Caesarean Birth

Key Messages

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A caesarean birth involves the birth of a baby through an incision in a woman’s abdomen and uterus. It should only be done for a medical reason.

Sometimes a caesarean birth will be planned in advance and other times a woman will begin labour first. You may need a planned caesarean birth if:

  • Your baby is in a position where it would not be possible for you to give birth vaginally.
  • Your placenta is covering the opening to your cervix.
  • Your placenta is not functioning well and would not manage the stress of labour.
  • You are going to give birth to multiple babies.
  • You have genital herpes and have symptoms.
  • You are HIV positive and have a high viral load.
  • Your blood pressure or blood sugar is too high for the process of labour.
  • You had a previous caesarean birth, and you have made an informed decision that you will not try vaginal birth after caesarean (VBAC).
  • You had a caesarean birth less than 18 months before your current due date.

You may need to have a caesarean birth after your labour begins if:

  • The health of your baby is at risk.
  • Your health is at risk.
  • Your labour is not progressing.
  • Your baby is unable to be born vaginally.

It is important to understand why a caesarean birth is needed. Fully understanding the reason, benefits, and risks will help you make an informed decision that is right for you and your baby. See the Interventions in Labour file for more information about making informed decisions.
Risks associated with a caesarean birth for women include:

  • Nausea and vomiting after the surgery.
  • Difficulty moving around easily after the surgery.
  • Developing blood clots that could travel to your lungs or brain.
  • Pain that lasts days to weeks after the birth.
  • Re-opening of the surgical wound.
  • Infection.
  • Scarring of the uterus, which can cause complications in future pregnancies and births.
  • Accidental cuts to your bladder or bowel.
  • Complications from the anesthetic.
  • Bleeding. If uncontrollable, in rare circumstances your uterus may need to be removed.
  • Death (extremely rare with today’s advanced technology and care processes).

Risks associated with a caesarean birth for babies include:

  • Less skin-to-skin time immediately after the birth.
  • Difficulty breastfeeding related to late initiation or difficulty with positioning.
  • Accidental surgical injury.
  • An increased need for ventilation or resuscitation at the time of birth.
  • Being born preterm if the estimated gestational age was incorrect. A preterm newborn can face many complications.

You can take the following steps to reduce your chances of having a caesarean birth by:

  • Attempting to have a breech baby turned.
  • Making sure your body is ready for labour.
  • Delaying hospital admission until your labour is well underway.
  • Being patient with labour.
  • Having continuous labour support.
  • Changing positions often and moving around during labour.

A caesarean birth must be done in a hospital setting. If you are planning a home birth you and your midwife will discuss plans for anything unexpected that may happen during your labour and birth. It is important to have a plan in case it becomes necessary to go to the nearest hospital.

Certain preparations are needed before a caesarean birth.

Before a caesarean birth you will:

  • Meet with the doctor doing the operation and possibly the doctor who will be managing your anesthesia. You will be able to ask them questions about the risks and benefits of the operation and give them your informed consent.
  • Have a sample of blood taken. This is done to check your blood type, hemoglobin level, and platelet level. Other blood tests might be done depending on your health. If your caesarean birth is planned, this may be done on a day before the birth.
  • Not eat or drink for six to eight hours before if it is a planned caesarean birth.

Right before the operation you will likely:

  • Need to remove any jewelry or nail polish and put on a hospital gown and hair covering.
  • Have an intravenous (IV) line inserted. Antibiotics and medications for nausea and pain may be given through the IV.
  • Drink a liquid antacid. This can make general anesthesia safer if you need it during birth.
  • Be taken to an operating room and asked to sit or lie on an operating table.
  • Be given a spinal or epidural anesthetic to numb the lower part of your body. Both are inserted by a needle in your lower back. When these methods are used, you are awake and can see your baby right after the birth. If you already have an epidural, this can be used.
  • Have a catheter inserted into your bladder to keep it empty.

Spinal or epidural anesthetic is used more often as you can stay awake for the birth, and it is better for breastfeeding. If your caesarean birth is urgent, or if you cannot have spinal or epidural anesthesia, you may be given a general anesthetic that puts you to sleep. A general anesthetic also makes your baby sleepy. It is used because it works quickly, but you will be asleep for the actual birth.

A team of people will be present during your caesarean birth. Each person will have their own role.

Your partner and/or support person may be with you for the birth if you have spinal or epidural anesthesia. He or she will sit beside you at the head of the operating table. A team of doctors and nurses will work together to keep you and your baby safe during the operation. One doctor will take care of the anesthesia. If you have a midwife, she can also be part of this team.

The time needed for a caesarean birth can vary.

The incision made for a caesarean birth is normally made across the lower part of your abdomen and then your uterus. You should not feel pain when the incision is made. You may feel some tugging or pressure when the baby is born. Use breathing techniques, visualization, hold hands, talk gently, and focus on your baby’s birth if you, or your partner, are feeling anxious. Usually, the baby is out in the first few minutes of a caesarean birth. The rest of the time is used to remove the placenta, to make sure everything is well, and to repair the incisions in your uterus and abdomen. Your uterus will be closed with dissolvable sutures. Either staples or dissolvable sutures will be used to close your skin incision. You may feel sleepy or start shivering during the repair. Both are normal reactions to surgery. The nurse caring for you will warm you up with blankets.

