Caesarean section : meaning & overview

Are you pregnant and wondering how the delivery will occur? First of all, congratulations, future mama! As you know, two delivery options exist: you can give birth vaginally or with a C-section. 

A C-section is a surgical birth procedure. Short for caesarean section, it’s a straightforward procedure: an incision is made through your abdomen and uterus to deliver your baby ¹. A C-section can be advised by your healthcare professional to avoid complications, or for other reasons. When this procedure is planned in advance, it is known as an elective C-section. 

In some cases, you may need an emergency C-section. For instance, you chose to give birth vaginally, but complications arise during labour or close to the term of your pregnancy ¹. To protect you and your baby, the healthcare team will then perform an emergency C-section. 

You can have an emergency C-section for various reasons ²:  

• Your labour is too long, despite medical interventions 

• Your baby shows signs of distress 

• Your baby is positioned feet or bottom first instead of head down (breech or transverse position) 

• Your baby is lying horizontally across your uterus (transverse lie) 

• You show placenta issues, severe high blood pressure (signs of preeclampsia or eclampsia), or infections 

The position of your baby or your placenta can change at the last minute and lead to an emergency C-section. But sometimes, it can also be predicted in advance. This will allow you to plan for a C-section before you get into labour. 

 
If you had a previous C-section, your doctor will probably recommend performing another one. In this case, it’s going to be an elective C-section.  It’s also the best solution to birth twins, triplets, or more babies. Don’t worry: the surgery is safe, even if it’s performed in an emergency, and typically lasts 45 minutes to an hour. 

To give birth, there are two options: vaginal birth or a C-section. In the traditional vaginal birth method, your baby comes out through your vagina. With a C-section, your baby is born through a surgical incision in your lower belly.

Since C-sections involve doing an incision, they usually leave a little scar. This scar can be a bit visible or more discreet; it depends on your recovery process. You could also feel a little more pain during your recovery period. Vaginal births, on the other hand, are no walk in the park either. They can include tearing or an episiotomy, which also requires healing. However, it is generally less invasive.

With a C-section, the recovery process is also a bit longer. After a caesarean delivery, you may need several weeks to recover fully, whereas vaginal birth recovery tends to be quicker.

Each method has its risks and benefits. To choose between a vaginal birth and a C-section, your doctor will give you advice based on your and your baby’s health and circumstances.

The difference between a planned and an emergency C-section is simple: it’s in the timing and circumstances of the surgery.

A planned (or elective) C-section is scheduled ahead of time during your pregnancy. You planned it because of health factors such as your baby’s position, you had a previous C-section, certain health conditions or for other reasons. A date and time is set for your delivery. Thanks to this planning, you and your healthcare team can be thoroughly prepared ¹. For example, you would have fasted beforehand and arranged special childcare with your partner or family.

An emergency C-section occurs when complications arise suddenly during labour or delivery, and they require immediate surgical intervention. You or your baby’s health is threatened, and the medical staff must act fast. Emergency C-section are urgent and usually performed quickly. But if this happens to you, don’t worry: this procedure is very safe. The medical staff is highly trained and used to performing this surgery ¹. They will act fast to protect you and your baby with all they can.

C-sections, like all medical procedures, come with their own set of benefits and downsides. 

Here are the main benefits:  

• Safety for you, mama: a C-section can prevent complications associated with prolonged labour, fetal distress, or delivering a large baby. 

• Safety for your baby: in some cases, vaginal birth could result in trauma to the newborn (e.g., with a large baby or breech position). As such, a C-section can be a safer alternative. 

But some downsides have to be considered: 

• The recovery period for a C-section is often longer and more painful than for a vaginal birth. You would have to stay at the hospital for 3-4 days and recover at home for several weeks. 

• C-sections carry some risks², such as infection, blood clots, and reactions to anaesthesia. But this is the case with any surgery. 

• You may need to repeat C-sections for your future babies. 

You can discuss it with your healthcare provider. 

It’s natural to worry about your C-section procedure ahead! But understanding how it works can help you feel more at ease. If you know what to expect, you’ll probably feel more prepared. Here’s a detailed look at each stage of the process:

• Pre-Operative Preparation

Before the surgery, you undergo a series of pre-operative steps. You fast for 6-8 hours to clear your intestines. You also complete necessary medical tests (such as blood work) and receive intravenous fluids to support your body. The healthcare team needs to review your medical history and get your informed consent for the procedure. You are prepped: your abdominal area is cleaned and possibly shaved. Finally, you receive anaesthesia, which might be spinal, epidural, or general, depending on the situation. Your partner and your loved ones can be by your side at the hospital or clinic. They can bring moral support while you prep.

