maternity department

Caesarian section

What will happen to you on the operating table during a Caesarean section? What will you see, hear and feel? How long will it take for your baby to be born, and when will you be able to see him or her? How long will you spend in the operating room and what comes next?

Welcome to the operating room! Do not expect a “movie” setting with lots of beeping machines, tubes, instruments, and dramatic lines.



What will happen to you on the operating table during a Caesarean section? What will you see, hear and feel? How long will it take for your baby to be born, and when will you be able to see him or her? How long will you spend in the operating room and what comes next?

Welcome to the operating room! Do not expect a “movie” setting with lots of beeping machines, tubes, instruments, and dramatic lines.

Once the anaesthetist has administered the anaesthetic, the midwife next to you will help you get comfortable on the operating table, after which your legs will be fixed to it to avoid the risk of falling. This is followed by a thorough disinfection of the surgical field and covering your body with sterile surgical linen. One end of it will be raised and a screen will be constructed using a special stand to restrict your view of the surgical field.

Anaesthesia is now in effect and you have no sensation or ability to move from the diaphragm downwards. Don’t be afraid that the operation will start before the anaesthetic has ‘caught’ you – the anaesthetist and operator will carry out appropriate tests. The anaesthetist and midwife will be by your head – please contact them with any questions and if you have any complaints.

Usually operative labour is performed with regional anaesthesia, but in some more special cases it may be necessary to use a general anaesthesia. Regional anaesthesia numbs you and dulls sensation in the area of surgery, you will feel touch, pressure and pulling but no pain. Except in the rare cases where general anaesthesia is required, you will be conscious during the Caesarean section and will be able to hear the team talking, as well as yourself talking to the anaesthetist who is close by your side at all times. You will also hear your baby’s first cry!

Caesarean sections used to be performed with a long vertical incision from the navel to the pubic bone. Nowadays, this technique is reserved for special cases, and the usual practice is much more discreet – the incision site is low down, just below the bikini line, right where we expect your baby’s head to be positioned. It is usual not to cut the muscles of the anterior abdominal wall, but to pull them aside and, on reconstruction, to attach them carefully with a few light stitches in their usual position. The baby is removed from the uterus with gentle effort – there is a maximum approximation of the process to normal birth and passage through the natural birth canal.

The birth of the baby takes place at the very beginning of the operation – around the fifth minute. What happens to the newborn and when you will get acquainted we will tell in a minute. Now two words about what happens in the remaining minutes on the operating table. After the baby is born, the placenta needs to be delivered – it has already fulfilled its functions and cannot remain in the uterus. In a normal birth, its separation from the walls of the uterus occurs naturally under the influence of the hormone oxytocin within a few minutes after the baby is born. In a Caesarean section, this process is simulated by the operator using a small dose of intravenously administered oxytocin to stimulate easier and more complete separation of the placenta.

After the placenta is removed and the uterine cavity is cleaned, the recovery of all layers of tissue proceeds in sequence. Sometimes this happens slowly – with bleeding, with old adhesions creating difficulties, with removal of cysts, small myomas, etc.  We know you can’t wait to get you out of the operating room, but careful execution of this part of the surgery is key to a normal recovery period afterwards, as well as for a normal subsequent pregnancy. Aesthetic suturing is not always possible – sometimes single sutures are preferred to better drain the wound.

Elective C-section

An elective Caesarean section is usually performed about 7-10 days before the probable due date of delivery. In multiple pregnancies or other medical indications, a date may be scheduled earlier.

Preparation requires tests (blood, urine), consultation with an anaesthesiologist and/or internist, ECG (at discretion), statement of indications for Caesarean section delivery.

Admission to the hospital is determined by the physician, and is usually the day before surgery. You will be directed from the Registry Office to the Admissions Office (room N. 17 on the ground floor) where you will be examined by the on-call physician and your admission medical records will be processed. You will need to bring your ID card, referral for hospitalization N. 7 issued by your GP and an exchange card (for insured patients), as well as the results of the following tests:

  • Rh-factor blood group test – original document (A4 format) signed and sealed by the laboratory where you had the test;
  • Virology (Hepatitis B, Hepatitis C, Wasserman, HIV) – original document with signature and seal from the laboratory where you had the tests. Please take note of their expiry date: testing for Hepatitis B, Hepatitis C, HIV has an expiry date of 6 months and for Wasserman – 3 months);
  • Original documents related to comorbidities, if any;
  • Medical history records from surgeries, if any;
  • Tests done during pregnancy.


You will also examine the informed consent declarations for the procedure will in the Admission Office.

Once your admission procedure has been completed, a member of our staff will escort you from the Admission Office to your inpatient room in the Gynaecology and Pathological Pregnancy Department on Floor 3.

Prior to surgery, you will be consulted by a critical care anaesthesiologist as well as an internist and other medical professionals as needed.

You will be instructed from what time on you should not eat any food the evening before your Caesarean section. When the operation is planned for the morning, eating is usually stopped from about 6.00 pm the previous evening, and only light and rapidly digestible food is acceptable. No water or food is taken on the morning before surgery.

