05/03/2024
I was asked a great question today by a partner in a follow up text after the consult : “Is there any situation she can think of that would require an emergency cesarean… or if that’s a made up excuse for a doctor to get off easy”
My answer: Absolutely!
Here are a few times a cesarean could occur that are definitely considered emergency:
⁃Cord prolapse (0.2% incidence rate): we spoke about this briefly at the consultation but if the cord came through the cervix first therefore compressed by the baby’s head this may be an emergency cesarean. In this event, you would get into an open knee chest inverted position. I would place my hand on the baby’s head to alleviate pressure off the cord and we would travel like that all the way to the OR.
⁃Placental Abruption: This is where the placenta starts to come off of the uterus prior to birth. There are varying degrees of emergency, but this is an instance where a cesarean would be considered reasonable and if severe absolutely recommended.
⁃Uterine Rupture: This mainly occurs in TOLACs (trial of labor after cesarean) p where the uterus tears. In this event, a cesarean is recommended
⁃ Fetal Hypoxia/distress/non-reassuring heart tones: This is the most common reason for an emergent cesarean. We listen to the baby the only way we can, the heart rate, and when we begin to hear them telling us they aren’t doing well (late deceleration, lack of variability) This is a sign the baby is possibly in distress and needs to be born. In this instance, cesarean is recommended.
For all of these have what I call pink flags, red flags, and white flags. Meaning, most of the time, I can see it coming and sometimes we prevent at home, while other times we travel by private vehicle BEFORE they become emergent, and others we are calling an ambulance and going FAST.
We are not waiting until the emergency is present in Midwifery. We are the safe protector of normal birth. knowing normal so well… it’s easy to spot a complication early.
Some of these complications arise from interventions themselves. Midwifery led care see less of the above for two reasons: We care for the low risk and we are not intervening!
Recommendations for cesarean when not an emergency definitely exist. The WHO recommends countries not exceed 10% - 15% cesarean rate while the US stands at over 30% and Louisiana is over 37% last reported on 2021. In some areas… over 60%!
Generality Statement number 1 million: Most of this increase is one of 2 reasons: An act to avoid the emergency moment no one loves OR is a combination of provider preference, money, lack of skill, or hospital policy barring them from attempting a vaginal birth under said circumstances. (Example breech: We have much evidence that vaginal breech birth is a safe option but many providers were never trained and therefore will not offer it, only recommending a cesarean)
I have experienced all of the above listed complications and some end with a with cesarean, some end with a smooth birth at home, and some end with a collaboration for a hospital vaginal birth.
Whew! I know it’s always a lot. Take your time and let me know what resources you need and how I can go deeper.
🧡Midwife Leila