A caesarean section, or C-section, is an operation to deliver your baby through a cut made in your tummy and womb.

The cut is usually made across your tummy, just below your bikini line.

A caesarean is a major operation that carries a number of risks, so it's usually only done if it's the safest option for you and your baby.

Around 1 in 4 pregnant women in the UK has a caesarean birth.

Why caesareans are carried out

A caesarean may be recommended as a planned (elective) procedure or done in an emergency if it's thought a vaginal birth is too risky.

Planned caesareans are usually done from the 39th week of pregnancy.

A caesarean may be carried out because:

• your baby is in the breech position (feet first) and your doctor or midwife has been unable to turn them by applying gentle pressure to your tummy, or you'd prefer they did not try this
• you have a low-lying placenta (placenta praevia)
• you have pregnancy-related high blood pressure (pre-eclampsia)
• you have certain infections, such as a first genital herpes infection occurring late in pregnancy or untreated HIV
• your baby is not getting enough oxygen and nutrients – sometimes this may mean the baby needs to be delivered immediately
• your labour is not progressing or there's excessive vaginal bleeding

If there's time to plan the procedure, your midwife or doctor will discuss the benefits and risks of a caesarean compared with a vaginal birth.

Asking for a caesarean

Some women choose to have a caesarean for non-medical reasons.

If you ask your midwife or doctor for a caesarean when there are not medical reasons, they'll explain the overall benefits and risks of a caesarean to you and your baby compared with a vaginal birth.

If you're anxious about giving birth, you should be offered the chance to discuss your anxiety with a healthcare professional who can offer support during your pregnancy and labour.

If after discussing all the risks and hearing about all the support on offer you still feel that a vaginal birth is not an acceptable option, you should be offered a planned caesarean. If your doctor is unwilling to perform the operation, they should refer you to a doctor who will.

What happens during a caesarean

Most caesareans are carried out under spinal or epidural anaesthetic.

This mean you'll be awake, but the lower part of your body is numbed so you will not feel any pain.

During the procedure:

• a screen is placed across your body so you cannot see what's being done – the doctors and nurses will let you know what's happening
• a cut about 10 to 20cm long will usually be made across your lower tummy and womb so your baby can be delivered
• you may feel some tugging and pulling during the procedure
• you and your birth partner will be able to see and hold your baby as soon as they have been delivered if they're well – a baby born by emergency caesarean because of foetal distress may be taken straight to a paediatrician for resuscitation

The whole operation normally takes about 40 to 50 minutes.

Occasionally, a general anaesthetic (where you're asleep) may be used, particularly if the baby needs to be delivered more quickly.

Recovering from a caesarean

Recovering from a caesarean usually takes longer than recovering from a vaginal delivery.

The average stay in hospital after a caesarean is around 3 or 4 days, compared with an average of 1 or 2 days for a vaginal birth.

You may experience some discomfort in your tummy for the first few days. You'll be offered painkillers to help with this.

When you go home, you'll need to take things easy at first. You may need to avoid some activities, such as driving, until you have had your postnatal check-up with the doctor at 6 weeks.

The wound in your tummy will eventually form a scar. This may be obvious at first, but it should fade with time and will often be hidden in your pubic hair.

Risks of a caesarean

A caesarean is generally a very safe procedure, but like any type of surgery it carries a certain amount of risk.

It's important to be aware of the possible complications, particularly if you're considering having a caesarean for non-medical reasons.

Possible complications include:

• infection of the wound or womb lining
• blood clots
• excessive bleeding
• damage to nearby areas, such as the bladder or the tubes that connect the kidneys and bladder
• temporary breathing difficulties in your baby
• accidentally cutting your baby when your womb is opened

Future pregnancies after a caesarean

If you have a baby by caesarean, it does not necessarily mean that any babies you have in the future will also have to be delivered this way.

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 you may need some extra monitoring during labour just to make sure everything is progressing well.

Some women may be advised to have another caesarean if they have another baby.

This depends on whether a caesarean is still the safest option for them and their baby.

What happens-Caesarean section

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 

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

Recovery-Caesarean section

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

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.

Risks-Caesarean section

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.