About 1 in 4 women have a caesarean section in the UK. Most experts agree that this is too many.
Vaginal birth is much safer than a caesarean section for most women and babies, but sometimes a caesarean section is the only safe option, for example when the baby is positioned side-to-side in the belly (transverse lie) or the placenta is covering the cervix (placenta praevia).
In other situations, having a caesarean section might have some possible benefits, and these need to be balanced against the risks. You have the right to know these risks and possible benefits, and only you can decide how important they are to you.
Read what the Royal College of Obstetricians and Gynaecologists say about choosing to have a caesarean section here
A caesarean section is a major operation and is usually done under an epidural/spinal anaesthetic, where the lower part of your body is ‘numbed’. Occasionally some caesarean sections are performed under general anaesthetic. It will either be:
- A planned (elective) procedure - when a medical need for the operation becomes apparent during pregnancy.
- Or, an emergency procedure, when circumstances before or during labour call for delivery of the baby by unplanned caesarean.
- Read more about how a caesarean section is carried out here.
- Read more about the partnership between UCLH and the Whittington Hospital regarding caesarean sections.
- Most women in the UK give birth vaginally, recover well and have healthy babies
- Most women who have a planned caesarean section will also recover well and have healthy babies
- However, there are risks for both you and your baby and it may take longer to get back to normal after your baby is born. Having a caesarean section also makes future births more complicated with increased risks
Doctors will not recommend a caesarean section unless it is necessary for medical reasons.
The possible benefits depend on whether you have any underlying problems in your pregnancy. Your doctor or midwife might recommend a caesarean section if labour or vaginal birth is more likely to be risky for you or your baby. For example, it can be difficult to birth a baby that is in a breech position (bottom first or feet first position), and some breech babies can get injured during vaginal birth. Or if the fetal heart rate has certain changes in labour, it could be a sign that the baby isn’t getting enough oxygen. In these special cases, a caesarean section may reduce the chance that your baby will be injured.
Having a caesarean section means you will undergo a surgical procedure. All surgeries have risks, like infection, injury to blood vessels and organs, and serious bleeding. It can also cause problems for babies, like breathing difficulties that need treatment in a neonatal unit. Recovering after a caesarean section is also more difficult than after an uncomplicated vaginal birth. Caesarean section can also cause certain ongoing problems. For example, a caesarean section can cause chronic pelvic pain in some women, through the development of adhesions to the bladder or intestines, and babies born by caesarean section are at increased risk of developing chronic childhood diseases like asthma and diabetes.
If you are having a planned caesarean section it will not be done until at least 39 weeks, unless there is a medical reason to have your baby sooner. The last days and weeks of pregnancy are important for the baby’s lungs, brain, and other organs to develop. Babies born before 39 weeks may need special care and have continuing problems if they are born before they are ready. Although we aim to schedule your caesarean section soon after you’ve reached 39 weeks, there are occasions when this could extend to the 41st week of pregnancy.
Once a date is given we are unable to change it unless there are exceptional circumstances in which case we will do our best to facilitate a change. Please be aware that occasionally on the day of the planned caesarean section, there may be a delay before your caesarean can be performed. Very rarely some planned caesarean sections may be cancelled and re-scheduled to the next day. This decision will ever only be taken in extreme circumstances where all other options to prevent a cancellation is explored as we are mindful of the preparations you would have put in place for your hospital stay.
Once you arrive in hospital, priority of order will be made by the midwifery & medical team on duty that day, but usually those women who are undergoing a caesarean for medical or clinical reasons, or those who face a potentially complicated procedure, will be done first.
- What is the benefit of a caesarean section for me or my baby?
- What problems might happen if I continue with my plan for a vaginal birth?
- How likely are those problems if I plan for a vaginal birth?
- Could they still happen if I have a caesarean section ?
- What are the possible harms of a caesarean section ?
- How likely are these possible harms?
If you need more information, you can find a comprehensive list of possible benefits and harms of caesarean section, along with information about how likely they are, at the RCOG website or through NICE guidance.
Once you have answers to your questions, think about what is most important to you and discuss these with your midwife or doctor so that you can make the decision that feels right for you and your baby.