A Caesarean birth (C-section) is a major surgical procedure to birth your baby, and while it may sound daunting, understanding what to expect and why it may be necessary, can help you feel more prepared and aid you with your decision making. Here's my step-by-step overview of the process.
Written by Lara Taylor, Specialist Midwife
I really want to raise awareness around the areas of a Caesarean birth that aren’t often talked about. So, whether you’re deciding about a potential Caesarean birth, planning one, recovering or supporting someone through it, this is for you!
Even if you’re planning a vaginal birth, it’s useful to prepare "just in case."
With Caesarean birth rates rising and information and support lacking in mainstream services, Caesarean Birth Awareness Month is a great opportunity to educate, reassure, and empower! It’s crucial to provide education about Caesarean birth as a choice, along with the risks and benefits and the reality of recovery and parenting.
So let me start by providing you with clear, up-to-date, evidence-based guidance, so you can feel empowered to take control of your birth journey and recovery, fully understanding the realities of your chosen birth path.
In 2023-24 NHS England reported that of the 545,149 births in this country, over 40% were birth by Caesarean. In comparison, rates in 2015-16 were around 25%. Just as Caesarean birth rates are rising, ‘Induction of labour’ (a medical procedure where labour is artificially started, using medication or other methods) rates are also increasing, with 33% leading to a Caesarean.*
Education and support surrounding birth choices are often lacking, leaving many women believing they have little to no control over their birth choice or experience. The lack of clear, accessible information can make it difficult for women to make informed decisions, which can lead to feelings of uncertainty or even regret.
I feel it’s crucial to provide women with the knowledge, support, and empowerment they need to feel confident in their birth choices.
A Caesarean, also commonly known as a C-Section is major abdominal surgery and involves cutting through several layers of tissue to safely deliver the baby.
The majority of births are carried out under spinal or epidural anaesthetic which means you'll be awake, but the lower part of your body will be numb. The sensation is checked rigorously before your operation commences, so you should never feel any pain, although you may experience strange sensations of movement and tugging.
Occasionally, a general anaesthetic (where you're asleep) may be used, particularly if the baby needs to be delivered more quickly. Surgical drapes will be put into place ready for the operation, to obscure yours and your birth partner's view. A urinary catheter will be sited to ensure you have an empty bladder, and to collect urine during the time post op when you’ll be immobile.
When the team are ready, the first incision will be made, starting with the skin and will be most commonly be under the bikini line.
1. Skin: The outermost layer of tissue
2. Subcutaneous fat: The fatty layer under the skin, which provides cushioning and insulation.
3. Superficial fascia: A connective tissue layer that supports skin and fat.
4. Muscle: The abdominal muscles are separated to allow access to the uterus. In most cases, the muscle is not cut but pushed apart to avoid damaging muscle tissue.
5. Peritoneum: A thin membrane that lines the abdominal cavity, which must be carefully cut to access the uterus.
6. Uterus: Finally, a surgical incision is made in the uterus, allowing the baby to be reached in its amniotic sac.
The amniotic sac that houses your baby will be ruptured and your baby will be gently lifted out and placed onto your abdomen.
If there are no complications, the umbilical cord can be cut after a short delay to ensure blood from the placenta is transfused through to baby, and then your baby can be placed on your chest for skin to skin contact.
The Placenta will then be removed...and work to repair those 6 layers can begin. This actually takes the longest time out of the whole surgical procedure, which for an uncomplicated Caesarean birth can take only around 45- 50 minutes in total.
So firstly, let’s look at some of the reasons why a Caesarean Birth may be recommended from a medical perspective, and why it would be known as a planned or elective Caesarean birth.
• Low lying placenta: where the placenta is less than 2 cm away from the inside of the cervix. Recommended because of a risk of heavy bleeding affecting Mother and Baby when the cervix dilates.
• Placenta praevia: This is where the placenta is covering the inside of the cervix, and so there’s literally no way out for baby.
