• Reference Number: HEY-252/2024
• Departments: Maternity Services
• Last Updated: 1 January 2024

Introduction

This leaflet has been produced to give you general information about your procedure.  Most of your questions should be answered by this leaflet.  It is not intended to replace the discussion between you and your doctor and midwife, but may act as a starting point for discussion.   If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team.

What is a caesarean section?

A caesarean section is an operation to deliver a baby. It involves making a cut in the front wall of a woman’s stomach and womb.

The operation can be:

• a planned (elective) procedure, when a need for the operation becomes apparent during pregnancy;
• an emergency procedure, when circumstances before or during labour call for delivery of the baby by unplanned caesarean.

A caesarean section is usually carried out under epidural or spinal anaesthetic, where the lower part of your body is numbed. The operation usually takes a minimum of 40 minutes, but can be performed quicker in an emergency. Some caesarean sections are performed under a general anaesthetic.

Why do I need a caesarean section?

A caesarean section is usually carried out when a normal vaginal birth could put you or your unborn baby at risk. The reason for your caesarean section will have been discussed with you by a senior obstetric doctor. 

Can there be any complications or risks?

Frequent risks when having a caesarean section include:

• Persistent wound and abdominal discomfort.
• Haemorrhage.
• Infection.
• Use of forceps at delivery.
• Injury to baby – minor skin cuts are 1–2% (1-2 in 100), difficulty in breathing is 12% (12 in 100).

Serious risks when having a caesarean section include:

Uncommon:

• Emergency hysterectomy (7–8 per 1,000 women).
• Return to theatre for further surgery (5 per 1,000 women).
• Admission to intensive care unit (9 per 1,000 women).
• Future pregnancies.
• Placenta (after birth) covering entrance to the womb (4–8 per 1,000 women).
• Tear in the womb (2–7 per 1000 women).
• Stillbirth (1–4 per 1,000 women).

Rare:

• Organ injuries: urinary and bowel system (1–1000 women).
• Developing a blood clot (4–16 per 10,000 women).

Very rare:

• Death, approximately one woman in every 12,000.

What is enhanced recovery?

Enhanced recovery following an elective caesarean section reduces the time that you spend in hospital. If all is well you will be discharged home the following day.

Am I eligible for enhanced recovery?

You may be considered for enhanced recovery when you are going to have an elective caesarean section and if you do not have any of the following:

• a problem with the placenta;
• a BMI above 50;
• diabetes requiring treatment with insulin;
• any clotting/cardiac conditions;
• a general anaesthetic for the procedure.

Or if:

• you are less than 36 weeks pregnant;
• you are unwell;
• your baby requires direct admission to the neonatal unit;
• if you have refused blood products that were recommended clinically.

Can there be any complications or risks to enhanced recovery?

If there are any concerns about the well-being of you or your baby then you will remain in hospital until you and your baby have been assessed by the midwives and doctors as ready for discharge home. You do not have to leave hospital the day after your surgery. If you do not feel ready to be discharged early you can stay in hospital.

How do I prepare for the caesarean section?

You will be contacted regarding the date for your caesarean section.  However, from time to time we may need to change the date or time of your appointment even at short notice.

You will be asked to attend the Antenatal Clinic to obtain the following:

• a sample of blood to check your blood group and to check for anaemia;
• swabs taken for MRSA screening (Methicillin Resistant Staphylococcus Aureus). This is to ensure that any required treatment is undertaken before you are admitted to hospital.

At this appointment you will be given two packets of tablets:

• one packet containing 2 Omeprazole tablets (this is to reduce the acid in your stomach);
• one packet containing 1 Metoclopramide tablet (this is to speed up the emptying of your stomach so you are less likely to be sick during the operation).

You will not be admitted to the hospital until the morning of your operation. It is therefore important that you attend this clinic to ensure we have your results from your blood samples and swabs on the date of your operation.

You will be required to have a pubic shave no less than three days before the day of your surgery. This is important as shaving within three days can cause wound infections.

Do not wear nail varnish (on finger or toe nails). Remove any acrylic/false nails. Please leave all jewellery at home other than a wedding ring. Please remove all body piercings.

