Planned caesarean birth

Key messages for you

• Please read this information carefully, you and your health professional will sign it to document your consent.
• It is important that you bring the consent form with you when you are admitted for surgery. You will have an opportunity to ask any questions from the surgeon or anaesthetist when you are admitted. You may sign the consent form either before you come or when you are admitted.
• You are advised not to eat or drink after 2am the morning of your caesarean birth if it is planned for the morning, or after 7am if it is planned for the afternoon. You can drink still (non-carbonated), clear fluids until 2 hours before the operation. It is important to follow these instructions about not eating or drinking or we may have to postpone your operation.
• You are advised to take two 20 milligram omeprazole tablets the evening before and the morning of your surgery – instructions are provided with the pack.
• Please bring with you all of your medications and its packaging (including tablets, capsules, oral solutions, inhalers, injections, creams, drops (eye, ear or nose), skin (transdermal) patches, insulin injection and herbal remedies), a current repeat prescription from your GP, any cards about your treatment and any information that you have been given relevant to your care in hospital. Please also notify us of any allergies.
• Take your medications as normal on the day of the birth unless you have been specifically told not to take a medication before or on the day by a member of your medical team.
• Change of appointment. Please call us if you need to cancel your appointment for any reason (including illness) so your slot can be used by others. You can call Sara ward directly on 01223 217671 (or if it’s more than 48 hours before your surgery please leave a message with the caesarean list coordinator on 07517 829260.

After the birth your consent form will be sent to the scan department for uploading into your electronic patient record (medical notes). We recommend you take this information leaflet home with you.

Topics included in this leaflet

• Important things you need to know
• About your planned caesarean birth
• Intended benefits
• Potential risks and complications of caesarean birth
• Alternative procedures that are available
• Who will perform my surgery?
• Before your admission
• Eating and drinking before your birth
• Hair removal before an operation
• Blood transfusion
• Day of planned birth
• During your caesarean birth
• After the birth
• Eating and drinking after the birth:
• Getting about after the birth:
• Information and support
• Information about important questions on the consent form

Important things you need to know

Patient choice is an important part of your care. You have the right to change your mind at any time, even after you have given consent and the procedure has started (as long as it is safe and practical to do so). As you will be needing pain relief (anaesthetic) you will also have the opportunity to discuss this with a specialist anaesthetic doctor (anaesthetist).

We will also only carry out the procedure on your consent form unless, in the opinion of the health professional responsible for your care, a further procedure is needed in order to save your life or prevent serious harm to your health. However, there may be procedures you do not wish us to carry out and these can be recorded on the consent form. We are unable to guarantee that a particular person will perform the procedure. However, the person undertaking the procedure will have the relevant experience.

All information we hold about you is stored according to the Data Protection Act 2018.

About your planned caesarean birth

Planned caesarean birth is an alternative to planned vaginal birth. This may be recommended for medical reasons or you may have chosen to have a planned caesarean birth. Following discussion with your obstetrician, you have also chosen to be sterilised at the same time to prevent further pregnancies.

A planned caesarean birth is usually booked in the week before your baby's due date. This ensures that your baby’s lungs are sufficiently mature before birth because multiple research studies suggest that babies born before 39 weeks without labour are more likely to require admission to a neonatal unit due to temporary breathing difficulties.

In exceptional circumstances the planned date/time of your caesarean birth may need to be postponed as it is important that you and your baby have the correct level of care after major surgery. This most commonly occurs if your baby is likely to need admission to the Neonatal Intensive Care Unit (NICU). This may happen on the day of your planned birth and your care and monitoring of you and your baby’s (or babies’) wellbeing will be discussed with you at the time.

Intended benefits

A caesarean birth is intended to provide safe birth of your baby.

Potential risks and complications of caesarean birth

A useful guide to the frequency of a risk occurring:

• 1 in 1 to 10 people = very common (like a person in the family)
• 1 in 11-99 people = common (like a person in the street)
• 1 in 100 to 999 people = uncommon (like a person in a village)
• 1 in 1 000 to 9 999 people = rare (like a person in a small town)
• 1 in 10 000 to 249 999 people = very rare (like a person in a large town)
• 1 in 250 000 people or more = extremely rare (like a person in a city)

A caesarean birth is a very safe operation both for you and your baby. However, in common with any major surgery there are some potential risks. Your obstetrician and midwife will ensure that the appropriate measures are taken to reduce your risk of the development of complications.