• Baby’s position: transverse (lying across) or breech with feet first. Research has shown that this is a safer option, due to baby’s head being the last thing to birth. You can have the option to birth vaginally, but data shows 4 in 10 babies end up with Caesarean. **
• Multiple pregnancy: Twins can be born vaginally but data shows just over 50% of twin are born by Caesarean *** This is often due to positioning, complications, or concerns for both the mother and babies.
• HIV and Herpes: If the mother has HIV or active herpes outbreaks, a Caesarean may be recommended to reduce the risk of passing the virus to the baby during birth.
• Blood Disorders: Conditions like Haemophilia or Von Willebrand Disease may require a Caesarean due to the risk of excessive bleeding for both mother and baby during a vaginal birth.
Another reason why a planned Caesarean birth might be carried out is because it’s your choice of birth.
And Yes, you do have a choice. This is your body, your baby and your birth experience.
It could be that you have had a previous traumatic birth, suffer with anxiety or you have a phobia of giving birth, also known as ‘Tokophobia’. Whatever your reason, if it’s what you want and you’re making an informed choice, it should be accommodated. If you feel you’re not being listened to, ask your Community Midwife to advocate for you, or find out who your Consultant Midwife is at the hospital you wish to birth at, and ask for an appointment.
There are also private midwives or doulas who are well versed in the NHS system and can support you to achieve your choice, or private hospitals you can birth your baby at also.
Ultimately you should be supported in your choice and if your consultant is unable to support you with your choice, they should refer you to one that does.
While there are situations where a Caesarean birth is the safest option for both you and your baby, that doesn't mean you shouldn't ask questions or feel like you're not being given all the information. It also doesn't mean that the decision is completely out of your hands.
If you've been told a Caesarean is necessary or feel like you have no choice, take a moment to consider how you can regain control of your birth experience.
A great way to guide your decision-making is by using the BRAIN acronym. This method helps you structure your questions to ensure you're fully informed, whether you're making decisions during pregnancy, labour, or the postnatal period. Whether you're facing a recommendation for a Caesarean birth or considering an induction, the key is to ensure the decision is right for you and that you have all the relevant information to make an informed choice. Here’s how the BRAIN approach works:
B - What are the benefits for my baby, for me and for my birth?
R - What are the risks to my baby and to me for my birth. What are the risks for following this recommendation, and what are the evidence-based statistics?
A - Is there an alternative option or procedure?
I - What is my intuition telling me? Something that should be considered and trusted.
N - What could happen to my baby and me if I do nothing and don’t follow the recommendations?
As we've mentioned benefits and risks, I feel its important to look at them in more detail. Keep in mind that these can vary depending on your individual situation, so please always ask your care provider for personalised information tailored to your specific circumstances.
Understanding the benefits and risks can help you make a more informed decision but be sure to have open conversations with your care team to ensure you have all the relevant information you need.
• You know exactly when baby is coming and can plan accordingly.
• No pain during the birth.
• No injury to the vagina.
• Shorter birthing time.
• Lower risk for loss of bladder control.
• Lower risk of pelvic organ prolapses.
While many women have smooth recoveries, it’s important to be aware that there can be an increased risk of certain complications when choosing a Caesarean birth.
Now this doesn’t mean that these will actually happen to you, but there may be a higher chance of them happening than if you had a vaginal birth. Also bear in mind that risk is relative to you, so what you perceive to be a big risk, may be a small risk for someone else.
• Slightly Longer hospital stay – typically around 2-3 days.
• Longer recovery time – this can take several weeks, as it involves major abdominal surgery.
• Uterus infection- in the endometriosis and may require a treatment of antibiotics.
• Wound infection – careful attention should be paid to the wound to avoid infection. (See more on this later in the post.)
• Bowel or bladder injury - a small risk and is usually repaired immediately.
• Blood clots – as with any surgery an increase of deep vein thrombosis is present, keeping mobile as soon as possible and wearing support tights can reduce this significantly.
