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There is an awful lot of information on the internet about what to expect from a planned c-section. But what will happen if you planned a vaginal birth and end up with a cesarean suddenly?

Both the c-section and the emergency that causes the need for it can be terrifying. Hopefully, knowing what happens during an emergency c-section will alleviate some of your fears. 

Will you have a c-section?

During a cesarean section, an incision in the maternal abdomen and then the uterus allows the baby to be born. Cesarean sections can certainly save lives, but they appear to be over-used in the United States today a third of all American mothers now deliver by c-section. Some of these are planned c-sections for various reasons (including, of course, having had a cesarean during a previous birth!), while others are emergency c-sections. The risks associated with an emergency cesarean section are higher than those associated with a planned c-section.

That means that it may be in your interest to plan a c-section instead of trying for a vaginal delivery, if you have risk factors that make it very likely that you will need a c-section. Vaginal birth is still the best option during most births, however. Even mentioning that sounds a little crazy, doesn't it? That's exactly how some doctors will formulate things, though. Wed MD, a popular source for online medical information, says: "If you are pregnant, chances are good that you will be able to deliver your baby through the birth canal (vaginal birth). But there are cases when a C-section is needed for the safety of the mother or baby. So even if you plan on a vaginal birth, it's a good idea to learn about C-section, in case the unexpected happens."

The chances of having a c-section are likewise "pretty good" in modern America. If you're low risk and are going to "try for a vaginal birth", you may like to engage in other practices that are going to increase your chances for success. Avoiding an induction of labor unless there is a very compelling medical reason is going to boost your chances of delivering vaginally. Saying no to an epidural, laboring at home for longer before heading to hospital (or staying there and having a homebirth!), and remaining mobile during labor may all decrease your chances of having a c-section. One other thing you can do to avoid a c-section is choosing a hospital that has a fairly low cesarean rate.

This shows that your hospital is committed to facilitating vaginal deliveries wherever possible. Having covered those things, it is of course worth noting that there are situations in which an emergency c-section is truly the best course of action. Let's take a look at the most common reasons for which emergency cesareans are carried out, as well as some of the less frequent reasons.

Reasons for an emergency cesarean section

There are several possible reasons for an emergency c-section. The most common of these are a stalled labor, fetal distress, and umbilical cord prolapse. Placental problems, a baby that appears to be too big to be delivered vaginally, and a less than ideal fetal position (like a sudden transverse, where the baby's arm comes out first!) are other reasons for an emergency cesarean to be carried out. A stalled labor is a labor that had already started, but the contractions petered out after a while.

This does not necessarily have to be a reason to carry out a c-section. If the mother's bag of waters has already broken, this poses an infection risk and that in turn causes the need for either c-section or (preferably first, in most cases) an induction with pitocin. Fetal distress is a situation in which there are indications that the baby has problems. a decreased heart rate, sudden lack of fetal movement, and meconium in the amniotic fluid all indicate fetal distress. Umbilical cord prolapse is a birth complication during which the umbilical cord leaves the birth canal before the baby does. The cord is then compressed, and the baby deprived of oxygen.

Emergency c-section: The procedure

A cesarean section usually takes 45 minutes to an hour to complete, from start to finish. The procedure starts with the administration of an appropriate anesthetic, is then followed by the incisions in the abdomen and uterus and the birth of the baby. Suturing the incisions is what takes most time. Women who are undergoing an emergency c-section can expect the procedure to look something like this:

  1. The woman is wheeled to the OR, if she was not already there. If the woman already had an epidural for pain relief during labor, the dose needs to be changed and she will be able to remain awake during the surgery. Epidural anesthesia may still be an option during an emergency c-section that does not need to be carried out within minutes. For real emergencies, total anesthesia is the only option because it is very quick.
  2. The incisions are made and the baby is born. The type of incision that a woman will have depends on the type of emergency she is facing. For placenta previa, for instance, the incision will have to be made in a way that does not cut into the placenta. Horizontal incisions are still preferable for emergency c-sections, wherever possible.
  3. After the baby's birth, the incisions will be closed. Those who had a total anesthetic will be woken up, and recover. All c-section patients are offered pain relief in the days following the procedure, and will be able to see their baby as soon as reasonably possible if you had an epidural, that is often immediately after birth.

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