Planned Caesarean: What Happens

When it is scheduled

NICE is direct about timing: "Do not routinely carry out planned caesarean birth before 39 weeks, as this can increase the risk of respiratory morbidity in babies." The NHS repeats it — "planned caesareans are usually done from the 39th week of pregnancy."

In NICE's urgency scheme, a planned caesarean with no compromise to you or your baby is Category 4: "birth timed to suit woman or healthcare provider."

Before the day

The NHS describes an appointment "in the week before the caesarean is due to be performed", at which you can ask questions, have a blood test for anaemia, receive medicines to take beforehand (which may include antibiotics, anti-sickness medicine and antacids), and may be asked to sign a consent form. The HSE notes some units do all this on the day instead.

NICE specifies the pre-operative tests: a full blood count to identify anaemia, antibody screening, and blood grouping with serum saved. It also tells teams not to routinely cross-match blood, run a clotting screen, or do a pre-operative ultrasound to locate the placenta.

Two HSE details are easy to miss. First: "Do not wear nail varnish or gel nails on the day you are admitted to the hospital. Your healthcare team will monitor your fingernails during the birth. This helps check your oxygen levels and your circulation." Second: you may be able to collect colostrum before the birth, possibly from around 37 weeks, using containers the hospital provides — though expressing before birth "is not recommended for everyone", so it needs a conversation with your midwife or obstetrician.

You will be asked to stop eating for several hours beforehand. The HSE notes you may be allowed water until shortly before going to theatre, and that you may be given omeprazole the night before and the morning of the procedure to reduce stomach acid.

Getting ready in hospital

You change into a gown. A small area of pubic hair is trimmed or shaved if needed. A cannula goes into a vein in your hand or arm "so fluids, medicines or blood can be given if needed". A catheter is placed in your bladder — NICE requires this for women having a caesarean under regional anaesthesia "to prevent over-distension of the bladder".

Consent is yours alone. The HSE is unambiguous: "Only you can give consent. You cannot ask a birth partner to do it for you."

The anaesthetic

NICE's recommendation is to "offer women who are having a caesarean birth regional anaesthesia in preference to general anaesthesia", and to induce anaesthesia in theatre rather than beforehand. The NHS explains what that means for you: "Most caesareans are carried out under spinal or epidural anaesthetic. This mean you'll be awake, but the lower part of your body is numbed so you will not feel any pain."

The HSE describes the check that follows: the anaesthetist tests the block, often by touching or spraying your chest with something cold and repeating it lower down. "If the spray feels cold, the anaesthetic may need more time to work. You may be given slightly more anaesthetic."

Under regional anaesthesia your birth partner can be with you. Under general anaesthesia they usually cannot — the HSE says they "can wait close by and will be updated during the procedure".

In theatre

The HSE describes the room honestly: "All staff wear medical scrubs and hats. Some wear surgical gowns and masks and gloves. The theatre team includes doctors, midwives, nurses, porters and care attendants." It is a crowded room, and that is normal.

You lie on the operating table, which NICE says should have "a left lateral tilt of up to 15 degrees or appropriate uterine displacement" applied once you are on your back, to reduce a drop in blood pressure. A screen goes across your chest. Both the NHS and HSE note the screen is there so you cannot see the operation — and the HSE adds that "if you would like to be able to see your baby being born, talk to your obstetrician", since some units can lower it at the right moment.

NICE also asks that fluids and blood products be warmed to 37 degrees, irrigation fluids to 38 to 40 degrees, and that forced air warming be considered if you shiver, feel cold or drop below 36 degrees. Shivering on the table is common and is anticipated.

The operation itself

NICE specifies "a low, transverse, straight skin incision with subsequent tissue layers opened bluntly". The NHS describes it as "a 10 to 20cm cut ... usually a horizontal cut just below your bikini line", noting that occasionally a vertical cut is needed.

Then the timings people ask about. The NHS: your baby is delivered through the opening, and "this usually takes 5 to 10 minutes and you may feel some tugging at this point." The whole procedure "usually takes around 40 to 50 minutes." The HSE gives about 45 minutes overall, "quicker or slower depending on the urgency", with the baby usually born in 5 to 10 minutes.

So most of the operation happens after your baby is out. That is the closing.

Once the baby is born you are given a uterotonic to contract the womb and reduce blood loss — NICE recommends carbetocin by slow intravenous injection for women who have had a caesarean birth. NICE also says to remove the placenta "using controlled cord traction and not manual removal to reduce the risk of endometritis", to repair the uterus inside the abdomen rather than lifting it out, and to consider sutures rather than staples for the skin.

Meeting your baby

NICE's recommendation is short and unconditional: "Offer and facilitate early skin-to-skin contact between the woman and her baby." It also asks that women who wish to breastfeed after a caesarean be supported to start "as soon as possible after the birth of their baby."

The NHS says you and your birth partner "will be able to see and hold your baby as soon as they have been delivered if they're well". Babies born by caesarean are more likely to have a lower temperature, so NICE asks for thermal care in line with good practice.

Straight afterwards

You are moved to a recovery room and observed. The NHS lists what you will be offered: painkillers, treatment to reduce the risk of blood clots such as compression stockings or injections, food and water as soon as you feel hungry or thirsty, and help with breastfeeding if you want it. The catheter "will usually be removed from your bladder around 12 to 18 hours after the operation, once you're able to walk around."

RCOG notes that women having straightforward caesarean births "are usually discharged after an overnight stay (24–36 hours)", and the NHS says most women go home 1 to 2 days after having a caesarean if there are no complications.