Caesarean sections are carried out in hospital. If there's time to plan your caesarean, you'll be given a date for it to be carried out.

You'll stay in hospital for 3 or 4 days on average.

Preoperative appointment

You'll be asked to attend an appointment at the hospital in the week before the caesarean is due to be performed.

During this appointment:

• you can ask any questions you have about the procedure
• a blood test will be carried out to check for a lack of red blood cells (anaemia)
• you'll be given some medicine to take before the procedure – this may include antibiotics, anti-sickness medicine (anti-emetics) and medicine to reduce the acidity of your stomach acid (antacids)
• you'll be asked to sign a consent form

The operation

Preparation

You'll need to stop eating and drinking a few hours before the operation. Your doctor or midwife will tell you when.

You'll be asked to change into a hospital gown when you arrive at the hospital on the day of the caesarean section.

A thin, flexible tube called a catheter will be inserted into your bladder to empty it while you're under the anaesthetic, and a small area of pubic hair will be trimmed if necessary.

You'll be given the anaesthetic in the operating room. This will usually be a spinal or epidural anaesthetic, which numbs the lower part of your body while you remain awake.

This means you'll be awake during the delivery and can see and hold your baby straight away.

It also means your birth partner can be with you.

General anaesthetic (where you're asleep) is used in some cases if you cannot have a spinal or epidural anaesthetic.

Your birth partner will not normally be present in this case.

What happens

During the procedure:

• you lie down on an operating table, which may be slightly tilted to begin with
• a screen is placed across your tummy so you cannot see the operation being done
• a 10 to 20cm cut is made in your tummy and womb – this will usually be a horizontal cut just below your bikini line, although sometimes a vertical cut below your bellybutton may be made
• your baby is delivered through the opening – this usually takes 5 to 10 minutes and you may feel some tugging at this point
• your baby will be lifted up for you to see as soon as they have been delivered, and they'll be brought over to you
• you're given an injection of the hormone oxytocin once your baby is born to encourage your womb to contract and reduce blood loss
• your womb is closed with dissolvable stitches, and the cut in your tummy is closed either with dissolvable stitches, or stitches or staples that need to be removed after a few days

The whole procedure usually takes around 40 to 50 minutes.

After the operation

You'll usually be moved from the operating room to a recovery room straight after the procedure.

Once you have started to recover from the anaesthetic, the medical staff will make sure you're well and continue to observe you every few hours.

You'll be offered:

• painkillers to relieve any discomfort
• treatment to reduce the risk of blood clots – this may include compression stockings or injections of blood-thinning medicine, or both 
• food and water as soon as you as you feel hungry or thirsty
• help with breastfeeding your baby if you want it – read more about the first few days of breastfeeding

The catheter will usually be removed from your bladder around 12 to 18 hours after the operation, once you're able to walk around.

Find out more about recovering from a caesarean

You'll probably be in hospital for 3 or 4 days after a caesarean section, and may need to take things easy for several weeks.

Recovering in hospital

The average stay in hospital after a caesarean is around 3 or 4 days.

You may be able to go home sooner than this if both you and your baby are well.

While in hospital:

• you'll be given painkillers to reduce any discomfort
• you'll have regular close contact with your baby and can start breastfeeding
• you'll be encouraged to get out of bed and move around as soon as possible
• you can eat and drink as soon as you feel hungry or thirsty
• a thin, flexible tube called a catheter will remain in your bladder for at least 12 hours
• your wound will be covered with a dressing for at least 24 hours

When you're well enough to go home, you'll need to arrange for someone to give you a lift as you will not be able to drive for a few weeks.

Looking after your wound

Your midwife should also advise you on how to look after your wound.

You'll usually be advised to:

• gently clean and dry the wound every day
• wear loose, comfortable clothes and cotton underwear
• take a painkiller if the wound is sore – for most women, it's better to take paracetamol or ibuprofen (but not aspirin) while you're breastfeeding
• watch out for signs of infection

Non-dissolvable stitches or staples will usually be taken out by your midwife after 5 to 7 days.

