Unplanned caesarean births
Caesarean births, also sometimes called abdominal births, are broadly divided into two categories; planned and unplanned. Nearly 25% of births in the UK are by caesarean - with approximately 40% of these being elective or planned, according to The BMJ.
In maternity care, we have tried to move away from the term ‘emergency’ caesarean, because although more than half of the UK’s caesarean sections are unplanned, the use of the word ‘emergency’ conjures images of panic and drama; of doctors and midwives running around in terrifying life or death situations. This is rarely the case.
The reasons for being offered an unplanned caesarean include concerns about the health of the woman or birthing person, concerns about the wellbeing of the baby, labour not progressing or vaginal bleeding in pregnancy or labour. In some of these circumstances your baby may need to be born as quickly as possible - but most of the time there is plenty of opportunity for you and your birthing partner to ask questions and make an informed decision without feeling rushed. More often than not, an unplanned caesarean section will have been discussed with you as a possible outcome earlier in your labour. For example, in the case of a caesarean section being offered due to labour not progressing, there will have been conversations around ways to try to support your labour to progress naturally and/or an offer of intervention to try to increase the speed of labour (maybe offering to break your waters or give you medication to increased the rate of surges). When mother, or birthing person, and baby are well, this conversation can be ongoing and there will be lots of time for discussion and consideration of options. By the point you may be offered a caesarean section, it will be something that has been discussed and explained as part of a pathway, not the panicky surprise that is easily imagined at 4am in the dark!
Nevertheless, caesarean births can be incredibly daunting experiences, especially if you don’t know what to expect.
Unplanned caesareans need a big team of people present in theatre - expecting a bit of a crowd is really helpful, as being met with lots of healthcare professionals that you weren’t expecting can easily cause you to worry that they must be there in response to a problem you are not aware of. Every unplanned caesarean section will involve;
An anaesthetist - they will stay by your head, keep you pain free and monitor your oxygen levels, blood pressure and are always a kind and reassuring presence. They will discuss pain relief options with you, and be the person who sites the spinal anaesthetic, or more rarely administers a general anaesthetic.
2 x obstetricians - one as the surgeon and one as the assisting surgeon. You are very likely to have met at least one of them during your labour as the doctors who are on call for labour ward are the doctors who perform unplanned caesareans.
Your midwife - the midwife who has been caring for you in labour will also be with you in theatre. It is their job to help keep you feeling calm and to continue to be your advocate. They will speak up for you and carry on doing their best to make your birth look the way you hoped and planned. If you did not already have a catheter in place, it is your midwives’ role to put that in place prior to the surgery starting.
Student midwife - if you are in a teaching hospital you may be asked if a student midwife can support you in labour, alongside your midwife. If you agree, your student midwife will follow you to theatre as well.
Theatre Nurses - at least two. One who is ‘scrubbed’ and can pass sterile instruments to the surgeons, and one who is not sterile so can open equipment and help with non-sterile requirements.
Operating Department Practitioner or ODP - qualified professionals who assist the anaesthetist and the working of the theatre in general.
Neonatologists/Paediatricians - doctors who specialise in the care of newborn babies. They are present at unplanned caesarean sections to ensure that your baby has any support required immediately after birth, If your baby is born happy and well, they will say congratulations and leave again - but it’s important to have them there for more high risk births.
Having a plan B that covers your preference for a caesarean section can help you to feel more in control of your birth experience in the event of an unplanned abdominal birth. What are your anchors to relaxation, and can you adapt them to come to theatre with you? Essential oils on a piece of fabric in your birth partner’s pocket or headphones to allow you to continue listening to your affirmations or music, your birth partner stroking your forehead, cheek or shoulders to keep using light touch massage techniques. Considering these options during pregnancy will support you, and your partner, to be flexible and positive when you meet bends in the road of labour and birth.
Following the birth of your baby, so long as you and the baby are well, you should be able to have skin to skin contact in theatre whilst the surgery is finished. Your midwife will then continue your immediate postnatal care either back on the labour ward or postnatal ward and you will be supported to feed your baby and begin your recovery.
Written by Senior NHS Midwife, Hannah O’Sullivan
Useful links / resources:
Tommy’s C-sections - everything you need to know!
Birthrights Right to a C-section
https://www.birthrights.org.uk/factsheets/right-to-a-c-section/
Royal College of Obstetricians and Gynaecology Birth after previous caesarean section
https://www.rcog.org.uk/en/patients/patient-leaflets/birth-after-previous-caesarean/