Information for people requesting a planned caesarean birth
Please read this page carefully. It is important that you take note of any instructions or advice given.
About this information
The information on this page contains information that you may find helpful in making a decision about request for planned caesarean birth.
If you do not understand any information or words/phrases, please ask your midwife or obstetrician at the hospital to explain them in more detail for you. You can bring someone with you to antenatal appointments if you need additional support in understanding what is said or in helping you to make a decision.
Introduction
A caesarean birth is the preferred mode of birth when it is considered that the risks of a vaginal birth outweigh the possible benefits. The National Institute for Health and Clinical Excellence (NICE) guidance recommends that where caesarean birth is requested, without a medical reason, a detailed discussion takes place explaining the overall benefits and risks of a caesarean birth compared with a vaginal birth. Most women in the UK give birth vaginally, they recover well and have healthy babies. Although there are risks with a vaginal birth with your first baby, future labours are usually shorter and the risks are very low for you and your baby. If after a detailed discussion, a caesarean birth is your preferred option, we will facilitate this. Some reasons for this decision may include:
- Your previous birth experience (including pregnancy, labour, delivery and recovery)
- Complications in your current pregnancy
- Current medical history
- Anxiety or fear of giving birth (Tokophobia)
- Concerns of the safety of vaginal birth
- Your thoughts regarding how many more babies you hope for in the future (the risks increase with each caesarean section, if you plan to have more babies it may be better to try to avoid another caesarean birth if possible).
Women with significant anxiety about giving birth can be referred to IAPT (Improving Access to Psychological Therapies) for additional support if required. To be able to support your choice and to help your decision-making around the birth of your baby the following information will guide you in the process of your request and our understanding of your individual needs to support your request.
How can I request a caesarean birth?
If you are considering a planned birth by caesarean for any reason, the earlier you let us know you are considering this as an option, the easier it is for us to provide you with all the information you may need and if necessary to refer you to the most appropriate support services. It is never too early to mention to your care provider that you are considering birth by caesarean.
Our local process and birth choices clinic
Once you have let us know of your request for a caesarean birth we will arrange a consultant appointment for you in the antenatal clinic at the hospital. During the appointment, they will discuss with you in more detail the reasons for your choice of birth. Following this appointment, you can be referred to our Birth Choices clinic where one of our senior midwives will discuss the risks and benefits of caesarean versus vaginal birth. This will ensure that you are fully informed with all relevant information when making your decision. If you remain unsure following this appointment, the midwives will arrange to see you for a second appointment. This will provide you additional time to think about any further questions or concerns you may have.
Later in your pregnancy, around 36 weeks you will be receive another appointment for the consultant clinic to confirm your choice of birth. At this appointment, they may go through the consent form with you. Your caesarean birth is normally performed any time between the 39th completed week of pregnancy up until the 40th unless there is a clinical indication to deliver earlier than this date. You will receive a phone call to confirm the date and an appointment to a Pre-Operative Assessment, usually the week before the date of your operation. At this appointment if you have not already signed a consent form it will be discussed and completed. You will see an anaesthetist, and you will have a blood sample taken to check your iron levels. Your fasting details will be given to you and a time for admission will be allocated. The date for your caesarean birth will be given to you the week before your operation – we are unable to provide a date beforehand due to the theatre scheduling process. Please wait for someone at the hospital to contact you or receipt of a letter; please do not ring the department.
What are the risks to my baby and myself if I have a planned caesarean birth?
Having a planned caesarean birth may make you feel more in control of your decision-making and avoid the anxieties and uncertainties of going into labour naturally. However, it is major abdominal surgery and because of this it carries with it associated risks.
Potential complications for you
- Although you should not feel any pain during the caesarean birth (because you will have an anaesthetic), the wound will be sore for the first few days after the operation. (Approximately 1:10 women will experience persistent wound and abdominal discomfort for the first few months after delivery).
- Wound infection – if this occurs it may take several weeks to heal (5 in 100 women)
- VTE (deep vein thrombosis) which is a blood clots in the legs that can travel to the lungs and PE (pulmonary embolism) – these are more common with a caesarean birth; see RCOG patient information Diagnosis and treatment of venous thrombosis in pregnancy and after birth and Reducing the risk of venous thrombosis in pregnancy and after birth (4-16 women in every 10,000). All women undergoing a caesarean birth will have a VTE risk assessment completed and offered the appropriate thromboprophylaxis after delivery of the baby.
- Bleeding can be more than expected (5 in 100 women).
- Repeat caesarean section in subsequent pregnancies may occur (1 in 4 women)
- Readmission to hospital may occur (5 in 100 women)
The time you spend in hospital is flexible irrespective of how you deliver. As with a vaginal birth, if you develop any complications during delivery, your recovery and stay in hospital may be longer than anticipated.
Serious complications are rare if it is your first caesarean birth and it is planned in advance, as long as you are fit and healthy and are not overweight. However, serious complications become more common if you have repeated caesarean births.
Potential complications for your baby
- The most common for babies born by caesarean birth is temporary breathing difficulty. Your baby is more likely to need some care and additional support on the neonatal unit than a baby born vaginally. For your reassurance, most elective caesarean births will be planned from the 39th completed week of pregnancy to try to avoid this.
- There is a small risk of your baby being cut during the operation – usually a small superficial cut that isn’t deep. This happens in 1-2 out of every 100 babies delivered by caesarean birth but usually heal without any further problems.
Further information is available from the Royal College of Obstetricians & Gynaecologists and National Institute for Clinical Excellence (NICE).
https://www.rcog.org.uk/en/patients/patient-leaflets/choosing-to-have-a-caesarean-section/
https://www.nice.org.uk/guidance/ng192/resources/caesarean-birth-pdf-66142078788805
What happens if you have a planned caesarean birth booked but you go into labour?
If you go into labour before the date of your scheduled caesarean birth date we will do our best to facilitate your birth preference. Please contact the maternity assessment centre (MAC) or delivery suite to inform a midwife if your waters have broken or if you have started having regular, painful contractions. If labour is confirmed a caesarean birth will be offered to you. However, if your labour is advancing quickly, it may be the safer option is to have a vaginal birth. This will be on a case-by-case basis to include a discussion with the on-call medical team and your individual birth preference.
Out of hours, the order of theatre cases will be decided on the individual risk assessment of all patients on the delivery suite. If a patient is deemed higher risk they may be prioritised meaning your caesarean birth will be performed as soon as the workload permits.
Further information is available from:
- Your named midwife
- Consultant appointment in the antenatal clinic.