• Delay with breast feeding - Some women may find it more difficult to establish breastfeeding immediately after a C-section, especially if they experience complications or need time to recover.
• Unable to drive for 4-6 weeks - You may be advised not to drive for several weeks to avoid putting stress on your healing body and reduce the risk of injury. Check with your car insurance provider.
• Slower return to exercise - Physical activity, especially high-impact exercise, may need to be postponed for several weeks to allow your body to fully recover from the surgery.
• Increased risk of admission to the Neonatal unit especially if preterm
• Respiratory difficulties.
• Infection – like any surgical procedure, there is always a risk of infection, including to the baby, though this would be very rare indeed.
• Injury During Surgery - although again very rare, there is a small chance that the baby may be accidentally injured during the procedure. This could include cuts from the surgical instruments or bruising from the extraction process. However, extreme care is taken to minimise these risks.
Whilst these may seem alarming, all of these risks are manageable with appropriate care and attention and your healthcare team will help guide you through the recovery process.
It's important to remember that while there are risks associated with Caesarean birth, many women recover well and go on to enjoy a healthy postpartum period.
If you’re happy that this is the route you’d like to take, take time in preparing, not only for the birth, but for the transition to parenthood and your recovery.
I’ll always recommend educating yourself as much as possible before your birth. The more you know, the more you can make informed decisions and knowledge is always power!
An unplanned (or emergency) Caesarean birth if often the most talked about, with this being necessary because there is concern for mum’s or baby’s wellbeing and baby needs to be delivered quickly. I firstly want to address the reasons why this might happen, and why it would be recommended.
Decline in your health: this could be due to pre-eclampsia or another severe condition.
Decline in baby’s wellbeing: Baby may show signs of distress during labour.
Heavy bleeding: this could be that the placenta is separating from the uterine wall, or there is a tear in the uterine wall.
Induction of labour: not progressing to labour.
Labour not progressing: This could be that the cervix isn’t dilating, or the baby isn’t descending because of position.
Cord Prolapse: when the baby’s cord presents before baby following your waters breaking.
Waters breaking: your waters have broken prior to a planned caesarean.
Infection: if you are showing signs of infection or Sepsis, it may be that Baby will be showing signs too, so a fast delivery may be needed to be able to treat you more effectively and ensure baby’s health also.
In most cases, there will be time to discuss the benefits and the risks, and for you to sign a consent form. If there is an immediate risk, you may be asked for verbal consent only.
When supporting families who have chosen a planned Caesarean, I always go through the entire birth process in detail, from admission to the ward and beyond.
This helps them visualise the experience and feel more reassured, knowing exactly what to expect. I recommend you ask your midwife to do the same, as each hospital may have slightly different procedures.
While birth plans are often discussed for vaginal births, they are sometimes overlooked for planned Caesarean births. However, if you choose a caesarean, you still have many options and decisions to make. A birth plan is a great way to express your preferences and ensure that you have the birth experience you desire in an environment where you feel comfortable and in control. It’s crucial to feel calm and relaxed, as this can help promote oxytocin production, which plays a key role in the immediate postpartum period.
Here are some things to consider when creating your Caesarean birth plan:
• Your preferences: for who is with you during the procedure.
• Skin-to-skin contact: immediately after birth, if possible.
• Feeding preferences: such as whether you plan to breastfeed or formula feed.
• Sound: Do you wish to have your birth playlist playing, or a selected song for the time of your baby’s birth.
• Sight: do you wish to keep the drapes raised or have them lowered when baby is born.
• Touch: Do you want to have your own pillow with you or have something that brings you comfort.
• Smell: Would you like a calming essential oil or scent on your pillow or a tissue.
There are many birth preferences for you to consider also:
• Photographs: would you like pictures or videos of your birth?
• Announcing the gender: would you like the doctor to announce this, your birth partner or to see for yourself
• Cord clamping: would you like delayed cord clamping?
• Skin to skin: Would you like skin to skin initiated straight away? This can absolutely be done and can be very beneficial for you and for baby.