IF YOU TAKE FRAGMIN IT IS IMPORTANT THAT YOU DO NOT TAKE YOUR FRAGMIN DOSE THE DAY BEFORE YOUR BOOKED CAESAREAN SECTION – THIS WILL CAUSE A DELAY, AND POSSIBLE CANCELLATION, OF YOUR CAESAREAN SECTION. IF YOU ARE UNSURE PLEASE DISCUSS THIS WITH YOUR MIDWIFE.

For example; if you are booked for a caesarean section Monday morning please take your fragmin as planned on Saturday and do not take your fragmin on Sunday. If you have any concerns it is important that you ring us as soon as possible to be checked over.

Morning caesarean section instructions

The evening before admission you may have a light supper and at 10pm take only 1 Omeprazole tablet

At 6.00am on the day of your admission you may have the following breakfast:

• One cup of tea or coffee and one slice of toast (lightly spread with butter/margarine and/or jam/marmalade) if desired.  No alternative is acceptable.  You must not eat or drink anything else after this.
• After 30 minutes (approximately 6.30am) take the Metoclopramide tablet and the second Omeprazole.

Please arrive on the ward no later than 7.00am accompanied by your birth partner.

A bed will have been booked for you on either:

• Labour and Delivery (second floor); OR
• Enhanced Recovery Maple Ward (first floor)

Afternoon caesarean section instructions

The evening before admission you may have a light supper and at 10pm take only 1 Omeprazole tablet

At 8.00am on the day of your admission you may have the following breakfast:

• One cup of tea or coffee and one slice of toast (lightly spread with butter/margarine and/or jam/marmalade) if desired.  No alternative is acceptable.  You must not eat or drink anything else after this.
• After 30 minutes (approximately 8.30am) take the Metoclopramide tablet and the second Omeprazole.

Please arrive on the ward no later than 12.00pm accompanied by your birth partner.

A bed will have been booked for you on either:

• Labour and Delivery (second floor); OR
• Enhanced Recovery Maple Ward (first floor)

What will happen?

You will be allocated a morning or afternoon slot and it is important you follow the correct instruction to ensure there are no delays with your caesarean section.

A midwife will be allocated to you on your admission who will coordinate, support and keep you informed of all procedures.

You will be seen by the anaesthetist and all options for anaesthesia will be discussed. If you are having an epidural or spinal anaesthetic, your birth partner will be able to attend and support you at the caesarean section.

You will be asked to have a shower in the hospital when you arrive (towels will be provided). You will be asked to change into a hospital gown prior to going to theatre and will be given a hospital dressing gown and slip socks to wear. Your birth partner will be shown where to change their clothes when arriving in the theatre department.

You will also be seen by an obstetric doctor who will explain the procedure and obtain your written consent. You will have an opportunity to discuss any concerns you may have.

To ensure the safety of both you and your baby it is not possible to give a specific time for your surgery. In some circumstances, your caesarean section may have to be rescheduled for another date. If this occurs, a doctor will provide a full explanation.

Please pack essential toiletries and a change of nightwear, a set of baby clothes and some nappies. Your belongings will remain on the ward where you are admitted. Ensure that you have any valuables with you at all times, or they are placed in the locker at your bed side while you are in theatre. Only a mobile phone or camera can be taken into theatre. Please do not bring with you any unnecessary items.

What will happen afterwards?

Following your caesarean section, you and your baby (or babies) will be transferred to a recovery area on the Labour Ward. You will be cared for and observed by the midwifery, obstetric and anaesthetic teams. You will be supported with caring for your baby (or babies).

Once you have recovered from the anaesthetic and all your observations are stable, you and your baby (or babies) will be transferred to the postnatal ward. If you are eligible for enhanced recovery you will stay on the Labour Ward for 30 minutes following your caesarean section.

If you are well, you will be transferred back to the enhanced recovery bay where you will be monitored for four hours. You will be encouraged to get out of bed prior to transfer to the postnatal ward.

Visiting

There is no visiting in the Enhanced or Labour Ward recovery area; however, your nominated birth partner can accompany you throughout your caesarean section and in the recovery area for 4 hours following the operation.

