Emergency caesarean birth

Around 15% of babies are born by emergency caesarean section, either during pregnancy or labour. You may need an emergency caesarean section if:

• your baby’s head is too big for your pelvis, or in the wrong position
• your labour doesn’t move on, your contractions are weak, and your cervix hasn’t opened enough
• your baby is distressed, and labour hasn’t gone far enough for you to have a safe forceps or ventouse delivery
• you develop a serious illness, such as heart disease or very high blood pressure
• for some other reason your baby needs to be born quickly, for example because of placental abruption (where the placenta separates too soon).

Most women will have an epidural or spinal anaesthetic to ensure they do not feel the operation, however in some cases where the pain relief isn’t adequate, or there isn’t enough time to put the spinal in, a general anaesthetic might be advised. The obstetrician will make a 10 to 15cm cut at the bottom of your abdomen, just at the top of your pubic hairline, which is big enough to deliver your baby through, then a cut through your womb to reach your baby, usually after a delay of one minute. You may feel some tugging when your baby’s lifted out – sometimes this is done by hand and sometimes with a pair of forceps. Your baby will have have their umbilical cord clamped and cut, be quickly checked over by the baby doctor, and if everything is well they’ll be passed to you or your partner, so you can hold them and have skin-to-skin contact. The placenta and membranes are delivered then the cut in your womb and abdomen are closed with stitches. It normally takes about 10 minutes to deliver your baby, and 30 to 40 minutes to complete the stitches. There are some associated risks with caesarean section delivery, for both you and your baby and your team will discuss these risks with you prior to the surgery. Recovery from emergency caesarean is the same as recovery from a planned caesarean.

Ventouse or forceps

In some cases your doctor may recommend assisting the birth of your baby by using either a ventouse or forceps. This may occur where the second stage of labour (the pushing stage) is longer than expected, where your baby’s head is not in the best position to come through the birth canal or if there are changes to his/her heartbeat meaning that birth needs to happen as soon as possible. A ventouse is a metal or plastic suction cup that is placed on your baby’s head. Forceps are curved metal tongs that are placed around your baby’s head. You will be offered pain relief for an assisted vaginal birth, with either local anaesthetic or an epidural. The birth will be managed by your doctor. Your midwife will be present to help and support you. Your doctor will gently pull using the ventouse or forceps whilst you push during your contractions. Sometimes several pulls are needed, or if one method doesn’t work, the other may be tried. You are more likely to need an episiotomy, particularly if forceps are used. In rare circumstances, if neither ventouse or forceps successfully deliver your baby, a caesarean birth might be recommended.

Episiotomy

An episiotomy is a cut that is made (with your consent) to the perineum (the area between your vagina and your rectum) to assist in the birth of your baby. Your midwife or doctor may recommend this if:

• your baby’s heartbeat suggests that he or she needs to be born as quickly as possible.
• if you are having an assisted birth; or
• if there is a high risk of a serious tear affecting your rectum. An episiotomy is repaired using dissolvable stitches and normally heals within a month of birth.

Oxytocin (known as synto or syntocinon)

Oxytocin is the naturally occurring hormone that causes your womb to have contractions. If your contractions slow down, or are not effective in causing the cervix to dilate, it may be recommended that you have a synthetic oxytocin drip which is given in small amounts directly into a vein via a cannula. Oxytocin makes contractions stronger and more regular. If you have an oxytocin drip, close monitoring of you and your baby (using continuous electronic fetal monitoring, sometimes called cardiotocograph or CTG) is recommended.

Breaking your waters (amniotomy)

Before, or during labour your waters will normally break at some point (although sometimes they don’t – and some babies are born in their amniotic sac). If your labour seems to have slowed down or there are concerns about your baby’s wellbeing, your midwife might recommend breaking your waters. This is done during a routine vaginal examination, it does not hurt your baby, and has been shown to sometimes reduce the length of labour. If you think your waters have broken it is important to call your maternity Triage/assessment unit straight away, particularly if you think you can see meconium, which is green or brown in colour. If you are less than 37 weeks pregnant this may be a sign of premature labour.

Interventions in labour

During labour, sometimes things can slow down or concerns can arise with your or your baby’s well-being. If this happens your midwives and/or doctors may recommend certain options  to help you to give birth to your baby safely.