What to expect during and after an emergency C-section
An emergency C-section is given when the mother or baby is in severe distress.
A prolapsed umbilical cord, placental problems, or uterine rupture may prompt an emergency C-section.
Once the medical emergency has been addressed, the mother and baby will usually recover normally.
The majority of expecting mothers plan to deliver their babies vaginally, but about 32% of them will need to have a cesarean section, or surgical delivery.
Now, some of these C-sections are planned ahead of time. But most are unplanned, says James Byrne, MD, chair of the Labor and Delivery Department at Santa Clara Valley Medical Center.
Although the common name for an unplanned C-section is an "emergency C-section," medical professionals divide unplanned C-sections into two categories - urgent C-sections and emergency C-sections, says G. Thomas Ruiz, MD, the OB-GYN lead at MemorialCare Orange Coast Medical Center.
Important: An urgent C-section is given when there's distress for the mom or baby that isn't life-threatening, says Ruiz, while an emergency C-section is given when the situation is more severe.
Having an unplanned C-section can be scary, but oftentimes it's the best option for delivering a baby. "They're very safe for both mom and baby," Byrne says.
What to expect during an urgent C-section
Urgent C-sections are done for reasons including labor that has stopped progressing or a baby who is progressively showing signs of going into distress. In this case, the baby will typically be delivered within half an hour, Ruiz says.
"You know you have to get the baby out fairly quickly, but you have a little bit more time," Ruiz says. Although the process moves quickly, the doctor and nurses can talk to the patient about what's happening.
Common causes for an urgent C-section:
Prolonged labor. Long labor can be taxing for both a mother and infant, and may indicate that the baby can't pass through the mother's pelvis or the birth canal safely, Bryne says. A large baby or small pelvis can cause prolonged labor.
Fetal or maternal distress. If a mother or baby experiences changes in the heart-rate or other vital functions doctors may decide an urgent C-section is necessary.
Baby's position. If a baby is not head-down it's more at risk for birth complications, so an infant that is breech or transverse (sideways) may require a C-section. Usually, this will be planned, but if the doctor notices during labor that a baby's position has changed this can prompt an unplanned C-section.
Once a doctor calls an urgent C-section the patient will be given a regional anesthetic in the spine (unless an epidural is already in place from labor), just as she would during a planned cesarean.
There is usually time for the partner to put on scrubs and be allowed in the operating room, and the mother can often hold the infant soon after birth if both are stable, Ruiz says.
What to expect during an emergency C-section
An emergency C-section is often performed very quickly by the on-call OB-GYN in the operating room, not necessarily your doctor, Byrne says.
You may qualify for an emergency C-section if there's been a recent change in your, or your baby's status. The process will vary depending on the severity of the medical situation, Ruiz says, for example, if the baby's umbilical cord comes out through the vagina ahead of the baby or if the baby's heart rate drops and is not recovering appropriately.
Medical term: Emergency C-sections happen when the mom or baby "crash," or experience a sudden change to their health.
There's little time to discuss what is happening because the medical team is aiming to have the baby delivered as fast as possible, often in 5-10 minutes, Ruiz says.
"In a true emergency you can see it in the patient's face, it's pure terror," Ruiz says. "We don't do much talking at this point. We have to do this now. This is life-threatening."
The mother is often given a general anesthetic because that is the fastest way to administer anesthesia, Ruiz says.
Her partner will not be in the operating room due to time constraints. Often, the mother or baby will require medical attention after the C-section, so she usually won't be able to hold the baby immediately, Ruiz says.
Common causes for emergency C-sections:
Tangled or prolapsed umbilical cord. The umbilical cord delivers oxygen and nutrients to the baby, and if that supply is interrupted the baby must be delivered immediately.
Placental problems or placental abruption. If your placenta detaches before birth or is not able to deliver nutrients to your baby, a C-section might be necessary to deliver the baby quickly.
Uterine rupture. Rarely, the uterus can rupture during labor. This is more common in women who have had a previous C-section and require delivery immediately
Risks involved during and after an emergency C-section
Complications from C-sections are rare but can include the following:
Risks to the baby
Breathing problems
Surgical injury, such as accidental nick of baby's skin
Prematurity and other conditions requiring a stay in the neonatal intensive care unit
Fluid in lungs
NICU stay
Risks to the mom
Infection or wound infection
Reactions to anesthesia
Surgical injury
Trauma or postpartum depression
Increased risk for C-section during future pregnancies
In most cases, once the medical emergency that caused the emergency C-section has been addressed, both mother and baby will make a normal recovery, says Ruiz. Since pregnant people are generally young and healthy, they often recover quickly.
