Childbirth: Caesarean section

Childbirth: Caesarean section
When is a caesarean section (C-section) performed? What are the side effects?

In Canada and in Quebec, a little over 1 in 4 women give birth by caesarean section. During this procedure, the baby is born through an incision made in the mother’s womb and uterus.

In some cases, caesarean delivery can be beneficial to both mother and baby, potentially even saving their lives. In other cases, the benefits to mother and baby are few or even doubtful. Furthermore, just like any surgical procedure, a C-section carries risks. When deciding whether to undergo this procedure, all associated benefits and risks must be taken into account. Should the possibility of a C-section arise, don’t hesitate to ask questions in order to fully understand the reasons behind it.

Why is a C-section performed?

The decision to perform a C-section is usually made based on the condition of the baby and the mother. In some cases, the doctor may even decide to schedule a caesarean section before labour begins to protect the health of the baby or the mother. In other cases, the decision to perform a C-section is made during labour. This is called an emergency or unplanned caesarean section, depending on the situation.

Planned C-sections

Being pregnant with twins doesn’t automatically mean you’ll need a C-section. The decision will depend on the position of the babies and how they present at the time of birth. Triplets, however, do require delivery by C-section.

A C-section may be planned for reasons related to the baby.

  • The baby’s position
    A baby’s position isn’t always favourable to a vaginal delivery. In 3–5 percent of pregnancies, the baby has an abnormal presentation, leading by the brow, face, buttocks, feet, or even shoulder rather than the head. When this occurs, at week 36 or 37 of the pregnancy, the doctor can attempt an ECV, or version, a procedure used to turn the baby into a head-down position if they are breech. This manoeuvre doesn’t always work, however, and it isn’t always possible due to medical reasons. In such cases, a caesarean section may be scheduled.
  • The baby’s size
    A C-section is necessary if the health care professional feels that the baby is too large for the diameter of the mother’s pelvis.
  • The baby’s growth
    If the baby’s growth is severely delayed, a C-section may be required to deliver the baby early.
Does a breech baby require a C-section?
In 2009, the Society of Obstetricians and Gynaecologists of Canada changed its guidelines for automatic caesarean delivery of breech babies. Vaginal delivery in these circumstances is now possible. After assessing the progress of your current pregnancy along with any previous pregnancies, your doctor will advise you on the feasability of a breech birth. That said, some doctors are more comfortable performing a breech delivery than others.

A C-section can also be planned for reasons related to the mother.

  • A previous C-section
    The old adage “Once a C-section, always a C-section” is no longer necessarily a given. The decision to perform a second C-section depends on the reason for the first surgery and the type of incision that was made. Today, 60–80 percent of mothers who’ve had a caesarean delivery in the past will be able to give birth vaginally in the future. For more information, read our fact sheet on vaginal birth after caesarean section (VBAC) (text in French).
  • Problems related to the placenta
    At the time of your first ultrasound, the placenta may be covering your cervix. If it doesn’t move back up during the pregnancy and is still partially or fully blocking the cervix (placenta previa), a caesarean section will need to be scheduled. Similarly, a C-section is necessary if the placenta remains firmly attached to the uterine muscle (placenta accreta, increta, or percreta), or when the blood vessels connecting the fetus to the placenta lie across or too close to the cervical opening (vasa previa).
Download your C-section birth plan to map out your preferences for labour.
  • The mother’s health
    A caesarean section may be necessary if the mother has a hypertensive disorder (e.g., preeclampsia) or diabetes and that has resulted in a high birth weight that would make it difficult for the baby to pass through the mother’s pelvis.
  • Various infections
    A caesarean section may be required if the mother has an infection. For example, if the mother has active herpes lesions on her vulva or vagina, a C-section should be planned to prevent the baby from becoming infected during delivery.

    On the other hand, it’s possible for a woman living with HIV to have a vaginal delivery, as long as appropriate treatment is started early. She would need to discuss this with her treating physician.

Emergency or unplanned C-sections

In some cases, the decision to perform a caesarean section is made during labour. This is called an emergency or unplanned C-section, depending on the situation.

  • Labour is not progressing
    This is the most common reason for having a C-section. In some cases, the mother’s cervix stops dilating for several hours despite strong and regular contractions. In other cases, the cervix may be fully dilated to 10 cm, but the baby isn’t descending into the pelvis or birth canal for delivery. If other methods used to advance labour are unsuccessful, an unplanned C-section will be required.
  • Concerns about the baby’s well-being
    This is the second-most-common reason for having a C-section. Typically, the main concern is unusual changes in the baby’s heart rate during labour. If the baby’s health appears to be at risk and delivery is not imminent, an emergency caesarean section may be recommended.
  • The placenta detaches from the uterus (placental abruption)
    The placenta needs to remain attached to the uterus until the baby is born. Premature placental abruption can cause severe bleeding and deprive the baby of the oxygen they need. In these cases, it’s necessary to do an emergency caesarean section.

