The caesarean (also called caesarean section or C-section) is a type of delivery performed when the baby cannot be born through the vagina. This surgical procedure involves cutting open the mother’s abdomen and uterus to remove the baby. In Québec, about one in four women give birth by C-section.

Reasons to have a caesarean

A caesarean can be planned or unplanned, and there are several reasons why it may be performed. Here are some examples of situations where a caesarean may be necessary.

Situations requiring planned caesareans

  • Certain medical problems in the mother
  • When the placenta fully or partially covers the cervix (placenta prævia)
  • Certain cases of breech presentation (see Breech presentation)
  • A previous caesarean combined with conditions not favourable for vaginal delivery (see Vaginal birth after caesarean)

Situations requiring unplanned caesareans

  • The baby is in a position that does not allow for a safe delivery
  • There are concerns about the baby’s health
  • Labour has not progressed adequately, despite proper stimulation
  • The mother has major medical problems

Essential information to rememberGenerally, the person accompanying the mother during a caesarean delivery can enter the operating room and sit near her.

Photo: Nicolas Léger

What happens during a caesarean

Before the caesarean, the mother will be given an intravenous solution (IV) and fitted with a urinary catheter.

Caesareans are generally done under an epidural (see Epidural) or spinal block. The spinal block is similar to the epidural, but the drug is injected into a different region of the spine. It allows for a faster anaesthesia. In both cases only the lower body is anaesthetised and the mother remains conscious. In rare cases, a general anaesthetic that puts the patient “to sleep” is used.

Generally, once the preparations for the caesarean are complete, the person accompanying the mother can enter the operating room and sit near her. A sheet hides the view of the belly during the operation.

The incision is usually horizontal, above the pubic hair line. Once the baby is delivered and the umbilical cord is cut, the baby is placed against the mother’s skin if both baby and mother are doing well.

The placenta is then removed, and the uterus and abdomen are closed with stitches or staples.

Even after a caesarean, the mother will be able to start skin-to-skin contact with her baby and initiate breastfeeding. Depending on the circumstances and where the delivery took place, this could be in the operating room, the recovery room, or the hospital room (see Is breastfeeding still possible?). If the mother is unable to start skin-to-skin contact, the father or another significant person can do so instead.

Possible consequences of a caesarean

Caesareans may have short and long-term consequences.

Short-term effects of a caesarean delivery include the following:

  • Abdominal and pelvic pains that require the use of drugs
  • Difficulty urinating
  • Possible difficulties with breastfeeding immediately after the caesarean due to the pain and discomfort caused by movement (see Is breastfeeding still possible?)
  • Hospital stay sometimes longer than for a vaginal birth
  • Longer recovery than for vaginal delivery

Most caesareans go well. However, since it is a surgical procedure, complications are possible for the mother, including infection, bleeding, thrombophlebitis, and injury to internal organs. These complications may require additional interventions and care.

In the long term, the caesarean may affect future pregnancies by increasing the risk of a placental disorder such as placenta prævia. There is also the possibility of uterine rupture during a future vaginal birth, although the risk is very low (see Vaginal birth after caesarean).

In the hours immediately after the birth, a baby born by caesarean may have a lower body temperature. Skin‑to‑skin contact with the mother or other parent can help improve the situation. Babies born by caesarean are also more likely to experience mild respiratory distress.

Recovering from a caesarean

At the hospital, you will be encouraged to gradually start walking, drinking, and eating as the effects of the anaesthesia wear off and you feel better. Moving around after a caesarean helps speed recovery and prevent complications.

The pain of the incision and numbness of the skin in the surrounding area may be uncomfortable. The presence and duration of the pain and numbness vary from one woman to another. Your doctor will prescribe drugs for pain relief. The incision will heal in the weeks following childbirth.

Before you leave the hospital, a health professional will tell you how to care for your wound and will give you advice for your specific situation. Don’t hesitate to ask all the questions you may have. You can also read the section The body after birth, for more information.

You will also be given advice on how to care for your newborn. Usually a baby born by caesarean does not require any special care.

It will take a few weeks before you can resume all your activities, such as driving, lifting heavy objects, engaging in certain physical activities and sports (see Physical activity), or having sexual relations (see Sexuality after birth).

Information to which special attention should be paidIf you experience any of the problems listed in the red box on page The body after birth, see your doctor or midwife right away or go to the emergency room.

When to consult a health professional?

After your return home, consult a health professional if you see any signs of a possible wound infection (e.g., redness, discharge).

You may also find that having a caesarean triggers a range of sometimes contradictory emotions. Each experience is unique, and the way you feel after a caesarean can change over time. Don’t hesitate to talk your feelings over with a professional.

Labour: Process by which the baby passes from the uterus to the outside world, primarily through contractions of the uterus.

Urinary catheter: A flexible tube that allows urine to drain freely from the bladder. The catheter is inserted into the bladder through the urethra.

Thrombophlebitis: Inflammation of a vein associated with clot formation.

Uterine rupture: Tearing of the uterine scar from a previous caesarean.