What to expect when you have an elective caesarean birth

Normally, you will visit the hospital before you come in for your caesarean birth. The midwife will see you and take some blood from you to check you haemoglobin (HB) to make sure that you are not anaemic and to confirm your blood group in case you need a blood transfusion after your operation. She will also check that you don’t have MRSA by taking some swabs from your skin. This is just a routine check.

Most women go home after the assessment and come back to hospital on the day of the caesarean birth, but you may need to come in the night before. The midwife will give you tablets to take before your caesarean birth to reduce the acid in your stomach and to help to prevent sickness. These are taken the night before your caesarean birth and on the morning of the caesarean itself.

You need to avoid eating and drinking for a certain period of time before you have your caesarean birth. This is to prevent you feeling sick during the surgery and minimise complications. Your midwife will explain all this to you.

You should be seen by an anaesthetist before your caesarean birth. The anaesthetist will talk with you about your medical history and any anaesthetic you have had in the past. The anaesthetist will also discuss the different types of anaesthetic you could have and answer your questions.

On the day of your caesarean birth, the midwife will see you to check that you have taken your tablets. Your bikini line may need to be shaved. You will have a name band on your wrist or ankle. The midwife may help you to put on special tight stockings (called TED stockings) to reduce the risk of blood clots forming in your legs. You will be given a theatre gown to put on.

In most cases, your birth partner, if you have one, will be able to be with you during the caesarean birth. A midwife will provide them with special clothes for the operating theatre.

There will be quite a few people in the operating theatre. This will include:

• The midwife who will help look after you and your baby.
• The anaesthetist and assistant.
• The obstetrician and an assistant and a scrub nurse.
• There will be another nurse who is responsible for fetching extra equipment.
• A paediatrician may be also present if he/she is needed.

At the very least there will be seven members of staff in the theatre as well as your birth partner (if you have one).

If you have a regional anaesthetic, your birth partner will be able to join you in the operating theatre. They will be asked to sit down and to avoid certain areas of the room. This is to reduce the risk of contaminating sterile operating instruments.

If you are to have a general anaesthetic (put to sleep) your birth partner will be asked to wait in another room.

For more information on what your birth partner can expect during your delivery, see the birth partners in theatre page.

Just before the caesarean starts, a member of the theatre team will confirm your name, date of birth and hospital number to ensure that we have the correct patient prior to the start of the caesarean birth.

A screen will separate you and your birth partner from the lower part of your body and the surgery. The anaesthetist will stay with you all the time. You may hear a lot of preparation in the background. This is because the obstetricians work with a team of midwives and staff in the operating theatre.

Your skin is usually cut slightly below the bikini line. Once the caesarean birth is under way you will hear the sound of instruments and suction of fluids from around the baby.

From the start of the operation it usually takes about 10 minutes until your baby is born. The obstetrician will take about another half-hour to complete the operation. However, because every caesarean birth is different, it may take longer than this.

Before your caesarean birth starts, an antibiotic will be put into your drip to reduce your risk of getting an infection. After the birth, a drug called oxytocin is put into your drip to help tighten your womb and to cut down blood loss.

If you feel sick, you may be given medicine to help you stop feeling sick or vomiting. If you feel any discomfort, the anaesthetist may give you extra medicine to help relieve the discomfort and, sometimes, they will need to give you a general anaesthetic.

For pain relief after your caesarean birth, see the question below.

There are several ways to give you pain relief after a caesarean birth.

You may be given a suppository (tablet) up your bottom to relieve pain when the anaesthetic wears off. If you’ve had a regional anaesthetic, the pain-relieving drugs given with your spinal or epidural should continue to give you pain relief for a few hours. In some hospitals, the team will leave the epidural catheter in place so they can give you more drugs later on.

If you’ve had a general anaesthetic, you may be given local anaesthetic to numb some nerves in your tummy as well as a morphine injection or a similar painkiller. In some hospitals, you may be given a drip containing morphine or a similar drug and you can control the amount of painkiller you have yourself. This is called patient-controlled analgesia or PCA.

A midwife will give you tablets such as diclofenac or ibuprofen, paracetamol or morphine. It is better to take regular pain medication when nurses or doctors offer it to you than to wait until you are sore. The drugs may make you feel sleepy. Sometimes if you are breastfeeding, your baby may be affected by the pain-relieving drugs and may be a little bit sleepy too.

After the operation, you will be taken to the recovery room where your blood pressure will continue to be monitored. Your partner and baby will usually be with you. Your baby will be weighed if not already done so in the theatre and then you can begin breastfeeding, if you want to.

In the recovery room your anaesthetic will gradually wear off and you may feel a tingling or itching sensation. Within a couple of hours you will be able to move your legs again.

Immediately after the birth of your baby, the midwife dries and examines your baby. A paediatrician may do this with the midwife. After this, as long as they are happy that the baby is doing well, you and your partner will be able to cuddle your baby and, in some cases, have skin-to-skin contact.