Emergency caesarean: why it can happen and what to expect

If you’re pregnant, chances are you’ve already put a lot of thought into what your birth is going to look like. Perhaps you’ve planned your music, considered a water birth and discussed pain relief (or lack of). 

But it’s good to be aware that, through no fault of your own, births don’t always go to plan. Babies don’t always read (or stick to) your memo. Bearing this in mind, it’s important to be prepared for all circumstances. That includes an emergency caesarean section.

 

In Australia, about 34 per cent of all births are caesarean sections (or c-sections). Of these, 40 per cent are emergencies. 

“Childbirth is – and always will be – unpredictable,” says Dr Danielle Wilkins, director of maternity services at Cabrini Health. “We’re very good at determining if a baby’s coping with labour by monitoring their heart rate. Because human life is so precious, we err on the side of caution,” she says.

Why an emergency c-section?

An emergency caesarean section (ECS) is generally performed for you and your baby’s wellbeing and safety. There are multiple reasons why an ECS may be needed.

“Some babies struggle to rotate to the correct position to fit through the pelvis or are simply too large,” says Wilkins. “This can cause distress and may also stall the progress through labour.  

“Occasionally the pelvis is the wrong shape or size for the baby and, less commonly, the medical condition of the mum may warrant an urgent delivery by caesarean section.”

Other reasons for an ECS include a labour that’s not progressing (possibly because contractions aren’t strong enough or the cervix is opening too slowly, or not at all); a tear in the uterus (known as a uterine rupture); and the baby showing signs of foetal distress, primarily caused by a lack of adequate amounts of oxygen.

What happens next?

If the decision’s made that an ECS is required, doctors will obtain your consent and explain what will happen both during and after the operation. 

You’ll then be taken to theatre. 

“Theatre’s a bright and busy room with at least 10 people present and a couple of noisy machines,” says Wilkins. “When you arrive, the anaesthetist and nurses will look after you.”

A regional anaesthetic such as a spinal or epidural top-up will be used, and a urinary catheter (soft rubber tube) will be inserted by the midwife to drain your bladder. 

“The anaesthetic makes the skin and tissues numb to pain, but it doesn’t take away the sensation of touch and movement which can be unsettling for some women,” says Wilkins. “We do a lot of testing for numbness before starting the operation.”

Once the anaesthetic has worked its magic, you’re set to become a mum. It takes about five minutes to deliver your baby and about 30 minutes to finish the operation.

While uncommon, a high-urgency ECS is treated slightly differently. 

To save time, doctors would explain the reasons for the ECS and obtain consent en route to the theatre where medical staff would be waiting.  

“There would be many hands ready to make the task run more smoothly, with one person leading the emergency,” explains Wilkins. “The anaesthetist would be ready to make the woman comfortable, as safely as possible, and the paediatrician would be ready to care for the baby.”

Occasionally an emergency ECS requires a general anaesthetic. 

What are the risks?

As with any operation, there are risks associated with an ECS. Aside from the emotional impact, there is a higher risk of post-operative infection, excessive bleeding, and damage to the abdominal and pelvic spaces. 

There’s also a risk of abnormal clotting of blood within veins, especially in the legs, and of a bladder infection from the catheter.

Prophylactic antibiotics given at the start of the operation, extra medications, injections and, in rare cases, blood transfusions or surgery all help prevent or fix any of these issues. 

What about recovery?

In the first 24 hours, you’ll experience pain and discomfort, so rest and gentle movement only is the order of the day. Pain relief should be taken, and all medicine made available is safe for breastfeeding.  

“By day five, most women are able to care for themselves and their baby by controlling their pain with regular paracetamol and NSAID medication [non-steroidal, anti-inflammatory drugs such as ibuprofen],” says Wilkins. 

“By the end of the first week, most women can walk about their house very comfortably, and by two weeks, walk around the block.”

Some car insurance policies are strict, but most will allow for driving following a medical review, which is possible between two and three weeks. Check with your insurer to find out, and of course, make sure you check in with your doctor about when it might be safe for you to start driving again.

“Around six to eight weeks after birth, we encourage women and babies to have a medical review. This is an opportunity for a further debrief, and to check on mental and medical wellbeing.” 

All heavy lifting – including washing baskets full of wet clothes and shopping – should wait until after this review.

What you might be feeling

When a birth doesn’t go to plan, some women feel like failures. Even more so if their friends or other mums in their antenatal group had a natural vaginal delivery. However, a woman who has gone through an ECS has done anything but fail. 

Each and every birth is different, and the most important thing is that both mum and baby are healthy and safe. 

“Postnatally, if someone’s really struggling with the outcome, it helps to go back to the beginning and step through each part of the journey to understand the choices or decisions made,” says Wilkins. 

Emotionally, Wilkins says that it’s important to get as many blocks of sleep in hospital as possible, and to reach out if you need support. 

Contacting a support service such as Beyond Blue or PANDA is worthwhile. Hospitals will also be able to organise or refer you to counselling services. 

  

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