Elective c-sections: what to expect


by Catherine Ball |

There are a number of reasons you might be considering or preparing for an elective caesarean section.

Elective c-sections, also referred to as planned c-sections, are when the delivery of a baby by caesarean is a planned event rather than a last-minute or emergency decision. This usually happens for medical reasons, although sometimes a woman may prefer an elective c-section for personal reasons, especially if she has had a previous vaginal birth which was difficult or traumatic.

When a caesarean section is not planned in advance, it is referred to as an emergency c-section. Some mums-to-be feel quite alarmed when they hear that phrase but it doesn’t necessarily mean they or their baby are in danger.

Ellis Downes, a consultant gynaecologist and obstetrician at The Portland Hospital, part of HCA Healthcare UK, says: ‘Patients often worry about the term “emergency”, this does not mean panic or dire urgency, just that the caesarean operation is unscheduled. About one in four women in the UK have a c-section to deliver their baby, with most of these being emergency c-sections.’

Why might I need an elective c-section?

Deciding whether or not to have an elective c-section is something you will discuss in detail with your midwife and consultant. Some women choose this type of delivery because it has been recommended due to medical issues relating to this or previous pregnancies, while others may feel it is the best decision for them for personal or psychological reasons.

Common reasons include baby being in a breech or transverse position, which could make a vaginal birth more difficult and issues with the placenta, including having a low-lying placenta, which may be blocking the baby’s way out.

If you are expecting twins, you may be asked to consider a planned caesarean, especially if the babies share a placenta or one of them is in a tricky position for birth. You may also be offered the option of an elective c-section if your previous baby was delivered by caesarean or there were complications during a natural birth.

Ellis says: ‘Women do sometimes opt for an elective caesarean for fear of the pain of giving birth vaginally. Some mothers-to-be feel guilty or worried about asking for an elective c-section, however, their dedicated healthcare teams will never judge them for their choice and always want them to have the best birth experience possible.

‘An obstetrician will always explain the benefits and risks of a c-section and vaginal delivery to any mother considering their birth options.’

How can I prepare for an elective c-section?

Once you have made the decision to have a caesarean section, it is a good idea to plan ahead. Most elective c-sections will be booked in for around the 39th week of pregnancy, unless there is a reason to deliver baby earlier.

You should still write a birth plan and think about the things which are important to you.

Ellis says: ‘If possible, it’s always helpful to plan and create a birth plan for your caesarean, as this can help to make things easier later on. Your doctors and midwives will always try to meet your wishes and give you the best birth experience possible.

‘You may also wish to speak to your midwife before the surgery to plan who you would like to have with you at the birth. I encourage my patients to prepare their own playlist of relaxing and special music to play when their baby enters the world.

‘We encourage early skin-to-skin contact if that is what you and you and your partner would like.’

Louise Broadbridge, who is the official midwife for Your Baby Club, says there is still a lot you can do to make the birth a personal experience.

She says: ‘Your partner will still be able to trim the cord and take pictures of your tiny baby as they are getting checked over before you enjoy your first lovely cuddles. If you haven't found out if you are having a girl or a boy you can let the surgical team know this so that the sex isn't revealed until you have a little look for yourself.

‘Or you could ask that your partner learns this news and comes back to let you know.’

Louise also suggests thinking about the practical things you might need once you get home before going into hospital.

She says: ‘Having some pre-prepared meals in your freezer can be a life saver as can having friends and family on standby to give a hand or run some errands.’

A few days before the date of your c-section, you will be asked to go into the hospital to be assessed. This will usually involve signing a consent form and having some blood tests to check what your blood type is and whether your iron levels are normal.

You’ll also be given some medication to take – usually antibiotics, anti-sickness medicines and antacids to make your stomach less acidic.

Can I eat before my elective c-section?

You will normally be asked to fast overnight the day before your procedure as you shouldn’t eat anything for at least six to eight hours before surgery. Most women will be asked to go into hospital in the morning so make sure you don’t eat any breakfast before you go.

You will often have to wait a while for your c-section to take place, depending on how many other women are booked in and whether the surgical team are needed to perform any emergency procedures.

Will it be painful?

The vast majority of elective c-sections are performed under local anaesthetic so you will be awake throughout the procedure. You shouldn’t feel any pain, however you will feel a tugging or pulling sensation and some women say it feels like someone washing up in your tummy.