The information below summarises the risks of planned caesarean birth compared to planned vaginal birth and is taken from the Royal College of Obstetricians and Gynaecologists’ consent form (RCOG 2022). Precise numerical estimates of risks cannot be given and will vary between individuals. Please note where there is an asterix (*), this means the figures include data from unplanned (emergency) caesarean births too. Further procedures may become necessary during the birth, including a blood transfusion, repair of any damage to the bowel, bladder or blood vessels, and as a life-saving procedure an emergency hysterectomy.

Summary estimates of risks to your baby for planned caesarean birth compared to vaginal birth

Risk: A cut to the skin at birth

• Planned caesarean birth: 1-2 in 100
• Planned vaginal birth: Unlikely with unassisted vaginal birth. Up to 10 in 100 with assisted vaginal birth.

Risk:

Alternative procedures that are available

The advantages and disadvantages of a vaginal birth will be discussed with you during the antenatal period.

Who will perform my surgery?

The surgery will be performed by an obstetrician trained in the surgery. An anaesthetist will perform the procedures for your anaesthesia.

Before your admission

You will receive an appointment for a pre-operative telephone call with a midwife. At this appointment we will ask for details of your medical history and discuss what clinical examinations and investigations are recommended before your planned caesarean birth, these will include blood tests and MRSA swabs. During this appointment we will discuss with you your wishes for the birth, and you can ask us any questions you might have about your birth preferences and the surgery, and discuss any concerns you might have.

We will ask if you take any tablets or use any other types of medication either prescribed by a doctor or bought over the counter in a pharmacy. Please bring all your medications and any packaging (if available) with you.

We will ask you to come to Rosie phlebotomy to have some pre-operative blood tests and to collect an information pack. This pack contains further information, MRSA swabs with instructions on using these, and a pack of omeprazole tablets. You are advised to take two 20 milligram tablets the evening before your surgery and two 20 milligram tablets the morning of your surgery. These are important to take before your planned caesarean birth in order to reduce the acid in your stomach and prevent sickness. You need to take one tablet the night before the operation and one tablet on the morning of the operation – the instructions are included with the medication.

You will see an anaesthetist on the day of your planned caesarean birth who will check that they have the correct medical history for you and ask some specific questions relating to anaesthesia.

Eating and drinking before your birth

It is important to follow the below instructions or we may have to postpone your operation.

For 7am arrival time you must not to eat any ‘solids’ after 2am the morning of your caesarean birth; for 11am arrival time you must not to eat any ‘solids’ after 7am the morning of your caesarean birth. You can drink still (non-carbonated), clear fluids until 2 hours before the operation. After this you should be ‘nil-by-mouth’ and may only have a sip of water if you need to take medication.

‘Clear fluids’ are: water, pulp-free juice, non-fizzy sports drinks and black tea/coffee. Clear fluids are those through which newsprint can be read.

‘Solids’ includes all food, milk, milky drinks, chocolate and sweets.

Hair removal before an operation

For a caesarean birth you are likely to need to have any hair around the site of the operation removed. Your midwife or maternity support worker will do this just before your caesarean birth starts, using an electric hair clipper with a single-use disposable head. Please do not shave or remove the hair yourself as this can increase the risk of infection. Your midwife will be happy to discuss this with you during your pre-operative appointment if you would like more information.

Blood transfusion

During your caesarean birth you may lose more than a normal amount of blood (under 500 millilitres is normal following birth). Some people are recommended to have a blood transfusion when the blood loss has been significant (over 1,500 millilitres), when your body is not coping with the blood loss and where blood loss is ongoing. This may be given in an emergency where you are not conscious or during or after surgery when you are awake. If you are awake we will discuss the risks, benefits and alternatives with you and ask for your consent again. A blood transfusion may include giving you other blood components such as plasma and platelets which are necessary for blood clotting. Your medical team will only advise a transfusion of blood or blood components during or after surgery if it is deemed absolutely necessary.

