When I’m working with parents who are hoping for a vaginal birth, I still make time to talk about caesareans. Around 45% of babies born in England are born by caesarean. I have questions about why the rate is so high, and I think those questions are worth asking. I also know that a caesarean can be necessary, lifesaving or the birth someone actively chooses. I’d be doing the families I work with a disservice if I left it out of their birth preparation. NHS
If you’re hoping to give birth at home or in a birth centre, we can spend time preparing for that and still have a conversation about what matters to you if you end up in theatre. Who would you want beside you? Would you like someone to talk you through what’s happening as it happens? If you and your baby need to be apart for a little while, what would help you feel involved?
Those questions are much easier to think about when you can picture where you’ll be and what might happen.
Two videos to help you picture a caesarean birth
Both videos are about planned caesareans. They use real hospital settings and maternity staff to help you get a feel for the environment and the steps involved. Some details will vary between hospitals, but much of what you see will be familiar if you have an unplanned caesarean too.
Whittington Health — What to expect during a caesarean birth. A labour ward matron and an anaesthetist talk you through the process, including what their roles are and what you can expect on the day. Watch the Whittington walkthrough. Videos & Movies on Vimeo
Norfolk and Norwich University Hospitals — Inside a caesarean theatre. The hospital’s patient video sits alongside a guide to its maternity theatres, including where the anaesthetic is given, where the birth happens and where you go for recovery. Watch the Norfolk and Norwich video. nnuh.nhs.uk
What actually happens during a caesarean?
In a planned caesarean, there’s usually a pre-operative appointment and time to talk through the operation beforehand. On the day, you’ll usually have a cannula fitted in your hand or arm, a catheter to keep your bladder empty and monitors to check things like your blood pressure and heart rate. You’ll be offered antibiotics to reduce the risk of infection. NHS
Most caesareans are done with a regional anaesthetic, usually a spinal. If you already have an epidural in labour, the anaesthetist may be able to top it up. You’ll be awake, and the anaesthetist will check that you’re numb before surgery begins. You may feel pressure, pulling or movement as your baby is born. If you feel pain or start to feel sick, tell the anaesthetist straight away so they can respond. Your birth partner can usually stay with you when you’re awake. NHS
There’s usually a screen across your tummy. Your baby is born through an opening in your abdomen and womb, and the team then delivers the placenta and closes the incisions. You may be able to meet and hold your baby while the operation is still going on. Afterwards, you’ll be monitored in recovery as the anaesthetic wears off. NHS
What might be different with an emergency caesarean?
The word emergency can make you imagine being rushed straight into theatre. Sometimes things do move that quickly. Other unplanned caesareans happen at a steadier pace, with time to talk through the recommendation, ask questions and prepare. The category tells you how urgently the team thinks your baby needs to be born.
The four categories of caesarean birth
The category describes how urgently the maternity team recommends your baby is born. An unplanned caesarean can happen at different speeds, depending on what’s happening with you and your baby.
Category 1 — Immediate. There’s an immediate threat to your life or your baby’s life. The team aims for your baby to be born as soon as possible, usually within 30 minutes of the decision.
Category 2 — Urgent. There’s a concern about your health or your baby’s health that needs prompt action, but it isn’t immediately life-threatening. The team aims for your baby to be born as soon as possible, usually within 75 minutes of the decision.
Category 3 — An earlier birth is needed. You and your baby are currently stable, but there’s a reason for your baby to be born sooner.
Category 4 — Planned. Your caesarean is scheduled in advance.
The 30 and 75 minute timings are NICE’s decision-to-birth targets for most situations. Your maternity team will judge how quickly to move based on what’s happening at the time. NICE guidance on caesarean birth
In a very urgent situation, several people may be getting you ready at once, and explanations may be brief. A spinal or epidural top-up may still be possible. Sometimes a general anaesthetic is needed, which means you’ll be asleep and your birth partner will usually wait outside theatre. Your baby may need extra checks or care before you can be together. If everything happened quickly, you can ask afterwards for someone to go through what happened and why. NHS
A sentence I like to put in a birth plan is “If we need to move quickly, please tell me what’s happening in short, clear sentences and let my birth partner know where to go.” You could also ask for quiet in theatre where possible, or for someone to tell you when your baby is about to be born. These are small details that can matter a great deal when the room is unfamiliar and a lot is happening around you.
Meeting your baby, skin-to-skin and feeding
If you and your baby are well, you can ask for skin-to-skin in theatre or as soon as possible in recovery. NICE recommends that staff help you have early skin-to-skin and support you to start breastfeeding as soon as possible if that’s how you want to feed. If you need extra care first, you can ask whether your birth partner can hold your baby skin-to-skin in the meantime. NICE
That first cuddle can feel especially important if the birth has taken an unexpected turn. If it happens later than you’d hoped, you still have all those ordinary moments ahead of you in which to get to know your baby. Holding them, talking to them, feeding them and learning how they like to be comforted are all part of how a bond grows. Some parents feel it straight away. For others, it builds slowly.
If you’re planning to breastfeed (or chestfeed), the early practicalities are worth thinking about. You might need someone to lift your baby to you, help you get comfortable or stay with you while you try a feed. A rugby hold, with your baby tucked alongside you, or a side-lying position once you can get into it comfortably and safely, can help keep pressure off your wound. If you and your baby are separated or feeding is taking time to get going, ask your midwife or infant feeding team to show you how to hand express and help you make a plan. If you’re bottle feeding, you can still ask for help getting comfortable, holding your baby close and taking the feed at their pace. NHS
What might it mean for another pregnancy?
After a caesarean, your options in another pregnancy may include planning a vaginal birth after caesarean (VBAC) or a planned repeat caesarean. The reason for your previous caesarean, the type of scar on your womb and how your next pregnancy is going all matter. RCOG estimates that around three in four women with one previous caesarean, a straightforward pregnancy and labour that starts on its own give birth vaginally. There is a small risk of the scar on the womb opening during labour, known as uterine rupture, and induction can increase that risk. RCOG
A planned repeat caesarean has a lower risk of uterine rupture and brings the risks and recovery of another operation. With each caesarean, scar tissue can make later surgery more complex, and the chance of placental complications in future pregnancies increases. One example is placenta accreta, where the placenta attaches too deeply into the wall of the womb. If you want to understand what your own caesarean might mean for another birth, you can ask your maternity team to go through your operation notes with you. RCOG
When I go through birth preferences with families, I like to spend a little time on what they’d want in theatre and in the first hours afterwards. Even a few lines about who you want with you, how you’d like people to communicate and what support you’d like to meet and feed your baby can give your birth partner and maternity team something concrete to work with.
You’ll find both walkthroughs above, along with more resources to explore under Caesarean Birth in the Birth Prep In A Box Resource Library.
Support for birth and the early days
Whether you’re planning a caesarean or want to feel more prepared for however your baby arrives, my antenatal sessions give you space to ask questions, explore your options and work out what matters to you.
If you’d like someone alongside you during pregnancy and birth, you can explore my Antenatal Education and Birth Doula packages. I also offer postnatal support, whether you’d like practical help as you recover or someone to talk things through with as you get to know your baby.
