Emergency C-Sections: A Step by Step Overview

Childbirth can be an unpredictable process. In anticipation of welcoming their new baby, parents often plan ahead, and many have a concrete birth plan in place; however, some find that once the birth process begins, labour may not progress as smoothly as originally foreseen, or the situation may change, sometimes  rapidly and unexpectedly.

In such circumstances, an emergency caesarean section (i.e.- “emergency c-section”) may be necessary in order to keep both mother and child safe and prevent additional complications. In fact, in an obstetrical emergency (eg: perinatal asphyxia, placental abruption, hypoxia-ischemia, cord prolapse, etc) an emergency caesarean section may be only way to expedite delivery and remove the fetus from harm, including brain damage.

While the circumstances of every procedure may differ, knowing what generally tends to happen during an emergency c-section may be helpful to expectant mothers in the event that they must undergo the procedure, or it can help parents who have already gone through an emergency c-section to understand whether something abnormal occurred during the process.

What is a Caesarian Section?

A caesarian section is the method of delivery of a baby through a surgical incision in the mother’s abdomen and uterus.

Recent statistics on c-section rates in Canada suggest that in 2014-2015, 17% of women under 35 delivered their first baby via c-section, and 23% of mothers over 35 did the same.

Scheduled C-Sections

In some instances, a c-section can be scheduled electively and in advance by a mother; however, in Canada, a doctor is required to provide a valid medical reason for an elective c-section.

Medical reasons for scheduling a c-section can include:

• A previous c-section or c-sections to avoid VBAC (vaginal birth after caesarean- which carries the risk of uterine abruption);
• The baby is in breech position (feet-first);
• Multiple babies (i.e.- twins or other multiples), especially if the position of Baby A is breech position or transverse lie);
• Maternal placenta previa (the placenta partially or wholly blocks the neck of the uterus);
• A very large baby, or large for gestational age (sometimes caused by gestational diabetes);
• Cephalopelvic disproportion (if the baby’s head is too big for the pelvis); and
• The mother has an infection (for example, the mother is HIV positive with a high viral load).

Emergency C-Sections

In some circumstances, a c-section is performed in response to an unforeseen complication during labour and delivery. Complications can include:

• The mother’s cervix stops dilating and attempts to stimulate contractions are not effective (arrested labour or ‘failure to progress’);
• A failed induction of labour;
• The baby stops moving down the birth canal and attempts to stimulate contractions are not effective;
• The baby’s heart rate changes or the baby is in distress and cannot withstand continued labour (fetal distress);
• The umbilical cord slips through the mother’s cervix (prolapsed cord); and
• The placenta begins to separate from the mother’s uterine wall (placental abruption).

In an emergency caesarean section, every minute counts towards the delivery of a healthy baby and avoiding brain damage. The obstetrical team must move as expeditiously as possible to deliver the baby and the hospital must have the capability and necessary resources available.

Before the Procedure

An operating room is made available and all the necessary personnel are called to the operating room including nurses, obstetricians and anesthesiologists.

All c-sections, whether planned or emergency, require some form of anaesthesia, whether general, spinal block, or epidural.

Epidural anaesthesia will numb the mother from the abdomen to below the waist (or lower, in some cases) so that nothing will be felt during the procedure. First, the spinal area is cleaned and a local anesthetic may be administered to numb the area, and a very fine, thin catheter is inserted. A catheter will be inserted to collect urine. Mothers will remain awake during the procedure. A screen will be placed above the mother’s stomach so that she will not see the doctor making the incision.

For non-emergent procedures, birth partners are generally permitted to be in room (although they must change into surgical scrubs).

Where babies must be born very quickly, it is more likely that general anaesthetic will be used, which will make the mother completely unconscious. For procedures under general anaesthetic, a mother’s birth partner will likely not be able to be in the operating theatre.

The degree of urgency of the situation will determine what type of anaesthetic will be administered.

During the Procedure

Once the mother is under anaesthetic, the procedure generally proceeds as follows:

• The mother’s abdomen is cleaned with disinfectant;
• An incision in the abdominal wall is made;
• Stomach muscles will be pulled apart so that the physician can access the uterus;
• An incision will be made into the uterus;
• Amniotic fluid will be suctioned out;
• Baby will be delivered, head first so that it’s nose and mouth can be suctioned;
• Baby is shown to the mother and birth partner (if mother awake, and if birth partner in the room);
• Baby passed to nurse for inspection;
• Placenta is delivered; and
• Closing up process begins.

During the procedure, there are likely going to be a number of medical professionals in the room. These can include an obstetrician, an anaesthetist, a pediatrician, nurses, as well as surgical assistants. In emergent situations where fetal distress or fetal compromise is suspected, a neonatal resuscitation team and respiratory therapist are also present.

Hospital Stay and Recovery Time

Generally, provided there are no complications following a c-section, the hospital stay is only a few days.  Depending on what happened at birth, this may be longer.

Recovery time after c-sections can range from weeks to months. Mothers will feel pain or discomfort along their incision, and will be tired and sore. Mothers may also suffer from constipation and have trouble moving around and caring for their baby.

Potential Risks During C-Sections

As with any medical procedure, a c-section comes with a number of  risks. These may include:

• Excessive bleeding;
• Allergic reaction to anaesthesia or medication;
• Infection to incision site, uterus, bladder, or other pelvic organ; and
• Adhesions (i.e.- scar tissue);

Long term effects of complications during labour and delivery include a host of conditions including: hypoxic-ischemic encephalopathy, cerebral palsy, , paralysis, cognitive impairment, developmental disabilities, learning disabilities, intellectual delay, hearing loss, and/or visual impairment.

If you have questions about the medical care provided to you or a loved one during labour and delivery, or you suspect that something abnormal occurred, contact the Toronto-based medical malpractice lawyers at Sommers Roth & Elmaleh. With a more than 40 year legacy of helping patients affected by doctor error and medical error, we are highly respected in both the medical and legal fields. We offer compassionate, knowledgeable, and skilled guidance on all aspects of medical malpractice claims.  Call us at 1-844-777-7372  or contact us online for a free consultation.