the family you want. If you have three or more caesarean
births, some complications become more common. https://ranzcog.edu.au/womens-health/patient-information-guides/
patient-information-videos/caesarean-section-video

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DISCLAIMER:This document is intended to be used as a guide of gen-

eral nature, having regard to general circumstances. The information
presented should not be relied on as a substitute for medical advice,
independent judgement or proper assessment by a doctor, with con-
sideration of the particular circumstances of each case and individual
needs. This document reflects information available at the time of its
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other available information. RANZCOG disclaims all liability to users
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