Caesarean section

During a caesarean section the child is not born through the vagina but through an operation. The doctor cuts open the abdominal wall and uterus and lifts the baby and the placenta (afterbirth) out. After that, the uterus and abdominal wall are sutured again. During a caesarean section the mother needs to be given an anaesthetic. In most cases, she is given an epidural, sometimes a general anaesthetic.

Discuss when a caesarean section is necessary or wise with your doctor or midwife.

Discuss all your questions with your doctor and read the following information:

Planned caesarean section

A planned caesarean section is also known as primary caesarean section.
A planned caesarean section is carried out even before the start of the contractions.

This can be extremely necessary for various different reasons.

Reasons for a planned caesarean section can be:

  • if there are problems during the pregnancy
  • if natural childbirth is dangerous due to illness contracted by the mother
  • if natural childbirth is dangerous due to illness contracted by the baby
  • if the baby is positioned in the womb, making natural childbirth impossible, for example transverse
  • if the mother has already had several caesarean sections
  • if the placenta is located in front of the cervix and the exit for the baby is blocked
  • in the event of multiple births

But there are also these cases:
A planned caesarean section is very likely but a natural birth is possible.

For example:

  • if the baby’s bottom is facing downwards, this is known as pelvic presentation.
  • if the mother has already had a caesarean section
  • if twins are born,
    but there are no additional medical problems

The best time to have a caesarean section for your baby is from the 39th or 40th week of gestation. If you and your baby are doing well, a planned caesarean section must only take place after the 39th week of gestation.

It might be that you experience contractions or a rupture of the membranes even before the date of the planned caesarean section. At this point, you must definitely go to the hospital.

Can I have a natural birth,
or do I need a caesarean section?

You do not need to decide this at the start of your pregnancy.

Discuss this question with your gynaecologist or midwife.

Important reasons for a caesarean section sometimes develop very early and other times at the very end of the pregnancy. It could also be that the situation changes during the course of pregnancy. Often the baby is positioned transversely for a long time and will only turn at the very end. In this case, a natural birth is possible.

If a caesarean section is not absolutely necessary, you should consider whether you would like to have more children. Each caesarean section increases the likelihood
of having problems with future pregnancies or with fertility.

Unplanned ceasarean section

An unplanned caesarean section is known as a secondary caesarean section.

An unplanned caesarean section is carried out by a doctor once the contractions have started of if the amniotic sac has burst.

Reasons for an unplanned caesarean section can be:

  • the baby is not receiving enough oxygen
  • if the birth no longer continues
  • in case of severe bleeding
  • in case of a umbilical cord prolapse: This means that the umbilical cord is in front of the baby’s head. This would be dangerous for the baby.
  • if the placenta is detached

Emergency caesarean section:

An emergency caesarean section is necessary if there suddenly is a risk for mother and child during childbirth. In this case, everything must take place quickly.
Sometimes the doctor will perform the caesarean section in the birthing room. The mother is given a general anaesthetic. You partner cannot be in the same room during the operation.

What happens in a caesarean section?


First your gynaecologist will tell you everything you need to know about the caesarean section.

An anaesthetic is given so that you do not experience any pain during the operation. An anaesthetist will tell you what type of anaesthesia you will be given in advance.

You can of course ask your doctor questions during the discussion. You will be given information about what consequences the caesarean section or an anaesthetic can have.

For this purpose, there is an “Information Sheet” form. The doctor will complete this information sheet with you.
This form is also known as self-discharge form. Your signature gives consent to the operation and the anaesthetic.

Before the operation:

Before the operation, your stomach must be empty. This means that 6 hours before the planned caesarean section you are not allowed to eat or drink anything.
It is likely that your pubic hair above the pubis will be shaved.
It is also possible that you are given an infusion to stabilise your circulation.
Finally, your doctor will insert a permanent catheter.
This is a thin tube that is inserted into the urethra. This is done so that you can relieve your bladder without having to stand up or go to the toilet.
The catheter will then only be removed, if after the caesarean section you are well enough to go to the toilet on your own.

The epidural – the regional anaesthesia:

Regional anaesthesia is a technique to induce the absence of pain in just one part of the body.
You will only be given a general anaesthetic in the event of an emergency caesarean section or if an epidural is not possible: You will be given a general anaesthetic.
In the operating theatre you will receive the epidural, this is an injection between two vertebrae of the spinal column. Don’t be scared, it sounds worse than it is.
The epidural can be a little uncomfortable. Then using ice, the doctor will test whether the epidural worked and you can no longer feel pain.
After that your stomach and your pubic area will be thoroughly cleaned with disinfectant.

Shortly before the operation:

Your arms will be stretched and fixed to the left and right side of your upper body.
For the operation, it is always safer if you move as little as possible.
You will be given an infusion so that your circulation remains stable. Different devices will also be connected, for example, to monitor your pulse and your blood pressure.
Your body will be covered by a large sterile cloth.
Sterile means that the cloth is completely clean and free of any germs.
Your partner can sit with you, very close to your head.
Both of you will not be able to see your stomach, sight is obstructed by the cloth.

The Operation

During a caesarean section, the doctor usually cuts across the stomach so that later on, the scar is hardly visible.

In rare cases, a longitudinal incisions to the navel needs to be made.

During the operation you will not feel any pain due to the anaesthesia with the epidural. However, you will feel a pushing or pulling sensation.
This sensation can intensify as the baby is lifted out of your stomach. The midwife will takeover your baby with a warm cloth.

A paediatrician or midwife will examine the baby to check whether it is doing well.

Then the gynaecologist will detach the placenta, i.e., the afterbirth, from the uterine wall.

The uterus and all other layers up to the skin will be stitched.
The skin is closed with sutures or staples.

Overall, the caesarean section lasts approximately 20 to 35 minutes.

In some hospitals you can already cuddle and breastfeed your baby in the operating theatre or recovery room.
In some hospitals this is only possible once you are in the obstetrics ward.

After the caesarean section

You will remain in the recovery room for around 2 hours after the caesarean section.
Here observations will be made to see whether your uterus contracts, whether your bleeding is normal and whether you need pain relief.

After an epidural, you will remain in the recovery room until your can feel your legs again.

After a caesarean section, some babies have problems with breathing for a short time and need support. It could also be that your baby needs to stay in the children’s ward for 1 to 2 hours for observation.

After a general anaesthetic, you will not be allowed to cuddle your baby immediately. It will take a while until you are completely awake.
But during that time, your partner can spend time with the baby.

The effect of a caesarean section on future pregnancies and births

A caesarean section leaves a scar in the uterine wall.
This means there is a certain risk for future pregnancies and births.

Therefore, many doctors recommend many women to have another caesarean section in the next pregnancy.

However, often a natural birth is also possible.

Whether a natural birth is possible depends on different circumstances.
For example, it is important to know what the reason for the first caesarean section was.

If you get pregnant again after a caesarean section, inform yourself well:

  • What are the advantages and disadvantages of a natural birth?
  • What are the advantages and disadvantages of another caesarean section?

Discuss the possibilities with your gynaecologist. Make a mutual decision on how you would like to proceed.
You can also obtain a second opinion from another doctor or midwife.

If you have already had three or more caesarean sections, every other baby must be born with a caesarean section.