Too many C-sections in Quebec?

In a study published in 2018, researchers observed that the rate of C-sections worldwide had nearly doubled since 2000. From 2002 to 2016, the C-section rate in Quebec increased from 20.9 percent to 25.1 percent. However, according to Quebec experts, health care professionals are aware of the risks associated with this procedure and being vigilant to avoid an increase in C-section rates. The World Health Organization (WHO) believes that C-section rates should not exceed 15 percent.

How is a C-section performed?

In the case of a scheduled C-section, a nurse will help you prepare for the surgery. Certain aspects may vary from one hospital to another.

Here are some guidelines you may need to follow.

  • Fast from midnight the night before your C-section, and no water for a few hours before the procedure.
  • Change out of your clothes and into the ones provided by the hospital (gown and cap for the operating room).
  • Remove all jewelry to reduce the risk of burns from the electrocautery instrument, which conducts heat. This instrument may be used to reduce bleeding from small blood vessels during the surgery.
  • Do not wear makeup before coming to the hospital and remove any nail polish if possible.
  • Do not wear contact lenses.
  • Shave the area above your pubic bone before the operation to reduce the risk of surgical wound infection.

To ensure your safety, the following steps may be taken.

  • An IV will be inserted to administer medication before, during, and after the operation. In most hospitals, you may also be given an antibiotic before surgery to prevent infection.
  • C-sections are usually performed under epidural anesthesia or a spinal block. The anesthesiologist will explain each step, and a nurse will be nearby to provide guidance and support. When an emergency caesarean section is required, the health care team may choose to put you under general anesthesia.
  • A urinary catheter will be placed in your bladder to keep it empty during the operation. This reduces the risk of bladder injury and helps the baby come out. The anesthesia used during surgery also reduces the feeling of a full bladder in the hours following your operation. The catheter will ensure that your bladder is emptied until the anesthesia completely wears off.
  • An antiseptic solution will be applied to your abdomen once it’s confirmed that the anesthesia is effective. Your abdomen and legs will be covered with a sterile sheet. Once these steps are complete, your labour partner may be able to join you if the situation allows.

In general, the same steps are followed whether a caesarean section is planned or unplanned. However, since the goal is to deliver the baby quickly and to stabilize the mother, the order may differ.

After the surgery

A liquid diet is necessary immediately after a procedure such as a C-section, followed by light foods in the first few hours. You will then be able to resume a balanced diet at your own pace, similar to the one before your pregnancy.

Once you are transferred from the recovery room to your hospital room, you should be alert enough to hold your baby. You will be able to get up for the first time within 6–7 hours post-surgery, depending on the type of anesthesia, the medication used, the dosage, how quickly your body eliminates the effects of the anesthesia, and your pain management.

For your safety, you must have someone with you in your hospital room to help with your care for the first 24 hours after the C-section. They can help lift your baby out of the crib, or change the baby’s diaper for you if you’re still in bed.

Pregnant women’s rights regarding caesarean sections

As with any procedure, your doctor should explain the risks of a C-section as well as the benefits of a vaginal delivery for you and your baby. They must also obtain your consent before proceeding.

Furthermore, the laws in Canada state that a woman can refuse to have a C-section, even if the medical staff is concerned about the safety of the fetus. According to case law, a baby becomes a human being only when it has fully emerged, alive, from its mother’s womb. That means the fetus does not have any rights that could limit those of its mother.

However, if there is no medical reason to warrant a C-section, the doctor is not required to perform one, even if the expectant mother requests it. Therefore, if a woman asks her doctor to perform a C-section out of fear or anxiety about labour, the care team will assess the mother’s reasons for making such a request. Every situation is analyzed individually to best meet the needs of each patient. When it comes to the fear of pain, several solutions can be offered to the mother to reassure and relieve her before resorting to a surgical procedure such as a caesarean section.

Possible consequences of a caesarean section for the mother

Before considering a new pregnancy, it’s generally recommended to wait at least 1 year to give the scar time to heal properly in the uterus before stretching it out again. Furthermore, it’s recommended that mothers wait at least 18 months before attempting a vaginal birth after a caesarean section (VBAC). Attempting a VBAC sooner poses too great a risk of uterine rupture.

Caesarean sections generally go smoothly. However, as with any surgery, a C-section can impact the mother’s recovery from childbirth.

