Here is what mums asked our midwives this week: planned C-sections, Category 4 and what happens if you go into spontaneous labour

If you have a planned caesarean section booked and your midwife has told you that you are Category 4, or that they cannot guarantee your section if you go into spontaneous labour, it can feel really unsettling — especially in the final weeks of pregnancy. This week a mum at 35 weeks asked us about exactly this. Here is what our midwives had to say, along with everything you need to know about your rights.

What does Category 4 mean?

The NHS categorises caesarean sections by urgency using a four-level system outlined by the National Institute for Health and Care Excellence, known as NICE.

Category 1 is an immediate threat to the life of the mother or baby. Category 2 is maternal or fetal compromise that is not immediately life-threatening. Category 3 is when there is no immediate threat but the birth needs to happen sooner rather than later. Category 4 is a planned or elective caesarean section at a time that suits the mother and the clinical team.

Being Category 4 is not a negative thing. It simply means your caesarean is planned rather than urgent, and that you and your baby are not in any immediate danger. It means the procedure can be scheduled at a convenient time and carried out in a more relaxed way than an emergency section.

Why can't they guarantee the section if I go into spontaneous labour?

This is one of the most common concerns mums with planned sections have, and the answer is straightforward. No one can predict what will be happening on a maternity ward at any given moment. If you go into spontaneous labour before your scheduled date, the team will assess what is happening on the ward at that time, how far along you are, and what is safest for you and your baby.

In most cases, if capacity allows and there are no clinical emergencies taking priority, they will carry out your section. It just may not happen immediately, and there may be a period of waiting or monitoring first. This is not a sign that your request is being ignored — it is simply the reality of how a busy maternity ward operates.

What are your rights when it comes to a planned caesarean?

If your planned caesarean is a maternal request, meaning you have requested it rather than it being clinically indicated, you have clear rights under NICE guidelines. According to NICE, if you request a caesarean and your obstetrician or midwife is not able to support that decision, they must refer you to a clinician who will. You cannot simply be denied a planned caesarean without being offered an alternative pathway.

Birthrights, the charity that protects human rights in childbirth, has a detailed factsheet on your right to a planned caesarean which is well worth reading if you want to understand your options fully. You can find it at birthrights.org.uk.

What should I do if I am worried?

If you have concerns about your birth plan, the most important thing is to have a clear and honest conversation with your midwife or consultant before your due date. Ask them directly what will happen if you go into spontaneous labour before your section date, what the process will be, and who will make the decision on the day. Getting these answers in advance can help you feel more prepared and less anxious when the time comes.

It is also worth writing your caesarean preference clearly in your birth plan so that anyone caring for you in labour is aware of it from the moment you arrive on the ward.

What happens during a planned caesarean?

Planned caesarean sections are typically scheduled from 39 weeks of pregnancy to allow your baby's lungs to develop as fully as possible before birth. On the day, you will usually be given a spinal anaesthetic so you are awake but cannot feel pain. The procedure itself takes around 40 to 50 minutes in total, with your baby usually born within the first 10 to 15 minutes. You will be able to have a birth partner with you throughout.

For a full overview of what to expect on the day, the NHS has a detailed guide at nhs.uk/tests-and-treatments/caesarean-section.

Got a question of your own?

Every week our midwives answer the questions mums are actually asking. Got a question of your own? Our midwives are available right inside the Dearbump app, ready to answer it directly.