Cesarean section is the most common surgery in modern obstetrics. Over the past decades, doctors have mastered life-saving technology almost perfectly, but the difference between planned and emergency c-section still persists.
Medical statistics claim that a cesarean section is the most common abdominal surgery among women. Even during pregnancy, the gynecologist at the antenatal clinic can reveal the indications for this surgery. In this case, the expectant mother has prescribed a planned cesarean section. Each woman decides for herself where to do the operation, but in any case, the expectant mother should undergo a medical examination before a cesarean section.
Often, doctors of the maternity ward face situations when, during the process of childbirth, they have to resort to an emergency c-section. As a rule, the need for urgent surgical intervention and cesarean section occurs in cases when childbirth cannot be resolved naturally without damage to the life or health of the mother and the child.
Unlike planned cesarean section, indications for emergency surgery can occur directly during labor. It also happens that a woman begins to give birth in a natural way, but after a while, it becomes clear to doctors that without a cesarean section, the child cannot be born.
In fact, the main difference between emergency c-section and planned surgery is that doctors use this type of surgery directly during childbirth in the presence of complications that threaten the life and health of the woman, as well as the fetus. Moreover, the indications for an emergency c-section can be problems not only with the health of the mother but also of the child.
Indications for Emergency Caesarean Section
In general, these are any complications that:
- threaten the child;
- or threaten mother;
- or hinder the very process of childbirth.
So, the main indications are the following:
- Weakness or discoordination of labor activity that is not amenable to therapy.
- Premature detachment of the placenta (low or normal).
- Placenta previa with bleeding.
- Acute fetal hypoxia. It is usually diagnosed by slowing the rhythm of the heart of the fetus, which is not restored.
- Clinically narrow pelvis, or a combination of a narrow pelvis and a large fetus.
- The threat of uterus rupture, or the beginning of a rupture.
- Incorrect insertion of the fetal head.
- Incorrect presentation of the fetus (frontal, facial, foot, sometimes transverse).
- Loss of umbilical loops with head or pelvic presentation, and incomplete opening of the cervix.
- Premature rupture of amniotic fluid and the absence of the effect of labor induction.
- Severe forms of preeclampsia, eclampsia.
- Acute form of genital infections (rash), with the risk of fetal infection.
- Worsening condition of the pregnant woman (cardiovascular system, lungs, nervous system, etc.).
There are also Combined Indications for Emergency C-Section
This may be a combination of factors, each of which in itself does not involve an operation, but in combination with others, it is an indication for c-section. For example, a post-term pregnancy, in itself, is not yet a reason for surgery. But, in combination with unprepared birth canal, lack of labor activity (and lack of response to labor induction), and, for example, the age of the woman, can be an indication for emergency c-section.
Or, for example, burdened obstetric anamnesis. This may include abortion, miscarriage, the birth of a child with pathologies, and so on. By themselves, these facts do not imply a mandatory surgery. But, in combination with the age of the woman in labor, and, for example, the fact that the pregnancy was caused by IVF, can already provide a basis for cesarean section surgery.
Who Makes a Decision about the Surgery?
The situation should be assessed by an obstetrician-gynecologist: how is the process going on, is the fetus’s health suffering, is it advisable to continue natural childbirth, etc. The doctor voices the reasons for the woman in labor and she can either agree to an emergency c-section or refuse. The final decision is made by the woman. If she is conscious, she needs to sign a consent. If the patient is against the surgery, it is necessary to sign another document, in which the woman confirms that she assumes responsibility for the life and health of the child.
Options for Anesthesia During Caesarean Section
If a catheter was inserted into the space above the dura mater during labor, epidural anesthesia can be used for emergency surgery, which occurs within 15-30 minutes. In this case, the woman is conscious.
If there is no catheter, and ongoing contractions make it difficult to make an exact puncture for epidural anesthesia, general anesthesia is used.
For emergency c-section, spinal anesthesia is also used, for which it is necessary to give an injection to the lumbar region. The effect of anesthesia begins in 5 minutes, so it is possible to quickly start the operation.
Features of the Procedure
Unlike a planned surgery, when in most cases a transverse incision is made in the lower abdomen, with emergency cesarean section, a longitudinal incision is possible from the pubis to the navel, providing full access to the pelvic and abdominal organs.
Occasionally, it may be necessary to have a blood transfusion during emergency care, as the woman in labor is losing a large amount of blood.
If the woman in labor is conscious, the newborn is shown to her immediately. Then, he is taken to the ward for observation by a pediatric neonatologist.
The whole surgery lasts about 40 minutes, and the extraction of the child takes about 10 minutes at the beginning of the operation.
Since there is no time to prepare for an unexpected surgery, the consequences of an emergency c- section are much more dangerous and pronounced than with a planned surgical intervention. Doctors cannot assess the whole situation objectively; some nuances can be missed, resulting in complications.
Implications for the Mother:
- spinal cord injuries and prolonged back pain during epidural and spinal anesthesia;
- toxic reactions to drugs injected during anesthesia;
- problems with lactation: milk may not appear;
- long recovery period, the need for bed rest is 2-3 weeks;
- great blood loss, anemia – as its consequence;
- pain of sutures, which causes the young mother to take drugs that are undesirable during lactation;
- you cannot play sports after an emergency c-section for a long time, so it can be hard to gain your former shape after giving birth;
- risk of adhesions; the next pregnancy after an emergency caesarean section can take place only in 2 years and, most likely, it will end with the same operation.
Consequences for the Child:
- As a result of anesthesia during emergency c-section, the child’s heart rate may decrease, breathing and motility may be disturbed, disorientation may occur;
- difficulty sucking;
- violation of the production of proteins and hormones, which in the future may have a bad effect on the child’s adaptation to the environment and his mental activity;
- reduced immunity.
With an emergency c-section, the consequences for the child mainly depend on the action of anesthesia. With planned surgery, complications are much less common. This delays the rehabilitation period and requires a longer recovery. If a young mother at this stage fulfills all the doctor’s instructions, this will help her cope with all the consequences of the operation both for her own body and for the baby.
Born in Belarus, 1985, a pedagogue and family psychologist, mother. Taking part in procedures of social adaptation of the foster children in new families. Since 2015 is a chief editor of the motherhow.com project, selecting the best and up-to-date material for those, who are planning, expecting, and already having babies.