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Having a caesarean section

This page explains what to expect if you are having a caesarean section at King’s College Hospital NHS Foundation Trust.

This information is general guidance. Your care may be different depending on your individual circumstances. Your midwife, obstetrician and anaesthetist will discuss your care with you.

Many people feel nervous before a caesarean birth, even when it is planned. This is completely normal. The maternity and anaesthetic team will support you throughout your care.

What is a caesarean section?

A caesarean section, also called a C-section, is an operation to deliver your baby through a cut in your lower abdomen and womb (uterus).

A caesarean birth may be:

  • elective, also called planned: arranged in advance
  • emergency: carried out urgently during pregnancy or labour if this is the safest option for you or your baby

Your healthcare team will discuss the safest option for you and your baby, based on your individual circumstances.

A caesarean birth may be recommended for several reasons, such as:

  • your baby is in a breech or transverse position
  • there are concerns about your baby’s wellbeing
  • labour is not progressing as expected
  • you have placenta praevia, where the placenta covers the cervix
  • you have had a previous caesarean section and prefer a repeat operation
  • you have certain medical conditions where caesarean birth may be safer
  • you choose to have a caesarean birth after discussion with your maternity team

This list does not include every possible reason for a caesarean birth. Your healthcare team will discuss the safest option for you and your baby based on your individual circumstances.

Benefits, risks and possible complications

A caesarean section can be a safe and appropriate way to give birth when a vaginal birth is not advisable or when caesarean birth is the safest option for you or your baby.

Benefits may include:

  • providing a safe way to deliver your baby when a vaginal birth is not advisable
  • reducing the risk of complications associated with difficult labour
  • providing a more controlled and predictable birth in planned caesarean cases
  • reducing the risk of birth trauma in some specific medical situations

As with any operation, there are some risks.

Short-term risks may include:

  • infection, such as wound, bladder or womb infection
  • bleeding and, rarely, the need for a blood transfusion
  • blood clots in the legs or lungs
  • damage to nearby organs, which is rare
  • anaesthetic complications, such as headache or nausea

Long-term considerations may include:

  • a slightly higher risk of complications in future pregnancies, such as placenta praevia or placenta accreta
  • a small increased risk of scar pregnancy, miscarriage or preterm birth in future pregnancies
  • potential challenges with vaginal birth after caesarean section, also called VBAC, although this is often safe

Risks to your baby may include:

  • temporary breathing difficulties, especially if your baby is born before 39 weeks
  • rarely, a small skin cut during the operation

Your obstetrician and anaesthetist will discuss the relevant benefits and risks with you before the operation and answer any questions you may have.

Before your caesarean section

If you have a planned caesarean birth, you will be asked to attend hospital for pre-assessment checks. At this appointment, we will provide information on how to prepare for the day of your caesarean section and what to expect.

If you are having your caesarean at King’s College Hospital, you will be given an appointment to attend the pre-assessment clinic (PAC) at the Maternity Assessment Unit.

If you are having your caesarean at Princess Royal University Hospital, you will be asked to attend the Oasis Birth Centre two days before your operation.

You will have blood tests before your operation to check your iron level, blood group and antibodies. This helps the team prepare safely for your caesarean section. The chance of needing a blood transfusion or blood products is low.

You may have other pre-operative checks, such as MRSA screening swabs, and you may be given medicines to take before the operation. Your team will explain what checks are needed and when to take any medicines.

You will be given instructions about when to stop eating and drinking before your caesarean birth. It is important to follow these instructions carefully.

Occasionally, the date or time of a planned caesarean birth may need to change at short notice because the maternity unit must prioritise emergencies. We understand this can be disappointing or stressful, and the team will keep you informed if this happens.

Practical things to remember

Please bring your hospital bag and any medicines you normally take.

We recommend leaving valuables at home.

You may be asked to remove nail polish or false nails so that we can monitor your oxygen levels accurately.

What happens on the day?

On the day of your caesarean birth, you will come into hospital and be prepared for theatre by the maternity team.

