Caesarean section

For some pregnant women and people, we may recommend birth by elective caesarean. This could be due to a pre-existing medical problem, your previous pregnancy history or because an obstetric complication develops during your pregnancy.  

We will discuss the reasons for recommending an elective caesarean with you. We will also go through the benefits and risks of the procedure.  

If you would like to request a Caesarean for non-medical reasons, please tell us early in pregnancy.  

If you have had a caesarean before, we will discuss your options for vaginal birth after caesarean (VBAC) or an elective caesarean.  

What to expect  

Elective caesareans are usually done at 39 weeks of pregnancy. If your elective caesarean is done earlier than this, you may need to have steroid injections to prepare your baby for an earlier birth.  

We will give you a pre-operative appointment to check your health and go through your anaesthetic options and surgery risks. This is also an opportunity to ask more questions.  

On the day of your surgery, you will usually be expected to arrive in the morning. There are regularly two or three elective caesareans each day at all our maternity units. You may have to wait a while if there are emergencies on the labour ward.

When we are ready, we will take you into theatre to meet the team and to have your anaesthetic.  

You can have one birth partner with you during the operation. You can also bring in your own music to listen to during the procedure.  

We will make sure that your elective caesarean is as individualised and special as possible. Please let us know if you have any extra requests. 

After your baby is born you can have skin to skin, if this is something you would like to do.

Around 15% of pregnant women and people will need an emergency caesarean section. All our maternity units have specialist theatres for this purpose. 

What to expect  

The obstetrician should discuss the decision about needing an emergency caesarean section with you. You should understand the reason it is being recommended, be told what will happen, and given information about the risks and side effects of the operation.  

We will ask you to consent to the operation; this will usually be a written signature on a consent form. In extreme emergencies we will ask you to verbally consent and sign the consent form afterwards.  

Your midwife will stay with you. If you have not had a general anaesthetic, they will explain the different things that are happening during the operation.  

One birth partner can come into theatre with you after you have had your anaesthetic. Please note that if you need to have a general anaesthetic your birth partner cannot come into theatre, and they will have to wait for you in recovery. Once surgery has started, your baby is usually born within 15 minutes.  

A neonatal doctor will be there when your baby is born to check them and provide immediate care if it’s needed. If your baby is well, we will return them to you as soon as possible. We encourage skin to skin for you and your partner in theatre if this is possible and part of your birth plan.

Sterilisation is a permanent way of preventing pregnancy. It usually involves having an operation.

You could consider sterilisation at the time of caesarean section birth, also called C-section, if you:

• decide you do not want more children
• wish to use a permanent method of contraception.

During the caesarean section, you can have an operation called tubal ligation. The fallopian tubes are a pair of tubes along which eggs travel from the ovaries to the womb (uterus). Tubal ligation is when we close the fallopian tubes by cutting and tying them.

This means that your eggs can no longer be fertilised by sperm through sexual intercourse. The egg dissolves inside you and your periods happen as usual.

This information should support, but not replace, discussions you have with health professionals. The doctor should tell you more about what the operation involves before you make a final decision. You should have a chance to talk about the operation in detail, to raise any questions or worries you may have, and to think about what it will mean for you.

Success rates

Sterilisation does not work if the tubes that have been cut or blocked join up later on. One in every 200 to 500 women who have sterilisation by tubal ligation may get pregnant at some point after sterilisation. It can be immediately after or even several years later. The risk of failure is lower if we operate at the time of a caesarean section, than if done laparoscopically (keyhole surgery).

There is less chance of a pregnancy after a vasectomy than after tubal ligation.

Risks of sterilisation

There is no evidence that a tubal ligation causes problems that would lead to a hysterectomy later in your life.

There is no evidence that having a tubal ligation affects your sex drive.

There is no effect on the timing of menopause.

If you are over 30 years old when you have a tubal ligation, it is not linked to getting heavier or irregular periods.

If you are under 30 years old when you have a tubal ligation, there is little evidence about how having a tubal ligation affects your periods.

Research suggests that tubal ligation may provide some protection from ovarian cancer.

Ectopic pregnancy

If you get pregnant after sterilisation by tubal ligation there is a risk that the pregnancy will develop in the fallopian tube rather than in the uterus (womb). This is called an ectopic pregnancy and requires medical attention.

For this reason, if you miss your periods after you have been sterilised, you need to see your doctor urgently.

Regretting your decision

Research has shown that if you choose to have a sterilisation procedure during pregnancy or delivery, you may regret it later. It is thought that the incidence of regret in women who undergo sterilisation at less than 30 years of age, is greater.

It’s best to give yourself time to think about what you want to do. Try not to rush into making a decision. If you do decide you want a tubal ligation at the same time as a caesarean, your doctor or midwife should make sure that you have been offered counselling and that you make the decision at least 2 weeks before your caesarean.

All sterilisation operations are meant to be permanent. The chances of successfully reversing this are generally low. If you change your mind, there is no guarantee of success and you will have to pay to have the operation reversed.