• Placenta: Would you like to keep your placenta for encapsulation, or for other spiritual reasons.
• Baby checks: would you like this done immediately or wait until you are in recovery. There is no rush for this!
• Feeding: Would you like to initiate breast feeding or feed by formula.
How your baby is welcomed into the world during Caesarean birth can be within your control. You can request what is termed as a ‘Gentle Caesarean’, where the environment is calm and baby is birthed slowly and gently, as to replicate how they would enter the world through the birth canal.
It’s also worth thinking about what you would like to happen if a medical emergency occurs, or if you need a general anaesthetic (where you are put to sleep). Knowing you have awareness and plans really can help reduce the “what if’s” and enable you to focus on the experience of birth, regardless of your birth choice.
Your hospital bag won’t be too different when having a Caesarean birth, but it a good idea to have a separate small clear bag with one nappy, a baby-grow, vest and hat for baby, to take into theatre. You might want to include your camera or use your phone for photos and videos.
SmartFit™ Maternity Maxi Pads With Wings SmartFit™ Lil-Lets Maternity Breast PadsBeing prepared for the possibility of a Caesarean birth is something I advise all the families in my care to consider. Having an awareness and an ‘in case’ plan can really help.
Understanding the process, what questions to ask at the time can make a big difference and help you retain an element of control if it does happen.
Every pregnancy is unique, and unfortunately, care pathways and advice often feel one-size-fits-all. This is why I want to empower woman to explore their options and decide what care pathway is most suitable for them.
I feel it’s important to make it clear that there should be absolutely no stigma or shame in choosing or needing a Caesarean birth. Every birth journey is unique, and what matters most is the health and well-being of both you and your baby. Whether your birth is vaginal or via C-section, it’s a valid and beautiful experience. It’s essential to honour your choices and trust in the care you receive, as every path to motherhood is worthy of respect and support.
Let’s remember, birth is a choice, and no one should be judged on which pathway they choose. There is no right or wrong way to birth, it just comes down to individual circumstances and ultimately, what’s right for you and your baby.
Your right to a caesarean birth - Birthrights
C-section (caesarean) tips for dads and partners | Tommy's
Having a c-section | March of Dimes
https://www.nice.org.uk/guidance/ng192
https://www.rcog.org.uk/for-the-public/browse-our-patient-information/considering-a-caesarean-birth/
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Recovery varies, but most women start feeling better after 6 weeks. However, full healing, especially internally, can take several months.
Yes, you’ll still have lochia, which is post-birth bleeding, for around 4-6 weeks as your uterus heals.
Yes, many women can have a Vaginal Birth After Caesarean (VBAC), but it depends on factors like previous incision type and overall health.
Yes, a 6-week postnatal check is important to ensure you’re healing well and to discuss any concerns about recovery or mental well-being.
Doctors typically recommend waiting 4-6 weeks, or after your post-natal examination, but it’s important to listen to your body and wait until you feel comfortable.
Gentle movement like walking is encouraged early on, but avoid strenuous exercise for at least 6-8 weeks or until cleared by your doctor.
Most doctors recommend waiting 4-6 weeks, but always check with your insurance provider and ensure you can brake safely without discomfort.
Yes, many hospitals now offer gentle or family-centered C-sections that prioritise immediate skin-to-skin contact where possible.
Not necessarily, but some mothers feel a delay due to pain, medication, or an unexpected birth experience. Skin-to-skin and responsive feeding can help.
Look out for redness, swelling, oozing, increasing pain, or a foul smell—contact your healthcare provider if you notice these symptoms.
Lara Taylor, Registered Midwife BSc Hons
Private and Independent Specialist Midwife
Educator, Trainer, Copywriter and Speaker.
Specialist knowledge in Fertility, Bereavement Care, Safeguarding,
Enhanced Postnatal Care, C-Section Advanced Recovery,
Newborn Cognitive and
Emotional Development & Breastfeeding.