It is best for your baby to be placed skin-to-skin with you after a caesarean birth.

Your baby will be assessed by a health care provider right after birth. After this assessment, the best place for your baby to be is skin-to-skin with you. If you are not able to hold your baby skin-to-skin your partner or support person can do this. If your baby needs medical care, or if you are not awake, you may not be able to hold your baby right away. You will be able to hold your baby skin-to-skin once you are both stable. Many of the benefits of skin-to-skin can still occur later.

Recovery following a caesarean birth takes time. You can expect to stay in the hospital for a few days following a caesarean birth.

Following a caesarean birth, you and your baby will be transferred out of the operating room to a recovery room, or to your postpartum care room, on a stretcher. Nurses will help you move from the stretcher to your bed as you may not be able to move your legs right after the birth.
Following the birth, a health care provider will:

  • Check your vital signs (i.e., blood pressure, heart rate, breathing rate, temperature, and oxygen level) regularly.
  • Press on your abdomen to check the firmness of your uterus, observe the amount of bleeding from your vagina, and check the bandage covering your incision regularly. Tell your health care provider if you notice any increase in bleeding from your vagina or incision.
  • Give you oxytocin medication through your IV to make sure that your uterus stays firm and that you do not bleed too much. If needed, you may get medication for nausea or pain through your IV.
  • Help you feed your baby soon after birth. You may find some breastfeeding positions more helpful than others after having a caesarean birth.
  • Remove your catheter approximately 12 – 24 hours after birth.

You will be able to drink and eat small amounts of food after the birth if you had spinal or epidural anesthetic. Eating small amounts of food at a time and gradually increasing the amount will help prevent nausea. Try to avoid the use of straws as this can create gas pain. You will be encouraged to get out of bed as soon as you are able. Your nurse will help you the first time you are up. Walking around can help reduce the risk of blood clots, help you have a bowel movement, and help you feel better. Chewing gum can also help your bowels move sooner.

Learn how to care for your incision at home.

While in the hospital, a health care provider will remove the bandage covering your incision to inspect your incision. If it is healing well, it will usually be left uncovered. It is okay to get your incision wet in the shower. Always make sure that the incision is dry after you shower, as bacteria can accumulate and cause infection if the area is left wet. If you have staples, your health care provider will remove them in a few days.
To prevent your incision from re-opening at home, avoid the following activities in the first six weeks or until your health care provider says that it is okay.

  • Lifting anything heavier than your baby.
  • Carrying your baby in a car seat.
  • Climbing stairs a lot.
  • Running, jogging, jumping, or any other high-energy activities.
  • Sit-ups or other activities that may cause you to strain your abdominal muscles.
  • Sexual intercourse.
  • Driving. If you need to brake quickly this could cause your incision to re-open.

At home, you will be a new mother as well as recovering from surgery. You may need extra help and support in the first few weeks. See the Recovery after Birth file for more information.

Seek help if you notice any signs of infection.

If you notice any signs of infection, see your health care provider as soon as possible. Signs of infection include:

  • Redness, pain, foul-smelling discharge, or heat at the site of your incision.
  • Fever.
  • Vaginal discharge or an increase in the amount of vaginal bleeding.
  • Nausea and/or vomiting.
  • Generally feeling unwell.

After a caesarean birth, you may need to take over-the-counter pain medication or pain medication prescribed to you by your health care provider.

Take pain medicationas recommended by your health care provider. It will make it easier to care for yourself and your baby. If the medication is making you or your baby drowsy, ensure that your baby is safe and contact your health care provider.

Take time to process an unplanned caesarean birth.

Mixed emotions following a caesarean birth are normal especially if surgery wasn’t part of your birth plan. When you are ready, talk to your partner, health care provider, or a friend about your feelings. Seek help if negative feelings persist and impact how you feel about being a mother.

Learn more about caesarean birth.

You can find out more about caesarean birth from the following resources. More suggestions can be found in the Resources and Links section.

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Supporting Evidence

The supporting evidence is written in third person and is aimed at prenatal education providers. It is not intended to be shared directly with new and expectant families; it is meant to provide the background information and evidence for the key messages.

About Caesarean Birth

Defining caesarean birth

A caesarean birth refers to the birth of a baby through a surgical incision made through a woman’s abdominal wall and uterus.1,2,3,4 A caesarean birth can be planned in advance, or it can be unplanned and occur after a woman begins labour.2,4 In some situations, it is the only way in which a woman can safely give birth.

Since the advent of caesarean births, maternal and fetal morbidity and mortality rates have significantly declined. In recent years, these rates have declined further due to the use of new surgical methods, improved anesthesia, antibiotics, and postoperative care strategies. However, a caesarean birth is a surgical procedure which means that a woman and her baby face significant risks.2,3,4,5,6 Due to these risks, the Society of Obstetricians and Gynaecologists of Canada (SOGC) and other organizations representing Canadian and international maternity health care providers maintain that caesarean births should only be performed when a woman or her baby’s health is at risk. For a caesarean birth, the benefits of the procedure should outweigh its risks.2,6,7,8

Preventing an unnecessary caesarean birth

Vaginal birth poses less risk than caesarean birth, and women should be aware that if they had a previous caesarean birth, they might be able to have a vaginal birth after previous caesarean birth.9,10,11 See the file on VBAC for more information about this topic, including its benefits and potential risks.

