Planned caesarean:
your questions answered

A planned (or elective) caesarean is an operation to give birth to your baby through a cut in your lower abdomen and womb. It is booked in advance, before labour starts, and is planned for a day agreed with your obstetrician. Occasionally the date changes because of emergencies on the day.

Every woman is different, so your own reasons will be discussed with you in clinic. Common reasons include:

• Your baby is lying bottom first (breech) or sideways, and turning the baby has not worked or is not suitable.
• Your placenta covers the cervix (placenta praevia), or is close enough to it that a caesarean is advised.
• You have had a caesarean or other womb surgery before and, after discussion, prefer a repeat caesarean.
• A medical condition in you or your baby means that labour carries extra risk.
• Some infections, such as certain cases of HIV or genital herpes, where a caesarean lowers the chance of passing the infection to your baby.
• Some twin or multiple pregnancies.

If you would like a caesarean without a medical reason, for example because of anxiety about giving birth, please tell us. We will talk through the benefits and risks of each option, offer support, and respect an informed decision.

If there is no medical reason to go earlier, a planned caesarean is usually booked from 39 weeks of pregnancy. Babies born by caesarean before 39 weeks are more likely to have temporary breathing difficulties. Your date may be earlier if there is a medical reason, and your team will explain why. Because labour can start before your date, you will be given clear advice on what to do if you think labour is starting, or if your waters break.

Most women recover well and have healthy babies after a caesarean, but it is major surgery and it is important that you understand the benefits and risks. Depending on your circumstances, a planned caesarean may avoid the risks of labour, an emergency caesarean or an assisted vaginal birth, and avoids a severe tear of the perineum. We will go through this with you and you will have time to ask questions before you sign your consent form.

Possible risks for you include wound infection, heavier bleeding, blood clots in the legs or lungs, a longer recovery than after a vaginal birth, and, rarely, injury to nearby organs such as the bladder or bowel. A caesarean also affects future pregnancies (see the section on looking ahead below). Babies born by planned caesarean before 39 weeks are more likely to need help with breathing than those born later. A baby may also get a small cut during the operation; this usually heals without further problems.

We will discuss how the benefits and risks apply to your health and pregnancy. Published risk figures are estimates, not a prediction of exactly what will happen to you.

• Ask your midwife or doctor about any preparation you need for your own pregnancy.
• If you smoke, ask your midwife or GP for help to stop.
• Pack your hospital bag early: loose, comfortable clothes, high-waisted underwear, maternity pads, toiletries, a phone charger, and clothes and nappies for your baby.
• Arrange help at home for the first few weeks, and arrange who will look after any older children while you are in hospital.
• Arrange a lift home. You will not be able to drive yourself.
• Think about your birth preferences, for example skin-to-skin contact, music, and who you would like with you. Share these with us.

At your pre-operative visit, you will see a nurse. At this appointment:

• We will check your iron levels to make sure you are not anaemic.
• We will take a blood group sample from you, in case you need a blood transfusion after your caesarean section.
• We will give you medication to reduce gastric reflux.
• We will advise you on your fasting times before surgery.

Yes. For your safety, your stomach needs to be as empty as possible before the anaesthetic. You will be given exact instructions for your own operation time. Your team will tell you when to stop solid food and which clear fluids, if any, you may drink and until what time. Do not use a general fasting timetable instead of these instructions. You may also be given tablets the night before and the morning of surgery to reduce stomach acid. Always follow the written instructions you are given, as these depend on your operation time and your own medical needs.

Please bring all of your medicines and tell us about any supplements or herbal remedies. We will tell you which to take as normal and which to stop. If you take blood thinners (such as low-molecular-weight heparin injections), we will give you precise timing instructions, as this affects when and whether you can have a spinal anaesthetic.

Have a normal bath or shower before you come in. You do not need to shave. If hair needs to be removed near the wound site, the theatre team will use clippers, as shaving with a razor can increase the risk of infection. Follow the instructions you are given about removing nail varnish, false nails, jewellery and make-up.

You will be welcomed by a midwife, who will check your pulse, blood pressure, temperature and your baby's heartbeat. You will change into a theatre gown and may be given compression stockings, and be asked to confirm your details, your fasting time and your consent. The anaesthetist and your obstetrician will see you, and you will have a drip put into a vein in your arm.

