C-section in Ireland: what to expect

Whether a C-section is circled on the calendar or arrives in a rush at 3am, it helps to know what is coming. Here is what happens before, during and after a caesarean in an Irish maternity unit, based on the HSE's own guidance.

New to how maternity care works here? Start with our guide to how pregnancy care works in Ireland.

What is the difference between a planned and an emergency C-section?

A planned (elective) caesarean is booked ahead for a medical reason, and you are usually given a date. The HSE lists common reasons as:

• You have had 1 or more caesareans before
• Your baby is breech (feet or bottom first)
• Your doctor thinks a vaginal birth would be too difficult, for example if the baby is measuring much bigger than most
• Complications such as the baby not growing well or a low-lying placenta (placenta praevia)
• Your baby needs surgery after birth and a timed birth is important

An emergency caesarean happens when complications come up before or during labour, most often because labour is not progressing or the baby needs to be born quickly. Things can move fast. If it all feels like a blur afterwards, ask your midwife or obstetrician to go back over what happened.

Can you simply ask for a section? Usually not. The HSE says you cannot usually decide to have a C-section instead of a vaginal birth, especially on a first baby, though if you have had one before you may choose another.

What happens on the day of a C-section?

Before you go to theatre

With a planned section, some hospitals see you a few days or weeks beforehand for blood tests and to sign the consent form. Others do all of this on the day. With an emergency section, there is less time, but you may still have bloods and sign a form.

• You will be asked to fast for a few hours beforehand. You may be allowed water until shortly before.
• Skip the nail varnish and gel nails. Staff watch your fingernails to check your oxygen levels and circulation.
• For a planned section you may be given a tablet (omeprazole) the night before and the morning of, to reduce stomach acid.
• You will wear a hospital gown, and a small area of the bikini line may be shaved or trimmed.

Having a planned section? Ask your midwife about collecting colostrum beforehand. The HSE says you may be able to start hand expressing from around 37 weeks, but it is not suitable for everyone.

In theatre

Most people have a spinal or epidural anaesthetic, which means you are awake and meet your baby straight away. You will not feel pain, but you may feel pulling or tugging. Sometimes a general anaesthetic is needed and you are asleep.

A catheter goes into your bladder, a screen goes up across your chest if you would rather not watch, and the obstetrician makes a cut of 10 to 20 cm, usually just below your belly button. The whole procedure takes about 45 minutes, but your baby is usually born within the first 5 to 10.

After the birth you get an oxytocin injection to help your womb contract. The cut is closed with dissolvable stitches or with staples that come out after 5 to 7 days. Your midwife will help you and your partner have safe skin-to-skin contact with your baby as soon as possible.

Can my partner be in theatre?

Usually, yes. Your birth partner is given a gown and mask and may have to wait outside until the procedure has started. The one exception is a general anaesthetic: then your partner cannot come into theatre, but they wait close by and are kept updated.

How long does it take to recover from a C-section?

Longer than a vaginal birth, and longer than most people expect. It is an operation, and you are recovering while you are also learning to care for a newborn. Here is the rough shape of it from the HSE's guidance:

When	What to expect
First 12 hours	Drip in your arm, catheter usually out within 12 hours, possibly a wait before eating
Day 1	Help to shower and get moving, deep breathing and leg exercises
Days 3 to 4	Usual time to go home
Up to 6 weeks	No driving, sex, exercise or lifting heavier than your baby
Around 12 weeks	Wound healed properly
3 to 4 months	Higher effort exercise such as swimming or running, if your scar is healing well

You will probably get injections in your tummy to prevent blood clots, because the risk of clots is higher in the 6 weeks after a caesarean. Some people continue these at home for up to 6 weeks.

Bleeding from the vagina can carry on for several weeks. Use maternity or sanitary pads, never tampons. Hold a pillow against your wound when you laugh, cough or get up, and wear loose high-waisted pants.