Once you have recovered you will be transferred to the postnatal ward where visiting hours are:

Birth Partners         08:00am – 23:00pm

All other visitors     13:00pm – 20:00pm

2 visitors per bed are permitted during visiting times.

Only the patient’s own children are allowed on to the postnatal ward.

You may choose one birth partner to stay with you overnight, please ask a midwife for the patient information leaflet ‘Visiting and Birth Companions on Rowan Ward’.

Caring for your wound

Your wound (area cut for the caesarean section) will be covered with a waterproof dressing which allows the midwife to see your wound so an assessment can be made. The midwife will give you advice about removing the dressing on day 7 after your caesarean section. If there are any signs of infection, the wound dressing may remain in place until day 10.

Whilst your wound dressing is in place, you may take a shower. Gently pat dry the wound area. Once the dressing has been removed, a midwife will continue to advise you on how to look after your wound to prevent infection. This will include advice on how to gently clean and dry the cut area daily using a clean towel.

It is advised that you wear comfortable underwear which does not press on the wound.

To reduce the risk of infection, wash your hands:

• before and after visiting the toilet;
• prior to feeding your baby.

Preventing blood clots

During your hospital stay, you will be assessed for your risk of thrombosis (blood clot). You will be asked to wear compression stockings and will be given some to take home with you. Following your caesarean section, you will be prescribed an anti-clotting daily injection. This is usually for 7 days or it may be longer if you are assessed as a high risk for thrombosis.

When you are discharged from hospital

A community midwife will visit you the following day. At this visit, the midwife will carry out a full review of you and your baby (or babies) needs and discuss a management plan for your care and visits. Part of this review will be to assess how your wound is healing. If she is concerned how your wound is healing, she will refer you to your doctor.

If you have concerns at any time you can call the hospital on the 24 hour contact telephone numbers included in this leaflet.

After having a caesarean section, contact your midwife or GP straight away if you have any of the following symptoms:

• severe pain
• leaking urine
• excessive vaginal bleeding
• your wound becomes more red, painful and swollen
• a cough or shortness of breath
• swelling or pain in your calf

These symptoms may be the sign of an infection or blood clot, which should be treated as soon as possible.

It takes longer to recover from a caesarean section than it does after a vaginal delivery. In the first few weeks after giving birth, try to get as much rest as possible. Avoid walking up and down stairs too often, as your stomach may be sore. However, you should take gentle daily walks to reduce your risk of blood clots.

You will be given regular pain relief medication to take at home, for as long as you need them. In general, it will take about six weeks for all your tissues to heal completely. Before this time, basic activities, such as caring for your new baby and looking after yourself, should be possible. It is advised not to drive for 6 weeks following your caesarean section. Ring your insurance company for advice if you feel able to drive before this time. It is advised not to lift anything heavier than your baby for 6 weeks. It is advised not to do any procedure that involves pushing or pulling for 4 weeks as this may place a strain on your abdominal muscles and the wound.

Future pregnancies

If you have had a delivery by caesarean section, it does not necessarily mean you will have to have a caesarean again in the future. You can discuss future pregnancy options with your obstetric doctor or midwife in the hospital or community who should take account of:

• the reason for your first caesarean;
• your preferences and priorities;
• the overall risks and benefits of a caesarean section;
• the risk of tearing the wall of your womb (uterine rupture) along the scar from your previous caesarean section;
• the risk to your own and your baby’s life and health at the time of birth.

Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact: Antenatal Clinic on (01482) 382623 or the Community Office on (01482) 382658/382742.

General Advice and Consent

Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.

Consent to treatment

Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.

The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:

• you must be able to give your consent
• you must be given enough information to enable you to make a decision
• you must be acting under your own free will and not under the strong influence of another person

Information about you

We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.

We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.

Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.

If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.

Your newborn baby’s NHS number

An NHS number is allocated to everyone whose birth is registered with a Registrar of Births and Deaths in England and Wales. You already have an NHS number and your baby will be assigned an NHS number soon after birth. Your NHS number is unique to you and provides a reliable means of linking you to the medical and administrative information we hold about you. NHS numbers are allocated on a random basis and, in themselves, provide no information about the people to whom they relate.