Yes. You will be offered an antibiotic through your drip before the first skin incision, which lowers the chance of infection. You will also be offered treatment to reduce blood clots. Your team will assess your risk and choose the right measures, which may include compression stockings, blood-thinning injections, keeping hydrated and getting moving early.

Most women have a regional anaesthetic, which means you stay awake. It is usually safer for you and your baby than a general anaesthetic and lets you experience the birth awake. You can usually see and hold your baby soon afterwards if you are both well.

• Spinal: an injection in your lower back that numbs the lower part of your body while you stay awake.
• Epidural: anaesthetic is given through a thin tube in your back. A spinal and epidural can also be used together.
• General anaesthetic: you are asleep. It may be needed if a spinal or epidural is not suitable, or if your baby needs to be born very quickly. Your anaesthetist will discuss any concerns or preferences with you. Your birth partner cannot normally be in theatre during a general anaesthetic.

Your anaesthetist will talk to you about which is best for you, and about the risks. Nausea, vomiting or discomfort can occur during the operation; your anaesthetist can give medicines to help.

You should feel no pain, but you may feel pressure, pulling or tugging as your baby is born. If you feel any discomfort, tell your anaesthetist straight away. You may feel sick; your anaesthetist can give medicines to help. A screen is placed across your chest, and can be lowered if you would like to see your baby being born.

Your baby is usually born within the first few minutes of the surgery starting. The rest of the operation, which involves delivering the placenta and carefully closing the layers of the womb and abdomen, takes longer. The operation usually takes about 40 to 50 minutes, but it can take longer. Preparing the anaesthetic and recovery afterwards add to this time.

Usually, yes. When you have a spinal or epidural, one birth companion can normally come into theatre, wearing scrubs, and sit by your head. They are asked to stay seated, and may be asked to wait outside if you need a general anaesthetic or if there is a complication. Please check with us in advance about the hospital's policy.

Yes, in most cases. If you and your baby are well, your baby can be placed on your chest as soon as you are both ready, even in theatre, and you can continue skin-to-skin in recovery. Early skin-to-skin helps bonding, keeps your baby warm and supports breastfeeding. Your midwife can help you with the first feed. If you cannot hold your baby straight away, your partner can have skin-to-skin contact in the meantime.

Your baby will be dried and checked by a midwife or a baby doctor. If your baby is well, they will stay with you. Cord clamping will usually be delayed for a short time if you and your baby are well. If your baby needs extra help, we will explain what is happening and keep you closely informed.

You will be looked after in a recovery area while the anaesthetic wears off, with regular checks of your blood pressure, pulse, wound and bleeding. Your baby stays with you when it is safe. You will have a catheter in your bladder and a drip. The catheter is usually removed once you can walk, around 12 to 18 hours after the operation. NICE advises that after regional anaesthesia it is not removed sooner than 12 hours after the last anaesthetic top-up. The drip is removed when your team says it is no longer needed. You will be helped to get up and walk, and to eat and drink as soon as you feel able.

Most women go home after one or two days, once you are eating, drinking, passing urine, walking, your pain is controlled and you and your baby are well. NICE recommends offering discharge after 24 hours with follow-up at home if you are recovering well, have no fever and have no complications. Some women need to stay longer. Your own discharge plan will be discussed with you.

It is normal to be sore for the first few days, and you will be offered regular pain relief so that you can move around, feed and care for your baby. This usually includes paracetamol and an anti-inflammatory such as ibuprofen (if suitable for you), with stronger medicines if you need them. Paracetamol and ibuprofen are commonly used while breastfeeding, if suitable for you. Stronger medicines need individual advice: some can make a breastfed baby sleepy or affect their breathing.

Do not take codeine or co-codamol while breastfeeding, including in over-the-counter medicines. Seek medical advice straight away if your baby is unusually sleepy or feeds poorly. Call 999 if your baby has breathing difficulties.

Take your painkillers regularly rather than waiting for pain to build, and tell your midwife if your pain is not controlled. Ask your midwife for help with comfortable feeding positions and moving around.

Yes. A caesarean does not stop you from breastfeeding. Ask your midwife to help you find comfortable feeding positions that do not put pressure on your wound. Ask what infant-feeding support is available during your stay and after you go home.

