For most pregnant women, a cesarean section is not something they’d like for their birth experience. If we add the word emergency to it, it gets scary and sounds dangerous. But what exactly is an emergency c-section?
Let’s find out everything there is to know about emergency c-sections and what this actually means.
Emergency C-Section #1. Definition
Researchers agree that an emergency cesarean section (sometimes written as ’emergency caesarean section’) is an unplanned c-section that can happen during labor or before its onset. Usually, it is needed because of maternal, fetal or placental problems, such as high blood pressure, uterine rupture, fetal distress, prolapsed umbilical cord or placental abruption.
The World Health Organization recommends keeping cesarean births under 10% of all births.
Emergency C-Section #2. Categories
There are various categories for any emergency cesarean delivery. Although all types of cesarean births are classified as emergencies, ending up in the operating room because of a life-threatening condition isn’t the same as having a c-section because a vaginal birth doesn’t seem the best option after a prolonged labor or a failed induction.
The UK’s National Institute for Health and Care Excellence (NICE) states there are three different categories or classifications for emergency c-sections, depending on the urgency of the surgical procedure. The decision delivery interval is of paramount importance in this classification.
Emergency c-section: Category 1
Also referred to as ‘crash section’, this category is the most urgent of all emergency c-sections. In these cases, the mother or the baby’s health is severely compromised and there’s an immediate life threat to either or both. The unplanned c-section should be performed as soon as possible – usually within 30 minutes of the decision being made.
Unless the mother has already had some consistent pain relief, such as a spinal injection, put in place for example, for a trial of instrumental delivery, it is most likely she will be put under general anesthesia, as it’s the fastest anesthesia when time is of the essence. A support person is usually allowed in the operating room with her while she’s awake and only leaves the theatre once the mother is under general anesthesia.
Examples of a Category 1 emergency cesarean section would be: a hemorrhage; a uterine rupture or a case where the baby’s heart rate drops consistently and fails to recover.
Emergency c-section: Category 2
A Category 2 emergency c-section is when there is either fetal or maternal compromise but it isn’t life-threatening. Although it should be performed as soon as possible, the time frame for it to be classified as Category 2 would be within 75 minutes of the decision for cesarean delivery being made.
Examples of a Category 2 cesarean section would be prolonged labor or cases where it is difficult for the baby’s head to engage in the birth canal.
Emergency c-section: Category 3
In this category, a c-section will be performed but there is no life-threatening condition for either the mother or the baby.
The main reason for a Category 3 emergency c-section is a failed induction. Everything has been put in place for birth to start artificially but, despite all efforts, the woman’s body hasn’t responded to the induction.
The vast majority of emergency c-sections fall into this category. Although it might be reassuring to some women, it is also quite disheartening to see that most emergency cesarean births are a consequence of medical intervention. Induction of labor can have a deep impact on a woman, especially when, after going through the medical induction, it fails and the baby is finally born by emergency c-section.
Read more in BellyBelly’s articles:
Do Inductions Increase The Risk Of C-Section?
How Do Inductions Lead To C-Sections?
Why Do Inductions Fail? When Inductions Of Labour Don’t Work
8 Reasons To Say No To Labour Induction.
Emergency C-Section #3. Reasons
Research has shown once and again that the main reason for emergency c-sections is medical intervention.
A cesarean section is a major surgery that has been mastered throughout the years, minimizing its risks and complications. This is good news, of course, but the number of unnecessary cesarean sections is increasing dramatically.
A c-section procedure can never be compared with vaginal birth. We aren’t simply talking about the difference in recovery; it’s almost instantaneous following vaginal birth compared with c-section recovery. It’s more than that. Life in general will change for a woman after a c-section and a first c-section will also have an impact on that woman’s future pregnancies. A previous c-section can cause adhesions and the scar tissue can affect future fertility.
Pregnancy and birth are physiological events in a woman’s life. When the medical community began to intervene in normal birth, a natural process was artificially medicalized, to the point where, in some hospital units, it created so many risk factors that has become difficult to find a low-risk pregnant woman. Once intervention starts, usually in early pregnancy but sometimes even before conception, the chain of interventions snowballs very quickly.
Unfortunately, the main reason for the elevated number of emergency cesarean sections is the level of previous interventions that lead to an emergency procedure that shouldn’t have happened in the first place.
Emergency C-Section #4. Risks
A cesarean section, whether it is an emergency or a scheduled c-section, carries far more risks than a vaginal birth.
1. Risks to the mother
The UK NHS has established the risk of death for the mother as 3 times higher during a c-section than during a vaginal birth.
In Canada, it’s been established that the difference in serious morbidity and mortality was as high as an additional 1.8 cases in every 100 cases.
The risks of adhesions, hematomas, wound infections and severe blood loss are also the direct consequence of a surgical birth.
At the same time, other complications can arise in future pregnancies – for example, the chance of developing placenta accreta, a potentially life-threatening condition that increases with the number of cesarean sections a woman has had.
As well as the risks of the surgical procedure, we must also take into account the risks of anesthesia.
2. Risks to the child
There is relevant research on the harm to babies when they are born before their ‘right time’. Bear in mind that, for some babies, their right time is beyond the estimated due date. Therefore, even if a cesarean section is done after 37 weeks gestation, there’s no way of knowing when the right time was for that baby.
Early-term births have been associated with higher risks of infant death and health problems later in life. Admissions to NICU and the need for respiratory support were also much higher for babies born before their time.
The least amount of intervention results in higher chances of a healthy baby.
Emergency C-Section #5. Crash c-section vs emergency c-section
A ‘crash’ c-section is a Category 1 c-section. It needs to be done as soon as possible because the life of either the mother or the baby, or both, is at risk.
A crash c-section should be performed within 30 minutes of the decision being made. Some bigger units have reduced this time to 20 minutes. Despite any stated time, a crash section should be done as soon as possible to get the best results.
Emergency C-Section #6. Is it more painful than planned?
There are two factors to be taken into account when comparing an emergency c-section with a planned c-section.
The emotional aspect
An emergency cesarean section is most likely to be a scary procedure. With a planned c-section, you know about it in advance so it’s not quite so scary. There isn’t an emergency and the staff can dedicate time to help you throughout the procedure. There’s also enough time for the anesthesia to be administered and you have time to think about your c-section birth plan.
For the baby’s health condition, at birth and later in life, an emergency c-section is usually better. This is because, although the baby doesn’t know exactly what’s happening, there’s been some kind of prelude or preparation, as something very different has been happening for the past few hours.
The physical aspect
An emergency cesarean has a very important advantage compared with a scheduled c-section. The uterine muscle is much thinner after a few hours of labor contractions, so it’s easier to cut through it and the bleeding from the incision site is lessened and the wound heals much better.
On the other hand, there’s an increased risk of accidental injury to the baby with a scalpel when the obstetric team is trying to deliver the baby quickly.
Emergency C-Section #7. Are you always put to sleep?
This really depends on the category of the emergency c-section and on the anesthesia the woman has previously had. General anesthesia is more commonly used in Category 1 c-sections and in women who haven’t any epidural anesthesia in place. However, women with an epidural will sometimes be put to sleep if there’s no time for the drug to act before the baby needs to be born.
Read more in BellyBelly’s articles C Section Rates | Alarming Highs For Western Australia and US Women Have Too Many C-Sections, With Too Much Risk.