Factors such as having one-to-one support during labour and predominately relying on non-pharmacological pain-management techniques such as frequent ambulation have been shown to reduce the need for a caesarean birth during labour.2,11,12,13 However, even under ideal birth conditions with labour support, some women will require a caesarean birth. See the file on Labour Support for more information on this topic.

National and provincial statistics

Caesarean birth rate

The caesarean birth rate is defined as the number of caesarean births expressed as a percentage of the total number of hospital births.14 The World Health Organization (WHO) recommends the caesarean birth rate not be more than 10 percent to 15 percent in any country.7,8 Over the last 25 years, the caesarean birth rate has been increasing in Canada.14,15,16,17,18,19 Between 2001 – 2002 and 2008 – 2009, the caesarean birth rate increased from 23.4 percent to 28.0 percent. The caesarean birth rate then stabilized and was still 28.0 percent in 2010 – 2011. Similar trends were observed for both first-time caesarean births (19.7 percent in 2010 – 2011) and repeat caesarean births (81.8 percent in 2010 – 2011).14 Similarly, in Ontario in 2010 – 2011, the caesarean birth rate was 28.3 percent.16

Some trends associated with the overall rise of caesarean births include the following:15,16,17,18

  • Decrease in the number of vaginal birth after caesarean birth (VBAC).
  • Increase in the number of repeat, elective caesarean births.
  • Increase in maternal age.
  • Increase in maternal BMI.
  • Increase in the use of electronic fetal monitoring.
  • Increase in the number of labour inductions.
Location of caesarean birth

A caesarean birth must take place in a hospital setting to ensure that the procedure can be done in a location that is sterile and equipped with all necessary supplies. In 2006, 78 percent of hospitals reported that caesarean births took place in an operating room, and 15 percent reported that caesarean births took place in a surgical suite in the labour and delivery unit.19

Type of anesthesia

In 2006 in Canada, among women who had a caesarean birth, 91 percent had an epidural or spinal anesthesia, 4 percent had general anesthesia, and 5 percent had both. The proportion of women who had general anesthesia (either with or without epidural or spinal anesthesia) was 6 percent for women with a planned caesarean birth and 13 percent for women with an unplanned caesarean birth.18

Presence of the support person

In 2007 in Canada, 92 percent of hospitals encouraged partners to be present for a caesarean birth when spinal or epidural anesthesia was used. Comparatively, only 15 percent of hospitals encouraged partners to be present when general anesthetic was used.19This may be because the role of a support person during general anesthesia is less clearly defined, and the presence of a support person may not be deemed as necessary or desirable.

Length of stay in hospital

In 2007 in Canada, the average length of stay in hospital following vaginal birth was 2.0 days. This has decreased from an average of 3.2 days in 1993.19 At present, the average length of stay, in some locations, has been reduced to 24 hours.

In 2007 in Canada, the average length of stay in hospital following a caesarean birth was 3.4 days. This has also decreased from an average of 5.0 days in 1993.19

Risks Associated with a Caesarean Birth

Potential complications

Caesarean birth is associated with various potential complications for both a woman and her newborn. These complications can vary in severity and can have short- or long-term consequences. 2,4,7,10,20 For these reasons, it is recommended that caesarean birth be reserved for situations when the suspected benefits clearly outweigh the risks.2,6,7,8 Women and their support person(s) should always weigh the benefits and risks of any procedure related to labour and birth with their health care provider.6,21 See the Labour Support file for more information about making informed decisions.

Potential complications for a woman

Women who have a caesarean birth are at risk of:1,2,3,4,5,9,12,16,22,23,24,25,26,27,28,29

  • Accidental injury to other organs. This can cause urinary or bowel dysfunction.
  • Complications from anesthesia.
  • Hemorrhage. If uncontrollable, in rare circumstances a hysterectomy may be needed.
  • Postoperative nausea and vomiting.
  • Difficulty moving around easily.
  • Developing blood clots that could travel to the lungs or brain.
  • Pain that lasts from days to weeks following the birth.
  • Decreased satisfaction with the birthing experience. This could lead to postpartum depression or a poor transition to parenthood if not adequately addressed.
  • Wound dehiscence.
  • Wound infection or infection of the lining of the uterus.
  • Scarring to the uterus that can cause complications (e.g., uterine rupture) or abnormal placental attachment (e.g., placenta accreta) in future pregnancies and births.
  • Mortality (extremely rare with today’s advanced technology and care processes).
Potential complications for a newborn

Newborns born via a caesarean birth are at risk of:1,2,4,5,9,16,23,24,25,26,28,30

  • Accidental surgical injury.
  • Requiring ventilation or other forms of neonatal resuscitation at the time of birth.
  • Being born preterm if the estimated gestational age was incorrect. A preterm newborn can face many complications.
  • Impaired bonding or attachment at birth if parents have to wait to have contact with their baby.
  • Less skin-to-skin time immediately after the birth.
  • Difficulty breastfeeding related to late initiation or difficulty with positioning.