Everyone recovers at their own pace. Allow around six weeks for physical recovery, although some women need longer. Discomfort may last for several weeks, and there is no single deadline for feeling back to normal. Rest as much as you can, accept help, and do not push yourself.

• Gently clean and dry the wound every day. Follow your dressing instructions about washing or showering, and pat the area dry gently.
• Wear loose, comfortable clothes and breathable cotton underwear.
• Follow the advice you are given on your dressing and any stitches. Most women have dissolvable stitches.
• Do not use creams, powders or perfumed products on the wound unless advised.
• Watch for increasing redness, pain, swelling, opening of the wound or discharge, and seek advice if these occur.

Plan not to drive for around six weeks. Recovery varies: NICE advises returning to driving only once you have fully recovered, without pain or physical restrictions. Check with your midwife or doctor if you are unsure, and with your insurer about its conditions. Being able to sit in a parked car is not enough to show that you are ready to drive safely.

• Get up and move as soon as your team says it is safe, then build up short, gentle walks gradually.
• Start your pelvic floor exercises as soon as you are comfortable.
• In the first weeks, avoid lifting anything heavier than your baby, such as heavy shopping, car seats or older children, and avoid strenuous housework.
• Return to formal exercise and heavier lifting only when you have recovered and can move without pain or restrictions. This may take six weeks or longer. Ask your midwife or doctor for advice before returning to strenuous exercise. NHS advice suggests waiting until after your six-to-eight-week postnatal check before high-impact exercise such as running.

You can have sex when you feel recovered, ready and comfortable; this may take six weeks or longer. You can become pregnant again very soon after giving birth, even if you are breastfeeding, so please talk to your midwife or doctor about contraception before you go home.

Many women feel emotional in the first days (the “baby blues”). Some women find that the birth did not go as they hoped, or find that they need to talk about it. This is understandable. If low mood or anxiety lasts more than two weeks, gets worse, or you are struggling to cope, please speak to your midwife, health visitor or GP, or contact us. Help is available.

Contact your midwife, GP or the maternity centre straight away if you have:

• A temperature of 38°C or above, or you feel hot, shivery or unwell. Do not wait for a fever if you feel seriously unwell.
• A wound that is red, hot, swollen, increasingly painful, opening, or leaking pus or fluid.
• Heavy vaginal bleeding, bleeding that gets heavier, passing clots, or smelly vaginal discharge. Do not wait for a particular number of soaked pads before seeking help.
• Pain, swelling, redness or heat in one calf or leg.
• Pain or burning when you pass urine, difficulty passing urine, or loss of control.
• Severe or worsening tummy pain, or persistent vomiting.
• A severe headache, especially one that is worse when you sit or stand up, or that comes with visual disturbance.

Call 999 straight away if you have chest pain, sudden breathlessness or coughing up blood (these can be signs of a blood clot in the lungs), severe bleeding, collapse or a seizure.

Not necessarily. Many women who have had one caesarean can choose between a planned repeat caesarean and a trial of labour, called vaginal birth after caesarean (VBAC). Both options carry benefits and risks, and the best choice depends on why you had your caesarean, your health, and your preferences. We will help you decide in your next pregnancy.

VBAC means planning to give birth vaginally after a previous caesarean. After one previous caesarean, about three in four women with a straightforward pregnancy who go into labour naturally give birth vaginally. This is not a success estimate for everyone planning a VBAC; your chance depends on your own circumstances. A VBAC has a small risk that the scar on the womb may open (uterine rupture), which is serious but uncommon. A repeat caesarean has its own risks, which are higher with each additional operation. We will give you personalised figures and support you in whichever you choose.

After a caesarean, there is a slightly higher chance of problems with the placenta in later pregnancies, such as it lying low or growing into the scar. It is helpful to tell any future midwife or obstetrician that you have had a caesarean, so that they can plan your scans and care. Most women who have had a caesarean go on to have healthy pregnancies.

Discuss the timing of another pregnancy with your obstetrician before trying to conceive. The advice should take account of your recovery, any complications, your age and fertility, and your plans for birth next time. This guide does not set a fixed waiting interval. Use contraception if you are not ready for another pregnancy: pregnancy is possible from three weeks after birth, even while breastfeeding.