The ambulatory caesarean section (ACS) is an innovative type of elective caesarean. It is a section performed through the same cut on the skin as the traditional caesarean section, horizontal just above your pubic area.  

Unlike traditional caesarean sections, the ACS uses an extraperitoneal (outside the abdominal cavity) approach, reducing postoperative pain, enabling quicker mobilisation, and promoting a faster overall recovery.  

Even though it is new at Hillingdon Hospital, it has been done in different places around the world (France, USA, Tunisia, etc.) since it was invented in 1997. 

• Reduced postoperative pain 

• Minimal need for strong pain relief 

• Early mobility 

• Reduced hospital stay 

• Faster overall recovery 

 
International studies have shown that it can decrease pain: in one study, less than 1% of patients required morphine after an ambulatory section, as opposed to around 70% with the standard technique. 

Its second benefit is that it improves autonomy and recovery. From previous studies, most patients were able to stand up, walk around, eat and pass urine/open their bowel on their own in the next 3h after the surgery, as opposed to 24-30h with the standard technique.  

In the best cases, it may even be possible to go home on the same day as the surgery, but it is not necessary if you do not want. 

The ACS is suitable if you: 

• Are at least 37 weeks pregnant 

• Plan an elective caesarean section 

• Consent to the ACS procedure 

However, you may not be eligible if you or your baby have certain medical or surgical conditions (e.g., severe obesity, complex maternal conditions, or certain placental issues). Your healthcare team will thoroughly assess your suitability and discuss it with you 

• Have a discussion with the clinician that is booking your surgery about the ACS and whether you are eligible 

• Meet the ACS team to receive a dedicated consent 

• Attend a preoperative assessment 2 to 3 days before the surgery to have blood sample and discuss. 

• Follow the specific fasting instructions provided by your healthcare team. 

• Come to the hospital on the day of the surgery with your own paracetamol and ibuprofen 

• Ensure you have arranged transportation home and support at home after your discharge. 

There is no difference for you if you have an ACS or a standard Caesarean Section

• Arrive at the hospital by 07:00 am. 

• Your procedure will typically be the first operation of the day. 

• You will receive a spinal anaesthesia, administered gently to minimise discomfort. 

• You will meet your surgical team and the anaesthetic team before the surgery to ask your questions and confirm the plan with you.

• The surgical incision (cut) is small and made horizontally above your pubic area, in the same way as in a standard caesarean section.

• Your baby will be delivered via a careful extraperitoneal approach (going behind the pouch that carried the bowel as opposed to through it usually). 

• After the birth, your incision will be closed meticulously, and your urinary catheter removed during the surgery (as opposed to be done in recovery in a standard caesarean section). 

Item descriptionYou will be encouraged to walk or move early in recovery, independently or with minimal assistance. 

• Early feeding (within 2 hours) and mobilisation will be encouraged. 

• Pain relief typically includes paracetamol and NSAIDs (ibuprofen). 

• You will be discharged home between 15:00 and 17:00 if you want and meet discharge criteria. 

Item descriptionBefore discharge, the healthcare team will ensure: 

• Stable vital signs (temperature, blood pressure, heart rate, etc) 

• Adequate pain control 

• Contraception is discussed and prescribed if needed 

• Independent mobilisation and ability to pass urine 

• Clean, dry, intact wound 

• First baby feeding done  

• Newborn checks performed by the paediatric teram 

There is no difference with the recovery after a standard caesarean section:

• Keep your wound clean and dry.  

• Monitor for signs of infection (red wound, discharge, increasing pain, fever, etc.). 

• Take prescribed pain relief regularly for comfort. 

• Rest but continue gentle mobilisation around your home to aid recovery. 

• Attend scheduled midwife home visits to monitor your recovery and your baby’s wellbeing. 

Community midwives will visit you at home on days 1, 5, and 10 to check your recovery, provide breastfeeding support, discuss contraception, and monitor your emotional wellbeing. 

The ACS, like any surgery, has some risks including possible bladder injury (reduced by careful technique and the presence of a urology specialist initially), difficulty in fetal extraction due to the smaller incision, and standard surgical risks (infection, bleeding, etc.). Your medical team will discuss these thoroughly during your consultation and on the day of the surgery.