Compared to other everyday risks the likelihood of getting a serious side effect from a transfusion of blood or blood component is very low. Your medical team can explain to you the benefits and risks from a blood transfusion and further information is also available on the NHS website: https://www.nhs.uk/conditions/blood-transfusion/. Your medical team will also give you information about whether there are suitable alternatives to blood transfusion for your treatment. The NHS leaflet Receiving a Blood Transfusion (opens in a new tab) will also be provided.

Day of planned birth

You will usually be admitted to hospital on the day of your planned caesarean birth. You will be informed what time you need to arrive by the midwife at the pre-operative telephone appointment and in the communications on MyChart. Please ensure you remove jewellery, including body piercings, where possible. Please tell your midwife and doctors if you are unable to remove jewellery or piercings. Ideally leave valuables at home or with your birth partner on the day.

You will be asked to put on a hospital identity band and a red allergy band if you have any known allergies. A maternity support worker will help you to change into a hospital gown and put on some compression stockings (TEDS) to reduce the chance of a blood clot developing in your legs.

The midwife, surgeon and anaesthetist will come and see you prior to the birth to confirm the birth plan and to answer any questions you may have on the day.

Just before going to theatre you will be asked to remove your underwear. A second gown will be provided to help maintain your dignity. You will normally walk to theatre with your birth partner and midwife or maternity support worker.

Your birth partner will be shown where to change into theatre clothes (scrubs) and will be provided with shoe covers and a white hat to wear. They can bring a phone/camera into theatre to take photos of your baby and must keep valuables in their pocket. We ask that no photos or video are taken of staff in theatre. The rest of your belongings will be placed in the recovery area where you will be transferred to after the birth. While this is generally a secure area, your bags will be unattended so no valuables should be left in them.

There are a lot of people who work in the operating theatre including the anaesthetist and their assistant, obstetrician and their assistant, the scrub nurse, the theatre nurse, the midwife and in certain circumstances a neonatologist. Additionally there may be students present as this is a teaching hospital. Please let us know in advance if you do not wish to have any students involved in your care.

When you arrive in the theatre and before starting your anaesthesia, the medical team will perform a check of your name, personal details and confirm the operation you are expecting. This is called the ‘WHO check’.

During your caesarean birth

Before the birth the anaesthetist will start your pain relief (see information above about anaesthesia). First they will ask to place a tube into a vein (cannula), usually in your hand, wrist or arm. They will also attach some sticky tabs to monitor your heart rate, oxygen levels and blood pressure.

Once your anaesthesia is working, your midwife will insert a tube (catheter) into your bladder to keep it empty during the operation and while you are unable to stand after the birth.

You can have music of your choice playing during the birth. A small curtain (sterile drape) will separate you and your birth partner from the medical team undertaking the surgery. The anaesthetist will stay with you throughout the surgery to ensure you are comfortable and safe. Your midwife will be preparing for the arrival of your baby and will contact a neonatal doctor to attend the birth if this is part of your birth plan.

Before the surgery starts you will be given an antibiotic through the tube in your vein (cannula). Following caesarean birth you have an increased chance of developing an infection compared to a vaginal birth. This can lead to increased pain, slower recovery, readmission to hospital, further surgery and, in serious cases, sepsis and death. Therefore antibiotics are routinely given to reduce the chance of this occurring.

Once the anaesthetist has confirmed you have effective pain relief, the obstetrician will make a small horizontal cut (incision) in your skin above your pubic bone (called a ‘bikini cut’). During the operation is underway you may feel pulling and pressure, but you should not feel pain. It has been described like “someone doing the washing-up in my stomach”. The anaesthetist will monitor you throughout the operation and can give you more pain relief if required.

The time it takes for your baby to be born after the start or the operation is variable, depending mainly on how much surgery you have previously had. Once your baby is born, cord clamping will be delayed for one minute so that your baby receives additional blood from the placenta and cord which increases their oxygen carrying blood cells (haemoglobin) and iron stores. At this point, so that you can meet your baby, the obstetrician will usually hold the baby above the sterile drape or lower the drape if this is what you’ve planned.