Your relatives may visit you during the designated visiting hours on the floor, if the epidemiological situation in the country allows it. In a pandemic situation, the visiting arrangements in the Department may be changed and temporarily restricted or suspended.

Free Internet access and television are available within the Department.

On the day of surgery, you will be transferred to preoperative preparation on floor 1, where Nadezhda’s operating theatres are located.

Immediate pre-operative preparation includes:

  • Toileting and hair removal on the intimate areas and lower abdomen;
  • Enema;
  • Removing underwear and putting on a hospital nightgown; 
  • Inserting an abacus for intravenous infusions;
  • Inserting a urethral catheter;
  • Administering anaesthesia;
  • Preparation of the operative field.

And how long before your loved ones hear the happy news? The length of the operation depends on the specific circumstances, with an average duration of between 40 minutes and an hour.

Emergency Caesarian section

The degree of urgency is determined by the specific condition of the mother and baby. In case of extreme urgency, surgery is proceeded to immediately. In most cases, however, we are talking about so-called . “delayed urgency”, in which it is not necessary to proceed to surgery within minutes, and the parturient waits under medical supervision for inclusion in the regular schedule of the operating teams.

As in these situations we do not have a planned admission from the day before and therefore the possibility to perform the pre-operative examinations and tests in the normal schedule, they are performed on an urgent basis:

  • Blood tests (if necessary);
  • Consultation with an anaesthetist;
  • Enema;
  • Toilet and hair removal on the intimate areas and lower abdomen.

Normally the so-called 'Emergency Caeseran section' is used in two situations:

Meeting the baby for the first time after Caesarian section

първа среща с новороденото след секцио в болница "Надежда"

You have had a Caesarean section at Nadezhda – when will you be able to see and touch the baby, will you be able to realise bonding, when will you be able to feed the baby?


As you may have already read, usually with a Caesarean section the baby is born early in your stay in the operating theatre – only about 5 minutes after the start of the operation. It is carefully removed by the operator in a way that somewhat mimics its passage through the natural birth canal. As the muscles of the abdominal wall are not usually cut today, but only separated, the baby experiences some resistance in overcoming this barrier. Usually, the baby’s head is born first and then the body – just as in normal birth. You won’t feel any pain, but you may feel a pulling or stretching as the baby is pulled out.


And there you have it! Congratulations! You’re a mom now!

Don’t expect to hear loud baby cries – some newborns just cry gently. Others cry loudly as if they want the whole world to know they’ve been born!


The baby is taken care of by a paediatric obstetrician and paediatrician. They examine the newborn and help the newborn adapt. They do the measurements for the baby, put a special bracelet with a number on the baby’s wrist, identical to the one they put on your arm. The numbers are unique and not duplicated.

Depending on whether the operation went without complications and whether the baby’s condition allows it, the baby may be placed on your chest for a minute. However, as all layers of tissue need to be carefully restored, this contact is not advisable to be prolonged to allow the operating team to complete the operation without interference or distraction.


Usually, after being shown to you, the newborn is also introduced to dad for a minute and then is taken over by the neonatal team who provide everything he/she needs while you leave the operating room and go through the intensive care period immediately following surgery.

Stay in AICD and recovery recovery after C-section

Интензивен сектор в Отделението по Анестезиология и интензивно лечение на болница "Надежда"

Immediately after your surgery is completed, you will be transferred to the Anaesthesiology and Intensive Care Department (AICD) where your intravenous infusions, pain relief and monitoring of your general condition will continue.


After surgery it is normal to have a cold sensation – this is due to the anaesthetic, the infusion of cool solutions and usually passes quickly. Do have in mind that despite the anaesthetic you will continue to experience some pain, as this is an important indicator and benchmark for monitoring your post-operative status and it is not advisable to dull it completely.

A few hours after the operation, if you feel well and the baby’s condition allows it, it is possible to bring your newborn to the AICD for a brief meeting – this is the point at which you will be able to put him/her to the breast briefly, or just cuddle him/her. If for medical reasons this is not possible at this stage, do not feel regret or disappointment – in the first hours after birth, the most important thing for both you and your baby is your quick and complete recovery.


After a surgical delivery, your stay in the intensive care unit will be between 6 and 24 hours at the discretion of the anaesthesiologist. When your condition permits, you will be allowed water intake and later you will be stirred. In the first few days after surgery you will have a pulling sensation and pain on getting up. Don’t worry – these are perfectly normal sensations that should not stop you moving around and will gradually pass. Before getting out of bed for the first time, it’s a good idea to do a few light stretches on different parts of the body in turn (arms, legs). Remember – getting up should always be smooth, with breaks, with your head and back straight. If you feel faint, stay in place, look for support to hold on to and breathe slowly and deeply!


During your stay in AICD, your baby is entrusted to the care of our peadiatricians and obstetricians in the Neonatology Department, where he or she gets everything he or she needs. After your recovery, you will be transferred to the Postnatal Clinic, where the Neonatology team will reunite you with your baby.


See also

Delivery rooms
Admission checklist
Postnatal care home visits
Stay in the Postnatal Clinic