What to expect after an emergency C-section
Your experience immediately after an emergency C-section will depend on what prompted the C-section.
If you had a true emergency C-section requiring general anesthesia, you will likely be groggy for the first few hours of your child's life. Once you are fully awake and stable, you can hold and breastfeed your child.
If you had a C-section with an epidural, rather than general anesthesia, you will be able to see, hold, and breastfeed your baby immediately after birth as long as you're both stable.
However, babies born via emergency C-sections have a higher risk of needing admission to the neonatal intensive care unit (NICU), says Ruiz. Most emergency C-sections are performed in response to fetal distress detected during the labor process. For this reason, babies born via emergency C-sections may require additional medical attention after birth.
If your baby is admitted to the neonatal intensive care unit (NICU), your team will likely work to get you stable as soon as possible to see your child, he says.
"We do everything possible to get the mother down to see the baby," says Ruiz.
Recovery after emergency C-section
In most cases, the physical recovery from an emergency C-section is similar to that from a planned C-section.
Occasionally a mother may have more pain because she's experienced the physical toll of labor - if she tried to deliver vaginally but was unable to - or because the surgery was rushed, says Ruiz.
"There can be more incisional pain because everything was moving fast," he says.
Important: After a C-section, most people will stay in the hospital for two to four days. Even after you leave the hospital, it can take up to six weeks to completely recover from a C-section, since your skin, muscle, and other tissue all need time to heal, says Byrne.
During the recovery period, you should avoid strenuous activities like carrying heavy things or intense aerobic exercise in order to allow the layers of the abdominal wall to heal. "Be cautious about overextending yourself even if you feel physically ready," says Ruiz.
However, it is important to be advised you should not be bedridden or immobile either. Activities such as walking and performing activities of daily living are recommended to prevent deconditioning and stimulate blood flow circulation throughout the body which assists with a healthy and timely recovery.
Mental health after emergency C-section
Having an emergency C-section may increase the risk of postpartum depression as shown by a 2017 review. Some people feel a sense of failure, loss, and anger after cesarean delivery. The trauma of unexpected surgery and associated mental and physical fatigue may affect the mental health of birthing people.
"People aren't used to seeing an emergency situation like that," says Ruiz.
Women who have had an emergency C-section are more likely than other women who have had a C-section to develop post-traumatic stress disorder (PTSD).
This can stem from the procedure itself, or from the trauma of being separated from your baby after delivery, Ruiz says.
For these reasons, it's important for patients and doctors to have an ongoing dialogue and communication plan in place regarding mental health after an emergency C-section. Patients should be encouraged to reach out, but it is even more important for health care providers to listen to patients and check in with them. When patients are in states of high stress and trauma, the burden should not be on them to further advocate for their own well-being.
Most doctors take time to debrief with their patients after an emergency C-section. Often the patient will come in for a check-up within a week, which is sooner than they would after a scheduled C-section, says Ruiz.
Emergency C-section and future pregnancies
Research has shown that women who have C-sections can be more fearful of subsequent deliveries.
Having one C-section may increase your risk of subsequent C-sections as compared to people who delivered vaginally.
The reason for the first C-section is important to understand and your provider can have a conversation with you about how your first C-section may or may not increase the risk of another C-section.
It is important to note that 60 to 80% of women who chose to attempt a vaginal delivery after one C-section have a successful vaginal delivery.
"The vast majority of women who have had one C-section will have the opportunity to labor and deliver vaginally with their next birth," Byrne says.
Insider's takeaway
Although many mothers prefer a vaginal delivery, there are cases where an unplanned C-section is medically necessary.
When mothers-to-be contemplate their birth plans, it's a good idea to consider the real possibility of an unplanned C-section in order to feel more in control of a situation that is inherently hard to control.
Physicians will not make the recommendation unless they feel it is in the best interest of the mother and baby - it is not a decision that is made lightly.
"It's great for women and their partners to have discussions in advance regarding a birth plan, and also how they would like to approach it when nature doesn't follow their goals," Byrne says. "Thinking about some of these paths in advance can help you feel much more empowered."
Moreover, the physical recovery from an emergency C-section is usually not markedly different from the recovery from a planned C-section. The majority of mothers will be able to see and breastfeed their baby soon after birth, and they will likely leave the hospital within four days. Many will be able to have a subsequent vaginal birth if they choose.
However, having an emergency C-section can have a lasting mental health toll, says Byrne. It's important to process those emotional effects.
"Very often, going through an unplanned C-section can be so disappointing," he says. "It's important to be kind to yourself and realize you're doing the best you can in the circumstances. Allow time for that physical and emotional recovery."
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