Midwife advice around C-sections for today's birthing mama

Planning an elective c-section? Midwife, educator, and mum Grace Strange, shares her advice for the modern birthing mama. 

According to Te Whatu Ora Health New Zealand’s National Maternity Collection, cesarean section births across New Zealand are steadily on the rise. Their latest report published in 2022 stated that 32% of all babies born in 2022 were born via c-section. Most of the increase comes from women having emergency c-sections, as elective c-sections have mostly remained stable.

This rate of c-sections is the highest ever recorded and I would speculate that that statistic is even higher now three years later in 2025. Some are predicting that these rates may hit 45% by 2030.

There are a few theories flying around as to why there is such an increase and some suspect that a major contributing factor is that women are having babies later in life with the average age of first-time mums sitting around 30 years old. Having a baby when you are older is associated with higher risks of complications during your pregnancy and during childbirth. Another theory is that rising obesity and diabetes in women is also contributing to the high rates of c-sections as these women can have a higher chance of complex pregnancies and complications during birth.

A c-section is a surgical procedure where a baby is delivered through an incision in the mother’s abdomen and uterus. The surgeon, not your midwife, will cut through seven layers – skin, fat, fascia, muscle and the peritoneum to get to the uterus where the amniotic sac will be broken and your baby will can be born. C-sections are either elective/planned or an emergency if complications arise during labour. At Antenatal Co. we call the different types of c-sections ‘Green Light, Orange Light and Red Light’.

ELECTIVE C-SECTIONS (GREEN LIGHT)

An elective c-section is one that’s planned and organised ahead of time. You will need to have an in-depth conversation with your Lead Maternity Carer (LMC) and hospital staff about your wishes and the risks and benefits of both vaginal and c-section births. If you have decided that a c-section is your best option and the hospital has assessed you and agreed (if you have a private obstetrician then you can bypass the hospital signing you off part), then your LMC will apply to the hospital for a date.

The hospital will come back with a specific date and time for your c-section and your baby to be born. You and your LMC have no control over this date or time, it’s purely up to the hospital booking gods!

Why might you have one
A lot of elective c-sections are done due to your first birth ending in an emergency c-section, so some people chose to have an elective with their second birth to avoid the emergency situation. (Note: you can absolutely have a VBAC or vaginal birth after c-section, you do not have to have a repeat c-section if you don’t want to.)

Other reasons why you might have an elective c-section include; if your baby is in the breech position that means they are coming out feet or bottom first instead of head first, and you have agreed with your LMC that this is the safest way to deliver your baby. You might have an elective c-section if you are pregnant with twins or if you have a fear of labour/birth and its better for your mental and emotional health to have your baby via elective c-section.

What you can expect
With an elective c-section you will need to have some bloods taken 48hrs prior. You will also need to stop eating and drinking 6 hours before your surgery time. In most hospitals they allow you to sip one cup of water an hour before your surgery to prevent you being too dehydrated. You will be given some oral medications upon arrival also to prevent reflux.

Once you arrive at the hospital you will be checked in and changed into a hospital gown (with all your underwear removed) and your partner/support person will either have some scrubs to put on or some kind of PPE type gear. I know at Auckland Hospital where I work, they put your support person in scrubs and a bright orange hat so that when you go into theatre everyone knows they are not medical and no one should give them a scalpel! Then you wait in a room with a bunch of other people who are also waiting for their elective c-section and when your name is called you stand up and walk into theatre with your partner and the whole process begins.

With an elective c-section it tends to be a lot more relaxed that an emergency. Everyone takes their time to do their specific job, and no one is rushing or stressed. The surgeon will take their time and go at their own pace to get your baby out.

Most surgeons will take about 10-15 minutes to get your baby born, some less and others more if there are any adhesions or scar tissue or complications especially if you have had a c-section before. With all c-sections most of the time in theatre is your surgeon sewing up all the layers after your baby has been born.

EMERGENCY C-SECTIONS (ORANGE LIGHT)

An ‘orange light’ emergency c-section is when you have gone into labour and then your baby is born via c-section but neither the baby or mother’s lives are in imminent danger.

Most emergency c-sections happen in the ‘orange light’ stage where there is some level of maternal or fetal compromise, but these are not immediately life threatening meaning they do need prompt attention but do not require immediate surgery.

