An emergency C-section is a Caesarean section that has not been planned by you and your obstetrician (doctor) during your pregnancy and which happens because it is considered the safest way to birth your baby according to your individual circumstances at the time. In contrast, an elective c-section will have been discussed, booked (given a date) and consented to well in advance of the procedure.
Reasons why you may need an emergency C-section
There are many different reasons why you may need or be advised to have an emergency C-section (EMCS) and these reasons determine the urgency in which the procedure will need to take place. To make communication clear among all the members of the multidisciplinary team, EMCS have been classified into 3 categories which define how urgently the baby needs to be born.
A category 3 EMCS has no strict time limit and may be needed if, for example, you are booked for an elective C-section and your waters break and/or you go into early labour. As long as there is no immediate risk to you or your baby, preparations can begin to bring your operation forward.
A Category 2 EMCS allows up to 90 minutes from decision to birth of baby and reasons for requiring one could include compromise to your health (for example, in the case of severe pre-eclampsia or other conditions) or to your baby (e.g., if labour is not progressing and there are signs that your baby may be distressed).
A Category 1 (or ‘Crash’) EMCS indicates that baby needs to be born as soon as possible and no longer than 30 minutes from the time the decision is made. Examples of reasons for needing one include evidence that your baby is severely distressed, heavy bleeding from your vagina, cord prolapse (when baby’s umbilical cord slips down before baby, after your waters break), to name a few.
Who decides that an emergency C-section is required?
In most cases, this is a decision that will be discussed with you by your doctor and midwife. A written consent form should be signed by you for category 2 & 3 emergency C-sections. In the case of a category 1 EMCS, verbal consent is acceptable, as time is often very limited.
How is an emergency C-section different to a planned C-section?
Emergency C-sections are similar to elective C-sections, although some things can be different:
- You may need to read and sign the consent form (or consent verbally) whilst you are in labour and feeling very tired. Your doctors and midwives will make sure they talk to you in between contractions, rather than during them.
- In most cases, you will be able to have a spinal anaesthetic or, if you already have an epidural, you could have this topped up – which will work in the same way. In the rare event that your baby requires to be born very quickly and there is no time to wait for the anaesthetic to work, you may need to be put under a general anaesthetic.
- A Paediatric doctor or team will most likely be present in theatre. Depending on the reason for the EMCS, your baby will need to be immediately checked by them once they are born.
- If you need a general anaesthetic and your baby is stable, he/she will be given to your partner for a cuddle and skin-to-skin until you come out of theatre. If your baby needs treatment in the special care baby unit, your partner will be able to join them as soon as your baby is stable.
Will my choices and wishes be honoured in an emergency?
Make several copies of your birth plan and make sure all the staff involved in your care (sometimes through two or even three shifts) have read it. Depending on the urgency of your EMCS and on your and your baby’s wellbeing, some of your choices and wishes could and should still be honoured.
For example, during a category 3 EMCS, the team should be able to adapt the operating theatre to enable a calmer and gentler birth for your baby by dimming the lights and/or playing music of your choice. In some cases, you may also still be able to have the drape lowered so you and your partner can see your baby being born.
If your baby does not require immediate medical assistance, delayed cord clamping could still be possible and you (ideally) or your partner could have immediate skin-to-skin contact with your baby.
Unless they are under the care of the Paediatric team, weighing your baby can wait until returning to the ward and giving the vitamin K injection (if you’ve chosen for them to have it) can be done during your skin-to-skin contact.
Seeding the microbiome is a relatively new practice that involves swabbing your baby with the friendly bacteria from your vagina, which helps to colonise your baby’s skin and gut, promoting a healthy start to their life. Preparing these swabs before going into theatre should be possible in most cases of a 3 EMCS.
How will my recovery be different?
From theatre, you will be taken to a recovery area where you will stay until you are well enough to be transferred to the postnatal ward. You will not be able to get out of bed for a few hours and will need assistance to do so when you are ready. If your baby is in the neonatal unit, you will not be able to see them until you are well enough and able to be taken there on a wheelchair. On the ward, midwives and other staff will look after you and help you with baby cares and feeding. You will need to take things slowly and take regular pain relief to help manage your recovery. If you have gone through labour before your EMCS, you will feel considerably more tired and weaker that a woman who has had an elective C-section, so be extra kind to yourself. The length of your stay on the postnatal ward will depend on your and your baby’s wellbeing. If your baby is in the neonatal unit, you may be given a side-room, so you don’t have to share a bay with other mothers and their babies.
There are many different reasons why an emergency C-section may be the optimal birth choice for you and your baby and requiring one should never be seen as a ‘failure’. Knowing why you may need one and what happens during and after an EMCS will help you feel informed and more at ease.