Caesarean births
A caesarean section is an operation to deliver a baby or babies. It can be planned ahead of time (also called an Elective Caesarean) or unplanned (also called an Emergency Caesarean). In Aoteaora New Zealand, around 30% (almost one in three) of births are by caesarean section.
Anaesthesia is very safe. It allows a patient to be comfortable during their surgery. Anaesthetists are specialist doctors who are highly trained to deliver anaesthesia and help look after you before, during, and after your surgery.
This information is meant as a general guide. It does not replace individual medical advice given by your healthcare providers. You should always ask your healthcare team If there is anything you’re unsure about.
Planned caesarean sections
Across Aotearoa New Zealand, around 1 in 10 births are by planned caesarean section. This is where a caesarean is organised ahead of time. This may be due to medical reasons (for the baby or birthing parent), because of a previous caesarean birth, or for parental choice.
Before, during and after your planned caesarean
On the day of your child’s birth and caesarean section, you should arrive at the hospital at the time given to you. It’s important you pay attention to all instructions, including making sure you don’t eat or drink any food for at least six hours before your caesarean, and stop drinking clear fluids (such as water) at least two hours before. Your hospital will give you advice to follow. This is important to protect your lungs if your anaesthetist needs to use a general anaesthetic.
Once you’re at the hospital there are lots of people for you to meet and talk to. You will meet your obstetrician, your anaesthetist, and the rest of the theatre team – this includes an anaesthetic assistant (who works alongside the anaesthetist) two to three nursing staff, and a midwife. It can feel like there are a lot of people around, they are all there to look after you!
In Aotearoa New Zealand most caesareans are performed in teaching hospitals. This means that there might also be registrars – these are doctors who are training to be specialists. They are always supervised by specialised doctors – this might be in theatre or nearby. You might also be asked if healthcare students can be present at your caesarean section. They are there to learn and observe, and it is your choice whether you consent to their presence or not.
The team will do a series of checks before you have your caesarean. These are done for all procedures like caesareans across the world and are designed to help keep you and your baby safe.
Our The day of your planned surgery page has lots of helpful information to help understand what to expect.
You are usually allowed to have one support person of your choice in theatre. This might be your partner, a friend, or someone from your whānau. Most of the time, they can be with you every step of the way including sitting next to you while your baby is born. It is ok to take photos of your family and baby.
Once you arrive in theatre, you will have a small plastic tube called an IV line put into your hand or arm. You will then be attached to a specialised machine that monitors you continually throughout your caesarean. The monitors help the anaesthetist watch your heart, blood pressure and oxygen levels during your caesarean, to make sure you are safe.
Most people have a spinal anaesthetic when they have a caesarean birth. This is an injection in the lower part of your back that aims to keep you comfortable during your operation. Before this is done, your anaesthetist will ‘scrub’ by putting on a gown, gloves and mask, and then clean your back with cold antiseptic. Next, they will put some local anaesthetic into your back to make it numb. This may sting or ache as it goes in. They will then place the anaesthetic, which is a very fine needle that goes into your back. Once this needle is in the right place, they will inject some local anaesthetic and strong pain relievers called opioids.
This injection usually works very quickly. As the medicine is injected you may notice your bottom and legs going warm and tingly. The staff caring for you will then help you lie back on the bed.
Once the anaesthetic is working, the theatre staff will place in a urinary catheter. This a small tube into your bladder to drain your wee/mimi.
Your anaesthetist will then check that your anaesthetic is working. That the nerves that carry messages to your brain about pain and temperature are responding well to the anaesthetic. Your anaesthetist will check your response to cold first, and they will also check you can’t feel any pain either. The nerves that carry information about touch and pressure usually continue to send messages to your brain, so you will be able to feel some pulling and pressure – especially while your baby is being born. You should not feel any pain, and your anaesthetist will be with you to check you’re comfortable.
Once the anaesthetist is happy that the injection has worked, the obstetrician will come and clean your belly with some antiseptic. They will then put a sheet-like drape over the lower part of your body, this helps to keep everything sterile. The obstetrician will also check the numbness before they start the surgery.
When your baby is born, they will usually spend a short amount of time attached to the umbilical cord for delayed cord clamping before they go for a quick check. If you and your baby are both well, then you’ll be able to do skin-to-skin while the surgeons finish the procedure. This usually takes around 45 minutes.
Once your caesarean section procedure is finished, you will be moved onto a more comfortable bed and will go to the recovery area where a nurse will look after you and your baby. You’ll be given regular pain relief and have stronger pain relief available if you need it.
When the nurses are happy that you and your baby are both comfortable and stable you will be transferred to the postnatal ward.
Emergency caesarean sections
An emergency caesarean is one that is not planned ahead of time. They can be done for many reasons, most often due to concerns about the health of the baby or the birthing parent.
Even in an emergency, there is usually enough time to do all the usual theatre processes and checks. However, sometimes the need for a caesarean is very urgent. This is called a Category 1 or ’urgent’ caesarean section. If this happens, there may be limited time to talk to your anaesthetist and obstetrician, but they will always do their best to explain what is happening and ensure there is informed consent. Category 1 caesarean sections are very uncommon – about 1% of all births in Aotearoa New Zealand.
The rest of emergency caesarean sections happen for a variety of other reasons and in a less urgent time frame. Most of the time an emergency caesarean can be done under an epidural top-up or spinal anaesthetic. This means you can be awake to meet your baby, and you can do skin-to-skin.
Helping your recovery
To help speed up your recovery it’s a good idea to:
- Have something to drink and eat as soon as you get to the postnatal ward.
- Get out of bed once your legs feel normal; ideally around 6 hours after your surgery. Make sure you have someone with you when you get out of bed and that you are not holding your baby.
- Have your urinary catheter taken out once you can walk to the toilet.
- Take enough pain relief to keep you comfortable. If you can’t move in bed because of pain or it hurts to breathe it is important to ask for more medication.
Frequently asked questions
More information
As a parent, there are many choices you can make for your whānau: from conception, through birth, breastfeeding and beyond. About 65% of pregnant people in Aotearoa New Zealand choose to or require the services of an anaesthetist during labour. This page and the resources linked below are supported by the National Obstetric Anaesthetists’ (NOA) Network. We hope this information on some of the choices where anaesthetists might be involved can help you feel more confident when the time comes to make those decisions.