Caesarean delivery: everything you need to know

25 July 2019

Caesarean sections are increasing around the world. One in five babies are now born by C-section 1 (caesarean). And depending on where you’re living, there are huge disparities between and within countries when it comes to C-sections, highlighting both overuse and underuse due to inequalities of healthcare. We’ve taken a closer look at why this is and what you should think about if you’re expecting, to help you make the best choices for you and your baby.

What is a C-section? 

It’s an operation to deliver your baby through an incision in your abdomen. It’s usually carried out under local anaesthetic – so you’re awake, but you don’t feel any pain. A screen is raised so that you don’t see the operation, and it usually takes around an hour. Once your baby is out, you should be able to hold them almost straight away while you’re being stitched up. 

A C-section is a major operation and the recovery time is generally longer than for a routine birth. Because of this, you’ll spend a few nights in hospital.  

The majority of C-sections are unplanned emergencies when the baby needs to be delivered urgently. Some C-sections are pre-planned – usually because of complications or risks during the current, or a previous, pregnancy. Sometimes, women have C-sections for non-medical reasons as a matter of personal choice. 

Whether a pre-planned C-section is due to medical reasons or not, they are generally called ‘elective’ C-sections. It’s worth noting that ‘elective’ doesn’t always mean it was the mother’s choice, it could be down to the beliefs and attitudes of the healthcare providers and societies, or a non-urgent medical reason.

Different ways of giving birth 

  • Routine birth – your labour begins either naturally or is induced and your baby is delivered through the vagina.
  • Assisted birth – a suction cup or a pair of forceps are used to help deliver your baby.
  • Emergency C-section – if your baby needs to be delivered urgently through surgery. 
  • Elective C-section – your baby is delivered during pre-planned surgery – usually for medical reasons.   

C-section rates have increased in some regions more than others

Around the world, C-sections are becoming more common. In 2000, 12% of all babies were delivered by C-section. This almost doubled to 21% by 2015 2

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Latin America and the Caribbean have the highest rates with 44% of babies being delivered by C-section, while the average for countries in West and Central Africa is only 4%. This is due to a lack of access to healthcare in these regions.

Which countries have the highest C-section rates? 

The use of C-section not only varies greatly by country but within countries. And the following map provides an overview of where rates are highest. More than half of births are by C-section in Brazil, Egypt, Turkey and Venezuela with the highest rate in The Dominican Republic where 58% of babies are being delivered by C-section. Whereas in South Sudan, for example, C-sections account for the lowest rate at just 0.6% of all births. 

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Why are C-sections becoming more popular? 

Rise in emergency C-sections 
Emergency C-sections are increasing in places where facilities are improving; helping to save the lives of mothers and babies. 

Rise in elective C-sections 
The factors influencing the rise in elective C-sections are intertwined with the ways society is changing. Many parents are waiting to have their children in their late 30s and early 40s when the risks around pregnancy and childbirth increase. Similarly, many more people are overweight or obese and this also increases risks during pregnancy.

Tradition and modern life 
As society becomes less traditional and pregnancy and childbirth are increasingly seen as a medical procedure, doctors and parents may feel more comfortable delivering a baby by C-section3

Medical professionals are under more scrutiny, and at risk of more litigation than ever before. They may feel they have more control in a C-section than in a routine birth. Some healthcare facilities, particularly in parts of Asia for example, use C-sections to create a predictable flow of patients – allowing them to book more in.

Medical reasons 
The large majority of C-sections happen for medical reasons. You might be advised to have a C-section if you:

  • are older or obese
  • are having a multiple birth
  • are having a baby who’s in the breech position
  • need emergency medical intervention
  • have been in labour for a long time and things are not progressing 
  • have a narrow pelvis and birth canal
  • have a traumatic association with birth
  • have developed preeclampsia
  • have had a C-section with a previous pregnancy (although this doesn’t necessarily mean you need a C-section).

Non-medical reasons 
There are very few non-medical reasons to have a C-section, but they might include:

  • obstetricians fearing a lawsuit if something goes wrong – 29% said this was why they performed C-sections4 
  • financial incentives for the hospital – such as charging more for C-sections than routine births
  • ease of patient scheduling – evenly spacing deliveries to avoid backlogs 
  • parental preference for a specific date – for example, when a particular obstetrician can attend or to avoid a sibling’s birthday
  • family pressure or culture and tradition.

“Every effort should be made to provide C-sections to women in need, rather than striving to achieve a specific rate.” World Health Organisation

Making the right choice for you and your baby 

If you need an emergency C-section, or an elective C-section for medical reasons, it may save your life and the life of your baby. But if everything is going well with your pregnancy and you’re choosing between an elective C-section and a routine birth, there are lots of things to consider before you decide.

Being prepared 
It’s important that you plan a delivery that feels right for you, your baby and your circumstances. You’ll be able to research and think about the birth plan you’d like. Of course, things don’t always go to plan, but your doctor and midwife will be able to talk you though all of your options.

If you’re thinking about a C-section for non-medical reasons, your healthcare team may advise against it. That’s because a routine birth is generally considered safer for both you and your baby unless there’s a specific risk. 

What to expect if you have a C-section 

  • You’ll have a urinary catheter fitted. This is because the anaesthetic used during the delivery means you won’t be able to feel when you need the toilet. 
  • You’ll be given an epidural, which is a local anaesthetic injected into your spinal column to numb your body from the chest down. Occasionally, C-sections are carried out under general anaesthetic so you’re asleep.
  • In many places you’re allowed a birthing partner with you in theatre, but you should check with your hospital beforehand.
  • You’ll need to stay in hospital for a few days afterwards.
  • You’ll be recovering at home for around six weeks.

Extra reassurance, at no extra cost 
When it comes to planning your delivery, a second medical opinion can help to make sure that every option has been explored before making any big decisions.

When you use the second opinion service, we’ll put you in touch with independent health consultants, who offer you a reassessment of the medical information you’ve been given, to help guide and support you through your treatment.

Busting common C-section myths 

  • Any future babies must be delivered by C-section - Routine deliveries in the future should be possible unless there are complications. 
  • Choosing a C-section is easier – A C-section is major surgery that needs more recovery time than a routine birth so it’s not an easier option.  
  • You won’t stretch your pelvic floor - Your pelvic floor is stretched during pregnancy regardless of how you deliver.
  • You won’t bond as well with your baby – If your C-section goes to plan, you can begin bonding with your baby while you’re stitched up. However, C-sections can interfere with milk production and make starting breastfeeding more challenging. 

Pregnancy healthcare systems around the world 
Depending on where you have your baby will influence how likely you are to have a C-section or a routine birth. Take a look at our guides to healthcare around the world to find out more. 

Sources:
1. https://newatlas.com/caesarean-global-rise-lancet/56745/  
2. https://newatlas.com/caesarean-global-rise-lancet/56745/
3. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)32394-8/fulltext  
4. https://thesocietypages.org/socimages/2010/04/26/non-medical-reasons-for-a-rise-in-caesarean-sections/  
5. WHO recommendations non-clinical interventions to reduce unnecessary caesarean sections – PDF infographic