An emergency Caesarean section may be needed prior to labour or during labour. Emergency Caesarean section may occur if there is a maternal condition and / or a fetal condition that requires delivery and it is not possible to induce labour or take the time for labour to proceed to delivery.
With any labour there is a chance that baby may become distressed or labour may not progress. If either of these complications occur before full dilatation, then a Caesarean Section is needed for delivery.
During labour the fetal heart may be monitored by a Cardiotocograph (CTG) and there are some patterns on the CTG that are concerning for baby’s welfare. The baseline for the fetal heart should be between 120 and 160. If the baseline falls below 100, then baby may not be receiving enough oxygen through the placenta and umbilical cord. Decelerations of the fetal heart below baseline that occur after or between contractions may also be associated with reduction in oxygen reaching baby. When these patterns of fetal distress cannot be corrected (by fluid boluses, maternal position changes, decreased contractions) and if vaginal delivery is many hours away, then Caesarean section is a safer option for baby than continuing with labour.
During the active phase of labour, we expect the cervix to dilate and the head to descend through the pelvis. There are guidelines to estimate progress during labour. If a labour is not progressing we aim to improve the contractions with a Syntocinon infusion over two to four hours, providing that mother and baby are well. In most cases this period of time of augmented contractions will result in further cervical dilatation and head descent. If progress does not occur, vaginal delivery becomes increasingly unlikely and a Caesarean section will be arranged.
Emergency Caesarean Sections have different categories. If there is severe fetal distress, then a Category 1 Caesarean aims to have baby delivered within 30 minutes of making the decision for Caesarean. Moving to theatre happens very quickly and can be stressful. There may not be time for a formal written consent process and the procedure can take place with verbal consent.
Most emergency Caesarean sections do not require such urgency. If there is a non-reassuring CTG or inadequate progress in labour, then moving to theatre does not need to be rapid. Explanations and formal signing of a Consent form can occur prior to theatre.
If there is a working epidural in place, there may be time to put more medication down the epidural to achieve a regional block that will remove all pain from the Caesarean procedure. If there is not an epidural in place, or the epidural is not working well enough, there may be time to achieve an adequate spinal block prior to surgery. If there is not enough time to achieve a regional block (epidural or spinal) or the regional block is not working well enough, then the procedure may require General Anaesthetic. Having a General Anaesthetic will mean not being awake to see baby being born. Less than 2% of Caesarean Sections need to be performed under General Anaesthetic.
The complications of an emergency Caesarean Section are the same as for an Elective Caesarean Section (infection; bleeding that requires transfusion; scarring on the skin and uterus; clots in the legs or lungs; damage to bowel, bladder, ureters and chance of further surgery). There is more likely to be infection, bleeding requiring transfusion and clots in the legs and lungs after an emergency Caesarean section compared to an Elective Caesarean section. Being in labour prior to Caesarean section increases the risk of these complications.
Recovery during the first few days after an emergency Caesarean Section is harder than after an Elective Caesarean section. There may be more pain and fatigue due to being exhausted from labour prior to the Caesarean section.