Indications for a Caesarean Birth

Planned caesarean birth

A caesarean birth may be planned in advance by a woman and her health provider if a vaginal birth is not a possibility for her or if it is believed that a caesarean birth is the safest method of birth for her and her baby. A surgery date, typically after 39 weeks’ gestation, will be scheduled for the caesarean birth. 2,28

Reasons for a planned caesarean birth

A planned caesarean birth can occur for a variety of reasons. A woman will require a planned caesarean birth if there are issues with the placenta such as:2,3,28

  • Complete placenta previa.
  • Placenta accreta.

The severity of a placental issue can determine whether a woman will be able to give birth vaginally or will need to have a caesarean birth. A planned caesarean birth will be recommended if there are risks of hemorrhage, fetal hypoxia, and maternal and/or fetal death during a vaginal birth.2 A woman may require a planned caesarean birth if she has a pre-existing or a new medical concern that could cause health risks for her or her baby during a vaginal birth. Maternal medical concerns that may indicate the need for a caesarean birth include:2,10,28,31

  • Human immunodeficiency virus (HIV) with a viral load over 1000 copies/ml and not on anti-HIV drugs at the time of birth.
  • Active genital herpes.
  • Uncontrolled hypertension.
  • Uncontrolled diabetes.
  • Other unmanaged medical concerns.
  • Previous caesarean birth. A woman may opt to either have a caesarean birth or a VBAC in this situation.

A woman may require a planned caesarean birth if the fetus is in a position that would make a vaginal birth difficult or impossible. If a woman is carrying multiple fetuses, malposition of even one fetus would warrant a caesarean birth. A fetal position that may warrant a planned caesarean birth includes:3,5,10,28

  • Transverse presentation.
  • Breech presentation.

For some breech presentations, there are mixed views on whether it is safer for a woman to give birth to vaginally or by caesarean birth.5,28 Sometimes a breech birth can be avoided with an external cephalic version (ECV). See the file on Breech Birth for more information about ECV.

If labour begins before the scheduled date

If a caesarean birth is planned, and a woman notices signs of labour, she should seek assistance from her health care provider as soon as possible to determine if she is in labour. If she is, the caesarean birth will need to be done sooner than originally scheduled. Women should be prepared for labour to begin at any time even if they have a caesarean birth planned.4

Support for a woman having a planned caesarean birth

When a caesarean birth is planned, a woman may find comfort in knowing when her baby will be born as well as knowing that she will not have to experience the pain associated with labour. However, not all women will view a planned caesarean birth as a positive experience.

Women may have concerns regarding the surgery as well as how they will cope in the postoperative period.4 See the Recovery after Birth file for more information on this topic. It is important for women to seek support in the prenatal period if they are dealing with some of these concerns. Information about referrals for women who may need additional help coping with a planned caesarean birth is available in the Referrals section.

Unplanned caesarean birth

A caesarean birth may be needed after a woman has begun labour if either her health or the health of her baby is at risk. It can be performed in the first stage or second stage of labour. When it needs to be performed as quickly as possible, it can be referred to as an emergency caesarean birth. In such instances, there is very little time for the woman to adjust to the new plan. Not all caesarean births performed after labour has begun are completed urgently. There is often no way to predict the need for an unplanned or emergency caesarean birth before labour begins.2,4,20,32

Reasons for an unplanned caesarean birth

A woman may need to have a caesarean birth after her labour begins for a variety of reasons, including:

  • The fetal heart rate is abnormal for a period of time, and the health of the baby is at risk.4,28
  • Umbilical cord prolapse occurs or is suspected to have occurred.4
  • Labour contractions fail to produce sufficient cervical dilation for a vaginal birth, even after methods of augmentation of labour have been used.
  • After full cervical dilation, the fetus is unable to fit through a woman’s birth canal. This is called cephalopelvic disproportion (CPD).4,28
  • A method of assisted vaginal birth fails to achieve birth in a reasonable time or when methods of assisted vaginal birth are not appropriate.1
Home birth plan

A caesarean birth needs to occur in a hospital setting. Women planning to give birth at home, or at a birthing centre without facilities to support a caesarean birth, need to have a transportation plan in place should they need an unplanned caesarean birth. A woman’s midwife will discuss this with her and make plans for transfer to a hospital if needed prior to labour. Women will also be made aware that if they have certain risk factors that may lead to a caesarean birth, they will not be eligible to give birth at home.21,33,34

Women may be ineligible to give birth at home if they are:33,34

  • Carrying multiple fetuses.
  • Carrying a fetus in a breech presentation.
  • Experiencing a medically complicated pregnancy.
  • Attempting a vaginal birth after caesarean birth (VBAC).
  • Less than 37 weeks’ gestation or more than 43 weeks’ gestation.

In these situations, a midwife must consult with a physician to help plan the mother’s care; this may include the recommendation for a hospital birth.

