Emergency Caesarean Section

What is an emergency caesarean section?

A caesarean section is an operation to deliver a baby through the lower part of your abdomen.  An emergency caesarean section is performed if any complications occur before or during labour.

Why would I need an emergency caesarean section?

• Progress – sometimes the progress of your labour slows down or may even stop, despite methods that can be used by the team caring for you to overcome this
• Baby showing signs of distress – your baby may indicate by showing signs in the pattern of its heart rate or other means that it is tired or not coping well with the labour. Your baby may then need to be delivered quickly and the fastest way if you are not ready to deliver your baby vaginally is by caesarean section
• Medical conditions – occasionally there may be a medical reason in which the doctor may suggest that a caesarean section is necessary, such as raised blood pressure or infection
• Placenta Praevia – This is when the placenta (afterbirth) may be low down inside the uterus and may cover the cervix (opening of the womb). This is usually identified in pregnancy but may present in labour with bleeding
• Abruption – this is when the placenta has started to come away from the womb before the baby is delivered. This may be evident with bleeding or may be related to severe abdominal (stomach) pain
• Cord Prolapse – this is very rare and is when the umbilical cord (which connects the baby to the mother and delivers the oxygen to the baby) may slip in front of the baby’s head and into the birth canal. The risk is that the cord will become trapped or get cold and go into a spasm therefore significantly reducing the oxygen supply to the baby
• Attempted forceps / ventouse – despite the expertise of the doctors it occasionally cannot be possible to deliver the baby by this method and a caesarean section will be necessary
• Breech (bottom first) or malposition (not the normal way for your baby to lie) – if your baby is lying bottom first the team caring for you will discuss the method of delivery with you. If it is neither the head nor the bottom coming first it is impossible to deliver the baby vaginally.
• Baby is premature – this will be discussed on an individual basis to decide what is best for you and your baby
• Planned elective caesarean section – if you start to labour before your planned date you may have to have the operation sooner

What kind of anaesthetic did I have?

There are two types of anaesthesia; you can be either awake (regional anesthesia) or asleep (general anesthesia). Most caesareans are done under regional anaesthesia, when you are awake but you are numb from your breasts down. It is usually safer for mother and baby and allows you and your birthing partner to experience the delivery.

Regional anesthesia

Spinal

This is the most common method used in pregnancy for both planned and emergency procedures. The nerves that carry messages to your brain regarding pain and sensation are bathed in a local anaesthetic by placing a very fine needle into a bag of fluid inside your backbone. This method is very fast and uses a very small amount of anaesthetic

Epidural

This is very similar to a spinal but the anaesthetic is not placed directly into the fluid filled bag but infused by a plastic tube / catheter outside the bag and is then absorbed. This is often used during labour and is a weaker solution, but can be sometimes topped up with a stronger solution for an emergency caesarean section

General Anaesthetic 

If you have this anaesthetic you will be asleep for the procedure. This is less common, however is still sometimes necessary in emergency situations or if the anaesthetist is unable to site a spinal or epidural. If you have this type of anaesthetic your birthing partner will be unable to go into theatre with you because you will need to have a tube passed into your airway during the anaesthetic and this may be distressing for your birth partner to witness  

Advantages of regional compared to general anaesthetic:

• Spinals and epidurals are usually safer for you and your baby
• You and your birthing partner can witness the delivery
• You will not be sleepy afterwards
• You can start skin-to-skin contact and breastfeeding as early as possible even whilst still in theatre
• Your baby may be more alert

Disadvantages of regional compared with general anaesthetic:

• Spinals and epidurals can lower blood pressure which can lead to dizziness and sickness but this is easily treated
• Often this may take longer to set up than a general anaesthetic
• Occasionally you may feel shaky
• Rarely, they do not work perfectly and a general anaesthetic may still be necessary
• You may feel slight tingling in one leg
• You may experience itching
• One in one hundred women experience a severe headache, however this can be treated
• Nerve damage is possible, but is rare

Spinals and epidurals do not cause chronic backache. Unfortunately backache is very common after childbirth, but there is no direct relationship with regional anaesthesia.

How long will I have to stay in the hospital?

Following an uncomplicated caesarean section you may be discharged home the following day. However your individual needs will be planned with the midwifery staff.

Following your discharge you will be cared for at home by the community midwifery staff and health care assistants.

Are there any risks to my baby?

The process of normal birth helps to clear the baby’s lungs of fluid. In a caesarean this process is missed and a very small number of babies may have breathing problems and may need extra help initially with oxygen.  If you are asleep (general anaesthetic) during the operation your baby may also need some support with breathing as the baby may also be slightly sleepy.  Very rarely the baby may suffer a minor injury from the operation which will heal very quickly e.g. a little cut on the part of the baby below the cut of the womb. This may leave a little scar.

Are there any risks to me?

• The main risk is of bleeding, approximately between five and ten in one hundred women need a blood transfusion 
• Eight in one hundred women develop an infection after a caesarean section, which is why antibiotics are given as a preventive measure during the operation
• One in three hundred women may get clots in their legs (deep vein thrombosis / DVT) or a lung (pulmonary embolism) which is why you will have leggings on during the operation that inflate up and down in theatre and recovery. You will also be prescribed a daily injection of Tinzaparin (a drug to reduce the chance of developing clots) until you are fully mobile and this will help prevent a DVT from developing. In addition you may be asked to wear support stockings immediately after your operation.
• There are risks of damage to any of the surrounding organs such as the bladder and the bowel (this happens in one in three hundred caesarean sections)
• The risk of death with a caesarean section is one in twenty five thousand (this number includes emergency and elective procedures). Vaginal delivery is generally safer for you, but an emergency procedure in labour has more risks than a planned elective one

Can I talk to anyone about my delivery?

Following the procedure it is important that you discuss your delivery with the midwifery and medical staff involved in your care so that you fully understand why the emergency caesarean section was necessary. Occasionally your consultant will arrange a follow up appointment in clinic a few weeks after delivery. 

Can I have a vaginal birth in the future?

If you have had one caesarean section, the midwives and doctors at the Queen Elizabeth Hospital would normally encourage you to have a vaginal birth in your next pregnancy, as long as everything else is normal. Up to 7 in 10 women can achieve a vaginal delivery. 

Please refer to the local Vaginal Birth after Caesarean Section (VBAC) patient information leaflet. 

How can I find out more information?

Please discuss any queries or concerns with your midwife or consultant during your appointment; alternatively if you need any more information please do not hesitate to contact the Maternity Pregnancy Assessment Unit to speak to a midwife.

Pregnancy Assessment Unit  – 0191 445 2764

(24 hours 7days) 0191 445 3678              

Other information

• National Childbirth Trust
• Royal College of Obstetricians and Gynecologists, Birth options after previous caesarean section patient information leaflet
• National Institute of Clinical Excellence
• Obstetric Anaesthetists’ Association
• Royal college of Anaesthetists

Data Protection

Any personal information is kept confidential.  There may be occasions where your information needs to be shared with other care professionals to ensure you receive the best care possible.

In order to assist us to improve the services available, your information may be used for clinical audit, research, teaching and anonymised for National NHS Reviews and Statistics.  

Further information is available via Gateshead Health NHS Foundation Trust website or by contacting the Data Protection Officer by telephone on 0191 445 8418 or by email [email protected].