You will be asked to sit in an upright position and the anaesthetist will administer a spinal block or epidural. This involves injecting pain medication into your lower back which will leave you numb from the waist down.

A cannula – a thin tube into a vein – will be inserted into your hand and a catheter will be fitted to empty your bladder during the operation and mean you won’t have to go to the toilet while you’re still recovering from surgery.

Your anaesthetist will use a cold spray on different parts of your body to check that your anaesthetic has worked properly. Your body uses the same nerves to detect cold and pain so this spray will tell them whether or not you are numb enough for them to start.

Ellis says: ‘There are lots of myths surrounding c-section deliveries which can often cause new mums unnecessary worry at a time when feeling calm is key. After over 30 years of performing Caesarean sections, 99% of my new mums say to me afterwards that the actual procedure was much less stressful than they thought it was going to be.’

What happens in the operating theatre?

Once you are taken into the operating theatre, you will be covered in sterile drapes. Don’t worry about being able to see them cut into you as they will put a screen up in front of you to hide the procedure itself.

Your birth partner will usually sit next to you to give you moral support and an anaesthetist will be there to keep an eye on you throughout the procedure.

The surgical team will clean your abdomen with fluid before making an incision around your bikini line. In most cases, this will be a single cut between 10cm and 20cm in length. They will then move your bladder and abdominal muscles and make another cut, this time in your uterus.

You may hear a suction-type noise but this is nothing to worry about. This is simply them removing the abdominal fluid once your waters have broken.

Delivering your baby usually takes between five and 10 minutes and this is when you feel the tugging. Once your baby has been born, he will be lifted up so you can see him and he will be brought to you as soon as it is practical to do so.

You’ll then be given an injection of oxytocin – often referred to as the love hormone. This encourages your uterus to contract and reduces the risk of heavy bleeding.

It may take a while for the surgeons to stitch your wound up after a c-section, particularly it isn’t the first time you have had one. The stitches will usually be dissolvable and will disappear themselves after a few days.

In total, your elective c-section is likely to take between 40 and 50 minutes.

What can I expect after my c-section?

Straight after the procedure, you will be moved into a recovery room and monitored by medical staff. You will probably be offered painkillers at this point and if you want to breastfeed your baby, you’ll be given support to do so.

You may also be given something to eat and drink. After your c-section, you’ll probably be asked to wear tight surgical stockings to reduce the risk of blood clots and you may also be given blood-thinning injections.

Your catheter will usually be removed around 12 to 18 hours after your c-section and you’ll be encouraged to get up on your feet and move around.

You may well have been told to expect vaginal bleeding after giving birth but you may not realise you will still experience this if you’ve had a c-section.

Louise says: ‘This is perfectly normal and, just like with a vaginal delivery, will stop after a couple of weeks. The level of discomfort once all of the analgesia has worn off can also be a bit of an eye-opener.

‘It is really important to keep on top of your pain relief, taking regular paracetamol and ibuprofen (assuming you are not allergic).”

Will I be left with a scar?

Having an elective c-section, will leave you with a scar but the good news is that for most women, this is small and in a discreet place. Usually, your scar will be just below the bikini line and once it heals it will be much less noticeable.

The wound left from your surgery will need to be dressed for the first few days after your baby is born. Once the dressing has been removed, it is important to keep the area clean and dry.

Keep an eye on your scar while it is still healing and seek advice if it becomes red or sore and this could be a sign of infection.

Ellis says: ‘Most scars will fade significantly with time and form a thin white line by the baby’s first birthday.’

What can I do to aid my recovery?

Remember that a caesarean section is major abdominal surgery so it is important not to push yourself too hard and to allow yourself time to rest and heal. You will usually be told to avoid driving and heavy lifting for at least six weeks.

Ellis says: ‘Rest and recovery are vital, so I would recommend asking for some help in the first few days and weeks after surgery. It is still important to slowly move around to maintain a healthy blood flow from the veins in your legs to prevent clots from forming.

‘I’d suggest going for a gentle walk every day with progressively longer distances to help recovery and get some fresh air. It is also important to avoid lifting heavy objects as your abdominal muscles will have been significantly weakened and will take time to heal and strengthen.’

Louise adds: ‘Get your partner to pass you your baby when cuddles are needed. If you notice that your bleeding gets a little heavier after activity, listen to your body and take it easy for a little while.’

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