A caesarean birth (C-section) is when a baby is born by abdominal surgery. We talk here about planned and emergency caesareans and the risks and benefits.
One in every four to five pregnant women in the UK has a caesarean birth (NHS Choices, 2016). Some are planned while others are emergency caesareans. Here we look at the types of caesarean birth, when a caesarean will be offered, and the risks and benefits of a caesarean section.
What is a caesarean birth?
A caesarean birth is when your baby is born through a cut in your lower abdomen to your womb. The cut is usually on the bikini line but can also be done vertically (NHS Choices, 2016).
Obstetricians, who are doctors specialising in pregnancy and birth, usually carry out caesareans. You’d be in an operating theatre during the procedure.
The actual birth takes five to ten minutes and you can usually have skin-to-skin contact with your baby straight after they’re born. It can take 40 to 50 minutes to complete the procedure, including removing the placenta through the same cut and stitching afterwards (NHS Choices, 2016).
What are the different types of caesarean birth?
There are two types of caesarean:
- A planned (or elective) caesarean is planned for before labour begins. You might have a planned caesarean for a medical reason or, more rarely, because you’ve chosen this type of birth in discussion with your obstetrician.
- An unplanned (or emergency) caesarean can take place during labour, or before labour starts if an unexpected medical problem comes up. This happens when your baby needs to be born quickly for their health or yours. (Lavender et al, 2014, Which?, 2018)
When is a caesarean birth necessary?
Sometimes a caesarean is the safest way for your baby to be born. This could be if you have:
- placenta praevia, which is where the placenta lies across your cervix
- placental abruption, which is when the placenta comes away from the wall of the uterus early
- pre-eclampsia, a condition that causes high blood pressure
- umbilical cord prolapse, which is when the cord slips through the open cervix before the baby is born
- specific infections occurring late in pregnancy, such as genital herpes, or untreated HIV (a woman with diagnosed and treated HIV will usually be offered a vaginal birth)
- an unexpected situation that arises during labour, for example if an assisted delivery is unsuccessful
- another medical condition that makes this the safest option for giving birth. (Hannah et al, 2000; NICE, 2011; Lavender et al, 2014; NHS Choices, 2016; Which?, 2018)
You will also be offered a caesarean birth if your baby:
- is lying in the oblique or transverse position (lying horizontally across your pelvis or diagonally with their head in your hip)
- has a medical condition that makes it safer for them to be born by caesarean. (Hannah et al, 2000; Patient, 2014)
Sometimes the decision about whether to have a caesarean birth can be less straightforward. For example if:
- your baby is breech (lying bottom down)
- the progress of labour is slow (failure to progress)
- monitoring of your baby’s heartbeat and/or other signs (e.g. meconium in the amniotic fluid) suggest your baby might be in difficulty (foetal distress)
- you’re carrying more than one baby. (Hannah et al, 2000; NICE, 2011; Lavender et al, 2014; NHS Choices, 2016; Which?, 2018)
Repeat caesarean births (ERCS)
In the past, women who had previously given birth by caesarean were commonly offered another caesarean in subsequent pregnancies. This is now changing.
We now know there is little or no difference in the risks between planned caesarean and vaginal births. That’s even he case in individuals who’ve had up to four previous caesareans (NICE, 2013).
A vaginal birth after caesarean (VBAC) is often possible. Read more in our articles on planning a vaginal birth after a caesarean (VBAC) and planning a repeat caesarean (ERCS) (Hannah et al, 2000; NICE, 2011; Lavender et al, 2014; NHS Choices, 2016; Which?, 2018).
One trend that’s increasing is the use of caesarean section for less specific medical reasons. Reasons include failure to progress and presumed foetal complications (Lavender et al, 2014). Caesarean births for non-medical reasons, for example a request by the mother, are also increasing (Lavender et al, 2014).
Requesting a planned caesarean birth
If you want to ask for a caesarean for non-medical reasons, you should be offered a discussion with healthcare professionals (NICE, 2011). You’d be able to discuss with them the overall risks and benefits of the procedure and the help and support available. This discussion should ideally include a midwife, obstetrician and anaesthetist (NICE, 2011).
If you want a caesarean because you’re extremely anxious about childbirth, you should be referred to a perinatal mental health specialist for support (NICE, 2011). If after the discussion you would still like a caesarean birth, you should be offered a planned caesarean section as requested (NICE, 2011).
Risks and benefits of caesarean section
Benefits of caesarean birth
A planned caesarean for some women might reduce the risks of:
- haemorrhage and blood transfusion
- urinary problems and problems with bladder control
- pain during the birth
- prolapse of the womb, vagina or bladder pushing against the wall of the vagina
- feelings of anxiety about vaginal birth and loss of control.
(NICE, 2011; RCOG, 2015a,b; Tommys, 2018)
Risks of caesarean birth
A caesarean birth involves surgery, and as such it can increase some risks to you and your baby. These risks include:
- wound infection
- a longer hospital stay
- a longer recovery time, of up to six weeks
- increased risk of bleeding after birth that may occasionally need hysterectomy (removal of the womb)
- a cut to baby’s skin during the surgery
- increased risk of intensive care unit admission of babies
- increased risk of blood clots in the legs that can travel to the lungs
- increased risk of respiratory problems for your baby
- possible complications of the scar and placenta in future pregnancies, occasionally requiring hysterectomy
- feelings of sadness or disappointment if a caesarean wasn’t planned (there might be a link between emergency caesarean and postnatal depression).
(NICE, 2011; RCOG, 2015a,b; Tommys, 2018)
Long-term effects of caesarean
Not much is known about the long-term effects of having a caesarean birth.
Some evidence suggests children born by caesarean might have a higher risk of conditions like childhood asthma, type 1 diabetes or obesity. Yet it’s not yet known whether this is caused by the caesarean itself.
One idea is that babies born by caesarean are not exposed to bacteria in the mother’s vagina so don’t form the same microbiome in their guts. The higher risk of certain conditions could also be linked to women after caesareans sometimes needing extra support with breastfeeding. This might be because breastfeeding can protect against these conditions (Tommy’s, 2018).
If you are considering a planned caesarean, talk through your options through with your midwife, GP or obstetrician. If you’ve recently had a caesarean birth, read our article about recovery after a caesarean birth.
This page was last reviewed in August 2018.
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