Caesarean Section Information

What is a caesarean section?

A caesarean section (often called a C-section) is an operation to deliver a baby. It involves making a cut in the front wall of your abdomen and womb (uterus). The operation is performed by an obstetrician (a doctor who specializes in pregnancy and childbirth).

At Leeds Teaching Hospitals NHS Trust, we perform both planned (elective) and emergency caesarean sections. About 1 in 4 pregnant women in the UK have a caesarean birth.

This information is designed to help you understand the procedure, what it involves, and how to prepare if you're having a caesarean at Leeds Teaching Hospitals.

Why might I need a caesarean?

There are many reasons why you might need a caesarean section. These include:

• Your baby is in a breech position (bottom or feet first)
• You have had a previous caesarean section
• Your placenta is lying low in your womb (placenta praevia)
• You are expecting twins or triplets
• You have a medical condition such as high blood pressure or diabetes
• Your baby is not growing as expected
• Your baby is in distress during labour
• Your labour is not progressing

Your midwife or doctor will discuss any reasons with you and explain why they recommend a caesarean section.

Planned vs Emergency caesarean

Caesarean sections can be planned (elective) or emergency:

Planned (elective) caesarean

A planned caesarean is booked in advance. You'll know when it's happening and can prepare for it. It's usually performed at 39 weeks of pregnancy, or earlier if there's a medical reason. You'll attend a preoperative assessment clinic where you'll meet the team and discuss the procedure.

Emergency caesarean

An emergency caesarean might be recommended if:

• Your labour isn't progressing
• Your baby is showing signs of distress
• Your womb tears during labour
• You experience bleeding during pregnancy

Preparing for your caesarean

If you have a planned caesarean

Before your planned caesarean, you will be invited to attend our Preoperative Assessment Clinic at Leeds General Infirmary or St James's University Hospital. During this appointment:

• Your general health will be checked
• You will have blood tests
• The anaesthetist will discuss your pain relief options
• The procedure will be explained in detail
• Any questions you have will be answered

Before coming to hospital

• Have a bath or shower at home
• Remove nail polish and makeup
• Remove all jewellery (unless you cannot remove a ring, in which case it will be taped)
• Bring your hospital bag with all the items you and your baby will need
• Do not eat or drink for 6 hours before your operation (you'll be given specific timing instructions)

When you arrive at hospital

You'll be welcomed to the maternity unit by our team. You'll change into a hospital gown and have your blood pressure, temperature and pulse checked. You may need to have a cannula (a thin tube) inserted into a vein in your hand or arm. This allows us to give you fluids and medicines during and after the operation.

Anaesthetic options

Most caesareans are performed under a spinal anaesthetic (similar to an epidural). This means you'll be awake during the birth but won't feel pain from the waist down. Very occasionally, a general anaesthetic (where you're asleep) might be necessary.

What happens during the surgery

In the operating theatre

When you go into the operating theatre, you'll be helped onto a specially designed operating table. Our theatre team will introduce themselves to you.

If you're having a spinal anaesthetic:

• You'll be asked to sit up or lie on your side
• The anaesthetist will clean your back and inject some local anaesthetic to numb the area
• A fine needle will be inserted into your back to deliver the anaesthetic
• Within a few minutes, you'll start to notice numbness in your lower body
• The anaesthetist will check that the anaesthetic is working properly

A screen will be placed across your chest so you can't see the operation. However, you can request for the screen to be lowered slightly as your baby is being born if you wish.

The operation

1. The surgeon will make a cut (incision) across your lower abdomen, usually just below your bikini line. In some circumstances, a vertical cut might be necessary.
2. A second cut is made in the womb, through which your baby will be delivered.
3. Your baby's nose and mouth will be cleared, and the paediatrician will check your baby.
4. The umbilical cord is cut, and your baby may be placed on your chest for skin-to-skin contact if you wish and if both you and your baby are well.
5. You'll be given an injection of oxytocin to help your womb contract and reduce bleeding.
6. The placenta is delivered, and the cuts in your womb and abdomen are closed with dissolvable stitches.

The operation usually takes around 30-40 minutes, but it can take longer if you've had previous caesareans or other abdominal surgery.

Recovery after your caesarean

Immediately after the birth

You'll be taken to the recovery room where nurses will monitor you closely. They'll check your blood pressure, pulse, breathing, and the amount of bleeding from your vagina and wound. You'll still have feeling of numbness for a few hours.

Once you're stable, you'll be transferred to the maternity ward, often with your baby by your side. Our midwives will help you with feeding and caring for your baby.

Pain relief

Good pain relief is important after your caesarean. The spinal anaesthetic usually lasts for a few hours. As it wears off, you may start to feel uncomfortable or sore. We'll offer you regular pain relief, which may include:

• Paracetamol
• Anti-inflammatory medication (such as ibuprofen)
• Occasionally, stronger painkillers such as codeine

Moving around

It's beneficial to get out of bed and move around as soon as possible after your operation. This helps reduce the risk of blood clots, helps your recovery, and helps your bowels return to normal. A midwife can help you the first time you get up.

Looking after your wound

Your midwife will check your wound regularly. Keep it clean and dry. The dissolvable stitches will disappear over time. If you notice your wound becoming red, swollen, or oozing fluid, please tell your midwife as this could be a sign of infection.

Duration of stay

Most women stay in hospital for 2-3 days after a caesarean. If you or your baby need extra support, you might stay longer. We'll discuss your individual needs with you and plan for your discharge home.

Recovery at home

Complete recovery from a caesarean can take 6-8 weeks. During this time:

• Rest as much as possible and avoid heavy lifting
• Continue taking pain relief if needed
• Follow the advice given about exercises and recovery
• Use sanitary towels (not tampons) for any bleeding
• Avoid driving for 6 weeks or until you can perform an emergency stop comfortably
• Don't have sex until you feel ready and any bleeding has stopped (usually after 6 weeks)

Make sure you accept any offers of help from family and friends during your recovery. Your health visitor will provide support and advice after you go home.

Your next pregnancy

Many women have successful vaginal births after caesarean (VBAC) in future pregnancies. However, the options for future births depend on your individual circumstances. Your healthcare team can discuss these options with you.

Support and additional information

Maternity teams at Leeds Teaching Hospitals

Our maternity teams at Leeds General Infirmary and St James's University Hospital are here to support you throughout your pregnancy, birth, and postnatal period. If you have any concerns at any time, please speak to your midwife or doctor.

Additional support

Our hospital employs patient experience leads who can provide additional support and information. We also have midwifery support workers available to help with feeding and caring for your baby.

Further information

If you'd like more information about caesarean section, please ask your midwife or doctor. The following resources may also be helpful:

• The Royal College of Obstetricians and Gynaecologists (RCOG) patient information
• NHS.uk caesarean section information
• TOMMY'S information on caesarean births

Contact information

If you have questions or concerns about your planned caesarean, please contact your antenatal clinic or the maternity department:

• Leeds General Infirmary Maternity Unit: 0113 392 4700
• St James's University Hospital Maternity Unit: 0113 206 5421
• For urgent advice when not in hospital, contact your local maternity triage department

Remember, if you're concerned about you or your baby's health, always seek medical advice promptly. If you're less than 28 weeks pregnant and concerned, contact your GP. If you're 28 weeks or more pregnant, contact your local maternity triage department.