Caesarean Section

Overview

What is a caesarean section (C-section)?

A caesarean section is the delivery of a baby through a cut (incision) in the mother's belly and uterus. It's often called a C-section. Sometimes a C-section is needed for the safety of the mother or baby.

When is a C-section needed?

In most cases, doctors do a C-section because of problems during labour. For example:

• Labour is slow and hard or stops completely.
• Your baby shows signs of distress, such as a very fast or slow heart rate.
• There's a problem with the placenta or umbilical cord.
• Your baby is too big to be delivered vaginally.

When doctors know about a problem ahead of time, they may schedule a C-section. You may have a planned C-section if:

• Your baby isn't in a head-down position close to your due date.
• You have a health problem that could be made worse by the stress of labour.
• You have an infection that you could pass to your baby during a vaginal birth.
• You're carrying more than one baby.
• You had a C-section before, and you have the same problems this time. Or your doctor or midwife thinks labour might cause your scar to tear.

What are the risks of a C-section?

Most mothers and babies do well after a C-section. But it's major surgery. It carries more risk than a normal vaginal delivery. Some possible risks include:

• An infection.
• Heavy blood loss.
• Blood clots in the mother's legs or lungs.
• Injury to the mother or the baby.
• Problems from the anesthesia, such as nausea, vomiting, and severe headache.
• Breathing problems in the baby if the baby was delivered before the due date.

If you get pregnant again, your C-section scar has a small risk of the scar tearing open during labour (uterine rupture). You also have a slightly higher risk of a problem with the placenta, such as placenta previa.

How a Caesarean Section Is Done

Before a C-section, a needle called an I.V. is put in one of your veins. The I.V. gives fluids and medicine (if needed) during the surgery. You will then get medicine (spinal or epidural anesthesia) to numb your belly and legs. Fast-acting general anesthesia, which makes you sleep during the surgery, is only used in an emergency.

After the anesthesia is working, the doctor makes the incision. Usually it's made low across the belly, just above the pubic hair line. This may be called a "bikini cut." Sometimes the incision is made from the navel down to the pubic area. The doctor lifts the baby out. Then the doctor removes the placenta and closes the incision with stitches.

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Who to See

A caesarean section can be done by a doctor who has specialized training, such as:

If your pregnancy care provider doesn't perform C-sections and thinks there's a chance you might need one, you will be referred to a caesarean-trained doctor ahead of time. Your family doctor or midwife can assist with the surgery and provide your follow-up care.

Why It Is Done

Some C-sections are planned ahead of time. Others are done when a quick delivery is needed to ensure the mother's and baby's well-being.

Planned primary C-section

If you are having a C-section for the first time, this is called a primary C-section. Primary C-sections may be planned when a known medical problem would make labour dangerous for the mother or baby. For example, a C-section may be needed if:

• Your baby is not head-down for birth (breech position).
• The placenta is blocking the cervix (placenta previa).
• You have an infection that you could pass to your baby during delivery. These include:
  • Open sores from active genital herpes.
  • Some cases of human immunodeficiency virus (HIV).
• You have a condition such as heart disease that may be made worse by the stress of labour.
• Your baby is estimated to be very large.
• Blood supply to the placenta is decreased.
• You are carrying more than one baby. A C-section may be needed, depending on the position and number of the babies, whether they share an amniotic sac, or whether you or the babies have any health problems.

Some women request to have a C-section even though they've never had one before and there is no medical need for it. This is called an elective primary C-section. Because of the risks of C-section, experts recommend that C-sections generally be done only for medical reasons. If you're thinking of having a C-section for personal reasons, you may want to talk to your doctor or midwife about reasons for and against an elective primary C-section.

Planned repeat C-section

Many C-sections are planned ahead of time for women who've had a C-section in the past. Reasons for a planned repeat C-section may include:

• Deciding not to try vaginal birth after caesarean (VBAC) after discussing the risks and benefits with your doctor or midwife.
• Things that increase the risk of uterine rupture during labour. These include having a vertical scar, triplets or more, or a baby thought to be very large.
• No access to constant medical supervision by a caesarean-trained doctor during active labour, or no available facilities for an emergency C-section.

Timing a planned C-section

Depending on the reason for a planned C-section and the risks to you or your baby, the C-section may be scheduled near your due date or weeks before. Talk to your doctor or midwife to learn about the timing that is best for your situation.

Unplanned C-section

Some unplanned C-sections happen when there is a problem before or during labour. Sometimes this is an emergency. You may have an unplanned C-section for medical reasons if:

• Your baby is in distress. A rapid or slow heart rate is a sign of distress.
• Labour is slow and hard, or labour has stopped completely.
• Your baby's head is larger than your pelvis.
• The placenta has separated from the uterus. This is called abruptio placenta. It can cause heavy bleeding and decrease your baby's oxygen supply.
• There's a problem with the umbilical cord. For example, maybe the cord has slipped into the birth canal ahead of the baby. This is called cord prolapse. When the baby moves into the birth canal and presses against the cord, the baby's blood and oxygen supply can be cut off. And when the cord is torn during delivery, it can decrease the baby's blood supply.

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Risks and Complications

Most mothers and babies do well after a C-section. But it's major surgery. It carries more risk than a normal vaginal delivery.

