Caesarean Birth (C-Section)

Most people labour and give birth vaginally. However, for some specific reasons your healthcare provider may recommend a caesarean birth (C-Section). Although you may have a caesarean birth scheduled based on your specific health information, often, the need for a caesarean birth cannot be decided prior to labour. It is important for you to learn about the benefits, risks, and alternatives of having a caesarean birth and have a discussion with your healthcare provider to answer any questions before labour begins. This helps you to make an informed decision about your care.

These are not all of the possible reasons, but they are the most common.

Benefits and Risks

A caesareans birth can be performed in two different situations: Prelabour (scheduled and performed before labour begins) and in labour (at some point once labour has begun). Depending on the situation, this can impact the risks for you and your baby. The following are population level benefits and risks. It's important to speak with your healthcare provider to discuss how these may apply to your individual situation to make an informed decision for your care.

Benefits:

Immediate (for you and/or your baby):

• A caesarean section is a procedure that can be lifesaving if the risks, at any time, of continuing your pregnancy for either you or your baby are higher than giving birth.

Long-term (for you):

• Decreased risk of urinary incontinence (leaking urine)^{1 2}
• Decreased risk of pelvic organ prolapse (uterus or vagina dropping down)^{1 2}

Risks for You:

Immediate:

• Haemorrhage (too much bleeding) that may require a hysterectomy (removal of the uterus) or blood transfusion^{2 12}
• Uterine rupture (tearing open)²
• Complications associated with anaesthetic (general, epidural, analgesic or sedation)^{2 12}
• Respiratory or cardiac arrest²
• Acute kidney failure²
• Mistaken surgical cut (e.g. nicked bladder or bowel)^{2 4 12}
• Post-operative pain and recovery⁴
• Increased risk of not establishing breastfeeding (higher risk for prelabour/scheduled caesarean)⁴

Delayed:

• Blood clots^{2 12}
• Infection^{2 6 12}
• Pelvic adhesions (attachment of organs to other organs or structures)^{2 4}
• Small bowel obstruction (blockage)²
• Severe &/or long-term pain at the site of the caesarean cut⁴
• Re-opening of the surgical wound
• Ongoing pain in the pelvis area^{4 12}
• Increased risk of needing a hysterectomy later in life and increased risk of surgical complications if a hysterectomy is required.³
• Mental health challenges related to unplanned caesarean, poor birth experience or birth trauma ^{12 13}

For future pregnancies:

• increased difficulty becoming pregnant^{1 2 4 12}
• increased risk of miscarriage^{1 4 12}
• Increased risk of ectopic pregnancy (pregnancy in the fallopian tubes)^{1 2 4 12}
• Increased risk of preterm birth^{2 12}
• Increased risk of stillbirth^{1 2 4 12}
• Increased risk of uterine scar rupture (increasing risk with use of prostaglandins for induction)^{1 2 4 12}
• Increased risk of hysterectomy^{1 2 4 12}
• Increased frequency of bleeding, need for blood transfusion, adhesions, intraoperative surgical injury with increasing number of caesarean sections²
• Increased risk of improper placental placement, growth or detachment:
• Previa (placenta grows low in the uterus and partly or completely covers the cervix)^{1 2 4 12}
• Accreta (placenta grows too deeply into or through the wall of the uterus)^{1 2 4 12}
• Abruption (placenta partially or completely separates from the uterus before the baby is born)^{1 2 4 12}

Risks for your Baby:

Immediate:

• Increased risk of breathing problems^{2 6 12}
• Low blood sugar²
• Less blood flow from the placenta at birth and less iron stores⁴
• Mistaken surgical cut^{4 12}
• Less skin-to-skin time immediately after the birth
• Increased risk of not establishing breastfeeding (higher risk for prelabour/scheduled caesarean)⁴
• Increased risk of needing to supplement breastfeeding with formula⁴
• Birth of a preterm baby when dating was inaccurate. A preterm newborn can face many complications ¹²

Long-term:

• Increased risk of childhood asthma^{1 2 4 12}
• Increased risk of obesity^{1 2 4}

Ways to Decrease the Risk of Having a Caesarean:

While caesarean birth is not always avoidable and can save lives, there are some things that you can do to lower your risk and give yourself and your baby the best chance of having a vaginal birth. It's best to let the process of birth be as undisturbed as possible to minimize the chances of a caesarean birth.