You will usually meet your midwife, the obstetric team and the anaesthetist before going to theatre. You can confirm the plan for your anaesthetic, discuss any previous anaesthetic experiences, allergies or medical conditions, and ask any questions you may still have. If there is anything you are worried about, please tell the team.

You can also discuss birth preferences with the team, such as music in theatre, skin-to-skin contact, lowering the screen at birth if appropriate, and photos after your baby is born.

King’s is a teaching hospital, so students or trainees may sometimes be present as part of the team. Your care will always be supervised by qualified staff.

If there are any delays, we will keep you updated and explain what is happening.

Theatre and anaesthetic

When you arrive in theatre, you will be welcomed by the team looking after you during your caesarean birth.

You may have one birth partner with you in theatre.

Theatre can feel busy because several members of staff are present, but everyone has a clear role in caring for you and your baby.

The team usually includes:

  • the anaesthetist
  • an anaesthetic assistant or operating department practitioner
  • obstetricians
  • a midwife
  • theatre nurses and support staff

Sometimes a baby doctor will be present if your baby may need extra care.

The anaesthetist will place a small drip, called a cannula, into a vein in your hand or arm so that fluids and medicines can be given easily.

Monitors will be used to check your blood pressure, heart rate and oxygen levels throughout the procedure.

We will try to position monitors and your gown in a way that supports skin-to-skin contact with your baby after birth, if this is possible on the day.

Spinal anaesthetic

For most people having a planned caesarean birth, the anaesthetic is a spinal anaesthetic.

This means you stay awake for the birth of your baby, but the lower part of your body becomes numb so that you do not feel pain during the operation.

To give the spinal anaesthetic, the anaesthetist will usually ask you to sit up or lie on your side and curl your back. Your lower back will be cleaned, and a small injection of local anaesthetic is used to numb the skin.

The spinal injection is then given in the lower back. This may feel uncomfortable, but it should not take long.

Once the spinal injection has been given, you will be helped to lie down. Your legs will begin to feel warm, heavy and numb.

Before the operation starts, the anaesthetist will carefully check that the anaesthetic is working properly, usually using a cold spray.

The spinal anaesthetic usually lasts for a few hours. During this time your legs will feel heavy and numb. In recovery, staff will monitor you while the spinal anaesthetic gradually wears off.

Epidural anaesthetic

If you are having a caesarean during labour and already have a working epidural, anaesthetic medicine may be given through the epidural instead.

Your anaesthetist will explain this if it applies to you.

General anaesthetic

General anaesthetic is uncommon for planned caesarean birth but may be needed if a spinal or epidural is not suitable, does not work well enough, or if there is an urgent clinical reason.

This means you will be asleep for the operation. Your anaesthetist will explain this if it applies to you.

If a general anaesthetic is needed, your birth partner will usually be asked to leave theatre while you are asleep. They can usually be with your baby as soon as this is safe and appropriate.

During the operation

Once the spinal anaesthetic is working well, the team will make the final preparations for surgery.

A urinary catheter will usually be inserted once you are numb, so that your bladder stays empty during the operation.

A sterile screen will be placed so that you do not see the operation itself. Surgery will only begin when everything is ready and the anaesthetist has checked that the spinal anaesthetic is working properly.

During the operation, you may feel pressure, movement or pulling, but you should not feel pain.

If you feel pain, or if anything does not feel right, it is very important to tell your anaesthetist straight away.

After your baby is born

You will be awake when your baby is born if you have a spinal or epidural anaesthetic.

Where it is safe to do so, the team may support delayed cord clamping and early skin-to-skin contact after birth.

The theatre may feel cold. Newborn babies can lose heat quickly after birth, so it is important that we keep your baby warm.

Occasionally, a baby doctor may briefly check your baby after birth. If your baby needs extra care, the team will explain what is happening.

After your baby is born, you will be given medicine through the drip to help your womb contract and reduce bleeding.