In an emergency C-section, pre-operative preparation is much quicker than in a planned one. You may not have the chance to fast, and any necessary medical tests will be done rapidly. The healthcare team will move swiftly, reviewing your medical history and getting your consent as quickly as possible, often verbally. If epidural or spinal anaesthesia isn’t already in place, general anaesthesia may be administered to ensure a fast start to surgery.

• The Surgery Itself

Once the anaesthesia takes effect, the surgery begins. You go to the operating room, where your partner can most of the time come with you and be there for your baby’s birth. However, they must stand away from the sterile surgical area, usually separated by a curtain. But they can still provide emotional support! For an emergency C-section, your partner may still be allowed to join you. However, in some urgent cases, they may need to wait outside until the procedure is underway.

The procedure starts with an incision, usually made horizontally just above your pubic hairline. This is known as a “bikini cut.” In some cases, a vertical incision may be necessary. The surgeon then carefully cuts through the layers of tissue and the uterus to reach your baby. You can feel a little pressure and pull. It’s normal. After your newborn is delivered, the surgeon cuts the umbilical cord, removes the placenta, and closes the wound with stitches or staples. The entire procedure lasts about 45 minutes to an hour.

If your baby needs extra care, they may be taken to a neonatal care unit. In some cases, the baby might need to stay in intensive care for a longer period. While this can be worrying, know that the medical team is doing everything possible to ensure the best care for your baby. You will be reunited as soon as it is safe to do so and begin to recover together.

• Post-Operative Care

Immediately after the surgery, you and your baby are moved to a recovery room, where you will be monitored for a few hours. During this time, medical staff checks your vital signs, manages your pain, and ensures that your uterus is contracting properly to minimise bleeding. When you feel ready, you can begin breastfeeding your newborn if they are with you. When your condition is stable, you will be transferred to a postpartum room to continue your recovery. If your newborn was taken to the neonatal care unit, they will join you in your postpartum room when everything is stable.

Then, the thrilling adventure of motherhood begins!

Having the right anaesthesia for a C-section is essential for your safety and comfort. The three most common types are spinal, epidural, and general anaesthesia.

• Spinal anaesthesia injects a single dose of anaesthetic into your lower back. This numbs your body from the chest down. It works quickly and is commonly used for planned C-sections.

• Epidural anaesthesia is similar to spinal anaesthesia, but it allows for continuous administration of the anaesthetic through a catheter. It’s often used in labour that may lead to an emergency C-section.

• General anaesthesia renders you unconscious. It is usually only used for emergencies, where speed is critical, or when spinal or epidural anaesthesia is not recommended.

C-sections are generally safe, and most moms and babies do beautifully. However, like any surgery, it’s important to be aware of potential risks ¹. This will help you feel prepared to make the right decisions for you and your newborn.

• Infections can sometimes happen around the incision or in areas like the uterus or urinary tract. But don’t worry—your medical team will closely monitor you for signs like fever or redness to ensure everything is healing correctly.

• There’s also a slightly higher chance of blood clots, especially in the legs. Thankfully, simple things like moving around as soon as you feel ready and taking medication if needed, helps reduce this risk significantly.

• In rare cases, scar tissue (adhesions) can form inside your body. But your doctors will keep an eye on this, especially if you’ve had previous surgeries.

• Excessive bleeding (haemorrhage) is another possibility. Rest assured that your team will be prepared to manage it swiftly and safely if it occurs.

• Lastly, anaesthesia can sometimes cause minor side effects like nausea, but severe reactions are very rare. Your anesthesiologist will be with you the entire time to make sure you’re comfortable and safe.

Your healthcare team is there to guide and support you every step of the way. They will make sure that both you and your baby receive the best possible care. Don’t hesitate to talk with your doctor about any concerns — it’s all part of preparing for a healthy, happy delivery.

Post-operative side effects from a C-section can vary widely from woman to woman ¹. It’s okay if you feel pain and discomfort around the wound. This sensation might last several weeks, so don’t hesitate to use pain medication recommended by your doctor. Moreover, recovering from surgery can leave you feeling unusually tired. Resting as much as possible is important, and you can ask for help with newborn care if you need it.

The discomfort from the incision can make breastfeeding challenging. If you struggle, know that you are not alone. To succeed at breastfeeding, if you plan to, you will need to find comfortable positions. Maybe ask for help from your doctor or lactation consultant? 

Constipation is also common after a C-section! It is often due to the effects of anaesthesia and pain medications. Stay hydrated and eat fibre-rich foods to help with this problem.

Hormonal shifts and the stress of surgery can bring a mix of emotions, from joy to unexpected feelings of overwhelm. It's completely normal to have emotional ups and downs in the days after your baby arrives. Some moms may feel the “baby blues,” while others might experience deeper feelings of sadness or anxiety. Be careful: these can be signs of postpartum depression. 

Remember, you’re not alone in this—many women go through it, and it’s okay to ask for help. Your well-being is just as important as your baby’s. So, be gentle with yourself, lean on your support system, and don’t hesitate to reach out to your doctor or loved ones if you're feeling down

Packing your hospital bag for a C-section is all about making sure you’re comfortable and prepared. This way, you will be able to focus on what matters most: welcoming your baby. Here’s a checklist with everything you’ll need, along with a few tips to help you through the recovery process.

For You:

• Documents: Don’t forget your ID, insurance info, and any medical records. Having these on hand will make check-in smoother. 

• Toiletries: Gentle soap (for you and baby), toothpaste and toothbrush, moisturisers, and healing cream for your incision (but the doctors might provide one at the hospital).

• Comfortable clothing: After surgery, you will crave comfort. Loose clothes will feel better on your body and avoid irritating your incision. And yes, high-waisted grandma knickers are a good idea! They sit above your incision and prevent friction with your wound. They can also help hold your dressings and pads in place to manage your postpartum bleeding. 

• Items for extra comfort: A belly binder can provide extra support for your abdomen as it heals, making movement a bit easier. Bringing your own pillow can make your hospital stay feel a little more like home.

• Breastfeeding essentials if you plan to breastfeed. Nursing bras can make breastfeeding easier and provide more support than regular bras; nipple cream and breast pads can soothe soreness and keep you comfortable, and a breastfeeding pillow will help you keep a good position for you and the baby, especially while you recover. 

• Entertainment & Snacks: C-sections usually involve some waiting and recovery time, so bring something to keep you relaxed and entertained: a tablet, books, or magazines. Hospital food might not always hit the spot, so you may want your favourite snacks to keep your energy up.

For Baby:

• Clothing: Onesies are soft and easy to change. Bring a few in case of spills! Newborns lose heat quickly, so little items like socks and hat help keep your baby cosy. 

• Baby Care Essentials: A blanket, perfect for swaddling and keeping baby snug. Diapers and baby wipes are often provided by hospitals, but it’s nice to have extras just in case.

• Feeding Support: If your baby needs a little extra help with digestion, especially if they’re born via C-section. But your healthcare team will guide you on what’s best. 

This checklist is here to help you feel ready and cared for. You can focus on your recovery and enjoy those precious first moments with your baby. You’ve got this!

The number of C-sections a woman can have safely varies depending on individual circumstances ³. But generally, healthcare providers recommend limiting C-sections to three or four. Indeed, each successive caesarean delivery increases the possible risk of complications.

That said, some women have had more than four C-sections with no significant issues! However, they would require closer monitoring during pregnancy. The key is to consult your healthcare provider to evaluate the possible risks based on your medical history and overall health.

Are you considering another pregnancy after a C-section? Most doctors recommend waiting at least 18 to 24 months before becoming pregnant again. This gives your body enough time to heal and reduces the risk of complications in future pregnancies. That’s because your uterus has been cut through; it needs time to heal to minimise the risk of uterine rupture. 

Are you considering a Vaginal Birth After a C-section (VBAC)? First, your doctor has to assess the thickness of your uterine scar and other factors to determine if it’s a safe option ³.

Recovering from a C-section takes time and care ³. Here’s what to expect and how to best manage your recovery process. 

You’ll likely stay in bed for the first 24 hours with a catheter to support your recovery. The medical team will monitor your vitals, pain levels, and bleeding. Try to keep your body moving, at least a little bit, to prevent blood clots.

