What to expect when you have an elective caesarean birth

Normally, you will visit the hospital before you come in for your caesarean birth. The midwife will see you and take blood from you to check your haemoglobin (HB) to make sure you are not anaemic. They will also confirm your blood group in case you need a blood transfusion. 

Most women go home after the assessment and come back to the hospital on the day of the caesarean birth. But you may need to come in the night before. The midwife will give you anti-digestion tablets to take before your caesarean birth. This reduces the acid in your stomach. These are usually taken on the morning of the caesarean birth.

Avoid eating and drinking anything other than water before your caesarean birth. This prevents you from feeling sick during surgery. It also reduces the risk of problems if you have a general anaesthetic. Your midwife will tell you when you should stop eating.

Most hospitals now allow you to drink water up until your caesarean birth. This should be no more than one cup an hour. Again, your midwife will explain this to you when you come in the day before.

An anaesthetist will see you before your caesarean birth. They will discuss the types of anaesthetic available to you. And find out what is important to you so you can agree together on the right type of anaesthetic for your birth.

Your midwife will meet you and ask about your medical and pregnancy history on the day you plan to give birth. They will also ask you about how you would like to feed and care for your baby.  They will give you a name band to wear on your wrist or ankle. And a theatre gown and special tight stockings to reduce the risk of blood clots.

In most cases, your birth partner, if you have one, will be able to be with you during the caesarean birth. A midwife will provide them with special clothes for the operating theatre.

There will be quite a few people in the operating theatre. This will include:

• The midwife who will help look after you and your baby
• The anaesthetist and assistant
• The obstetrician and an assistant and a scrub nurse

• A nurse or healthcare assistant, responsible for helping the team doing the operation

• A paediatrician or neonatal practitioner

• There may also be healthcare students present (you can ask for students not to be present, if you wish)

It might feel that there are a lot of people there, but they are all there to care for you, your birth partner and your baby.

A member of the theatre team will confirm your name, date of birth and hospital number as part of a safety check.

When your spinal or epidural is working, a screen will go up so you and your birth partner cannot see the lower part of your body and the surgery. The anaesthetist will stay with you all the time. You may hear a lot of preparation in the background. This is because the obstetricians work with a team of nursing staff in the operating theatre.

The cut is usually just below the bikini line. Once the caesarean birth is underway, you will hear the sound of instruments and suction of fluids from around the baby. You will feel movement and pressure but should not feel any pain or discomfort.  If you do, please tell your anaesthetist, and they will help you.

From the start of the operation, it usually takes about 20 minutes until your baby is born. The obstetrician will take about another 45 minutes to complete the operation. However, it may take longer than this, as every caesarean birth is different.

Before your caesarean birth, the medical team will give you an antibiotic through your drip to reduce the risk of infection. After the birth, they'll give you a drug called oxytocin to help tighten your womb and reduce blood loss. You may need other medications to help tighten your wound.

If you feel sick, the team can give you medicine to stop nausea or vomiting. If you have discomfort, the anaesthetist can give extra pain relief. In some cases, they may need to give a general anaesthetic.

There are several ways to manage pain after a caesarean. Some pain relief from your spinal or epidural can last up to 24 hours, even after your legs regain movement. At the end of the procedure, you may receive a pain relief suppository in your bottom while you are still numb. You will also have tablet pain relief, usually paracetamol and ibuprofen. It's best to take these when offered rather than waiting for pain to start. If needed, morphine liquid will be available. All these medicines are safe for breastfeeding.

If you had a general anaesthetic, you may receive a local anaesthetic to numb some nerves in your tummy. You will still need to take paracetamol and ibuprofen. You may also have morphine liquid or a drip containing morphine (or a similar drug). If you have a morphine drip, you can control the amount of pain relief yourself. This is called patient-controlled analgesia (PCIA).

After the operation, the team will take you to the recovery room and continue monitoring your blood pressure. Your birth partner and baby will usually be with you. If your baby hasn’t been weighed, the team will do it there. If you want to breastfeed, you can start as soon as you're ready.

In the recovery room, the anaesthetic will gradually wear off, and you may feel tingling or itching. Within a few hours, you will be able to move your legs again.

During a planned caesarean birth, there is usually no rush when your baby is born. If agreed beforehand, the obstetrician can lie your baby down before cutting the cord. This gives the baby extra blood cells from the placenta (delayed cord clamping). If you wish, they might hold your baby up above the screen for you to see.

He or she may not cry immediately after they are born. Don’t worry. The paediatrician (baby doctor) or your midwife will give them any care they need. Once baby is breathing well, they will bring baby to you. If they have concerns, they may take your baby to the Special Care Baby Unit (SCBU). As soon as they can they will tell you how your baby is and explain what they are doing

If all is well, your midwife may ask you if you would like ‘skin to skin’ with your baby lying on your chest. This can help keep your baby warm and give an early time for bonding. If you do, your midwife will help you get in a comfortable and safe position. Otherwise, your midwife can wrap your baby in a towel for you to cuddle.