The obstetric team will then complete the operation. This often takes around 30 to 40 minutes after your baby is born but may take longer if you have previous surgery scars or there are complications.

After your operation

After the operation, you will be taken to the recovery area. Your blood pressure, pulse and oxygen levels will continue to be monitored while the spinal anaesthetic gradually wears off.

Your baby and birth partner can usually stay with you if all is well, and staff can support skin-to-skin contact and the first feed.

Once the team is happy that you are stable and recovering well, you will be transferred to the postnatal ward. Your drip and urinary catheter will be removed when it is safe to do so.

You will be encouraged to start moving gently as soon as possible. Early movement helps recovery and reduces the risk of complications.

Staff will continue to support you with feeding and caring for your baby as you recover.

To help reduce the risk of blood clots, your team will assess your individual risk and may recommend medicine to help prevent clots, usually a small injection. If this is needed, a member of your team will explain it to you, including how long to continue it after you go home.

Recovery, pain relief and going home

Regular pain relief, eating and drinking when it is safe to do so, and gentle early movement are important parts of recovery after a caesarean birth.

Many people go home after 1 to 2 days, and some may be able to go home after around 24 hours if they and their baby are well.

Eating and drinking

After your surgery, you can usually start drinking water as soon as you feel thirsty. If you do not feel sick, you can then have a cup of tea, coffee or another drink. Most people can have a light meal about 2 to 3 hours after their caesarean birth.

It is best to start with small amounts of food and build up gradually. Your bowel may take some time to recover after surgery, so eating little and often can help you feel more comfortable and support your recovery.

Pain relief

Good pain relief is an important part of your recovery after a caesarean birth. It helps you move around, care for your baby and recover more comfortably.

Most caesarean births are performed under a spinal or epidural anaesthetic. These may include longer-acting pain-relieving medicines that continue to work for several hours after the operation.

As these medicines wear off, pain may become more noticeable, particularly during the first 24 to 72 hours. It should then gradually improve over the following days.

After your operation, you will be offered painkillers regularly rather than waiting for pain to become severe. During the first 24 hours, this will usually include paracetamol, ibuprofen (if suitable for you) and dihydrocodeine.

After the first 24 hours, most people continue regular paracetamol and ibuprofen, with stronger pain relief available if needed.

Taking regular paracetamol and ibuprofen can reduce the amount of stronger pain relief you need. Everyone experiences pain differently, so please tell your midwife if your pain is not well controlled. Your pain relief can be reviewed and adjusted if necessary.

Before you go home, you will be given advice about which painkillers to continue and how to take them safely. It is useful to have a supply of paracetamol and ibuprofen at home, if these medicines are suitable for you. You may also be given a small supply of stronger pain relief to use if needed.

Pain should gradually improve during your recovery. If your pain remains severe, becomes worse, or is not controlled with the pain relief you have been advised to take, please seek medical advice.

Moving around

The team will help you start moving safely.

Early movement helps recovery and reduces the risk of complications.

Everyone recovers at a different pace. In the first few weeks, take things gradually and avoid heavy lifting, other than lifting your baby.

Try to increase your activity slowly as you recover.

Wound care

Keep your wound clean and dry.

Contact your midwife, GP or maternity unit if the wound becomes red or discoloured, swollen, increasingly painful, leaks fluid, or has an unpleasant smell.

It is common to have some numbness around the scar for several months after a caesarean birth.

Emotional wellbeing

A caesarean birth can be a very positive experience. However, some people may feel disappointed, surprised or anxious, especially if the caesarean was unplanned.

If you have concerns or feel upset, talk to your midwife, obstetrician or GP.

How your baby was born does not define you or your birth experience.

When to seek medical advice

Please contact your midwife, GP or maternity unit if you have:

  • heavy vaginal bleeding or passing large clots
  • a red or discoloured, swollen, painful or leaking wound
  • pain or swelling in one leg
  • shortness of breath or chest pain
  • a high temperature or feeling generally unwell

If you feel very unwell or need immediate medical help, call 999.

Leaflets and further information

Useful resources include: