All About Caesarean Sections

A Caesarean section, also known as a “C-section”, is the delivery of the baby through surgery via a cut in the abdomen and uterus in the operating room. In most healthy, uncomplicated pregnancies, vaginal deliveries are possible. However, there are a few reasons your health care provider may recommend delivery by C-section.

When Is A C-Section Needed?

Caesarean sections can be “planned” or “unplanned” (i.e., decided before vs on the day of delivery).

Reasons for Planned C-Sections

• malpresentation of baby (e.g., breech position)
• twins/triplets where the first baby is not head down or if the second baby is predicted to be much larger
• two or more previous C-sections
• one previous C-section within 18 months (birthday to birthday)
• one previous C-section with a vertical or inverted T scar
• persistent placenta previa or low lying placenta
• previous uterine rupture
• specific previous uterine surgery (e.g., removal of fibroids through an abdominal incision or laparoscopic approach)
• medical problem that carries a high risk for labour (e.g., certain heart conditions)
• active infection that could pass to baby during vaginal birth (e.g., genital herpes simplex virus, HIV)

Reasons for Unplanned C-Sections

• labour is too long or stops completely *
• baby is showing signs of distress during labour
• failed induction of labour
• umbilical cord prolapse (i.e., the umbilical cord comes out before the baby)
• baby is too big to be delivered vaginally

* Please see our handout “The Stages of Labour” for more information on abnormal progression of labour.

What Happens During A C-Section?

1. pain medication is administered through a needle in your back, to numb your abdomen/legs *
2. a foley catheter is inserted to drain your bladder to make the surgery safer
3. a sheet is hung over your chest to divide you/your support person from the ‘sterile field’ of the operation
4. after several tests to ensure pain control is adequate, the obstetrician will make a cut across your belly, just above your pelvic bone (“bikini line incision”)
5. the baby is taken out of the uterus
6. the umbilical cord is clamped and cut, and the placenta is removed
7. your tissue is stitched back together
8. you get to meet your baby!

Except for the rare event that you need to be put totally asleep for the surgery, a partner or support person is typically welcome in the operating room with you.

* If you are having an unplanned C-section, your epidural will be ‘topped up’ for the additional pain control needed for surgery

* If there is a serious emergency, we may recommend general anesthesia (being put to sleep), because this can be done faster

Time to recover:

• You will usually be in the hospital for 1-2 days after the operation
• It will take up to 6 weeks to recover

Postoperative symptoms:

• You will have pain in your belly and typically need pain medication for 1-2 weeks after delivery
• You will likely have vaginal bleeding for several weeks

Important postoperative notes:

• When you go home you may shower as usual and pat the incision so it stays clean and dry.
• Be careful of lifting anything heavier than your baby and engaging in strenuous activity while the incision heals.
• Taking your pain medicine regularly for 1-2 weeks will help to control pain.
• Walking, staying hydrated, and avoiding constipation will be helpful in your recovery.
• Return to the emergency department if you experience severe belly pain, fever, chest pain, trouble breathing, vomiting that does not stop, heavy vaginal bleeding, swelling/pain/redness in one of your legs, or concerns about your incision.
• If you have Steri Strips (thin bandages) on your incision, take these off 7-10 days after delivery.

What Are the Risks?

Most people and their babies do well after C-sections. However, as it is surgery, there are associated risks, such as:

• infection (e.g., to the wound, uterus, or urinary tract, or bloodstream)
• bleeding
• longer recovery time than vaginal delivery (48 hour hospital stay compared with 24)
• blood clots in your legs or lungs
• injury to the bowel (where you poo from), bladder (where you pee from), or urinary tract
• more difficult recovery than vaginal delivery, including pain/ tenderness of the abdomen

I Have Had One C-Section Previously. Do I Have to Have Another for Future Pregnancies?

Not necessarily. Some patients are candidates for a trial of labour after Caesarean section (TOLAC). Patients are safest to try for TOLAC if they have only had 1 C-section before, if the C-sections are at least 18 months apart (birthday to birthday) and if there were no major complications or deviations form a normal C-section that would make an attempt at a vaginal delivery less safe.

Have a conversation with your health care provider about whether TOLAC is a good option for you, and refer to our handout “Trial of Labour After C-Section (TOLAC)”.