Support for a woman after an unplanned caesarean birth

When a caesarean birth is needed during labour, the reason for the procedure needs to be fully explained to the woman, and her informed consent needs to be obtained before the surgery. However, the time to explain the reason for the procedure may be limited if the birth needs to occur urgently. If this is the case, the women and her support person(s) may still have questions following the birth. To ensure that a woman fully understands the reason for the caesarean birth, reflects on the experience realistically, and positively considers future pregnancies and births, she should be encouraged to review the procedure as early as possible with her health care provider following the birth.4

What to Expect for a Caesarean Birth

Before the birth

The hospital and operating room procedures for a caesarean birth are usually the same whether a caesarean birth is planned or unplanned. One difference is the amount of time allotted for preparatory procedures. For a planned caesarean birth, preparation may involve a few hours whereas for an unplanned caesarean birth preparatory procedures can occur within an hour or faster if needed.4,28,32

Informed consent

Prior to a caesarean birth, a woman will be given the opportunity to discuss the reason, benefits, risks, and alternatives for the caesarean birth with the physician performing the operation to ensure she fully understands these. This could be a woman’s primary health care provider or it could be a new health care provider she has not yet met. The woman will need to give her informed consent to this physician for them to be able to perform the operation. If a woman is having a planned caesarean birth and consent for the operation was gained prior to the date of the operation, the procedure will still be reviewed, and consent for the operation will be confirmed.4,32

The anesthesiologist will also likely meet with a woman prior to the surgery. He or she will explain the anesthetic process, benefits, risks and alternatives to ensure she fully understands these and obtain the woman’s informed consent for the procedure.4

Blood sample

A blood sample will be collected prior to a caesarean birth so that the hospital can determine the blood type of the woman and ensure that enough of this type of blood is available for transfusion should the woman lose an excess amount of blood during the operation.4,32 The sample of blood will be analyzed to determine the level of certain components in the blood such as the amount of red blood cells, white blood cells, platelets, and the hemoglobin level. This is referred to as a complete blood count. It serves as baseline data that can be compared to samples taken after the birth. It is also used by the anesthesiologist to determine if epidural or spinal anesthesia can be safely performed.4

If the caesarean birth is planned, a sample of blood will be taken before the day of the birth. If the caesarean birth is unplanned, a sample will be taken prior to the birth if this has not already been done so during labour.4

Nothing by mouth

Before any operation, patients are usually advised not to eat or drink anything to prevent them from aspirating the stomach contents during the operation as well as to prevent postoperative nausea and vomiting.

If a caesarean birth is planned, a woman will likely be advised not to eat or drink anything for six to eight hours before the operation. If a caesarean birth is unplanned, a woman will not be able to eat or drink directly before the operation. If she ate or drank during the labour, and even if she did not, a woman may be given an oral antacid (e.g., sodium citrate) to neutralize the contents in her stomach and prevent damage to her lung tissues if aspiration ocurs.4,24,28

Medications and allergies

Prior to a caesarean birth, a health care provider will review any allergies that a woman has. It is important for women to advise their health care provider of confirmed or possible allergies or sensitivities, especially if these involve medications.

The health care provider will also review any medications that the woman may be taking or has previously taken. Women should be advised to inform their health care provider about all over-the-counter medications that they are taking, including herbal remedies, vitamins, and supplements.4,32


For any operation, a person is usually asked to remove or to inform their health care provider of any pieces of metal attached to themselves such as jewellery, dentures, or metal plates. Metal can interfere with medical processes and equipment. If a woman wears glasses, she may be able to wear them, or they can be given to her when she needs them such as when she wants to see her baby. Most hospitals also require women to remove any nail polish on their fingers or toes, which enables health care providers to adequately assess the degree of blood flow in the tips of the fingers and toes. For a caesarean birth, a woman wears only a hospital gown and hat.4

Vital signs and fetal heart rate

Prior to a caesarean birth, a woman’s temperature, blood pressure, heart rate, breathing rate, and level of oxygen saturation will be assessed. These vital sign measurements will be used as baseline data for the operation and postpartum.4,32
The fetal heart rate will be assessed prior to caesarean birth. If a woman is having a planned caesarean birth, this will usually be done with a Doppler. If a woman is having an unplanned caesarean birth, it is likely that the fetal heart will already be continuously monitored. See the Interventions in Labour file for more information about fetal heart-rate monitoring.4,35

Intravenous (IV)

Prior to caesarean birth, the woman will receive an IV. This will maintain her hydration throughout the operation and serve as a point of access for health care providers to give her medications. Medications provided by IV can include antibiotics, antinauseants, and pain medications. Most women are given antibiotics prior to caesarean birth to prevent the risk of infection.4,24,28

Operating room

When the operating room and the health care team are ready, the woman will be brought into the operating room where the caesarean birth will occur. In the operating room, the woman can expect:4,32

  • The lights to be bright.
  • The room to be a cooler temperature.
  • The nurses and doctors to be wearing gowns, hats, and masks to maintain a sterile environment, and to prevent the risk of infection.
  • An operating table to be centered in the middle of the room. This is where the woman will sit or lie down.
  • Music to be playing. A woman can request this to be turned off or changed if she desires.
  • A surgical checklist to be completed, which includes identifying the patient and the operation to be performed.

Prior to a caesarean birth, an anesthesiologist will administer an anesthetic. This will allow the woman to feel no pain during the operation. Epidural, spinal, and general anesthetic methods are used for caesarean birth.4,28,36,37
Epidural and spinal anesthesia result in a regional sensory block from the level of a woman’s chest downwards. See the Pain Medications in Labour  file for information on how epidural and spinal anesthesia are administered and information on the associated risks.

