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Caesarean sections: an overview

Mother and father with newborn delivered via caesarean
Photo credit: iStock.com / Don Bayley

What is a caesarean section?

A caesarean section is an operation during which an obstetrician makes a cut through your belly and uterus (womb), to allow your baby to be born.

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It's the most common major surgery that women have (Anorlu et al 2008). In Australia, almost one third of women give birth by caesarean every year (Hilder et al 2014).

What's the difference between a planned and an emergency caesarean?

A planned (elective) caesarean is scheduled to take place before your labour begins. In Australia, for women giving birth at term (37 to 41 weeks pregnant), about 60 per cent of caesarean sections are planned (Hilder et al 2014).

An emergency caesarean is unplanned and can happen if:

  • You were planning a caesarean, but your waters break, or you go into labour before the operation; or if you were intending to give birth vaginally, but your labour has stalled or is very slow. Your caesarean will go ahead within a few hours, if you and your baby are well.
  • You or your baby develop a serious complication during pregnancy or labour, but it’s not immediately life-threatening to either of you. This is more urgent and a caesarean will usually be done within about an hour of the decision, depending on the complication.
  • You or your baby develop a complication during pregnancy or labour that is immediately life-threatening. Your baby should be born as quickly as possible, ideally within 30 minutes, depending on the complication (NCCWCH 2014, Thomas and Paranjothy 2001).


Most unplanned caesareans are in the second category, where there’s a serious complication but it’s not immediately life-threatening. So they aren’t true medical emergencies (Thomas and Paranjothy 2001) and you, your partner and the maternity staff should still have enough time to prepare for the operation.

Read more about the reasons for needing a caesarean.

What will happen before my caesarean?

Your doctor or midwife should talk you through the procedure. They will:

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  • tell you what will happen during the caesarean section
  • explain why they think you need the operation
  • explain any possible risks to you and your baby (RCOG 2006)
  • ask for your consent (NCCWCH 2014, RCOG 2006), which you have the right not to give


Before surgery, you’ll need to change into a hospital gown and remove all jewellery, though rings can be taped over. If you have a brace or false teeth, you'll need to remove these, too.

You’ll also need to take off make-up and nail polish, so your skin tone can be monitored during the operation. If you have gel nail overlays, they’ll need to be removed with acetone remover.

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You won't be able to wear contact lenses. If you wear glasses, give them to your partner or midwife, so you can see your baby after the operation (Chippington Derrick et al 2004).

In most cases, your partner will be with you during your caesarean. He will need to wear thin cotton theatre clothes, a mask, a hat and special footwear.

You'll lie on an operating table, which is tilted or wedged to the left. This is so the weight of your uterus (womb) doesn't reduce the blood supply to your lungs and make your blood pressure drop.

You’ll then have:

  • A blood sample taken, to check that you haven't got anaemia, as this would mean you can’t tolerate blood loss well.
  • A drip inserted into a vein in your arm, to give you fluids and drugs that prevent low blood pressure, and to make it easy to give you drugs later if you need them.
  • A regional anaesthetic that numbs your bottom half, via a spinal or epidural. It's safer for you and your baby than a general anaesthetic, which puts you to sleep.
  • A thin tube (catheter) inserted into your bladder via your urethra. Spinal or epidural anaesthetic can prevent your bladder from working properly, so the catheter empties it, ready for surgery. You won’t feel it, thanks to the painkiller.
  • The area where the cut will be made shaved and cleaned with antiseptic.
  • White stockings, extra fluid and blood-thinning injections to reduce the risk of a clot forming in one of your leg veins (deep vein thrombosis).
  • A cuff put on your arm to monitor your blood pressure.
  • Electrodes placed on your chest to monitor your heart rate. You may have a finger-pulse monitor attached, too.
  • A sticky plastic plate attached to your leg to act as a harmless earth for the electrical equipment used (Chippington Derrick et al 2004, NCCWCH 2014).
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You'll be offered:

  • an injection of antibiotics to ward off infection
  • anti-sickness medicine to prevent vomiting
  • drugs, such as antacids, in case you need a general anaesthetic, to reduce the risk of pneumonia
  • strong pain relief during and just after the caesarean, as well as for any lasting soreness in the following weeks (NCCWCH 2014)
  • oxygen through a mask, if your baby is in distress


You may be surprised how many people are needed to do a caesarean section.

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What happens during my caesarean?

A screen is put up over your chest so that you can't see the operation. In most hospitals it will lowered as your baby is born and you can ask for it to be done if it isn’t offered. Your anaesthetist will check that your painkiller is working properly.

Once you're numb, your doctor will make a straight cut, called a bikini cut, into the skin of your belly. It's usually two to three fingers’ width above your pubic bone, at the top of your pubic hair (NCCWCH 2014). This sort of cut is less painful after the operation and tends to look better as it heals than a cut down the middle of your tummy (NCCWCH 2014).

Layers of tissue and muscle are opened so the surgeon can reach your uterus. Your tummy muscles are parted, rather than cut. Your bladder will be moved down to expose the lower part of your uterus.

The cut to your uterus is usually small and the surgeon will make it bigger using scissors or fingers. This causes less bleeding than a sharp cut (NCCWCH 2014). The opening to your uterus is usually in the lower part, which is why the operation is sometimes called a lower segment caesarean section (LSCS).

