What to expect during an emergency C-section

• An emergency C-section is given when the mother or baby is in severe distress.
• A prolapsed umbilical cord, placental problems, or uterine rupture may prompt an emergency C-section.
• Once the medical emergency has been addressed, the mother and baby will usually recover normally.

The majority of expecting mothers plan to deliver their babies vaginally, but about 32% of them will need to have a cesarean section, or surgical delivery.

Now, some of these C-sections are planned ahead of time. But most are unplanned, says James Byrne, MD, chair of the Labor and Delivery Department at Santa Clara Valley Medical Center.

Although the common name for an unplanned C-section is an "emergency C-section," medical professionals divide unplanned C-sections into two categories - urgent C-sections and emergency C-sections, says G. Thomas Ruiz, MD, the OB-GYN lead at MemorialCare Orange Coast Medical Center.

Important: An urgent C-section is given when there's distress for the mom or baby that isn't life-threatening, says Ruiz, while an emergency C-section is given when the situation is more severe.

Having an unplanned C-section can be scary, but oftentimes it's the best option for delivering a baby. "They're very safe for both mom and baby," Byrne says.

What to expect during an urgent C-section

Urgent C-sections are done for reasons including labor that has stopped progressing or a baby who is progressively showing signs of going into distress. In this case, the baby will typically be delivered within half an hour, Ruiz says.

"You know you have to get the baby out fairly quickly, but you have a little bit more time," Ruiz says. Although the process moves quickly, the doctor and nurses can talk to the patient about what's happening.

Common causes for an urgent C-section:

• Prolonged labor. Long labor can be taxing for both a mother and infant, and may indicate that the baby can't pass through the mother's pelvis or the birth canal safely, Bryne says. A large baby or small pelvis can cause prolonged labor.
• Fetal or maternal distress. If a mother or baby experiences changes in the heart-rate or other vital functions doctors may decide an urgent C-section is necessary.
• Baby's position. If a baby is not head-down it's more at risk for birth complications, so an infant that is breech or transverse (sideways) may require a C-section. Usually, this will be planned, but if the doctor notices during labor that a baby's position has changed this can prompt an unplanned C-section.

Once a doctor calls an urgent C-section the patient will be given a regional anesthetic in the spine (unless an epidural is already in place from labor), just as she would during a planned cesarean.

There is usually time for the partner to put on scrubs and be allowed in the operating room, and the mother can often hold the infant soon after birth if both are stable, Ruiz says.

What to expect during an emergency C-section

An emergency C-section is often performed very quickly by the on-call OB-GYN in the operating room, not necessarily your doctor, Byrne says.

You may qualify for an emergency C-section if there's been a recent change in your, or your baby's status. The process will vary depending on the severity of the medical situation, Ruiz says, for example, if the baby's umbilical cord comes out through the vagina ahead of the baby or if the baby's heart rate drops and is not recovering appropriately.

Medical term: Emergency C-sections happen when the mom or baby "crash," or experience a sudden change to their health.

There's little time to discuss what is happening because the medical team is aiming to have the baby delivered as fast as possible, often in 5-10 minutes, Ruiz says.

"In a true emergency you can see it in the patient's face, it's pure terror," Ruiz says. "We don't do much talking at this point. We have to do this now. This is life-threatening."

The mother is often given a general anesthetic because that is the fastest way to administer anesthesia, Ruiz says.

Her partner will not be in the operating room due to time constraints. Often, the mother or baby will require medical attention after the C-section, so she usually won't be able to hold the baby immediately, Ruiz says.

Common causes for emergency C-sections:

• Tangled or prolapsed umbilical cord. The umbilical cord delivers oxygen and nutrients to the baby, and if that supply is interrupted the baby must be delivered immediately.
• Placental problems or placental abruption. If your placenta detaches before birth or is not able to deliver nutrients to your baby, a C-section might be necessary to deliver the baby quickly.
• Uterine rupture. Rarely, the uterus can rupture during labor. This is more common in women who have had a previous C-section and require delivery immediately

Risks involved with emergency C-section

Complications from C-sections are rare but can include the following:

Risks to the baby

• Breathing problems
• Surgical injury, such as accidental nick of baby's skin
• Prematurity and other conditions requiring a stay in the neonatal intensive care unit

Risks to the mom

• Infection or wound infection
• Postpartum hemorrhage
• Reactions to anesthesia
• Blood clots, deep vein thrombosis, or pulmonary embolism
• Surgical injury
• Trauma or postpartum depression

In most cases, once the medical emergency that caused the emergency C-section has been addressed, both mother and baby will make a normal recovery, says Ruiz. Since pregnant people are generally young and healthy, they often recover quickly.

Insider's takeaway

Although many mothers prefer a vaginal delivery, there are cases where an unplanned C-section is medically necessary.

When mothers-to-be contemplate their birth plans, it's a good idea to consider the real possibility of an unplanned C-section in order to feel more in control of a situation that is inherently hard to control.

Physicians will not make the recommendation unless they feel it is in the best interest of the mother and baby - it is not a decision that is made lightly.

"It's great for women and their partners to have discussions in advance regarding a birth plan, and also how they would like to approach it when nature doesn't follow their goals," Byrne says. "Thinking about some of these paths in advance can help you feel much more empowered."

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