Emergency caesareans

About half of all Caesareans performed in the UK are due to emergency situations: here’s what to expect if it happens to you.

You may be planning an all-natural, drug-free home birth, with a caesarean the furthest thing from your mind, but sometimes even the best laid birth plans go slightly awry. Here’s why you might end up needing an emergency section – and how to deal with it if you do.

Your baby’s breech

In most cases, you’ll already be aware that your baby is in a breech position – that is, with his head facing other than downwards, but occasionally (in about 10-15 percent of cases) it’s not discovered that the baby is breech until you are already in labour.

‘It is possible to give birth to a breech baby vaginally,’ says obstetrician Gabrielle Downey, ‘however, it’s advisable to have medical staff on hand who have experience of this type of delivery.

Thanks to a poorly-conducted study that was carried out several years ago, it’s become increasingly common to deliver a breech baby via Caesarean, so there are fewer and fewer staff who have this necessary experience.’

If your baby is breech as you approach full term, external cephalic version (ECV) may be performed: this is when the baby is manually manoeuvred from outside the womb by your midwife.

‘You can also try to encourage your baby to turn by adopting helpful postures that lengthen your torso and give him room to change position, such as on all fours,’ says Dr Downey.

‘There’s no hard and fast evidence that it works, but it certainly won’t hurt.’ Moxibustion, an acupuncture-based remedy, has also been shown to be effective in getting the baby to turn. Visit acupuncture.org.uk to find a trained practitioner near you.

You’re not progressing

Some degree of stopping and starting in early labour is normal, albeit frustrating, but when you’re in established labour and your cervix ceases to dilate, or the baby stops descending through the birth canal then a Caesarean may be advised to avoid you or the baby suffering distress or exhaustion.

What constitutes lack of progress will depend on a number of factors, such as what stage of labour you’re in, whether or not this is your first baby, and how reassuring the baby’s heartbeat is. ‘Between 0.5 to 1cm dilation per hour is the standard,’ says Dr Downey.

‘If progress is slower, and it’s your first baby, you’ll generally be put on a Syntocinon drip; this drug imitates the action of oxytocin, the hormone produced in labour to stimulate contractions. You’d generally be given about four hours to see if this made a difference.’

And if it’s not your first labour? ‘A Caesarean is more likely to be the result in this case. The uterus is a very efficient organ; it will remember what to do from your last labour – so the slow progress is more likely to be because of an irresolvable issue, such as the baby being large or in an awkward position.’

You have a placental abruption

Around one in 100 women will experience some degree of placental abruption in pregnancy or, more rarely, during labour. This is when the placenta begins to detach from the wall of the uterus before your baby has been born and is usually spotted on a scan. ‘There’s no known cause for abruption,’ says Dr Downey, ‘although risk factors include high blood pressure, smoking, or having had an abruption before.’

Warning signs may include bleeding and abdominal pain. Although placental abruption may sound alarming, it’s generally not serious enough to warrant intervention. ‘A small amount of separation tends not to be cause for concern,’ says Dr Downey, ‘as the placenta is large enough to compensate.

You can lose up to 30 percent without there being need for intervention.’  More than this, however, could potentially deprive your baby of vital oxygen and nutrients and put you at risk of haemorrhaging.

Your cord prolapses

This is when the umbilical cord leaves the uterus while your baby is still high in the pelvis. ‘It’s more likely to occur if the baby is breech, if the head is not engaged, or if there is a large gush of fluid as the waters break,’ says Dr Downey.

‘It’s not such a problem if you’re already fully dilated and the baby can be pulled out quickly, but earlier in labour, there’s a risk that the baby can cut off the blood supply by pressing on the cord with his head as he moves down the birth canal, so a Caesarean would have to be performed.’

Although this sounds scary, try not to worry too much about it happening to you – according to Dr Downey, it’s a rare situation that occurs only in about 1 in 400-500 births.

Your baby gets distressed

It’s not called labour for nothing – birth is hard going for mum and baby alike, and some babies simply cope with it a little better than others. ‘Babies go into labour with a certain amount of energy for the task ahead,’ explains Dr Downey.

‘If the length of the labour or the strength of the contractions is more than what they’re prepared for, they may get distressed. Unfortunately, there’s no way of knowing in advance how your baby will react, but being in the best possible health certainly can’t hurt your baby’s chances of coping well.’

Around one in five Caesareans in the UK are performed because of fetal distress, either when the baby is not getting adequate oxygen or because his heartbeat drops to a lower rate than expected. ‘This may occur because of prolonged labour,” says Dr Downey, ‘or it may be related to how the placenta has developed.’

The appearance of meconium, your baby’s first poo, in the waters, may also be reason to perform a Caesarean. ‘The response of a baby, as with an adult, to fear or distress is often a loosening of the bowels,’ says Dr Downey.

‘If the baby inhales this into his lungs, it can cause respiratory problems and pneumonia, so getting him out quickly will be a priority.’

What really happens during a Caesarean?

• First, you or your birth partner needs to sign a consent form. You’ll be asked to remove your jewellery, and the top five centimetres of your pubic hair will be shaved off.

• A drip dispensing fluids and drugs will be inserted into your arm or the back of your hand as well as a catheter into your bladder to empty it.

• Finally, you’ll be given a local anaesthetic (epidural or spinal, both of which are injected into your back) - this means that you are awake for the operation, but you won’t be able to feel anything. In some cases, such as if your baby needs to be delivered quickly, you might be given a general as this is effective in a few minutes, so it may be a better option in an emergency.

• There will be a number of people in the operating theatre during a Caesarean: your birth partner, the anaesthetist, a surgeon and assistant, a theatre nurse, and possibly a medical student. There will be a midwife and a paediatrician for each baby – so if you are having twins, two midwives and two paediatricians.

• If you’re awake, you’ll be able to feel the cutting, as well as a tugging sensation in your stomach. It won’t hurt, but it may feel a bit odd. There will be a screen up around your midsection, blocking your actual view of what is going on, and within about 10 minutes of the surgeon making the incision,  your baby will be held up over this for you to see once he’s been born.

• After he’s been checked over by the paediatrician, your baby will be brought back for you to hold throughout the rest of the procedure, which involves the removal of the placenta and stitches, all of which takes around 45 minutes.