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What to expect in an emergency C-section

Learning an emergency C-section has become necessary during your delivery isn’t easy news. But by arming yourself with the right information, you can prepare yourself for the challenges that might come your way on the big day.

Woman undergoing c-section |

Why might an emergency C-section become necessary?

Dr. Noha Kadhom, an obstetrics and gynecology resident at The Ottawa Hospital, explains that one of the most common reasons for an emergency Caesarean section is an abnormal fetal heart rate. “While you’re in labour, the best way for us to determine how your baby is doing is by monitoring their heart. There are patterns associated with poor outcomes, and that’s when we would decide to proceed with a Caesarean section,” says Kadhom.

Another reason is labour dystocia, which essentially means your body (or cervix) is not progressing (dilating), she explains. Although this is not necessarily an emergency, if your cervix doesn’t dilate or stops dilating, vaginal delivery is not possible. Your medical team might try to break your water if it hasn’t broken already as a way to augment labour, but if your body doesn’t respond, the next step would be to proceed with a C-section, says Kadhom.

Although abnormal fetal heart rate and labour dystocia are two of the more common reasons a C-section might be required, the real obstetrical emergencies are placental abruption and cord prolapse, explains Kadhom. Placental abruption occurs when your placenta starts to detach. This might cause you to experience pain, contractions and bleeding. Because the placenta connects the mother to the fetus and is an essential source of nutrients and oxygen, if that connection is broken, the baby can die, says Kadhom. Therefore, when this condition is diagnosed, an immediate Caesarean section is warranted. Similarly, in cord prolapse, the cord slips beside or below the presenting part, causing cord compression, which means the baby is cut off from blood and oxygen. This can also cause fetal distress and death, so a C-section would be necessary, says Kadhom.

What happens during an emergency C-section?

Kadhom recommends mothers prepare for there to be a lot of people and plenty of noise if an emergency Caesarean is required. But she also encourages you to keep in mind there is order in the chaos. When you are brought into the operating room, you will meet your anesthesiologist, who will decide on the best course of pain relief (see below for more information on your options).

The entire medical team will then do a “surgical brief,” where they discuss the plan for surgery to ensure everyone is on the same page. Then, Kadhom explains, a nurse will put a catheter into your bladder, and your abdomen will be cleaned with a solution. The anesthesiologist will also use this time to give you an antibiotic through the vein to decrease your risk of developing an infection, and the surgeons will prepare themselves for the surgery. Sterile drapes will be placed over your body, and they will test your skin to ensure you are well frozen. Then the surgery begins.

If you are awake for the surgery, Kadhom suggests you prepare yourself to feel some pressure, but you should not expect to feel anything sharp or painful. At some point you will feel as if an elephant is sitting on your chest, says Kadhom, and that means your baby is about to come.

Once delivered, the baby will be handed over to the awaiting neonatal team, who will ensure he or she is OK. If so, you will get to hold your baby. If not, they will do everything they can to help your baby, explains Kadhom. During this time, the surgeons will close you up, which means your time in surgery is nearly at an end.

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Needle | Sheknows.caWhat are your pain relief options?

At the time of an emergency C-section, some patients might already have pain relief, such as an epidural, in place for labour, explains Dr. Kelvin Kwan, an anesthesiology resident at The Ottawa Hospital. If you already have a working epidural catheter in place, then additional anesthetic solution can be added to provide you with pain relief, says Kwan. If an epidural is not in place, spinal anesthesia might be used instead. If a spinal needle is not possible due to anatomic reasons or other medical issues, such as concerns about bleeding, general anesthesia might be used. This would cause you to be “put to sleep,” similarly to how it would occur in other surgeries, he explains. There are advantages and risks to each form of pain relief, and it is worth considering the risks before the labour pains start, when your head is more clear, suggests Kwan.

What are the risks of an emergency C-section?

Even a planned Caesarean section has serious potential risks, such as infection, bleeding, injury to surrounding organs and post-operative clots. The risks of injury to surrounding organs or major vessels are greatly increased due to the speed at which an emergency C-section has to take place, explains Kadhom. An elective Caesarean can take up to 15 to 30 minutes from skin incision to delivery of the baby, whereas during an emergency C-section, it all happens in less than a minute, says Kadhom, so the risks are much higher. All this said, never forget that the doctors and nurses are there for you. “As obstetricians, our job is to ultimately ensure the safe arrival of the baby while ensuring the mother’s well-being,” explains Kadhom. So if you have any questions leading up to or on the day of your delivery, ask.

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