Caesarean birth: a guide to planned and unplanned caesarean

About caesarean birth

A caesarean section is an operation to give birth to your baby.

Sometimes health problems or pregnancy complications mean that a caesarean birth is a safer option than vaginal birth.

You might have a planned or elective caesarean birth for medical reasons or because there are signs late in your pregnancy that you or your baby might have problems with a vaginal birth.

Unplanned (emergency) caesareans can happen when there are problems either with your health or your baby’s health in your pregnancy and during your labour.

In Australia, both planned and unplanned caesareans are common and fairly safe.

Caesarean birth is also called caesarean, c-section or caesar.

It’s good to talk with your midwife or doctor about your health, your baby’s health and your birth options. If you have a medical condition or other health concern, it’s important to discuss which kind of birth will be safest for you and your baby.

Your feelings about caesarean birth

Birthing mothers often have strong feelings, expectations and preferences about giving birth.

Some birthing mothers feel fine about having a caesarean birth, whereas others feel disappointed or sad that they won’t be giving birth vaginally.

It can really help to talk through your feelings with your partner, family, friends and health care professionals. You can also call the Pregnancy Birth and Baby Helpline on 1800 882 436 for free advice and counselling, 24 hours a day, 7 days a week.

Caesarean section surgery

Caesarean birth involves surgery.

If you’re having a planned caesarean birth, the preparations for surgery might happen over time. For example, you might sign your consent form in advance and have other preparations in the maternity ward. If you need an unplanned caesarean birth, things might happen quickly and unexpectedly in the birthing unit.

For both planned and unplanned caesarean birth, medical staff will prepare you for surgery by:

clipping or shaving your lower tummy and some of your pubic hair
cleaning your tummy area with antiseptic
giving you an anaesthetic – usually an epidural or spinal anaesthetic, or sometimes a general anaesthetic
inserting a small plastic tube in the back of your hand or the crook of your elbow for your fluid drip.

In the operating theatre, there’ll be quite a few people with you. They include the obstetrician, an assistant surgeon, an anaesthetist, theatre nurses, a midwife and sometimes a paediatrician. Everyone in the theatre plays a role in keeping you and your baby safe.

Your support person is usually allowed into the operating theatre with you too, unless you need a general anaesthetic.

There’ll be a drape or curtain over your chest area so that you and your support person can’t see the surgery.

The obstetrician will cut an opening in your lower tummy area and into your uterus, so your baby and the placenta can be lifted out.

Caesarean surgery usually takes 30-60 minutes, although it might be several hours before you’re back in the maternity ward with your baby.

The things that happen after your baby is born are similar for both planned and unplanned caesareans. They include:

having skin-to-skin contact with your baby as soon as possible
getting an injection or intravenous medicine to reduce bleeding
being stitched up or stapled
spending time in the recovery ward
getting to know your baby and learning to breastfeed in the maternity ward
having a drip and a urinary catheter for the first 12-24 hours
managing some pain and discomfort.

You should be able to have skin-to-skin contact with your baby in the operating theatre after a caesarean birth. Skin-to-skin contact helps to keep your baby warm, lets you and baby bond physically, and helps with breastfeeding. If you can’t have skin-to-skin contact, your support person will probably be able to hold your baby instead.

Types of caesarean section

There are 2 types of caesarean section – a lower segment caesarean section and a classical caesarean section.

From looking at your tummy, you won’t be able to tell the difference. That’s because the difference is where the cut is made on your uterus. And sometimes the cut on your tummy is different from the cut on your uterus.

Before you leave hospital, it’s a good idea to ask your doctor or midwife what kind of cut was made on your uterus during your caesarean section. This is helpful information when you’re making decisions about future births.

A lower segment caesarean section
This is the most common type of caesarean section. The obstetrician makes a horizontal cut across the lower part of the uterus, usually along your bikini line. This type of caesarean section usually heals well and is less likely to cause problems in future pregnancies.

A classical caesarean section
This is when the obstetrician makes a vertical cut on the uterus. A classical caesarean section is rare and is generally used only in very serious emergencies. If your baby is very premature or lying sideways or if your placenta is lying very low, you might need a classical caesarean section.

Planned caesarean birth: why you might have one

The most common reasons for having a planned caesarean are:

a previous caesarean
the position of your baby – your baby is positioned bottom or feet first (the breech position) or sideways (the transverse position) and can’t be turned
placenta praevia – your cervix is covered by the placenta
a twin pregnancy, with your first baby positioned bottom or feet first
a multiple pregnancy – triplets, quintuplets or more.

Not all women have, or need to have, caesareans in these circumstances. You can make the decision based on your doctor’s advice about your particular situation.

For example, if you’ve had a previous caesarean birth or your baby is breech, you can ask about having a vaginal birth after caesarean (VBAC) or a vaginal breech birth. Some public hospitals have clinics specifically for women planning VBACs or a breech births.

If your caesarean is planned, you’ll know the day and time of your surgery, which means you’ll know when your baby will be born. A planned caesarean also means the birth will usually happen before you go into labour.

Unplanned caesarean birth: why you might have one

You might need an unplanned caesarean if you become unwell or your:

baby’s head doesn’t move down or ‘fit’ through your pelvis during labour
labour doesn’t progress as expected
baby starts getting distressed in labour – for example, there are changes in your baby’s heartbeat.

Things that can reduce your chances of needing an unplanned caesarean include:

having a support person with you in labour to help you stay calm
having a midwife with you all the time during labour (midwifery-led care)
keeping active and relaxed during labour
involving your doctor and midwife in decisions about your birth
avoiding an unnecessary induction before 41½ weeks of pregnancy (an induction can increase pain and medical intervention during labour).

You can’t have a caesarean in a birth centre or if you’re having a homebirth. If you have complications and it looks like you might need an unplanned caesarean, you’ll go to the nearest public hospital by car or ambulance, depending on your stage of labour and whether it’s an emergency.

You have a right to be involved in and make decisions about your care. A caesarean can be done only if you give your written permission. Your partner or next of kin can give written permission if you can’t.

Caesarean birth: problems and risks

A caesarean birth is major surgery.

Birthing mothers who have caesarean births will probably have:

longer stays in hospital
pain around their tummies and caesarean wounds
restricted activities for up to 6 weeks – for example, limits on lifting, housework and driving.

Some birthing mothers might also have medical problems including:

above-average blood loss (haemorrhage)
blood clots in the legs
infection of their wounds and bladders or in the lining of their uteruses
fever caused by infections or by other factors related to the surgery
complications from the anaesthetic, including nausea, drowsiness or dizziness
increased risk of postnatal depression
a higher chance of caesarean section for future births
special health concerns for any future attempts at vaginal birth.

Babies born via caesarean birth are more likely to need time in the special care nursery, but they’re usually ready to go home when you are.

After you’ve had a caesarean, there’s a higher risk of medical problems for each pregnancy and birth you have after that. For example, there’s an increased chance of the placenta growing into or over the scar inside your uterus. There’s also a higher risk of the uterus tearing or rupturing in future pregnancies. In rare cases this can lead to a hysterectomy (removal of the uterus).

Planned caesarean surgery is less likely to cause medical problems than unplanned caesarean surgery.

Caesarean rates at public hospitals tend to be lower than at private hospitals. If you want to know about a hospital’s caesarean birth rates, ask your doctor or midwife. You can also check caesarean rates for some hospitals online.