When Should A C-Section Be Performed?
Cesarean sections save lives.
In emergency situations, like fetal distress, umbilical cord prolapse or placental abruption, ordering a prompt c-section is often the only way to avoid tragedy. Sometimes labor simply stalls, and an obstetrician will perform a c-section to avoid serious fetal complications like birth asphyxia.
By the same token, failing to order a necessary c-section under life-threatening circumstances can lead to severe injuries, for both mothers and children.
These emergency situations, however, are surprisingly rare, according to George Macones, MD, chairman of the obstetrics department at Washington University in St. Louis. Macones, who spoke to CNN, estimates that only around 5% of c-sections are performed for true emergencies. The vast majority of procedures fall into a gray area, between purely elective and urgently needed.
Other c-sections are scheduled long before labor, because a doctor thinks vaginal delivery could endanger the mother or her child. Pre-scheduled cesarean sections are most common in cases of cephalopelvic disproportion, when a baby’s head is too large to fit through the mother’s pelvis. Breech babies, who present feet rather than head first, are often delivered by cesarean section, too.
Most women who have had cesarean sections before, around 80%, will end up having c-sections again. The majority of twin and multiple pregnancies are also delivered by cesarean section, according to Parents.com.
Many obstetricians today feel that cesarean sections are a far safer choice than assisted vaginal deliveries. This is undoubtedly true. Forceps and vacuum extractors, which are frequently used to facilitate difficult births, can be extremely dangerous. In fact, when a forceps or vacuum-assisted delivery proves unsuccessful, the generally-accepted standard of care is to perform an emergency c-section.
Some researchers have even suggested that c-sections are safer, on the whole, than healthy vaginal deliveries. Counter-intuitively, health experts at the University of Texas estimate that if every woman in America chose to undergo an elective c-section at 39 weeks of fetal gestation, this increase in surgical deliveries would save the lives of up to 6,000 babies.
The potential benefits of cesarean section are still being hotly debated, although most researchers believe that American women are having too many c-sections. These are, after all, major abdominal surgeries. The risk of serious complications can be high.
Cesarean Section Birth Injuries
Alongside the risk of surgical complications that harm a mother after her child is born, cesarean section deliveries can also leave newborn children with severe injuries. Most c-section malpractice lawsuits fall into one of two basic categories:
- failing to perform a necessary c-section
- performing a c-section incorrectly
Researchers estimate that around 1% of the infants who are delivered via cesarean section will suffer serious injuries during the procedure.
Traumatic fetal injuries are certainly possible during a cesarean section, especially emergency procedures, which can be quick and somewhat rough. Some children will accidentally be cut by the scalpels doctors use to perform the operation.
Pulling an infant through the incision is also a delicate task, and in rare cases, a baby’s bones will be broken (usually the clavicle or collar bone). In some cases, a child’s head can be twisted improperly, leading to brachial plexus nerve damage in the arm, which can result in lifelong disability. Another form of nerve damage, in which a baby’s facial nerve is stretched or torn, is also possible.
Failures To Act
But many infants will also be hurt – in some cases, severely – because an obstetrician fails to perform a c-section under emergency circumstances. The most frequent – and severe – risk to an infant’s health is what can happen when doctors miss the opportunity to perform a necessary c-section.
Oxygen deprivation, or birth asphyxia, is a leading cause of brain damage in newborns, along with all the neurological and muscular disorders that serious brain trauma can cause. Several minutes of oxygen deprivation is all it takes – and doctors must remain incredibly vigilant, constantly monitoring a pregnancy for any signs of the numerous pregnancy complications that can lead to birth asphyxia.
Cesarean section is the indicated intervention for numerous complications of labor and delivery; it’s considered standard practice to perform a c-section, rather than attempt a vaginal delivery, under these circumstances. Obstetricians are expected to notice these dangerous situations and act accordingly. And, of course, there’s no benefit in figuring out that a c-section is necessary, if the procedure isn’t performed in a timely manner.
C-Section Complications & Post-Operative Side Effects
Unfortunately, c-sections have become so common that many women enter the delivery room with a false sense of security. But as with any serious surgical procedure, cesarean sections pose significant risks to mothers.
Blood Loss (Hemorrhage) During C-Section
Obstetricians first cut into the abdomen, move organs out of the way, and then make additional incisions – with scalpels coming very close to vital internal organs like the bladder and intestines.
Without extreme care, an obstetric surgeon can easily pierce organs surrounding the uterus, leading not only to organ damage, but excessive internal bleeding as well. The rate of organ injury is actually shockingly high. Up to 1 out of every 50 women who undergo a cesarean section will suffer organ damage, AmericanPregnancy.org reports.
These risks only increase with multiple cesarean sections, since scarring from previous procedures can strengthen the link between a mother’s uterus and the placenta. In fact, 4 in 10 women who undergo more than one c-section will require a blood transfusion to replace the blood they have lost during the procedure. Some require a hysterectomy to stop the bleeding.
Scar tissue formation can also lead to pain, even in women who choose to have only one child.
How Much Blood Loss Is Normal In C-Section?
Children’s Hospital of Wisconsin says that the average mother will lose about 1,000 milliliters, or one quart, of blood in a cesarean section. In vaginal deliveries, on the other hand, the average woman will lose half that – around 500 milliliters of blood.
Pregnant women are at an increased risk for developing blood clots. There are two factors at play here. For one, increased estrogen levels stimulate the production of clotting proteins. Second, an expanding uterus puts significant pressure on the veins that transport blood from the legs.
This risk only increases after a cesarean section, Healthline reports. Additional factors can boost the danger even more:
- overweight or obese
- long cesarean section procedure
- longer bed rest after the procedure
Thankfully, effective treatments are out there. Many women are put on blood thinners, like warfarin, after delivery. But untreated blood clots can detach from a vein in the legs and travel to the lungs, threatening the mother’s life.
Infections After C-Section
Some women will develop infections after a cesarean section procedure, usually at the site of incision. After the operation, women should watch out for the following signs:
- abdominal pain
- redness or swelling at the incision site
- pussy discharge from the incision site
Seek medical attention immediately if you notice any signs of a wound infection around the incision site. If you can’t see the incision site yourself, have a loved one check it regularly for signs of infection. Newborns can also develop serious infections, especially when an obstetrician fails to properly prevent bacteria or viruses from entering the abdomen during a c-section.
Around 3% of women who undergo a c-section will develop endomitritis, an infection that inflames the uterine lining. Endomitritis can result in uterine pain, fever and foul-smelling discharge. It’s usually treated with antibiotics, but misdiagnosed cases can lead to septicemia (a serious blood infection) and even infertility.
While women can get endomitritis after any sort of surgery that involves the uterus, cases that develop after childbirth are usually more complicated. Some women will have to stay in the hospital longer to receive appropriate treatment.
C-Section Anesthesia Lawsuits
Most women who undergo a c-section will be put under regional anesthesia, which only numbs the lower part of the body. A spinal block is probably the most common method, according to the Mayo Clinic. In this procedure, an anesthesiologist injects anesthesia directly into a sac that surrounds the spinal cord. Emergency c-sections often call for general anesthesia, which knocks you out completely.
In either case, the amount of anesthesia has to be monitored closely. With too little anesthesia, women can experience extreme pain during the procedure. Overdoses of anesthesia can lead to dangerously low blood pressure, which could put the health of an infant at even greater risk. The mother’s tolerance for anesthesia must also be taken into account beforehand. Some women will have severe allergic reactions to the drug.