A Caesarean section is usually carried out when a normal vaginal birth could put the mother or unborn baby at risk. Other reasons include if the mother has had two or more previous Caesarean sections or their baby is in the breech bottom first position. Another 20 per cent were delivered by an emergency Caesarean section, which meant events before or during labour eventually meant this operation has to be carried out even thought the mother had not initially chosen it. It usually takes minutes, but can be performed quicker in an emergency. A third of women with pain at six months after the birth said this pain persisted a year later One of the study's authors, Ellie McDonald, from the Murdoch Childrens Research Institute, Victoria, Australia said: Mothers who had a vaginal birth using vacuum extraction — in which a midwife applies a vacuum with a soft or rigid cup to the baby's head to help guide it out of the vagina — were also twice as likely to report pain more than a year after giving birth. The researchers said other factors associated with pain during sex at this time include whether the women experienced it before becoming pregnant, partner abuse and fatigue. Of the women, 49 per cent had a vaginal birth, and two thirds of these women had a tear in the area between their vagina and anus that needed stitches, or an episiotomy. Women who had an elective Caesarean section, an emergency Caesarean section or a vaginal birth with vaccum extraction were twice as likely to report pain during sex 18 months after giving birth. This went down to 43 per cent at six months, 28 per cent at 12 month and 23 per cent by 18 months. Of those that reported pain during sex at six months after having their baby, a third said this pain persisted a year later. Less than 10 per cent were delivered by an elective Caesarean section — where a medical reason meant the mother had opted for this operation before the birth. By six months, 94 per cent of women had resumed having sex; 97 per cent resumed 12 months after giving birth and 98 per cent 18 months afterwards. This could be if the labour doesn't progress naturally, the mother has placenta praevia where the placenta is low lying in the womb and covering part of the womb's entrance. The researchers found 78 per cent of women resumed having sex three months after having their baby. However most of the women 86 per cent who had started having sex again 12 months after the birth experienced pain. A Caesarean section is an operation to deliver a baby.