Epidural and spinal anesthesia are used more commonly than general anesthesia for caesarean birth as these methods:4,24,26,28,36,37

  • Allow a woman to be awake for the birth.
  • Cause less nausea and vomiting.
  • Reduce the risk of aspiration.
  • Involve a quicker recovery time.
  • Enable a woman to hold baby skin-to-skin sooner and initiate breastfeeding sooner.
  • Provide pain relief up to 12 hours after the surgery.

General anesthesia involves a reversible state of unconsciousness, loss of memory, and pain relief.38 General anesthesia may be needed for a caesarean birth if:4,28,37

  • There is no time to perform the epidural or spinal procedure due to an immediate need for birth.
  • A woman declines to have an epidural or spinal anesthesia.
  • The epidural or spinal method was unsuccessful.
  • A woman is not able to receive epidural or spinal anesthesia due to contraindications such as a bleeding disorder, a lower back injury, or an infection at the needle insertion site.
Urinary catheter insertion

To ensure that the woman’s bladder remains empty during caesarean birth, a health care provider will insert a catheter into her bladder. Ensuring that the bladder is kept empty can decrease the risk of accidental puncture to the bladder and make it easier to remove the baby from the uterus. The catheter is usually inserted after the anesthetic medication has been administered so that a woman will not feel discomfort when it is done. However, the insertion of a catheter is not usually painful unless it is inserted improperly.4,28

Hair removal

Very rarely will hair need to be removed from a woman’s perineum or abdomen prior to a caesarean birth. If this is needed, in most cases the hair will be clipped instead of shaved to prevent nicks and scrapes that could lead to an infection. Women should also be advised against shaving their pubic hair and abdomen themselves prior to birth.28,39

Support person

If desired, a women’s partner or support person is usually encouraged to be in the room with her during caesarean birth. The only time that a partner or support person may not be encouraged to be in the operating room is when general anesthesia is used. While preparations are being done such as when the epidural or spinal anesthetic is being administered, a woman’s partner or support person may be asked to wait in a waiting area. Before going into the operating room, a woman’s partner or support person will be given a gown, hat, shoe covers, and possibly a mask to wear to ensure that the environment in the operating room remains sterile. They may be able to wear a front-opening hospital gown or shirt to facilitate skin-to-skin contact if the mother is not able to hold the baby after the caesarean birth. When entering the operating room, a woman’s partner or support person will also have to be careful not to touch anything designated as sterile.

For the birth, a woman’s partner or support person will be able to sit beside the woman near her head and hold her hand if this is desired. A shield will be placed between the woman’s chest and her abdomen for the birth, but if the woman’s partner or support person would like, he or she may peer over this shield to witness the birth. The surgeon can indicate when the appropriate time to do this is.4,21,28

If a woman wants to have a photographer present, she will need to check with her health care provider and the birth setting before the birth. Some birth settings have policies pertaining to this. If a photographer is permitted, he or she will also have to wear a gown, hat, shoe covers, and a mask.4,21

During the birth

The health care team

Once all of the preparations for caesarean birth are complete, and the anesthesia for the operation is in effect, the health care team will assemble for the operation. The anesthesiologist will remain at the woman’s head and monitor the pain medication as well as the woman’s vital signs during the operation. The obstetrician will be on one side of the woman, and the assisting physician will be on the other side of the woman. A nurse will assist the physicians performing the operation, and another nurse will circulate throughout the room. In another area of the operating room, a nurse and another health care provider skilled in neonatal resuscitation will be present at a warming cot equipped with resuscitation equipment. If the woman has a midwife, she may also be in the room.44,28

The incision

Prior to making the surgical incision for a caesarean birth, a member of the health care team will clean the woman’s abdomen with antiseptic solution to prevent infection.4

When the incision is made, the primary physician first makes a cut through the skin and fatty tissue of the abdominal wall. The muscles of the abdomen are usually separated manually. An incision is then made in the wall of the uterus. This incision is not always done in the same location or direction as the incision in the abdominal wall.4,28,40

It is important for a woman to know what type of uterine incision was made as this will determine her ability to have a VBAC in a future pregnancy. It is not possible for women to know what type of uterine incision was used simply by seeing what type of abdominal scar they have on their skin. Women can request this information in writing from their primary health care provider after the surgery. See the VBAC file for more information about contraindications to VBAC.

There are three possible locations for the abdominal and uterine incisions:4,28,40,41,42

  • Horizontally in the lower part of the abdomen or uterus.
  • Vertically in the lower part of the abdomen or uterus.
  • Vertically in the upper part of the abdomen or uterus beginning at the umbilicus. This is referred to as a classic incision.

See the possible locations for a caesarean birth uterine incision in the diagram below. In most cases, a low horizontal abdominal incision is followed by a low-segment horizontal uterine incision. However, there are occasions when the abdominal incision is different from the uterine incision.
A low-segment horizontal uterine incision is the most common type of incision for a caesarean birth. When compared to other types of incisions, a low-segment horizontal incision is least likely to result in:4,28,40,41,42

  • Perinatal morbidity.
  • Bleeding.
  • Pain.
  • Infection.
  • Uterine rupture in subsequent pregnancies and during a VBAC.

A vertical incision, either in the lower or upper part of the abdomen and/or uterus, may be needed in the following circumstances:4,42

  • Shoulder presentation.
  • Multiple fetuses.
  • Placenta previa.
  • Emergency caesarean birth.
  • Early preterm birth, as the lower segment of the uterus is often not developed in preterm gestation.