After a C-section, the most common problems for the mother are:

• Infection.
• Heavy blood loss.
• A blood clot in the legs or lungs.
• Nausea, vomiting, and severe headache. These can be related to the anesthesia.
• Bowel problems, such as constipation.
• Injury to another organ (such as the bladder). This can occur during surgery.
• Maternal death. This is very rare. About 2 in 100,000 caesareans result in maternal death.^{footnote 1}

After a C-section, the most common problems for the baby are:

• Injury during the delivery.
• Need for special care in the neonatal intensive care unit (NICU).^{footnote 2}
• Immature lungs and breathing problems, if the due date has been miscalculated or if the baby is delivered before 39 weeks of gestation. ^{footnote 2, footnote 3}

Long-term risks of C-section

Women who have a uterine C-section scar have slightly higher long-term risks with future pregnancies. These risks can increase with each C-section. They include: ^{footnote 4}

• Breaking open of the incision scar during a later pregnancy or labour. This is called uterine rupture.
• The growth of the placenta low in the uterus, blocking the cervix. This is called placenta previa.
• Problems when the placenta grows deeper into the uterine wall than normal. These problems are called placenta accreta, placenta increta, and placenta percreta. They can lead to severe bleeding after childbirth. And sometimes they require a hysterectomy.

What to Expect After a C-Section

After a C-section, you'll be watched closely to make sure that you don't develop problems. You'll likely get pain medicine and be encouraged to walk around a little.

Most women go home in 3 to 5 days. But it may take 4 weeks or longer to fully recover. Before you go home, a nurse will tell you how to care for yourself. In general:

• You'll need to take it easy while the incision heals. Avoid heavy lifting, intense exercise, and sit-ups. Ask family members or friends for help with housework, cooking, and shopping.
• You'll have pain in your lower belly. You may need pain medicine for 1 to 2 weeks.
• You can expect some vaginal bleeding for several weeks. (Use sanitary pads, not tampons.)

When to Call a Doctor

Share this information with your partner, family, or a friend. They can help you watch for warning signs.

Call 911 anytime you think you may need emergency care. For example, call if:

• You have thoughts of harming yourself, your baby, or another person.
• You passed out (lost consciousness).
• You have chest pain, are short of breath, or cough up blood.
• You have a seizure.

Where to get help 24 hours a day, 7 days a week

If you or someone you know talks about suicide, self-harm, a mental health crisis, a substance use crisis, or any other kind of emotional distress, get help right away.

• Call or text Canada's suicide and crisis hotline at 988.
• Call Talk Suicide Canada: 1-833-456-4566 or text 45645 (4 p.m. to midnight ET).
• Go to the Talk Suicide Canada website at https://talksuicide.ca for more information.

Consider saving these numbers in your phone.

Call your doctor, midwife, or nurse advice line now or seek immediate medical care if:

• You have loose stitches, or your incision comes open.
• You have signs of hemorrhage (too much bleeding), such as:
  • Heavy vaginal bleeding. This means that you are soaking through one or more pads in an hour. Or you pass blood clots bigger than an egg.
  • Feeling dizzy or light-headed, or you feel like you may faint.
  • Feeling so tired or weak that you cannot do your usual activities.
  • A fast or irregular heartbeat.
  • New or worse belly pain.
• You have symptoms of infection, such as:
  • Increased pain, swelling, warmth, or redness.
  • Red streaks leading from the incision.
  • Pus draining from the incision.
  • A fever.
  • Frequent or painful urination or blood in your urine.
  • Vaginal discharge that smells bad.
  • New or worse belly pain.
• You have symptoms of a blood clot in your leg (called a deep vein thrombosis), such as:
  • Pain in the calf, back of the knee, thigh, or groin.
  • Swelling in the leg or groin.
  • A colour change on the leg or groin. The skin may be reddish or purplish, depending on your usual skin colour.
• You have signs of preeclampsia, such as:
  • Sudden swelling of your face, hands, or feet.
  • New vision problems (such as dimness, blurring, or seeing spots).
  • A severe headache.
• You have signs of heart failure, such as:
  • New or increased shortness of breath.
  • New or worse swelling in your legs, ankles, or feet.
  • Sudden weight gain, such as more than 1 to 1.3 kilograms (2 to 3 pounds) in a day or 2.3 kilograms (5 pounds) in a week.
  • Feeling so tired or weak that you cannot do your usual activities.
• You had spinal or epidural pain relief and have:
  • New or worse back pain.
  • Increased pain, swelling, warmth, or redness at the injection site.
  • Tingling, weakness, or numbness in your legs or groin.

Watch closely for changes in your health, and be sure to contact your doctor, midwife, or nurse advice line if:

• Your vaginal bleeding isn't decreasing.
• You feel sad, anxious, or hopeless for more than a few days.
• You are having problems with your breasts or breastfeeding.

Self-Care

It can take 4 weeks or more for a caesarean (C-section) incision to heal. It's important to take care of yourself while you're healing.

• Rest when you feel tired.

  Getting enough sleep will help you recover.

• Try to walk each day.

  Walking boosts blood flow and helps prevent pneumonia, constipation, and blood clots.

• Avoid strenuous activities for 6 weeks or until your doctor or midwife says it's okay.

  This includes bicycle riding, jogging, weight lifting, and aerobic exercise.

• Don't do sit-ups or other exercises that strain the belly muscles.

  Avoid these exercises for 6 weeks or until your doctor or midwife says it's okay.

• Don't lift anything heavier than your baby until your doctor or midwife says it's okay.
• Wear pads if you have vaginal bleeding.
  • Do not use tampons until your doctor or midwife says it's okay.
  • Do not douche.
• Hold a pillow over your incision when you cough or take deep breaths.

  This will support your belly and decrease pain.

• Follow your doctor's instructions about caring for your incision.

  You can shower as usual. Pat the incision dry when you're done.

• Drink lots of fluid and eat high-fibre foods if you have constipation.

  Ask your doctor or midwife about over-the-counter stool softeners or fibre supplements.

• Ask your doctor or midwife when it is okay for you to have sex.

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