• Choose a healthcare provider that supports physiological labour and birth⁹
• Let labour begin on its own^{9 10}
• Change positions often and move around during labour^{9 10}
• Ensure you have continuous labour support. Consider hiring a Doula^{7 9 10}
• Take a prenatal education course to learn ways to work with the pain of labour and decrease the use of medical pain managment⁵
• Learn about informed decision-making. Have conversations with your healthcare provider during pregnancy to learn about the benefits, risks and alternatives of interventions that may be used in labour⁵ Avoid interventions that are not medically necessary.¹⁰
• Stay home until you are in active labour^{5 9}
• Follow the Lamaze Healthy Birth Practices

• If your baby is in a breech position, learn about breech birth and external cephalic version (ECV) as an alternative to caesarean so you can make an informed decision.⁹

• If you are having twins, have a discussion with your healthcare provider about the option of a planned vaginal birth. A large Canadian-led randomized trial showed that caesarean birth did not reduce the risk for babies if the first baby was head down and between 32 and 38 weeks gestation.⁸

What to Expect During the Procedure:

• You will need to remove any jewelry or nail polish and put on a hospital gown and hair covering.
• You will be transferred to the caesarean section room or the operating room.

• An intravenous (IV) will be started if one is not already in place.¹¹ Antibiotics and medications for nausea and pain may be given through the IV.
• You may be asked to drink a liquid antacid. This can make general anesthesia safer for you.¹¹

• A catheter (tube) will be placed in your bladder, after you are frozen, to remove urine. It keeps your bladder empty and out of the way during the surgery.¹¹
• An epidural or spinal anaesthesia block is used to numb the lower part of your body and, in some cases, general anaesthesia may be used.¹¹ Epidural and spinal anaesthesia are the preferred methods. General anaesthesia is used when you may not be able to have an epidural or spinal or for emergency situations where there isn’t time to wait for a block to be at the highest level (nipple area). If you have laboured and have an epidural in place, the epidural may be used to provide anaesthesia for the surgery. If you do not have an epidural or if your caesarean birth is scheduled, spinal anaesthesia is usually offered.
• With a spinal or epidural, you will remain awake and your support person may be present with you for the birth of your baby.¹¹ If a general anaesthetic is used, your partner will not be able to stay with you for the birth. In this case, your support person will wait in a nearby area and is usually able to see and hold your baby shortly after birth.¹¹
• The entire operation will take approximately 45 minutes to 1 hour.¹¹
• During this time, the anaesthesia is given, you are covered by sterile drapes, your abdomen is cleaned with an antiseptic wash, an incision is made into both your abdominal wall and uterus, your baby is born, the placenta is removed, and the incisions are closed with dissolving stitches &/or staples. Your abdominal incision will be covered with a sterile dressing.¹¹
• You should not feel pain when the incision is made. You may feel some tugging or pressure when the baby is born. Use breathing techniques, visualization, hold hands, talk gently, and focus on your baby’s birth if you, or your partner, are feeling anxious. Usually, the baby is born within the first few minutes of a caesarean birth.
• Discuss the following with your physician and anaesthesiologist before the surgery to see if they can be arranged for you. Many hospitals now agree to these¹¹:
• Lowering the surgical drapes at your head to see your baby's birth
• Delayed cord clamping
• Immediately putting your baby skin-to-skin on your chest

