A caesarean birth or caesarean section means your baby is born by an operation. The surgeon makes an opening in your stomach and then the uterus, and takes the baby out.

Why it's done

If you know in advance you are having a caesarean, it's called an elective section. The decision to have a caesarean may be made well in advance or during labour, depending on your particular needs. You might have one because:

your baby's head is too big, or your pelvis makes it hard for the baby to be born
you have a very low-lying placenta (called placenta praevia) which blocks your baby's way out
you have twins or triplets
there are complications, such as previous surgery on the vagina
your baby is in a position, which makes vaginal birth difficult or impossible

You might have an unplanned (known as an emergency) section after you've gone into labour because:

your baby is suffering from distress (lack of oxygen) and your labour hasn't progressed enough for a forceps or a ventouse delivery
you have the conditions called eclampsia or severe pre-eclampsia, which can be risky for you or the baby. Pre-eclampsia is a serious condition that occurs in pregnancy and can affect both mother and baby. If it develops into eclampsia, the baby may have to be delivered quickly if
you suddenly become ill, or have very high blood pressure
your labour is making very slow progress
you're exhausted
the baby's having a hard time coming out because of his position, and this wasn't realised before

What happens

You'll have an anaesthetic - a spinal or an epidural - that allows you to stay awake without feeling the operation. Or you may have a general anaesthetic. The surgeon first makes a cut in your abdomen and then through the uterus, in a line just above your pubic hair. You may feel some tugging when the baby is lifted out, sometimes by hand, sometimes with a pair of forceps. The baby's umbilical cord is cut and clamped, and he's given to you (unless you're under general anaesthetic). The placenta and membranes come out next, and the doctor then stitches you. It takes about 10 minutes to deliver the baby and about 30 minutes to stitch you afterwards. After a caesarean You feel very tired for a few days and you may have some pain, especially from wind, just as with any abdominal op. Laughing or coughing are uncomfortable for you, too. You'll be offered pain-relief of a sort that's safe to take while breastfeeding.

Q: Will I need a caesarean section if I have another baby?
A: Probably not, unless the reason for your caesarean happens again, or if you produce a big baby and you have a small pelvis - though it's always worth getting another opinion on this, as the diagnosis isn't always cut and dried. When you go into labour, there is a really very tiny risk that the scar on your uterus might start to break down, but with proper care, this will be spotted before it becomes a problem.

You after a caesarean

In the first days or so, expect to feel tired - and to be offered an extra day or two in hospital compared to women who've had a vaginal birth. Here's what else to anticipate:

Discomfort from trapped wind in your tummy.
Tenderness on your tummy, where it's been stitched.
Laughing or coughing may be uncomfortable for you (you'll be shown how to support your scar when you need to laugh or cough to avoid any pressure).
The need for help at first positioning your baby for feeding, so you can hold him comfortably across your body, at your side or lying down.
At first, you may be fitted with a small drain, which collects any blood that might otherwise pool under the scar. This is usually removed in a day or so. You may also have an intravenous drip in your arm, to replace lost fluids. At first you won't be able to get up to pass urine, and you will either have a catheter in place, or else be helped to use a bedpan.

How you'll feel

Sometimes, women feel disappointed if they've had a caesarean birth - especially if it was unexpected. Then, if the baby is fine, they may feel guilty at being disappointed. Your friends and family may think all there is to worry about is the health of the baby and if the baby's okay, why should you be concerned about the way he came into the world?

But maybe you feel you have missed out on something - so do talk about these feelings with your partner, with your midwife, and with other mothers who have had caesarean births. In time, you may accept the way things just didn't go to plan - like so much else in life. If you don't know why you had a caesarean section, ask; as this will help your feelings and make you feel more positive about it.

Mother's tip: 'I found it more comfortable after the caesarean to wear real passion-killer knickers - the sort that comes up to your waist. Anything smaller and the edge rubbed against my stitches.'