Why you might have one
In the latest clinical report put out by National Women’s Auckland Hospital in 2023, of the 44.6% of babies that were born via c-section, 43.5% were for a labour dystocia reasons. Meaning that labour is abnormally slow and prolonged or obstructed from either the cervix not dilating adequately or there being a mismatch between the size of the baby and the mother pelvis making it difficult to pass through. 32.5% of the baby’s born via c-section were due to a fetal reason where your baby’s heart rate becomes abnormal and is showing us that they are getting stressed and tired and need to be delivered soon. In all these examples if you are not fully dilated or close to it, then a vaginal birth is not possible, and your baby will need to be delivered by emergency c-section. And the remaining 8.9% were from those who had had a c-section in a previous delivery.

What you can expect
You and your support person will have a detailed conversation with your obstetrician or the hospital obstetrician or obstetric registrar about the operation and procedure and you will give your written consent for it. Your baby will continue to be monitored via a CTG machine, this machine continuously monitors your baby’s heart rate very closely and this will stay on until the time of surgery because if your baby’s heart rate suddenly deteriorates your care plan might change and you might be upgraded to a category one or a ‘Red Light’ emergency c-section. You will have an IV leur put in if you don’t already have one and have fluids running and some IV medications will also be given to prevent stomach reflux. If you have an epidural already in situ then the anesthetics team can easily top it up but if you don’t then they will pop a spinal anesthetic in. You will have a catheter put in your bladder also. Your partner will get changed into scrubs and their hat and when there is a theatre available you will be pushed into theatre on your bed and transferred over to the theatre bed ready for your c-section to begin.

EMERGENCY C-SECTIONS (RED LIGHT)

A ‘red light’ emergency c-section is what we might call a category one c-section, meaning that there is immediate threat to the life of the woman or her baby so a c-section needs to be performed as soon as possible. Sometimes known as a crash c-sections, these are very uncommon and occur in less than 1.5% of all birth in New Zealand.

Why might you have one
Examples of this might be a uterine rupture, where a previous uterine scar might dehiscence or the uterus literally ruptures causing a large amount of blood loss for the woman and a reduction in blood flow/oxygen to the baby. Another reason might be a major placental abruption, this is where the placenta separates from the side of the uterus before the baby is born again causing a large amount of blood loss for the woman and a major reduction in blood flow/oxygen to the baby. You would also need a ‘red light’ emergency c-section if you have a cord prolapse, this is where the cord comes through the cervix before the baby which can lead to it getting compressed by the baby coming through behind and causing reduced blood flow and therefore reduced oxygen to the baby. Sever fetal hypoxia is another reason for a category one c-section and this would be noted by your baby’s heart rate being very slow or other abnormalities picked up by the CTG that is monitoring your baby’s heart rate.

What you can expect
Your obstetrician or the hospital obstetrician or obstetric registrar will provide you and your support person with an adequate explanation about the operation and procedure and you will give your verbal consent as there is no time for written consent.

Your baby will continue to be monitored via a CTG machine, this machine continuously monitors your baby’s heart rate very closely and this will stay on until the time of surgery. You will have an IV leur put in if you don’t already have one and have fluids running. The medications that were given via IV in an ‘orange light’ c-section are given to you orally as they don’t have time to go through via IV. You will have a catheter put in also.  If you have an epidural already in situ, then the anesthetics team can easily top it up but if you don’t then it’s likely they won’t have time to site a spinal anesthetic so you will probably need to have a general anesthetic. This means that you will be asleep when your baby is born and because you are asleep then no support person is in the room because you are asleep you don’t need supporting. If you do have an epidural in situ, then your partner will quickly get changed or be given some PPE to throw on and you will be raced into theatre and transferred to the theatre bed for your c-section to begin asap.There will likely be lots of staff in the room to help get everything prepped as fast as possible and there will also be pediatricians in the room too to assist with the baby if it comes out compromised. Your surgeon can get your baby out in less than five minutes if they need to.

I’ve been a midwife for over a decade and been to every possible birth, including hundreds of c-sections. I’ve also had an elective c-section myself and I want you to know that c-section births are just as wonderful, beautiful, and amazing as any other birth!

Please don’t think you have failed or that you have had a less birth experience – you still get that magical moment of meeting your new baby that you’ve been waiting nine months to meet!

Grace Strange is a midwife and creator of Antenatal Co. – independent antenatal classes that were born out of a desire to ensure parents have access to the very best antenatal education and head into labour, birth and beyond fully prepared. Find out more at antenatal.co.nz or on Instagram antenatalco.