Your scar

Credit:

DR P. MARAZZI/SCIENCE PHOTO LIBRARY

The wound in your tummy will eventually form a scar.

This will usually be a horizontal scar about 10 to 20cm long, just below your bikini line.

In rare cases, you may have a vertical scar just below your bellybutton.

The scar will probably be red and obvious at first, but should fade with time and will often be hidden by your pubic hair.

On darker skin, the scar tissue may fade to leave a brown or white mark.

Controlling pain and bleeding

Most women experience some discomfort for the first few days after a caesarean, and for some women the pain can last several weeks.

You should be given regular painkillers to take at home for as long as you need them, such as paracetamol or ibuprofen.

Aspirin and the stronger painkiller codeine present in co-codamol is not usually recommended if you're breastfeeding.

Your doctor will be able to advise you on the most suitable painkiller for you to take.

You may also have some vaginal bleeding.

Use sanitary pads rather than tampons to reduce the risk of spreading infection into the vagina, and get medical advice if the bleeding is heavy.

Returning to your normal activities

Try to stay mobile and do gentle activities, such as going for a daily walk, while you're recovering to reduce the risk of blood clots. Be careful not to overexert yourself.

You should be able to hold and carry your baby once you get home.

But you may not be able to do some activities straight away, such as:

• driving
• exercising
• carrying anything heavier than your baby
• having sex

Only start to do these things again when you feel able to do so and do not find them uncomfortable. This may not be for 6 weeks or so.

Ask your midwife for advice if you're unsure when it's safe to start returning to your normal activities.

You can also ask a GP at your 6-week postnatal check.

When to get medical advice

Contact your midwife or a GP straight away if you have any of the following symptoms after a caesarean:

• severe pain
• leaking urine
• pain when peeing
• heavy vaginal bleeding
• your wound becomes more red, painful and swollen
• a discharge of pus or foul-smelling fluid from your wound
• a cough or shortness of breath
• swelling or pain in your lower leg

These symptoms may be the sign of an infection or blood clot, which should be treated as soon as possible.

A caesarean section is generally a very safe procedure, but like any type of surgery it does carry a risk of complications.

The level of risk will depend on things such as whether the procedure is planned or carried out as an emergency, and your general health.

If there's time to plan your caesarean, your doctor or midwife will talk to you about the potential risks and benefits of the procedure.

Risks to you

Some of the main risks to you of having a caesarean include:

• infection of the wound (common) – causing redness, swelling, increasing pain and discharge from the wound
• infection of the womb lining (common) – symptoms include a fever, tummy pain, abnormal vaginal discharge and heavy vaginal bleeding
• excessive bleeding (uncommon) – this may require a blood transfusion in severe cases, or possibly further surgery to stop the bleeding
• deep vein thrombosis (DVT) (rare) – a blood clot in your leg, which can cause pain and swelling, and could be very dangerous if it travels to the lungs (pulmonary embolism) 
• damage to your bladder or the tubes that connect the kidneys and bladder (rare) – this may require further surgery

Women are now given antibiotics before having a caesarean, which should mean infections become much less common.

Risks to your baby

A caesarean can sometimes cause the following problems in babies:

• a cut in the skin (common) – this may happen accidentally as your womb is opened, but it's usually minor and heals without any problems
• breathing difficulties (common) – this most often affects babies born before 39 weeks of pregnancy; it'll usually improve after a few days and your baby will be closely monitored in hospital

If you think your baby is having breathing difficulties after you have left hospital, see a GP or call NHS 111 straight away.

Risks to future pregnancies

Women who have a caesarean usually have no problems with future pregnancies.

Most women who have had a caesarean section can safely have a vaginal delivery for their next baby, known as vaginal birth after caesarean (VBAC).

But sometimes another caesarean may be necessary.

Although uncommon, having a caesarean can increase the risk of certain problems in future pregnancies, including:

• the scar in your womb opening up
• the placenta being abnormally attached to the wall of the womb, leading to difficulties delivering the placenta
• stillbirth

Speak to your doctor or midwife if you have any concerns.

For more information, the Royal College of Obstetricians and Gynaecologists has a leaflet on birth after previous caesarean (PDF, 494kb).