Having a caesarean birth

Arriving at the hospital birth centre

You need to go to the hospital birth centre in the North Wing of St Thomas' Hospital.

Please arrive at the time listed in your MyChart message. This is either 7.30am or 12.30pm. We will also call you to confirm this. If you arrive late, your planned caesarean birth may be delayed.

You are admitted to an area called a bay in the hospital birth centre. A midwife, anaesthetic specialist (anaesthetist) and doctor specialising in pregnancy (obstetrician) assess you. Sometimes, you also see a member of the research team.

In the hospital birth centre, we:

• check your blood pressure, pulse and temperature (these are called your observations)
• give you omeprazole tablets before your surgery. Omeprazole is medicine that reduces the amount of acid your stomach makes
• monitor your baby’s heartbeat
• give you elastic stockings to prevent blood clots in your legs
• take samples from your nose and throat (swabs) to test you for MRSA, unless this has already been done during your pregnancy

MRSA is a type of bacteria commonly found on your skin. It does not respond to several widely used antibiotics. This means that it can be harder to treat MRSA than other bacterial infections.

When the team is ready, you walk to the operating theatre with your birth partner.

Only 1 birth partner is allowed in the operating theatre with you.

We have 2 operating theatres in the maternity unit and aim to do your procedure on time. Sometimes, however, emergencies take priority. Please bring something to read or listen to in case there are any delays. 

Very rarely, we may need to cancel your caesarean. If this happens, we will invite you to have your caesarean the next day. 

We try to keep you fully updated if there are delays.

Anaesthetic for your caesarean birth

First, we put a small plastic tube (cannula) into a vein in your arm. We use this tube to give you fluids and medicines, such as antibiotics to prevent infection.

Most people have a spinal or epidural anaesthetic. We give you an injection in your back. This makes the lower half of your body numb. You are awake for your baby's birth, but do not feel any pain.

Sometimes, it is difficult or not possible to have a spinal or epidural anaesthetic. You then have a general anaesthetic (where you are asleep) instead, but this is rarely needed in a planned birth.

The anaesthetic specialist (anaesthetist) takes a few minutes to do the spinal or epidural injection. This is not usually uncomfortable. You might feel a tingling going down one leg for a few seconds.

After having the injection, we ask you to lie on your back while tilting the bed slightly to the left. Over the next 10 to 20 minutes, the numbness gradually spreads upwards. 

You might have some mild side effects, such as:

• shivering
• dizziness
• faintness
• nausea (when you feel sick)
• vomiting (when you are being sick)

You can talk to your anaesthetist about any side effects and they can give you medicines to help.

The anaesthetist uses a cold spray to check that the anaesthetic is working.

You may feel some pushing or pulling during the surgery, but this is not usually uncomfortable.

During your surgery

The midwife puts a thin tube (catheter) in your bladder to remove urine (pee). They shave your tummy (abdomen) just above the bikini line.

To reduce the chance of wound infection, we clean the skin on your tummy and your vagina. We also give you a single amount (dose) of antibiotics.

You are awake, but do not see the operation because we put a screen across your tummy. If you would like to see your baby being born, we can lower the screen at this time. This is a good chance to take photos, but please do not make a video.

The umbilical cord delivers food and oxygen to your baby in the womb. After birth, we cut the umbilical cord and put a clamp on the stump left behind to pinch it off.

If your baby is well, we encourage a delay of at least 1 minute before cutting and clamping the umbilical cord. This is called delayed cord clamping. It allows time for extra blood to flow to your baby and may improve their health.

You can have skin-to-skin contact with your baby in the operating theatre. The midwife will do a quick assessment and dries your baby in warm towels. They can then put the baby on your chest for a hug and for you to keep close contact with your baby.

The operating theatre can be cold. We need to make sure that your baby is kept warm.

We do our best to meet any special requests, such as playing music in the operating theatre.

Your surgery usually lasts about 1 hour. It may take longer if you have scars from previous surgery or there are any difficulties.