Giving birth by C-section

These days, about one in six babies in Sweden is born by C-section, about half of which are planned. The mother-to-be is usually fully awake during the procedure, but in emergency situations, the surgery is performed under general anaesthesia.

Are there risks with a C-section?

With a normal pregnancy, vaginal birth is generally best for both baby and mother. The risks of bleeding or of the wound becoming infected are a little higher after a C-section. In addition, babies born via C-section sometimes have breathing issues and need to be in an incubator or given additional oxygen for a little while.

However, lots of C-sections are performed every day and even if there are some risks of complications, in most cases everything is fine.

When would a C-section be planned?

There are a few reasons why you might plan a C-section. The most common are:

• The baby is positioned in what is called a breech presentation, with its bottom facing down.
• The baby is very big.
• You are expecting twins or triplets and your pregnancy is complicated.
• The placenta is blocking the cervix, making it difficult for the baby to be born vaginally.
• In some cases of preeclampsia.
• When the pelvis is too small.
• Previous injury or abdominal surgery.
• Two previous deliveries via C-section.
• With severe fear of childbirth, you might be granted a planned C-section, but that can vary from one hospital to the next.

Planned C-sections are usually carried out between 4 and 10 days before your due date, i.e. during week 38 or 39.

When would you have an emergency C-section?

An emergency C-section is done if something happens during labour that requires the baby to be taken out as quickly as possible. For example, if the baby’s head has not engaged properly in the pelvis. Another cause might be if the baby is not getting enough oxygen.
In most cases, C-sections –including in emergency situations – are carried out with local spinal anaesthesia. This numbs everything from the chest down, allowing you to remain awake during the surgery, so that you can hold the baby as soon as it arrives in the world. But if a C-section must be done very quickly – known as an emergency C-section – because the situation is considered even more acute, you would be given general anaesthesia instead, and would be asleep when the baby is born.

What happens during a C-section?

A C-section is a surgery and is therefore carried out in an operating theatre. The stomach must be empty, they insert an IV, shave the hair to the pubic hairline and insert a catheter – a small plastic hose – into the bladder. Next, an anaesthesiologist gives the mother the spinal anaesthesia. This allows the mother to be fully awake during the procedure. But the procedure is not visible, because a screen is put up at the stomach. Once the anaesthetic has taken effect, the procedure begins. The doctor makes a horizontal “bikini cut” and a few minutes later, the baby is lifted out of the uterus – the birth is complete! If the baby is healthy, then you get to hold them and welcome your child to the world! While the baby is on your chest, the surgeon sews up the incision.

After a C-section

The midwife helps the mother go to the toilet to pee – a function that you want to monitor the return of after anaesthesia. Because the incision site is sore, pain medication is provided afterwards. Getting up and moving around as soon as possible is good for healing of the incision and is an important part of recovery. Walking around can help reduce pain, speed up recovery and minimise the risk of blood clots. But be careful, and avoid any kind of lifting.

Usually, you will be released from the hospital after two days, or when it feels like you are ready. When you return home after a C-section depends a bit on the hospital, how the baby is doing, and the course of events after the procedure. Most people do not go on sick leave after a C-section; it is considered a routine delivery and those first few days at home with a brand-new baby will be just as amazing, no matter how the baby arrived in the world.

How many C-sections can you have?

If you want more children after giving birth via C-section, vaginal birth is often fine the next time – but it depends a little on why you had the C-section. A midwife or doctor can give you more information. How many C-sections you can have varies from person to person and depends on how the uterus looks after each procedure, because scar tissue increases after every surgery, which means the uterus might be too weak to carry another baby. People are usually advised against giving birth vaginally after having two C-sections.

Please note that all information above is based on Swedish recommendations.