What happens during an elective or emergency caesarean section?
If you have planned in advance to have a caesarean, you will be given the opportunity to meet the anaesthetist to discuss your anaesthetic options.
These days the majority of caesareans are carried out with spinal anaesthesia. This is a one-off injection in the lower spine that works quickly and gives sufficient anaesthesia for the length of the operation.
When epidural anaesthesia has been used for pain relief in labour, this can usually be topped up to provide the anaesthesia required for an emergency caesarean. An epidural is sometimes used for elective caesareans but is becoming less common.
Around 10% of caesareans – both elective and emergency – are performed under general anaesthetic. If you have a general anaesthetic, you will not be aware of anything going on around you. General anaesthetics are less safe than regional anaesthesia, but may be used for various reasons. For example, you may wish not to be awake during the operation, or you may have a medical problem that prevents the use of a spinal or epidural.
The exact procedure varies with different hospitals and obstetricians, but in all cases you will be asked to sign a consent form, without which the operation cannot legally take place.
For an elective caesarean
If you are having an elective operation, you will have some routine blood tests done beforehand. You will be asked to go into hospital the night before or early on the morning of the operation, and to take a medicine to reduce the acidity in your stomach.
Before your operation, the final preparations will take place. These will involve: changing into a hospital gown; having a bikini shave if necessary; and removing nail varnish, glasses or contact lenses and jewellery. The nursing staff will put a name-band on your wrist. You may also need to take some clothes for your baby.
You will then be taken to the operating theatre. If you are having a spinal or epidural anaesthetic, your birth partner will be able to stay with you during your caesarean, but will have to change into theatre clothes. If you are going to have a general anaesthetic, your birth partner will usually be asked to stay outside the operating theatre.
For an emergency operation
If you are having an emergency caesarean, the same process applies. However, the degree of urgency will determine how much time is available.
The procedure is similar whether the caesarean is elective or an emergency. There are likely to be a large number of people in the operating theatre with you. The staff may include: a midwife; the obstetrician, and an assistant; a theatre nurse and an assistant; an anaesthetist and an assistant; and probably a paediatrician (doctor specialising in children).
If you have a spinal or epidural anaesthetic, and you are awake, a screen will be placed near your head so you can’t see what is happening. You shouldn’t feel any pain at all during the operation, though you may be aware of some sensations. Some women describe the feeling as ‘like having someone doing the washing-up in your tummy’. If you have had a general anaesthetic, you won’t be aware of anything until you wake up.
Your baby will be born very quickly, during the first five minutes, followed by the delivery of the placenta. It will then take about half an hour to have your wound stitched. Your skin will usually have one continuous stitch with beads at either end, or special skin staples that need to be removed later.
If you are awake and your baby is well, he will be handed to you immediately. If you have had a general anaesthetic, he can be given to your birth partner outside the operating theatre. If your baby needs any help breathing, or has other problems, he may need to be taken to the special care baby unit.
Your baby should be able to have skin-to-skin contact with either you, or your birth partner, as soon as he is born and some mothers have even breastfed their babies while still in theatre.
Exact procedures will vary between hospitals and obstetricians. Typically, you will be moved out of the operating theatre to another room called a recovery room. A midwife will monitor you to make sure there are no problems until you have recovered sufficiently to be taken to the postnatal ward. If you have had a general anaesthetic, your birth partner and baby should be there with you when you wake up.
After the operation, it is usual to be given a painkiller that lasts for several hours. It is also usual to be recommended to wear tight stockings and/or be given medication to reduce the risk of getting blood clots (thrombosis).
NCT's helpline offers practical and emotional support in all areas of pregnancy, birth and early parenthood: 0300 330 0700. We also offer antenatal courses which are a great way to find out more about birth, labour and life with a new baby.
NHS Choices offers a section on caesarean birth.
The site www.caesarean.org.uk offers research-based information and support on all aspects of caesareans and vaginal birth following caesarean section.