Pregnancy week by week



Caesarean section

About half of the women who have caesarean know that they will be having one in advance. We explain why you might need a planned or “elective” caesarean and what happens.

Reasons for elective caesarean include:
  • The baby is thought to be too big to go through the pelvis
  • Placenta praevia

  • Sever pre-eclampsia

  • Baby in awkward position (such as breech or lying crosswise) and attempts to turn the baby have failed

  • If the mother is HIV positive

  • Any other complication that may affect the mother’s or baby’s health

If you are booked in for an elective caesarean, you will know your baby’s birth date in advance. Usually you go into the hospital the day of the operation.
Caesarean sections are occasionally done during labour without being planned if:
  • Your placenta separates from the uterine wall before your baby is delivered (abruption placenta)

  • The umbilical cord comes out before your baby (cord prolapse)

  • Foetal distress (baby’s heart rate is irregular)

  • Contractions stop and cannot be forced again (induction fails)

On the day, you will have a drip put into your arm. A catheter (drainage tube) will be used to empty your bladder and the top centimetre of your pubic hair is shaved off. Monitors will be placed on your chest to record your heart beat and you are likely to be given a spinal or epidural anaesthetic. Very few planned caesareans are now carried out under a general anaesthetic.

If you have an epidural, the anaesthetist will usually ask you to sit at the edge of the bed. He/she will then clean your back with some cold antiseptic solution and inject a local anaesthetic under your skin before asking you to curl up into a ball so that they can put the epidural needle into your back. He/she will inject some local anaesthetic through it which will make you go numb from your chest to your toes. It normally takes around 20 minutes for the epidural to fully start working and the surgery to start.

Important complications of the epidural include itching which can last up to 24 hours; shivering lasting a few minutes; bruising to your back which may contribute to backache which a lot of women suffer shortly after giving birth; and nausea.

Your doctor will make an incision in your abdomen and uterus to remove the baby rather than you delivering vaginally. The birth of the baby is quite quick. A screen is put up so that you cannot see the actual operation taking place, but the baby is lifted up for you to see as soon as he or she is born. You may feel some tugging and pulling and hear odd sounds from the machinery used to suck out the fluid and seal the cut. Once the baby is born, the wound is stitched up- and this process can take a lot longer than the birth. The wound is closed with clips or a running stitch just below the skin level.

Spinal and epidural- what’s the difference?

Both these are injections into your back, and both have a numbing effect. An epidural can be “topped up” and last for many hours, but it does take 20 minutes or so to set up. When the speed is needed-for instance, for an emergency caesarean section- a spinal can be used instead. This is a single injection that gives pain relief for about 30-60 minutes, depending on the dose.

Once a caesarean.....

It used to be said that once a caesarean always a caesarean. Many women who have a caesarean with one baby go on to have a vaginal birth the next time. It often depends on the reason for the caesarean last time. If your last baby was breech but this one is head down, then you would probably have a vaginal birth without a problem. You can have an epidural for pain relief and your labour will be carefully monitored. If you had a section last time, talk to your doctor about the options you have.

Coping after a Caesarean Section

If you have had a section, you may find your postnatal recovery is slower than that of other mums who delivered vaginally.  No wonder, you have had major abdominal surgery. You will have:

A cut

It may look enormous at first, but it will gradually shrink along with your tummy and eventually fade to a thin, fine line. You may also have a drain in the cut, a catheter in your bladder and a drip in the back of your hand. All of these things will gradually be taken out over the first 24 hours or so, making you free to enjoy your baby. If you need to cough or pass wind, it can be very painful. Hold a pillow or both of your hands over the wound while you do so.


You will probably have a running stitch along the cut with a bead at either end, or you may have a number of individual stitches along the cut; either will probably be removed after four or five days. Some hospitals use dissolvable stitches which don’t need to be removed.

Pain relief

You will be given regular pain killers as injections, tablets, or suppositories (which are put in your back passage) every few hours. They are very effective in keeping down the pain and are not harmful if you are breastfeeding. Do tell your doctor if you are still in pain as it is important that you are comfortable enough to cuddle and feed your baby.


The surgery will have disturbed your digestive system and wind may make you very uncomfortable. Eat plenty of fruit and drink plenty of fluids to keep things moving. It will soon get better.

Moving around

Keep your circulation working while in bed by wiggling your toes and circling your ankles.  To get out of bed, work your way towards the edge of the bed, roll onto your side, push yourself up using your hands while swing your legs over the edge of the bed into a sitting position and get up gently. You may need a nurse to help you begin with.

The first few days after a caesarean can be difficult, but things will get better. You may go home at about day three. You will need your hubby or your mother to help out when you get back home. It will only be a few weeks before you feel really fit again.

Long term care after a Caesarean Section

Rest and exercise

Rest whenever you get the opportunity in the first 4-6 weeks. A good form of general exercise is walking. Start with 5-10 minutes of daily walking and gradually increase this time to 30-40 minutes over the first two months. It is important to continue doing your pelvic floor exercises to strengthen your muscles.

Moving in and out of bed

Move slowly and try to avoid using the abdominal muscles in the first 4-6 weeks. To get in the bed, sit on the edge of the bed, lean down onto your elbow towards the pillows, bend your knees and lift your legs up onto the bed, then roll onto your back. Reverse this action to get up.

Coughing and sneezing

Support your lower abdominal muscles by placing your hands or forearms over the Caesarean wound. Contract the pelvic floor muscles before coughing or sneezing as this reduces the risk of urinary leakage. To clear your chest, take three slow deep breaths in and out, then huff (as if to steam up a mirror), then support your cough as above.

Lifting and housework

Avoid lifting heavy objects for the first 4-6 weeks. Also, avoid doing strenuous house work. In order to lift any object, keep your back straight, draw your tummy in, squeeze your pelvic floor muscles and bend your knees. Keep the object close to you as you lift it up. Use your legs to take the weight of the lift and not your ack.


It will be about 6 weeks before you can drive.

Pain relief

If you are breast feeding, consult your doctor before taking any non-prescribed medicine.

Breastfeeding after a caesarean

If you have had a caesarean, you might need help with holding your baby for the first few feeds. Use a pillow on your tummy to cushion your wound and spread the weight of the baby. Try different feeding positions, such as tucking the baby under your arm in a rugby ball position. Refer to our section on breast feeding to learn about different feeding positions.


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