What happens during a c-section?
If you’re having a planned c-section, your midwife will give you information about what to do on the day. This will include:
- what time to arrive at the hospital
- when to stop eating and drinking – this is usually 6-8 hours before your c-section
- having a shower before you leave home, to reduce the risk of infection
- whether you should take other medicines, if you usually take them
- whether to take anti-sickness medicine at home ‒ you may also have this during the operation after your baby has been delivered
- whether your birth partner can go into the operating theatre with you.
You may have a blood test to check whether you are anaemic (a low number or quality of red blood cells), in case you lose blood during the c-section.
Your doctor may offer you antibiotics before your c-section, to reduce your risk of infection.
Your c-section may be delayed if there are emergency operations happening that day. You can pass the time by taking some books, magazines, a phone or tablet with headphones to the hospital.
This short video from NHS University Hospitals NHS Trust explains the c-section process.
Giving your consent
The doctor or midwife will explain what will happen and ask you to sign a consent form. This describes what happens before, during and after the c-section. It also explains the risks of the c-section and the anaesthetic.
If your c-section is planned, you will sign the consent form at an appointment before your operation. Ask your doctor to explain anything you do not understand before you sign the form.
If you’re having an emergency c-section and your baby needs to be delivered quickly, you may either sign a consent form or give verbal consent. If there’s time, your midwife or doctor can answer any questions you or your birth partner have about the operation before you give consent.
Anaesthetic during a c-section
When you’re in the operating theatre, you’re likely to have either a spinal or epidural anaesthetic. This is an injection in your spine that numbs the lower part of your body.
You will either lie on your side or sit leaning forward, curving your back, while the anaesthetist inserts a very fine needle into your spine.
“When I was having the spinal anaesthetic, I had to keep very still. I was well supported by the medical team but I found it a bit overwhelming and I got a bit tearful as it hit me that I was about to meet my baby for the first time!”
Most women have a spinal anaesthetic because it starts to work quickly. If you’re having an emergency c-section, the anaesthetist will usually top up an existing epidural with a stronger anaesthetic.
You may have a painkiller called diamorphine injected into your spine at the same time as your spinal or epidural anaesthetic. This reduces the amount of pain relief you need after the operation.
You will be awake throughout the operation. You won’t feel any pain but you may feel some pressure or tugging sensations. Tell the anaesthetist if you feel any pain.
“I didn’t feel any pain during the c-section (I didn’t even know they had started!) but I did feel a pressure, pushing down on the top of my bump as they lifted the baby out. This was uncomfortable but very quick.”
If you can’t have a spinal or epidural anaesthetic, or if your baby needs to be delivered very quickly, you may need a general anaesthetic. This means you will be asleep for the operation. Your birth partner won’t usually be able to go into the operating theatre but they should be able to be with you in the recovery room.
The c-section operation
If you’re having a planned c-section, the midwife will ask you to put on a hospital gown and walk to the operating theatre.
Your birth partner can usually stay with you throughout a planned or emergency c-section. The midwife or operating assistant will give them a top, trousers and hat to wear in the theatre for hygiene reasons.
In the operating theatre
There will be lots of people in the operating theatre, including 2 obstetricians (who will do the operation), an anaesthetist, a midwife and other support staff.
You will lie on your back on the operating table. The table is tilted so you’re leaning on to your left side. This reduces the risk of your blood pressure dropping during the operation.
You will have:
- fluids through a needle in your arm (a drip), to stop you getting dehydrated and to reduce the risk of low blood pressure during the operation
- anti-sickness medicine to stop you feeling or being sick
- a small tube (catheter) into your bladder to drain urine – this will stay in place for at least 12 hours and until you feel able to walk to the toilet.
The top part of your pubic hair may be shaved or clipped. Do not do this yourself at home in case it causes an infection. Read more about how to prepare for a c-section.
“Since I was chatting away to the anaesthetist and my husband, the surgery itself seemed quick, and all I felt was a bit of jostling and tugging while the surgeons worked behind the cloth.”
Annie. Read more about Annie's c-section experience.
The doctor will make a cut just below your bikini line and into the womb. They will then lift your baby out. There will be a screen between your head and lower body so you can’t see the operation but you can ask for it to be lowered so you can see your baby being born. You may want to ask your birth partner or one of the theatre staff to take some photos of this moment.
If you don’t want to have a screen up during the operation, speak to your doctor in advance to find out if this is possible.
The doctor then removes the placenta and closes your wound using stitches, staples or surgical glue.
Unless your baby needs help to breathe, the doctor should wait for at least 1 minute before clamping the cord, to increase the amount of blood your baby gets from the placenta. This is called delayed or optimal cord clamping. Not all hospitals do this routinely, so you may want to include this in your birth plan.
The midwife will check your baby and dry them to help them stay warm, before placing them on your chest. This early skin-to-skin contact helps you bond with your baby and can help you start to breastfeed.
If you’re not able to hold your baby in the operating theatre, you can usually have skin-to-skin contact after the operation. Your birth partner can also have skin-to-skin contact with your baby. The whole operation takes about an hour.
“I asked for the surgeon to delay the cord clamping. It was very peaceful until the cord was cut and he began to scream! I had asked for him to be placed on my chest but I actually found this quite suffocating because I was lying flat and didn’t have much room, so my husband held him next to me.”
- Beake S et al (2016) Interventions for women who have a caesarean birth to increase uptake and duration of breastfeeding: A systematic review. Matern Child Nutr. 2017; 13: e12390.
- Desai N, Carvalho B (2020) Conversion of labour epidural analgesia to surgical anaesthesia for emergency intrapartum Caesarean section. BJA Education 2020; 20(1): 26e31.
- Guy’s and St Thomas’ NHS Foundation Trust (2020). Elective caesarean birth. https://www.guysandstthomas.nhs.uk/resources/patient-information/maternity/elective-caesarean-section.pdf
- NICE (2015, updated 2017). Intrapartum care. Quality standard 105. Quality statement 6: Delayed cord clamping. National Institute for health and care excellence www.nice.org.uk/guidance/qs105/chapter/Quality-statement-6-Delayed-cord-clamping
- NICE (2021). Caesarean birth: NICE guideline 192. National Institute for health and care excellence https://www.nice.org.uk/guidance/ng192 RCOA (2020). Raising the Standards: RCoA Quality Improvement Compendium. Chapter 7: Obstetric practice. https://rcoa.ac.uk/safety-standards-quality/quality-improvement/raising-standards-rcoa-quality-improvement-compendium
- Royal College of Obstetricians and Gynaecologists (2015) Obtaining Valid Consent (Clinical Governance Advice No. 6). London Royal College of Obstetricians and Gynaecologists. www.rcog.org.uk/en/guidelines-research-services/guidelines/clinical-governance-advice-6/