Roughly one in three births in Singapore is a caesarean, so this isn’t an unusual outcome. But the preparation given for it’s thin compared with what’s offered for vaginal birth, and much of what’s missing is practical.
Why they happen
Planned (elective) caesareans are decided in advance, usually for:
- Breech or transverse position at term
- Placenta praevia, where the placenta covers the cervix
- Twins or more, depending on positions
- Previous caesarean, if a repeat is chosen
- Certain maternal medical conditions
- Maternal request, which is a discussion to have properly, not a box to tick
Unplanned or emergency caesareans are decided during labour, usually because labour isn’t progressing, the baby’s heart rate pattern is concerning, or something urgent occurs. “Emergency” covers a wide range of urgency, from a calm decision over half an hour to a very fast one. Most are the former.
What happens
- Anaesthetic. Usually a spinal, occasionally an epidural topped up. You’re awake, and your partner is normally with you. General anaesthetic is used only when speed is critical.
- Preparation. A drip, a catheter, and a screen across your chest. You can ask for it to be lowered at the moment of birth if you want to see, and many units are happy to do this.
- The birth. Baby is usually out within five to ten minutes of starting. You’ll feel pressure, pulling and movement, not pain. That sensation surprises people who were expecting to feel nothing at all.
- Closing. Another thirty to forty-five minutes. Skin-to-skin in theatre is often possible; ask beforehand.
Ask in advance: whether your partner can stay throughout, whether the screen can be lowered, whether skin-to-skin in theatre is possible, and who takes the baby if you’re unwell.
What recovery is like
This is major abdominal surgery, and the recovery is longer than for a vaginal birth. Plan help for the first fortnight instead of assuming you’ll manage.
- Two to three days in hospital, typically.
- They’ll get you up within a day. It feels premature, and it reduces the risk of blood clots. Do it.
- Take the pain relief on schedule, not when it gets bad. Staying ahead of the pain is what lets you move, feed and sleep.
- Support the wound when you cough, laugh or sneeze: a pillow held against it. This one tip makes the first week much easier.
- Six weeks before heavy lifting. Nothing heavier than your baby.
- Driving: usually four to six weeks, but check your insurer as well as your doctor.
- Constipation is very common after surgery and pain medication. Ask for a stool softener before you need it.
- Numbness around the scar is normal and can last months.
What to pack
High-waisted underwear that comes well above the scar; loose clothes; a pillow for the car journey home to sit between you and the seatbelt; and a long phone cable, since you won’t be able to reach the bedside table easily at first.
Get help for
- Increasing redness, swelling, heat or discharge from the wound, or it opening
- Fever
- Heavy bleeding, soaking a pad an hour, or large clots
- Pain that worsens instead of improving day by day
- Calf pain or swelling, or chest pain or breathlessness: possible clot. This is an emergency; call 995
- Severe headache after a spinal or epidural, particularly one worse when upright
Feeding afterwards
- Breastfeeding is entirely possible, and the anaesthetic doesn’t prevent it.
- Position matters more than usual. The rugby hold or lying on your side keeps the baby off the wound.
- Milk sometimes takes a little longer to come in after a caesarean. It isn’t a failure and it usually resolves.
- Ask for the lactation consultant early, in hospital, instead of struggling at home in week two.
How you might feel about it
An unplanned caesarean, particularly after a long labour, can leave a real sense of disappointment or of having failed. That reaction is common, and it isn’t a failure. You didn’t do birth wrongly, and a caesarean is a birth.
It also helps to ask for a debrief. Most units will go through the notes with you and explain exactly what happened and why. Many women find that a single conversation resolves months of replaying it.
If low mood, intrusive replaying or anxiety persist, mention it at the postnatal check. Difficult birth experiences are a recognised contributor to postnatal depression and to birth-related trauma, and both are treatable.
Next time
A vaginal birth after caesarean (VBAC) is possible for many women, and having had one caesarean doesn’t commit you to another. It depends on why the first one happened, the type of incision and your circumstances. Raise it early in the next pregnancy, not at 36 weeks.
Frequently asked questions
Will I be awake during a caesarean?
Usually yes. Most are done under a spinal anaesthetic, occasionally a topped-up epidural, with your partner present. General anaesthetic is reserved for situations where speed is critical.
Does a caesarean hurt?
You shouldn’t feel pain, but you’ll feel pressure, pulling and movement, which surprises women expecting to feel nothing. The baby is usually born within five to ten minutes, with another thirty to forty-five minutes for closing.
How long is the recovery?
Two to three days in hospital and around six weeks before heavy lifting: nothing heavier than your baby. Driving is usually four to six weeks, and you should check your insurer as well as your doctor. Plan help for the first fortnight; this is major abdominal surgery.
What helps most in the first week?
Taking pain relief on schedule instead of waiting for pain, getting up and walking within the first day, and holding a pillow against the wound when you cough, laugh or sneeze. Ask for a stool softener before you need it, since constipation is very common after surgery and pain medication.
Can I breastfeed after a caesarean?
Yes, and the anaesthetic doesn’t prevent it. Use the rugby hold or lie on your side to keep the baby off the wound, and ask for the lactation consultant while still in hospital. Milk sometimes takes slightly longer to come in, which isn’t a failure.
When should I seek help after a caesarean?
Increasing redness, swelling, heat or discharge from the wound, or it opening; fever; heavy bleeding; pain that worsens instead of improving; or a severe headache that’s worse upright. Calf pain or swelling, or chest pain or breathlessness, may indicate a clot: call 995.
Can I have a vaginal birth after a caesarean?
Often, yes. It depends on why the first caesarean happened, the type of incision and your circumstances. Raise it early in a subsequent pregnancy, not near term.
What to remember
You’ll be awake, your partner will usually be there, and you’ll feel pressure, not pain. Ask beforehand about lowering the screen and skin-to-skin in theatre.
Recovery is longer than people expect. Take pain relief on schedule, get up on day one, hold a pillow when you cough, and arrange help for a fortnight.
And if it was unplanned and you’re still turning it over, ask the hospital for a debrief. It resolves more than it sounds like it would.
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This article is general information and not a substitute for medical advice. Discuss your own situation with your obstetrician.