Take the painkillers you are prescribed. Once they run out, paracetamol may be enough. Your public health nurse will visit you at home after discharge.

When can I drive, lift and exercise after a C-section?

The HSE's guidance is that you may need to wait up to 6 weeks before driving, having sex and exercising, and before lifting or carrying anything heavier than your baby. Short gentle walks are encouraged from early on, because moving about lowers the risk of clots. Start walking without pushing the buggy.

In practice, the car seat, the laundry basket and the big shop are someone else's job for a while. Say yes to every offer of help. For higher effort exercise like swimming or running, the HSE says to wait 3 to 4 months, and only if your scar is healing well. Your 6 week check with the GP is a good time to ask about your own recovery.

Can I breastfeed after a C-section?

Yes. If you are well enough, you will be supported to breastfeed in theatre or the recovery room as soon as possible. If you are not, your partner can do skin-to-skin until you are ready.

Your milk may come in a day or so later than after a vaginal birth, but colostrum meets all your baby's needs at first. Babies born by section can be a little sleepy, so lots of skin-to-skin and hand expressing help. Positions that keep the baby off your wound:

• Side-lying, with pillows between your knees and behind your back
• Laid-back, with baby's tummy on your body, away from the scar
• Football hold, with pillows for support and your feet up on a low stool

All the pain relief prescribed after birth is compatible with breastfeeding, and you will feed more comfortably with your pain under control. Use the extra days in hospital to get help with positioning. If the latch is giving you trouble once you are home, our guide to latch problems and tongue tie may help.

Those first days blur together, especially on painkillers. Lullagram lets you log each feed and nappy with one tap so you are not trying to remember which side or what time when the midwife asks.

What are the signs of infection after a C-section?

Contact your GP, PHN or midwife urgently if you notice signs of wound infection:

• The wound becomes red, painful or swollen
• Oozing or pus around the wound
• A temperature of 38°C or above

The HSE also says to contact your GP, obstetrician, midwife or PHN immediately if you have:

• Heavy vaginal bleeding, especially with large clots
• Severe pain
• A vaginal discharge that smells bad
• Shortness of breath, chest pain or a cough
• Swelling or pain in your lower leg

In an emergency, call 112 or 999.

Can I have a vaginal birth after a C-section (VBAC)?

Often, yes. According to the HSE, after 1 caesarean about 3 in 4 mothers have a vaginal birth. VBAC is not recommended after 3 or more caesareans, after a previous womb rupture or if you had a high (classical) cut. It is also less likely to succeed if labour is induced.

If you plan a repeat caesarean instead, the HSE says it is usually scheduled for 39 to 40 weeks. Many maternity hospitals run VBAC classes, which we cover in our guide to antenatal classes in Ireland. The HSE also recommends waiting at least 6 months after a caesarean before trying for another baby.

Frequently asked questions

How long will I stay in hospital after a C-section?

Usually 3 to 4 days, according to the HSE. You will be helped out of bed and into the shower the day after the birth, and the catheter usually comes out within 12 hours of surgery.

When can I drive after a C-section?

The HSE advises avoiding driving for up to 6 weeks after a caesarean. Ask your GP at your 6 week check if you are unsure whether you are ready.

Can I breastfeed after a C-section?

Yes. If you are well enough you will be supported to breastfeed in theatre or the recovery room as soon as possible. Side-lying, laid-back and football hold positions keep the baby off your wound, and all the pain relief prescribed after birth is compatible with breastfeeding.

What are the signs of an infected C-section wound?

Watch for a wound that becomes red, painful or swollen and for oozing or pus around the wound. A temperature of 38 degrees Celsius or above is another warning sign. Contact your GP, PHN or midwife urgently if you notice any of these.

Can I have a vaginal birth after a C-section?

Often, yes. The HSE says about 3 in 4 mothers have a vaginal birth after 1 caesarean. It is not recommended in some situations, such as after 3 or more caesareans, so talk it through with your obstetrician or midwife.