You may hear and sense fluid whooshing out through the opening, and feel the surgeon’s assistant pressing on your belly to help your baby be born. Your obstetrician will lift out your baby. If your baby is breech, he will be born bottom first.

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This all happens quickly. It's possible that only five or 10 minutes after the operation starts you’ll be able to meet your baby.

If you're having twins the lower twin is born first, just as if you'd given birth vaginally.

Sometimes, forceps are used to bring out your baby's head carefully (NCCWCH 2014, RANZCOG 2013).

Surgeons make larger, vertical cuts in the uterus in fewer than one in 100 caesareans. Your surgeon may make a vertical cut if:

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  • your baby is very premature (Petersen et al 2009), or is lying across your uterus
  • you have a condition such as a low-lying placenta
  • you have adhesions or growths (fibroids) in the lower part of your uterus (Baker and Kenny 2011)
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What will happen after my baby is born?

Usually a pediatrician will check out your baby immediately after delivery. This generally takes a few minutes and your partner can usually observe the whole process. Then your baby is placed on to your chest for you to cuddle. Your partner can usually hold your baby if you’re unable to yet. Babies born by caesarean tend to be a little colder than babies born vaginally, so need to be wrapped up well (NCCWCH 2014).

Your baby will be given an Apgar score one minute and five minutes after he's born to measure his wellbeing (NCCWCH 2014). Some babies need oxygen or to go to special care for a while.

You'll be given the synthetic version of the hormone oxytocin (Syntocinon) via a drip to help your uterus contract and to reduce your blood loss (NCCWCH 2014). Your doctor will gently tug the umbilical cord to pull out the placenta, and will check to make sure it’s complete before you're stitched up.

You'll be in theatre for up to an hour. This is because it takes much longer to close you up than to open you up (Chippington Derrick et al 2004). The process may take longer if you’ve had one or more caesareans. It depends on how many adhesions and bands of scar tissue you have from previous operations (Chippington Derrick et al 2004).

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Your doctor will probably use a double layer of stitches to repair your uterus (NCCWCH 2014). The cut in your belly will be closed in layers, but not all layers need stitching (NCCWCH 2014). Finally, your skin wound will be closed with stitches or staples (NCCWCH 2014).

When you're ready, you'll be moved into the recovery room where you, your partner and, if all is well, your baby or babies can be together.

You may start shivering, because your body temperature drops during the operation (RCOA 2013) and theatres are often kept cool. The shivering is usually harmless and only lasts about half an hour. The midwife or nurse looking after you will warm you up with blankets and fluids.

Try to cuddle your baby skin-to-skin as soon as you can (NCCWCH 2014). If you want to breastfeed, you can try while you're still in the recovery room. Skin-to-skin can help with bonding and with breastfeeding (NCCWCH 2014). Your midwife will help you get comfortable for breastfeeding and will take care of you straight after the operation (NCCWCH 2014).

Get some tips on writing a caesarean birth plan.

Caesarean birth notes pdf
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BabyCenter's editorial team is committed to providing the most helpful and trustworthy pregnancy and parenting information in the world. When creating and updating content, we rely on credible sources: respected health organisations, professional groups of doctors and other experts, and published studies in peer-reviewed journals. We believe you should always know the source of the information you're seeing. Learn more about our editorial and medical review policies.

Anorlu RI, Maholwana B, Hofmeyr GJ. 2008. Methods of delivering the placenta at caesarean section. Cochrane Database of Systematic Reviews (3): CD004737. onlinelibrary.wiley.comOpens a new window

Baker PN, Kenny LC. eds. 2011. Obstetrics by ten teachers. 19th ed. London: Hodder Arnold

Chippington Derrick D, Lowdon G, Barlow F. 2004. Caesarean birth: your questions answered. London: The National Childbirth Trust

Hilder L, Zhichao Z, Parker M et al. 2014. Australia's mothers and babies 2012. Perinatal statistics, 30. Cat no. PER 69. Canberra: AIWH. www.aihw.gov.auOpens a new window [pdf file, accessed June 2015]

NCCWCH. 2014. Caesarean section. National Collaborating Centre for Women's and Children's Health, NICE Clinical guideline. London: RCOG Press. www.nice.org.ukOpens a new window [pdf file, accessed July 2015]

Petersen SG, Wong SF, Urs P, et al. 2009. Early onset, severe fetal growth restriction with absent or reversed end-diastolic flow velocity waveform in the umbilical artery: perinatal and long-term outcomes. Aust N Z J Obstet Gynaecol 49(1):45-51

RANZCOG. 2013. Delivery of the fetus at caesarean section. Royal Australian and New Zealand College of Obstetricians and Gynaecologists. Clinical Guidelines, 37. Melbourne: RANZCOG. www.ranzcog.edu.auOpens a new window [pdf file, accessed June 2015]

RCOA. 2013. Risks associated with your anaesthetic. Section 3: shivering. Royal College of Anaesthetists. www.rcoa.ac.ukOpens a new window [pdf file, accessed July 2015]

RCOG. 2009. Caesarean section. Royal College of Obstetricians and Gynaecologists, consent advice, 7. www.rcog.org.ukOpens a new window [pdf file, accessed July 2015]

Thomas J, Paranjothy S. 2001. The National Sentinel Caesarean Section Audit Report. Royal College of Obstetricians and Gynaecologists Clinical Effectiveness Support Unit. London: RCOG Press.

Megan Rive is a communication, content strategy and project delivery specialist. She was Babycenter editor for six years.
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