What to Expect After the Procedure

• Your baby will initially be assessed by the Neonatal Intensive Care Team nearby. Once the assessment is completed, they will bring your baby to you (if you have an epidural or spinal anaesthesia and are awake).
• Hold your baby skin to skin, if you are able, while the team repairs the incision. If not, your partner or support person can do this.¹¹ You will be able to hold your baby skin-to-skin once you are both stable. Many of the benefits of skin-to-skin can still occur later.
• After the surgery is complete, you will be transferred to a recovery room for 1-2 hours. You will be assessed frequently (every 15 minutes). A nurse will:
• Check your vital signs (i.e., blood pressure, heart rate, breathing rate, temperature, and oxygen level).
• Press on your abdomen to check the firmness of your uterus, observe the amount of bleeding from your vagina, and check the bandage covering your incision regularly. Tell your healthcare provider if you notice any increase in bleeding from your vagina or incision.
• Give you oxytocin medication through your IV to make sure that your uterus stays firm and that you do not bleed too much. If needed, you may get medication for nausea or pain through your IV.
• You will be given the opportunity to breastfeed your baby during your time in the recovery room. You may need additional support to establish breastfeeding while in hospital and after going home from hospital. For breastfeeding supports see our Breastfeeding webpage.
• You will be able to drink and eat small amounts of food after the birth if you had spinal or epidural anesthetic. Eating small amounts of food at a time and gradually increasing the amount will help prevent nausea. Try to avoid the use of straws as this can create gas pain.
• You will be encouraged to get out of bed within hours of giving birth once the numbness has left your legs. Your nurse will help you the first time you are up. Walking around can help reduce the risk of blood clots, help you have a bowel movement, and help you feel better.
• The catheter will be removed from your bladder approximately 12 – 24 hours after birth.¹¹
• You will likely go home from hospital on the third or fourth day. You will have the usual postpartum changes as with a vaginal birth, but you will have some pain where you had the abdominal incision. This may last for a few days to several weeks. Give yourself time to heal and avoid strenuous activities. 
• Once home, you will need plenty of rest and extra support from your partner and family for several weeks.¹¹
• Caring for your incision at home:
• While in the hospital, a healthcare provider will remove the bandage covering your incision to inspect it. If it is healing well, it will usually be left uncovered. It's okay to get your incision wet in the shower. Always make sure that the incision is dry after you shower, as bacteria can accumulate and cause infection if the area is left wet.
• If stitches are used, they are self-dissolving.
• If staples are used, they are removed after several days following the birth, or a staple remover is sent home with you so that you can visit your family doctor or midwife to have the staples removed.
• To prevent your incision from re-opening at home, avoid the following activities in the first six weeks or until your healthcare provider says that it is okay:
• Lifting anything heavier than your baby
• Carrying your baby in a car seat
• Climbing stairs, a lot
• Running, jogging, jumping, or any other high-energy activities
• Sit-ups or other activities that may cause you to strain your abdominal muscles
• Sexual intercourse
• Driving; if you need to brake quickly this could cause your incision to re-open

Take time to process an unplanned caesarean birth.

Mixed emotions following a caesarean birth are normal especially if surgery wasn’t part of your birth plan. When you are ready, talk to your partner, healthcare provider, or a friend about your feelings. Seek help if negative feelings persist and impact how you feel about being a mother.

Having one caesarean birth does not always mean you will need another caesarean with future pregnancies. It is important to have a conversation with your healthcare provider about whether vaginal birth after caesarean, or VBAC, is appropriate for you.

 

For more information, decision aids & tools

• Ottawa Family Decision Guide
• Perinatal Services BC: My Next Birth Decision Tool
• Association of Ontario Midwives: Thinking about VBAC: Deciding what’s right for me
• My Alberta Health: Should I Try Vaginal Birth After a Past C-Section (VBAC)?
• Quali-Dec app: vaginal delivery or caesarean section
• HealthLink BC Vaginal Birth After Caesarean (VBAC)
• Making Informed Decisions About Your Care - other decision aids & tools

If you have specific questions:

• Speak with your healthcare provider. 
• If you are giving birth at LHSC, speak with the nurse at the London Health Sciences Centre (LHSC) Preadmission Clinic.