Possible location of uterine incision, regardless of location of abdominal incision:

The birth

After the incision is made in the uterus, a woman may feel some pressure or pulling as the health care team works to remove the baby from her uterus.4 The total amount of time from when the first surgical incision is made to the time of the birth of the baby is generally 10 to 15 minutes.

After the birth

The arrival of the baby

Upon the birth of a baby via caesarean birth, the umbilical cord will be clamped and cut. 4,28 The neonatal health care providers may want to examine the baby upon birth. Some babies born by caesarean birth require neonatal resuscitation or close observation.2,4 If the health care team deems that this is not required, the best place for the baby is skin-to-skin with the mother. If the mother is unable to hold the baby skin-to-skin, the woman’s partner or support person can also do this.21,26,43

Completion of the operation

The surgical health care team will complete the operation by removing the placenta, the amniotic fluid, and any excess blood from the woman’s uterus. The uterine incision will be closed with dissolvable stitches, the muscle layers and fascia will be put back into place, and the skin incision will be closed with dissolvable stitches or staples. A large abdominal bandage or dressing will be placed over the incision to protect it. This dressing will be tight to decrease bleeding.4,28 Some facilities are also now using a clear plastic spray-on dressing instead of a bandage.

Transfer to a recovery room/postpartum care room

Once the operation is complete, the woman will be transferred to a stretcher and brought to a recovery room. If she had epidural or spinal anesthesia, she will likely be unable to fully lift her legs on her own so nurses will assist her in moving to the stretcher and later to her bed. If she had general anesthesia, it will take time for her to fully wake. After a caesarean birth, a woman will be observed closely. A nurse will stay with her until she is stable. During this time, some routine care procedures can be expected.4,28,44

Vitals signs
Following a caesarean birth, a woman’s vital signs are frequently assessed. If needed, oxygen or other medication may be given.4

Following a caesarean birth, a woman’s IV will continue to be used. Synthetic oxytocin is usually added to her IV to ensure that her uterus contracts following the birth, preventing her from bleeding. Additional pain medications and/or antinauseant medications may also be added to the IV if needed.4,24,28

Abdominal dressing
Following a caesarean birth, a woman’s abdominal dressing will be regularly assessed. Small amounts of bleeding on the dressing are normal. A health care provider may outline bloody areas on the dressing to track if the bleeding is increasing. If a woman notices that her dressing has a large amount of blood on it during the postpartum period, she should notify her health care provider.4

Fundus checks
The location and firmness of her fundus will be regularly assessed to ensure that her uterus is firm and not displaced. If it is not firm, a health care provider may massage it to try to make it firm. If it is not firm, and the woman is also experiencing a large amount of vaginal bleeding, a health care provider may give her additional synthetic oxytocin or other medications through her IV.4

The amount of bleeding from a woman’s vagina will be regularly assessed. A woman should notify a nurse if she experiences a large gush of blood from her vagina or notices any blood clots in her flow. Some blood clots are normal, but a health care provider will always want to assess a blood clot to determine if it is a piece of placenta. If it is, this could mean that there are other pieces of placenta remaining in the uterus that could cause bleeding. The primary physician can often manually remove them if this is the case.4

Compression stockings
A woman may be given compression stockings to wear; these may also have been put on before the operation. Alternatively, she may have her legs wrapped in pads that are attached to an automated compression pump that will intermittently compress each leg. Compression devices such as these act as a second heart to pump blood around the body to try to prevent blood clots while a woman is immobile.4,44

Food and drink
Following a caesarean birth, a woman may eat and drink small amounts of food and fluids. Women should be cautioned against eating or drinking too much right away following the operation as this may cause nausea. When drinking, women should avoid the use of straws as this could cause excess gas to build up in their stomach. Chewing gum can help the digestive system to recover after abdominal surgery and enhance bowel motility.4,28,45,46

Urinary catheter
A woman can expect to have her urinary catheter left in for approximately 12 to 24 hours following the birth. This will ensure that her bladder remains empty and prevent the need for her to go back and forth to the bathroom while recovering.4,28

Please note that these are potential expectations. Hospitals all have their specific postoperative protocols. If possible, the baby will room-in with the mother at all times. 21 Twenty four hour presence of the partner or other support person facilitates the infant to room in.


It is recommended that breastfeeding be initiated within the first hour of life, starting with skin-to-skin contact in the OR and in the recovery room (PAR). Directly following caesarean birth, women may need more support with breastfeeding from a nurse or other support person than following vaginal birth. There are breastfeeding positions that may be advantageous for women following caesarean birth such as the football hold or a side-lying position. A pillow for abdominal support can provide comfort. 4,26,28,47 See the file on Breastfeeding for more information.

Postpartum Care


Once a woman regains the sensation in her legs, she will be encouraged to ambulate. Ambulation following a caesarean birth can help prevent blood clots, reduce gas pain, and lead to quicker a recovery. When walking for the first time, a woman should go slowly to ensure that her legs are steady and that her incision is protected. A woman is encouraged to walk for the first time with the help of a nurse or midwife. The first time she gets up, it will likely be just to stand and take a few steps. The first time out of bed is typically within the first 12 hours following a caesarean birth. 4,28,44

When a woman is fully mobile and doing well, she will be discharged home from the hospital, which is typically after two to three days. At home, a woman should continue to try to be mobile, but may feel fatigued and need a lot of rest. Seeking a balance between activity and rest is encouraged. 4,28,48 She will also need to be cautious with or avoid certain activities to prevent her incision from re-opening.

