Planned caesarean section: What you need to know

What to expect during a planned caesarean section

Most women when asked, state that they would like to have a physiological (natural) birth, with only a few opting for a planned caesarean section. However, currently the number of caesarean sections performed in many countries means that 1 in 4 to 1 in 3 women will have a caesarean birth.^{1, 2}

Can I decide for myself whether to give birth by caesarean section?

Every woman can decide for herself what kind of birth she wants. However, you should discuss the risks and benefits of having a caesarean section versus a physiological vaginal birth, with your midwife as well as your doctor.

It is important to remember that there often needs to be compelling reasons for a planned caesarean section.

A physiological birth is preferred by midwives and obstetricians, as it enables the woman to experience less medical interventions and be empowered both physiologically and emotionally in the labour and birth.

If it is foreseeable that there will be greater risks to you or your baby during the physiological vaginal birth, the obstetrician will discuss with you the safest birth options, and this may mean that they advise a caesarean section by appointment for medical reasons. For example, if the placenta is in any way covering the cervix (known as placenta praevia) a planned caesarean section would be essential, to avoid trauma to the placenta and reduce the chances of increased bleeding during a vaginal birth.

How is a planned caesarean section set?

During your routine antenatal consultation, you will talk with the doctor/ obstetrician about the arrangements for a planned caesarean section. Depending on the reason for a caesarean birth, this discussion could take place anywhere between the 32nd up until the 38th week of pregnancy. Prior to that discussion, it is a good idea to write down queries and concerns that you might have so that you have enough time to really discuss the information with your doctor and ask all your questions, so that you come out of the appointment feeling informed and in control.

How does a planned caesarean section work?

Together with your doctor, you will decide whether you want a general or spinal anaesthetic for the procedure. Spinal epidural anaesthesia for a caesarean section has many advantages; you are awake during the procedure, your partner can be in attendance, you can hold your baby immediately in skin-to-skin contact, as well as give your baby a breastfeed very soon after the caesarean section.

A general anaesthetic, is where you are put to ‘sleep’ for the duration of the operation. This is generally not offered for a planned caesarean as it means that there is a delay between ‘anaesthetic sleep’ to being awake and you are able to hold your baby after the procedure. A general anaesthetic is usually given only in very rare emergency situations.

When is the right time for a planned caesarean section?

Nowadays, obstetricians aim to perform a caesarean section as close as possible to the estimated due date. This is when your baby's development (especially the lungs) is matured, your baby is able to maintain his temperature to keep warm, is able to latch and feed at the breast, and is unlikely to need a stay in the special care baby nursery or NICU. If your doctor recommends a planned caesarean section and there are no medical reasons for an earlier delivery, the procedure is usually performed around 39-40 weeks of pregnancy (this will vary between hospitals and countries).

If I had a previous caesarean birth does this mean that I cannot have a vaginal birth?

Many women are often fearful that they will not be able to experience their next pregnancy with a physiological vaginal birth. But this should not be ruled out automatically, women who wish to birth differently can discuss having a VBAC (vaginal birth after caesarean) with their midwife and doctor. This is an opportunity to discuss the reasons why caesarean was necessary with the previous birth, how that impacts on your current pregnancy and what is the best option for you and your baby this time around. It is important to read up on the many good resources on VBAC^{3, 4} that are available, and speak at length with your midwife and doctor so that you make a decision that feels right for you and your baby.

If this is your third pregnancy and you have had two caesarean sections before, your doctor is more likely to recommend a planned caesarean to minimise stress on the caesarean scar. However, it is always important to discuss this further as every woman and every birth is individual and there are no set rules that fit everybody!

Talking with your doctor and midwife to discuss your birth options in the weeks up to your labour and birth will help you make the right choice for you and your baby.⁵