ENMany families ask whether a caesarean can simply be chosen. A caesarean section in Germany is performed when there is a medical reason for it: it is real surgery with its own benefits and risks, not a way of speeding things up.
Below: the reasons for the operation, vaginal birth after a caesarean, the operation itself, recovery and the flight home, where it is done and how AlenMed arranges it. For childbirth in general, see giving birth in Germany.
When doctors recommend a caesarean
Doctors recommend a caesarean when surgery is safer for the mother or the baby than a vaginal birth. A planned caesarean is scheduled when the reason is clear in advance: the baby lying transversely, placenta praevia (the placenta covers the exit of the womb) or some multiple pregnancies. For a breech baby (lying head up), previous surgery on the uterus or some conditions of the mother, the doctor decides case by case. Hence the difference between an absolute reason, with no safe alternative to surgery, and a relative one, where the options are weighed.
An emergency caesarean is done when something changes during labour: the baby’s heartbeat suffers, the placenta separates from the wall of the womb too early, or labour does not progress.
A woman who wants a caesarean without a medical reason needs an honest conversation with the doctor about the risks for this birth and for the next pregnancy (for instance, the placenta is then more likely to grow too firmly into the wall of the womb). The German S3 guideline “Caesarean section” (Sectio caesarea) describes this conversation: the reasons for the wish are discussed, and the risks and benefits are compared with those of a vaginal birth. The decision comes after this counselling.
Can you give birth naturally after a caesarean?
For many women, yes: a vaginal birth after a caesarean is possible. It depends on the type of incision in the uterus, the reason for the previous operation, the time since the last birth and the course of the current pregnancy.
So bring the report of the previous operation in translation: the doctor needs to know the type of incision. The decision is made by the doctor and the woman at the hospital, with no promise in advance.
How the operation goes
A caesarean is done in the operating theatre under anaesthesia, after some preparation. The woman is examined, blood is tested and the anaesthetist talks her through the anaesthesia. For a planned operation the date is set in advance.
Usually a spinal anaesthetic is given: an injection in the lower back numbs the lower half of the body, while the mother stays awake and sees her baby straight away. General anaesthesia is needed in some emergencies. Whether a partner may attend depends on the hospital’s rules, so ask in advance.
The incision is usually low and transverse. If the baby is well, skin-to-skin contact on the mother’s chest begins in the operating room, and a neonatologist (a doctor for newborns) checks the baby if needed.
Recovery and returning home
Recovery takes a little longer than after a vaginal birth, and so does the hospital stay. Getting up and walking early is encouraged: movement helps recovery and lowers the risk of thrombosis. Painkillers compatible with breastfeeding are given, and compression stockings and, at higher risk, heparin injections help prevent thrombosis. Staff look after the wound. Breastfeeding works despite the wound; getting started can be harder, and staff help.
The flight date is agreed with the doctor, depending on how the wound heals and how mother and baby are doing. See a doctor for fever, increasing pain, discharge from the wound, or pain and swelling in a leg. The interval before the next pregnancy is also discussed with the doctor.
Where it is done: perinatal centres and doctors
Caesareans are done only in hospitals; if the newborn may need intensive care, a level 1 perinatal centre is chosen, with neonatal intensive care under the same roof as the delivery unit (see how maternity hospitals in Germany are organised). One such centre is Bürgerhospital Frankfurt, where the women’s clinic is headed by Prof. Franz Bahlmann. Katholisches Marienkrankenhaus Hamburg also has a level 1 perinatal centre with a neonatology unit; its gynaecology is led by Assoc. Prof. Ahmed Farouk Abdelkawi EG.
In Munich, Dr Ina M. Rühl leads obstetrics at Rotkreuzklinikum München (subspecialty: special obstetrics), and Dr Olaf Neumann is chief physician of gynaecology and obstetrics at München Klinik Schwabing (subspecialty: special obstetrics and perinatal medicine).
Frequently asked questions
What anaesthesia is used for a caesarean?
Most often a spinal anaesthetic: the woman stays awake and should feel no pain, though she may notice pressure and pulling during the operation. An epidural already placed during labour can also be used for the caesarean. General anaesthesia is used in some emergencies or if the woman clearly asks for it. The choice is discussed with the anaesthetist beforehand.
Can my partner be present at a caesarean?
Usually yes, under spinal or epidural anaesthesia: the companion is given theatre clothing and sits by the woman’s head. Under general anaesthesia the partner usually waits outside. Rules differ between hospitals, so check them in advance, ideally when you book the birth.
When can I fly home after a caesarean?
There is no single answer: the date is agreed with the obstetrician and the paediatrician, who look at how the wound is healing, how the mother is recovering and how the baby is doing. Book return tickets that can be changed, and carry the translated discharge report so that a doctor at home can continue the follow-up.
How AlenMed arranges a caesarean section in Germany
AlenMed handles documents, travel and contact with the hospital; medical decisions rest with the hospital’s doctors. Before the trip, AlenMed translates the pregnancy records and reports of previous operations and sends them to a suitable hospital. The doctor replies with a proposal: a planned caesarean or a trial of labour. The hospital issues an official cost estimate (Kostenvoranschlag) with a reserve for the unexpected; see the cost of giving birth in Germany.
AlenMed then helps with the hospital’s visa invitation, books accommodation near the hospital and arranges an interpreter. AlenMed’s office is in Munich, with partner clinics across Germany; see arranging treatment in Germany.
After the birth, AlenMed helps with the newborn’s documents, the translated discharge report and the follow-up plan for doctors at home.
This material is for reference only and is not an offer. The mode of delivery is decided by the doctor after an in-person examination at the hospital.