What really happens when you have a C-section?

Earlier this month, Beyoncé opened up about all things life, body and motherhood with Vogue. A great read, her experiences regarding the birth of her twins particularly struck a chord with us.

“I was 218 pounds the day I gave birth to Rumi and Sir,” she told the magazine. “I was swollen from toxemia and had been on bed rest for over a month. My health and my babies’ health were in danger, so I had an emergency C-section. We spent many weeks in the NICU.”

She went on to talk about the effects the surgery had on her afterwards. “I was in survival mode and did not grasp it all until months later. Today I have a connection to any parent who has been through such an experience.

"After the C-section, my core felt different. It had been major surgery. Some of your organs are shifted temporarily, and in rare cases, removed temporarily during delivery. I am not sure everyone understands that. I needed time to heal, to recover.”

It’s a surprisingly common procedure (the NHS reports that one in four pregnant women in the UK have one), but as pointed out by Beyoncé in her interview, what’s actually involved isn’t all that widely known. We spoke to Dr Penelope Law, consultant obstetrician and gynaecologist at The Portland Hospital, part of HCA UK, to demystify the subject and shed a light on what’s involved, when it’s most commonly done, the risks and recovery time.

It’s usually done because it’s safest for mother and baby

Like with Beyoncé, a caesarean is most frequently conducted in the event of an emergency or as a planned procedure if a vaginal birth is deemed too risky. Dr Law breaks down some of the most common reasons for us:

If a labour is not progressing

“If labour goes on for many hours, both the mother and the baby can become exhausted and then unwell (most labours are completed in under two hours once started, i.e. the cervix is opening and there are regular contractions). When a woman is in labour for a prolonged period (usually over 15 hours), doctors consider a C-section to avoid complications.”

Due to abnormal positioning

“Sometimes babies can present bottom first or ‘transverse’, lying across your abdomen - if this is the case you may be offered a caesarean section. Some women do choose to have their breech babies vaginally - these babies are more likely to need to be looked after in the special care unit initially but achieve the same level at one year like the babies who are delivered head first. If your baby is lying across, there is a worry that the umbilical cord can descend into the vagina and cause the baby to go into shock.”

Twin or triplet deliveries

“Twin babies that present with the first twin head first are usually delivered vaginally unless the second twin is significantly bigger than the first.”

Foetal distress

“If the doctor believes the baby is in difficulty, for example not getting enough oxygen or there’s umbilical cord prolapse, they may decide the safest method to be C-section. If the baby looks to be struggling with the labour and is showing signs of a dipping heart rate, a caesarean section will be offered unless delivery is imminent.”

You can ask for a caesarean

It is also possible to ask your midwife or doctor for a caesarean for non-medical reasons too. They aren’t routinely offered though because of the risks involved.

“Every woman can choose if they wish to have their baby delivered by C-section,” says Dr Law. “What is important is that you have understood the risks and benefits of the operation. The reason why C-sections are not routinely offered is that a major potential complication is placenta praevia in a subsequent pregnancy cycle, which can lead to catastrophic bleeding and even in some cases a hysterectomy in order to save the mother’s life.”

It is major surgery

It might sound obvious but it’s a fact that not enough women are aware of in Dr Law’s experience:

“Many people believe C-sections to be an easy, glamourous option for women however, it is a major form of surgery that does come with pain and risks. Recovery can be far from glamorous and is usually more difficult than that of vaginal births.”

Caesareans tend to be carried out under anaesthetic. “Most C-sections are carried out with regional anaesthetic, either spinal or epidural,” Dr Law explains. “This consists of a single injection in the lower spine and is considered safer.”

She tells us that while general anaesthetic is also an option, it’s far less common due to safety concerns. It carries a risk of inhaling stomach contents (such as stomach acid because of the cough reflex being disabled) which can cause lung damage and pneumonia. There are exceptions though: “It may be performed if a woman cannot have a spinal or epidural anaesthetic, due to previous back problems or if she would rather be asleep during birth (as long as the risks to her are fully understood).”

If you’ve been administered spinal or epidural anaesthetic, you’ll be awake, but a screen will be placed across your stomach so that you’re unable to see the operation. An incision about the same size of the baby’s head will be cut (usually around 10 to 20cm) which will lie either horizontally or vertically below your belly button. You may feel some pulling and tugging, but this is perfectly normal. Dr Law points out to us that it’s not unusual for contact to be made with the bladder during the procedure, but this is usually the extent of the interference with your organs. "The organs are not removed from the body," she says. "Occasionally the uterus is partially ‘exteriorised’ to allow access to bleeding points. This is all done while the patient is awake and they are usually unaware of any movement."

If there are no complications, delivery normally takes three to five minutes and then another 30 to 45 minutes to suture all of the different muscles and skin layers back together again. Afterwards, you'll need to be monitored. “Once the operation is finished, you will stay in a recovery area for one to four hours to make sure your blood pressure, heart rate and breathing are normal,” says Dr Law. “You should be able to feel your legs within a couple of hours and get up four hours after your operation. It is always better to take painkillers regularly for the first four to five days and it is important to move around normally."

Don’t worry about losing out on bonding time

“Some believe C-sections create a less personal experience and prevent women from bonding with their baby after birth,” says Dr Law. “However, as long as there are no complications, women are usually able to hold their baby and even begin to breastfeed.” After a C-section, most babies will be handed straight to their mother on the operating table for immediate skin to skin bonding time.

There could be complications

As it’s major surgery, there are certain risks involved. “There are many potential complications - mainly involving infection,” says Dr Law. “There is also a risk of developing blood clots in your legs or chest and bleeding however, these happen in less than one per cent of cases”.

Risks also extend to the baby too. “If the baby’s head is very close to your abdominal wall and there is a need to deliver the baby very quickly, there is a small chance of a scalp cut,” says Dr Law. “This again is unusual at less than one per cent.”

There are usually 8 to 10 people in the room

It’s quite the number, but each person plays a vital role. “In theatre, there will be two surgeons, one midwife, one or two paediatricians, one scrub nurse, one anaesthetist, one anaesthetic assistant and at least one circulating nurse,” Dr Law tells us. Your partner can stay with you and to make you more comfortable, you can choose your own music too.

There is a longer stay in hospital…

...when compared to vaginal births because of it being major surgery. “Women should expect to stay in hospital for three to four days as opposed to the one to two days required for vaginal births," says Dr Law. "Yet, this does vary between patient to patient and longer stays can be necessary. Recovery is longer too - the patient should feel fully healed six weeks on.”