Caesarean section

Summary

A caesarean section is an operation to deliver your baby through a cut in your abdomen and womb, done when a vaginal birth would be riskier for you or your baby — or, after discussion, by your choice. It is one of the most commonly performed operations in Sri Lanka: around a third of births here are by caesarean.

• The operation usually takes under an hour; you are normally awake, with the lower body numbed by a spinal anaesthetic, and feel no pain.
• You can see and hold your baby straight away, and breastfeeding can begin before the operation is finished.
• Most mothers go home on the second day.
• Serious complications are uncommon; the main ones are bleeding, infection and blood clots.
• A caesarean affects future births — most women can still labour after one caesarean (VBAC), which is discussed in your next pregnancy.

This information supports discussion with your healthcare team. Reading, saving or printing it does not constitute consent to surgery.

About the operation

In a caesarean the baby is delivered through a horizontal cut of about 10 cm low on the abdomen — the "bikini-line" incision, placed where underwear covers it — and a second cut in the lower part of the womb. After the baby is born, the placenta is delivered, the womb is checked and each layer is closed with stitches. Skin stitches are usually dissolvable.

There are two kinds:

• Planned (elective) caesarean — the need is identified in advance and the operation is booked for a set date, usually from 39 weeks.
• Emergency caesarean — carried out when a complication arises before or during labour and delivering promptly protects you or your baby.

Why it is performed

A caesarean is recommended when the benefits of surgery outweigh the risks of continuing towards a vaginal birth. Common reasons include:

• The placenta lying low over the cervix (placenta praevia)
• The baby lying bottom-first (breech) or sideways near term
• Concerns about the baby's condition before or during labour
• Labour not progressing despite good contractions
• Some previous caesareans or womb surgery, twins in certain positions, or maternal conditions that make labour unsafe
• Maternal request, after a full discussion of benefits and risks

Benefits

• A planned, controlled delivery when labour would put you or your baby at risk — this is the operation's purpose and main benefit.
• Avoids the specific risks that made vaginal birth unsafe in your case (for example bleeding from a low-lying placenta).
• For a planned caesarean, a known date and team, which some families also find practically helpful.

A caesarean is not "the easy option" — recovery is longer than after a straightforward vaginal birth, which is why it is recommended only when there is a reason.

Alternatives

• Vaginal birth — the natural way of giving birth and the default where it is safe; most pregnancies are suited to it.
• Waiting or re-assessing — some indications change: a breech baby may turn (or be turned — see ECV), and a low placenta early in pregnancy often moves up on later scans.
• External cephalic version (ECV) — for a breech baby, gently turning the baby head-down so a vaginal birth becomes possible.
• After a previous caesarean — vaginal birth after caesarean (VBAC) is a realistic option for most women; the choice between VBAC and a repeat caesarean is discussed in the next pregnancy.

Preparing for surgery

For a planned caesarean you will have a pre-operative check: blood tests, blood pressure, and a review of your medicines and pregnancy record. Tell the team about all medicines you take and any previous surgery or anaesthetic problems.

• Fasting: exact instructions are given; typically no food from 6 hours before, water allowed up to 2 hours before.
• At home: plan for help in the first two weeks — you will be caring for a newborn while recovering from surgery, and should avoid heavy lifting.
• For an emergency caesarean these steps are compressed into minutes rather than days; the team explains as much as time allows, and fully afterwards.

The day of surgery

You are admitted on the day (or the evening before). The team confirms your identity and the plan, and you meet the anaesthetist and obstetrician. You will be asked to sign the consent form — this is the time for last questions, and you can still change your mind.

Before the operation the lower abdomen is shaved if needed, a urinary catheter is placed to keep the bladder empty, and the skin is cleaned and covered with sterile drapes. For Dr Mathota’s caesarean sections in private hospitals, your birth partner is welcome in theatre when the operation is under spinal anaesthesia.

During the operation

Most caesareans are done under spinal anaesthesia: an injection near the spine numbs you from the waist down, so you are awake but feel no pain — you may feel pressure and pulling. A general anaesthetic (fully asleep) is used only when a spinal is unsuitable or in some emergencies.

The surgeon opens the abdomen through the bikini-line cut, makes a sideways opening in the lower womb, and delivers the baby — you can see your baby immediately, and in most cases skin-to-skin contact and breastfeeding can begin while the operation is completed. The cord is cut, the placenta is delivered, the womb is checked and cleaned, and each layer — womb, abdominal wall, skin — is stitched. The whole operation usually takes under an hour.