  • More and more birthing centres are promoting skin-to-skin contact immediately following a caesarean delivery (see box below). However, if the mother’s health does not allow it, there may be a delay before she can have skin-to-skin contact with her baby, particularly in emergency situations.
  • There is a greater risk of pain following the operation and once the mother is back at home.
  • The risk of infection at the wound site, in the uterus, or in the urinary tract (if a urinary catheter has been used) is also greater. Antibiotics can be prescribed to prevent or eliminate the infection.
  • The risk of bleeding and clotting issues is increased.
  • There is usually more blood loss after a C-section than after a vaginal delivery, which can lead to iron deficiency. Your doctor may prescribe iron tablets. A nutritious diet during and after pregnancy will ensure you have good iron reserves in anticipation of the birth and help replenish your reserves afterwards.
  • As with any other surgical procedure, anesthesia and pain medication may cause constipation. Drinking regularly to satisfy your thirst and eating foods rich in fibre will help eliminate this discomfort. Moving as soon as possible after surgery will also help stimulate your bowels. If necessary, your doctor may prescribe medication to relieve constipation. The medication must be taken regularly, especially in the first 24 hours.
  • The mother may have an emotional reaction to the disappointment of giving birth by caesarean section (e.g., anxiety and depression). These feelings may arise shortly after delivery or later in the recovery period. Regardless of when they come up, it’s important for the mother to share them with her doctor or midwife so that she can receive professional support before she leaves her birth location or once she gets home. This is especially important because depression can interfere with the parent-child bond.
  • The likelihood of having to return to the hospital due to complications (e.g., bleeding) is greater.

Risks specific to women who’ve had a previous caesarean delivery

A mother who has already given birth by caesarean section is at greater risk of the following during a future pregnancy or delivery:

  • The likelihood (20–40 percent) of a repeat caesarean delivery if conditions don’t favour a vaginal delivery.
  • A small risk (approximately 1 percent) of having a placenta-related problem, such as the placenta covering the cervix (placenta previa) or detaching from the uterus before the baby is born (placental abruption). This risk increases with the total number of caesarean sections.
  • A small risk (1 percent) of uterine rupture in future pregnancies. The level of risk may vary depending certain factors, such as the type of incision made during the previous caesarean section.
Parent-child bonding after a C-section
Nowadays, hospital practices are shifting in order to promote rapid bonding between mother and baby following a caesarean delivery. The health of the mother and baby permitting, some birthing centres encourage placing the baby on the mother’s chest for skin-to-skin contact in the operating room and recovery room. You can assess this possibility during your pregnancy and request it if necessary. Early skin-to-skin contact between newborns and mothers is associated with numerous benefits.

If conditions do not allow for skin-to-skin contact between mother and child (e.g., the mother had to have an emergency C-section with general anesthesia), the father is encouraged to hold the baby as soon as possible to promote the development of the attachment bond. As with the mother, skin-to-skin contact with the father is also encouraged.

Possible consequences of a caesarean section for the baby

There are few significant consequences associated with caesarean birth for the baby. However, it can sometimes lead to the following:

  • Mild and usually transient respiratory distress. The baby’s lungs may also contain slightly more secretions than if they had been born vaginally, since they weren’t able to expel them during passage through the vaginal canal.
  • Lower body temperature, as operating rooms are cooler than normal room temperature. Skin-to-skin contact with one of the parents soon after birth helps to remedy this situation.
  • Transfer to the neonatal care unit for closer observation and additional care if the caesarean section was performed after a long and difficult labour. However, if the baby’s condition is good at birth, they will go directly to the hospital room with the parents.

Recovering from a C-section

Postpartum recovery can be longer after a C-section. The mother may stay at the hospital 1–2 days longer than if she’d had a vaginal delivery. Increasingly, however, doctors are offering women who have had a planned C-section the option of being discharged 48 hours after giving birth, as long as both mother and baby are recovering nicely.

For more information, read our fact sheet on C-section recovery (text in French).


Consider the possibility of a caesarean section
Since it’s impossible to predict how a delivery will go, you should be aware that a C-section may be needed to deliver your child.

It’s best to discuss this possibility with your doctor or midwife before you go into labour. Share any concerns you have so that you can work together to identify all possible alternatives before opting for a C-section. Part of making an informed choice is weighing the benefits versus the risks of a C-section for you and your baby.

Consider including a section in your birth plan detailing your preferences should you require an emergency or unplanned caesarean section.


Things to keep in mind

  • A caesarean delivery is sometimes needed to ensure the safety of the mother or baby.
  • As with any surgical procedure, a C-section can affect the mother’s recovery.
  • Caesarean delivery has few major consequences for the baby.


Naître et grandir

Scientific review: Roxanne Piché, nursing adviser, Maternal Fetal Medicine Clinic, CHU Sainte-Justine
Research and copywriting: The Naître et grandir team
Updated: April 2021

Photo: iStock/RapidEye



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