Research Summary - Caesarean Birth

What is a Caesarean?

A Caesarean is an operation to allow the baby to be born through the abdominal wall instead of through the birth canal. The operation is done under either a general anaesthetic or, more usually, a local anaesthetic (such as an epidural) which allows the woman to be awake.

There are two kinds of Caesarean operation, elective and emergency.

• An elective Caesarean is one that is planned by the woman and her obstetrician before labour begins.
• An emergency Caesarean is one where a decision is made (usually when the woman is already in labour) to carry out a Caesarean because an unexpected problem has arisen and the baby needs to be born quickly.

When is a Caesarean necessary?

Reasons why an elective Caesarean is necessary include where the baby is lying persistently horizontally, where the placenta covers the entrance to the birth canal, and medical conditions of the baby or mother which make a vaginal birth unsafe.

Reasons why an emergency Caesarean is necessary include where the baby is in danger from a problem with the placenta, where there is evidence that the baby is not getting enough oxygen, and situations where the baby stops moving through the pelvis.

In some cases, doctors have different opinions about when a Caesarean is necessary. These include:

• having had a previous Caesarean
• having twins or triplets
• slow progress during labour
• having a very large baby
• because a woman has asked to have a Caesarean
• having a breech baby

A Caesarean operation is not usually available at a community maternity unit such as a midwifery-led unit. If a Caesarean operation becomes necessary, the woman will be transferred to the nearest obstetric unit. There is usually plenty of time for this to happen.

What are the risks?

A Caesarean birth involves major abdominal surgery, so the benefits need to be weighed against the risks in each case.

For the woman:

• A vaginal birth is overall four times safer for a woman than having a Caesarean (although an elective Caesarean is thought to be slightly safer than an emergency Caesarean)
• Following a Caesarean operation, women are at more risk of health problems such as:
  • wound or uterine infection
  • haemorrhage
  • blood clots
  • damage to the bowel or bladder resulting from the operation
  • possible effects on fertility
• Women vary in their ability to recover from a Caesarean operation. A Caesarean will usually:
  • require a hospital stay of several days
  • make getting out of bed, standing and walking around difficult and painful to begin with
  • once at home, make it difficult to use stairs and to carry anything, including the baby, for the first few days
  • make it difficult to do activities which require bending down, lifting or stretching, for several weeks
• Some women experience a sense of loss or failure as a result of having a Caesarean. They take time to recover emotionally as well as physically, and may need extra support.

For the baby:

• the major risk for the baby is breathing difficulties, which are four times more likely in a baby born by Caesarean. (The severity of breathing difficulties can be reduced by waiting until at least 39 weeks to have a Caesarean)

Having a baby by Caesarean does not mean that a woman has to have a Caesarean birth next time, although the policies vary at different maternity units. Many "low-risk" units will not book women who have had a previous Caesarean birth.

Avoiding a Caesarean

Sometimes a Caesarean operation will be unavoidable, but there are ways which may help to reduce the likelihood of a Caesarean operation:

• if your baby is breech, having the baby turned by external cephalic version (ECV) or by consulting a homoeopath, acupunturist or reflexologist
• in the later part of pregnancy, using upright, forward positions (where the hips are higher than the knees, and the shoulders are more forward than the hips) to help the baby get into a good position for labour
• during labour, keeping upright and mobile so that labour progresses well
• having the baby intermittently monitored rather than continuously monitored
• for low risk women, having your baby at home

Requesting a Caesarean

Obstetricians do not agree on whether a woman should be able to have a Caesarean on request, in the absence of any medical problem.

Some believe that unnecessary operations should be avoided because of the risks associated with them, when compared to a vaginal birth.
• Others believe that an elective Caesarean is safe and should be available as a choice for women who are fully informed of the risks.

Any woman requesting a Caesarean for whatever reason should ensure she is fully informed of all the facts, and be aware that her obstetrician may not consider it her right to choose.

For more information or support visit the Caesarean Birth and VBAC Information website.

For more detailed research evidence, click here

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