Activities that should be avoided include: 4,28,47

  • Strenuous activity such as biking, running, or jogging for at six weeks or until the primary health care provider says it is okay.
  • Frequently climbing stairs.
  • Sit-ups or other exercises that put a strain on the abdominal muscles.
  • Lifting anything heavier than the baby. This is generally considered to be anything above 4535 g (10 lbs).
  • Carrying the baby in a car seat.
  • Sexual intercourse, usually for four to six weeks until the lochia has ceased and once the woman is physically and psychologically ready.
  • Driving. If a woman needs to brake quickly, this could cause her incision to re-open. Pain may also cause distraction.

When coughing, sneezing or laughing, a woman can protect her incision, and reduce discomfort, by covering her abdomen with a pillow and splinting her abdominal muscles by applying pressure to the incisional area with the pillow.4
As a woman is restricted from doing certain things following a caesarean birth, she may need extra help during the first few weeks at home.4

Pain relief

In the postpartum period, women may require pain medication. Nonsteroidal anti-inflammatory medications such as ibuprofen and diclofenac and analgesics such as acetaminophen are typical non-opioid pain medications prescribed. If a woman requires something stronger, she may be prescribed a narcotic. Narcotics can pass through the breastmilk to the baby and in a small minority can cause side effects such as central nervous system depression and apnea.

If a baby does not feed well, does not wake up to feed, does not gain weight, or shows limpness, he or she should be examined by a physician. Side effects for women can include feeling drowsiness and constipation. If pain still necessitates narcotics after four days, an attempt should be made to decrease the dose or to switch to non-codeine pain medication. Women should ask about the possible side effects of pain medications and choose the option that works best for them when experiencing pain.4,49

Gas pain

Following a caesarean birth, women may experience gas pain. Ambulation, rocking in a chair, and avoiding the use of straws, carbonated beverages, and gas-forming foods can help relieve or prevent this pain. To prevent constipation and/or having to strain as a result of a hard bowel movement, women are usually also prescribed a stool softener to be taken once or twice a day with a meal. Eating food high in fibre can also help. Women should not expect to have a bowel movement right after a caesarean birth. It may be a few days before their bowels regain normal function.4,50

Caring for the incision

Following caesarean birth, women will need to take good care of their incision to promote healing and prevent infection. In the hospital, their health care provider will remove the dressing covering the incision. If the incision is healing well, it may be left uncovered. If tape or Steri-Strips are placed over areas of the incision, women should allow these to just fall off naturally.4,50

Women will usually be able to shower in the hospital after the dressing is removed.

It is okay to get the incision wet in the shower, but following a shower, women should ensure that the incision is clean and dry. This can be done by using a clean towel or cloth to pat the incision dry. If left wet, bacteria could accumulate and cause an infection. To prevent the staples from tugging on clothing, women may also want to wear something loose around their abdomen. To assist with healing, women should eat a nutritious diet. Foods that contain protein such as nuts and lean meats can promote healing.4,51

Signs of infection to watch for include:4,28,49,52

  • Redness or swelling at the site of the incision that was not there before.
  • Heat at the site of the incision.
  • Increased pain or tenderness at the site of the incision.
  • Oozing or pus at the site of the incision.
  • Foul-smelling discharge from the incision or vagina.
  • Nausea and/or vomiting.
  • Fever with a temperature ≥ 38º C.
  • Feeling unwell.
  • Separation of the incision.
  • Increased vaginal bleeding.
  • Painful urination.
  • Severe abdominal pain.

If a woman cannot see her incision, she can use a mirror. Alternatively, her partner or support person can check the incision for her. If a woman or her partner notices any of these signs, the woman should promptly seek assistance from her health care provider.4,50

If a woman has staples closing her incision, she will need to make an appointment to have these removed if they are not removed prior to her discharge. The removal of staples is usually not painful.

See the file on Recovery after Birth for more considerations in the postpartum period.


When to refer

A woman and/or her support person(s) may need a referred to a supplemental source of support if they:

  • Are overly anxious or fearful about having a planned caesarean birth or the possibility of having an unplanned caesarean birth.
  • Need more information about how to prepare for a caesarean birth, what to expect during a caesarean birth, and/or how to care for themselves during the postoperative and postpartum period following a caesarean birth.

Where to refer

A woman and/or her support person(s) who require more information and/or support in regards to a caesarean birth can be referred to the following sources:

  • Their health care provider (obstetrician, family physician, Nurse Practitioner, or midwife).
  • In-person prenatal education classes, if not already enrolled.
  • Support groups.

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Resources & Links

Please note this is not an exhaustive list of available resources, nor should any of these resources be used in place of seeking professional advice. The resources cited throughout this resource are not necessarily endorsed by the Best Start Resource Centre or the Government of Ontario. When in doubt, professionals should contact the organization responsible for issuing a specific recommendation/practice guideline.

Professional Guidelines




  • Telehealth Ontario 1-866-797-0000

Prenatal Education Provider Tools

Client Resources and Handouts



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