After the operation

You and your baby go to the recovery area together. The numbness in your legs wears off over about 4 hours; as feeling returns you will need regular pain relief — take it on schedule rather than waiting for pain, so you can feed and care for your baby comfortably.

• Catheter: removed once you are fully mobile — usually within 12 hours of the operation.
• Eating and drinking: usually the same day; you can normally eat, drink and breastfeed independently once the spinal wears off.
• Moving: by the second day most mothers are out of bed and walking short distances — early walking speeds recovery and protects against blood clots.
• The wound: closed with dissolvable stitches covered by a waterproof adhesive glue (LiquiBand) — no plaster, nothing to remove, and you can wash normally.
• Going home: usually on day 2 if there are no complications.

Recovery at home

• First two weeks: normal day-to-day activities and caring for your baby are fine; avoid heavy lifting — as a rule, nothing heavier than your baby. With modern, finer surgical techniques most of Dr Mathota’s patients return to normal work earlier than the standard published timings.
• Vaginal bleeding (lochia): normal after any birth; it lightens over several weeks.
• The wound: the waterproof glue layer means you can wash normally; mild pulling sensations are normal as it heals.
• Driving: when you can move freely and brake hard without hesitation — commonly around 4–6 weeks; check your insurer's policy.
• Contraception: you can become pregnant again from about 6 weeks after the birth — discuss a contraception plan with your doctor or public health midwife before then.
• Future births: most women can plan a vaginal birth after one caesarean (VBAC); this is discussed early in your next pregnancy.

These are typical figures; your own advice may differ and comes first.

Risks and complications

Caesarean section is very safe, but like all major surgery it carries risk. The figures below are averages from published UK guidance (RCOG); your individual risk depends on your health, weight, previous surgery and the reason for the caesarean.

Expected, temporary effects

• Pain around the wound and when moving, for the first weeks
• Vaginal bleeding for several weeks (as after any birth)
• Numbness or tingling around the scar, which can persist for months

Complications

• Infection — of the wound, womb lining or urine; antibiotics are given during surgery to reduce this (common: around 1 in 10 or fewer, most cases minor).
• Bleeding heavy enough to need a blood transfusion (uncommon).
• Blood clots in the leg or lung (VTE) — pregnancy and surgery both raise this risk, so preventive measures are routine (uncommon).
• Injury to the bladder or bowel — recognised injuries are repaired (rare).
• Cuts to the baby's skin at delivery — usually superficial and healing without treatment (uncommon).
• Effects on future pregnancies — a higher chance of the placenta implanting low or into the scar, and of the scar opening in labour (rare); this is why the number of caesareans matters and VBAC is discussed.
• Anaesthetic effects — headache after a spinal (uncommon); serious anaesthetic complications are rare.

When to seek help

After you go home, seek medical advice the same day if you notice:

• Heavy vaginal bleeding — soaking a pad in an hour, or passing large clots
• Fever (38 °C or higher) or feeling increasingly unwell
• Worsening abdominal or wound pain not controlled by your painkillers
• A wound that becomes red, swollen, hot or leaks fluid
• Burning on passing urine, or being unable to pass urine
• A painful, swollen or red leg
• Foul-smelling vaginal discharge

Preparing for your consent discussion

Consent is a conversation, not a signature. Before agreeing to a planned caesarean you should feel you understand why it is recommended for you, what the realistic alternatives are, and which risks matter most in your case. The checklist below is a starting point — print it and bring it to your consultation.

Sources and review

This page was drafted against the published guidance below. Each reference was live when checked; dates will be confirmed at clinical review.

1. Royal College of Obstetricians and Gynaecologists. Caesarean birth — consent advice. London: RCOG. Available from: https://www.rcog.org.uk/guidance/browse-all-guidance/consent-advice/ [last checked 28 July 2026].
2. National Institute for Health and Care Excellence. Caesarean birth. NICE guideline NG192. Available from: https://www.nice.org.uk/guidance/ng192 [last checked 28 July 2026].
3. National Health Service (UK). Caesarean section. Available from: https://www.nhs.uk/conditions/caesarean-section/ [last checked 28 July 2026].

Patient information from our own clinics

1. Sugabi Clinic Ragama. Caesarean delivery: when it's needed, what to expect, and how to recover. Available from: https://sugabi.lk/blog/325/…
2. vog.lk — සිසේරියන් සැත්කම ගැන හරියටම දැන ගන්න (Sinhala, by Dr Chaminda Mathota). Available from: https://vog.lk/449-caesarean-section.php