Your baby will then be passed to the midwife who will dry them and support you with skin-to-skin contact if that is what you have planned. A paediatrician may also be present. If your baby is very small or unwell, they might need to go straight to the neonatal intensive care (NICU) or special care baby unit (SCBU). Otherwise you or your birth partner can hold your baby while the afterbirth (placenta) is being delivered and your womb (uterus) is being stitched (sutured).

Immediately after the birth, a medication called Syntocinon®, which is an artificial version of the hormone oxytocin, is put into your drip to help your womb (uterus) contract. This will be running for four hours after the birth.

After the birth

Once your surgery is completed you will be transferred onto a bed. Your baby will usually be placed skin-to-skin with you if that is your wish. You, your baby and your partner will be taken to the recovery ward where you will be looked after by specially trained nurses, under the direction of your anaesthetist. The nurses will monitor your heart rate, blood pressure and oxygen levels. You may be given oxygen via a facemask, fluids via your drip and additional pain relief until you are comfortable enough to be transferred to the postnatal ward (Lady Mary ward). You can have an additional birth partner for up to two hours after the birth on the recovery ward before your transfer, and any siblings are also welcome. Additional visitors are at the discretion of the nurse in charge.

It is usual to be prescribed regular pain-relieving tablets (paracetamol and usually ibuprofen) four times a day. Please let your doctor or midwife know that if you have asthma or a gastric ulcer. You will be given these medications in hospital but make sure you have some available at home. The midwives will be able to give you additional pain relief if required. Assuming your baby is born after 37 weeks and is healthy, all of these medicines are considered safe and will not affect your baby if you intend to breastfeed or chestfeed.

You will need pain relieving medication for one to two weeks after the caesarean birth. It is important that you are comfortable to aid faster recovery from the surgery and because lack of pain relief can impact success of breastfeeding / chestfeeding and milk expression, as the hormones needed for milk production are less effective when you are in pain.

Eating and drinking after the birth: You may have small sips of water, and when you feel well enough you can resume a light diet.

Getting about after the birth: We will help you to become mobile as soon as possible after the birth. This helps improve your recovery and reduces the risk of certain complications. You can usually stand and move about within 6 to 12 hours of a caesarean birth. We offer an enhanced recovery pathway – speak to your midwife about this. We will help you control your pain from the wound with regular pain relieving medication.

Leaving hospital: Most women and birthing people leave hospital 24 to 48 hours after a caesarean birth. The actual time that you stay in hospital will depend on how quickly you recover from your operation, other medical problems, and the health of your baby.

Resuming normal activities, including work: We advise you to not resume work for six weeks after the operation. Until you feel fully recovered, usually six weeks, you should avoid any exercise other than walking and not lift anything heavier than your baby.

Driving: Please check with your car insurer who can inform you when you should be able to drive again. Usually this would not be before 6 weeks following the birth.

Special measures after the birth: A physiotherapist will see you on the ward to discuss early postnatal exercises before you leave. You should avoid lifting anything heavier than your baby.

Check-ups and results: Your midwife will discuss any follow-up arrangements with you before you leave the hospital.

Information and support

We will give you some additional patient information before and after the birth, for example an information pack about your recovery and what problems to look out for. If you have any concerns, please speak to your midwife.

You can find our postnatal information video and links to useful postnatal information and support here.

• Birth after caesarean
• Caesarean birth: A guide to anaesthesia
• Caesarean birth wound care
• Enhanced recovery pathway after planned caesarean birth
• Headache after epidural analgesia or a spinal
• Information for parents in hospital on what to expect in the first six hours after birth (opens in a new tab)
• Information for parents whose baby is at increased risk of low blood sugars
• Pain relief during pregnancy and after birth
• Self-administration of Medicines (SAM) in the Rosie Hospital Maternity Wards
• Labourpains - Caesarean birth (opens in a new tab)
• How to use your MRSA screening test
• RCOG: Considering a caesarean birth (opens in a new tab)
• RCOG: Birth after caesarean (opens in a new tab)
• RCOG: Blood transfusion, pregnancy and birth (opens in a new tab)
• Receiving a Blood Transfusion (opens in a new tab)