After that:

• Days 2-4: You start moving around more, and the catheter is removed. Pain management continues, and you can start to walk short distances.

• First Two Weeks: Focus on rest, gentle movement, and avoiding heavy lifting. You may need help with daily activities, including caring for your baby. Don’t hesitate to lean on your loved ones.

• Weeks 2-6: Gradually increase your activity level, but avoid strenuous exercise. You’ll have a follow-up appointment to check your healing and address concerns. 

• After Six Weeks, many women start feeling more like themselves. Your doctor will clear you for everyday activities, including exercise and even sex, if it’s on the table.

Managing pain after a C-section is an important part of your recovery, and there are plenty of options to help you feel more comfortable. Over-the-counter pain relievers can often do the trick, but if you need something stronger, your doctor can provide prescription options that are safe for you ¹.

A belly binder can be really helpful for extra support. It can ease discomfort by gently supporting your abdomen, especially when moving around. It’s also a good idea to rest in positions that don’t put pressure on your incision—using pillows to prop yourself up while sitting or lying down can make a big difference.

If you ever feel unsure or if your pain seems to be worsening, don’t hesitate to reach out to your doctor. It’s perfectly okay to ask for help, and your care team is there to make sure you’re healing as smoothly as possible.

Taking care of yourself after a C-section is important, but it doesn’t have to be overwhelming. Try to keep the incision site clean and dry. Your healthcare provider will gently guide you on how to care for it, including when it’s safe to shower. Nourishing your body with a balanced diet and staying hydrated—especially if you're breastfeeding—can help your healing process.

Light walking can also do wonders. It improves circulation and reduces the risk of blood clots. Just take it easy and listen to your body, avoiding heavy lifting or intense activity until your doctor gives the green light. Most importantly, be kind to yourself during this time. Don’t hesitate to ask for help when you need it. After all, as the saying goes: it takes a village to raise a child. Feel free to lean on your care team's advice—you’re doing an amazing job!

C-section scars vary depending on the type of incision used and how your body heals. There are two main scars¹:

• Horizontal Scar (Bikini Cut): This is the most common type, just above the pubic hairline. It’s typically less visible and heals more smoothly.

• Vertical Scar: Less common and usually used in emergencies, this incision runs from just below the navel to the pubic area. It’s more noticeable and may take longer to heal.

To help your healing process, you can:

• Gently start massaging your scar once the incision has healed. This can help minimise scarring by softening the scar tissue.

• Use silicone sheets or gels to reduce the visibility of the scar. They keep the area hydrated and reduce excess collagen formation. Collagen is a protein that helps heal the skin, but too much can cause thicker, more noticeable scars. 

• Keep the scar out of the sun, or use sunscreen. This is important to prevent discolouration. 

Every woman’s body heals differently, and while some scars may fade significantly, others may remain more prominent. Feel free to consult with your doctor about the best options for scar care.

Babies born via C-section might experience slightly different challenges compared to those born vaginally. Because C-section babies don’t go through the birth canal, they might miss out on the “squeeze” that helps expel fluid from their lungs. They also miss out on an additional immunity boost that enriches their little gut with Bifidobacteria from your birth canal ⁴'⁵.

Initial breastfeeding can also be more challenging after a C-section. It is due to physical discomfort and because your baby might be sleepier from the anaesthesia. Don’t worry if you experience this: in South Africa, 1 in 2 mothers who had a C-section breastfeed a bit later ⁶. However, with patience and support, you will most likely successfully breastfeed.

Immediate skin-to-skin contact might be delayed if you need additional care after the surgery. But hospitals and clinics increasingly prioritize early bonding, even after C-sections.

Studies show that babies born by C-section have a different gut microbiome, which affects their immune system development ⁴⁻⁷. Moreover, there’s evidence that C-section delivery may be associated with a higher risk of allergies and asthma ⁴. 

But don’t worry: babies can catch up on immunity from the start! You can reach out to your healthcare provider to talk about these potential effects, and make sure your baby receives the best possible care.

Do you have a better understanding of what a C-section involves, from surgery to recovery? It can help you feel more confident and prepared for your delivery. Whether it’s planned or an emergency, a C-section is a safe option for bringing your baby into the world. Even though it comes with its challenges! When you know what to expect and take good care of yourself afterward, you can focus on the joy of welcoming your new baby.