Two medical associations – the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics – co-author Guidelines for Perinatal Care. This reference serves as a problem solver for hospitals and medical professionals nationwide. It offers recommendations, policies, and practices for a wide variety of obstetric and pediatric issues and procedures.
One topic covered in the Guidelines is emergency c-sections. The textbook states that all hospitals or medical centers with obstetrical services should be able to perform emergency c-sections within 30 minutes of the decision to operate. This is often referred to as the “30 minute decision-to-incision rule.”
In many cases, the 30 minute rule may be appropriate, for example, when there is a failure for labor to progress or where the baby is doing well in labor. In other situations, the Guidelines recognize that 30 minutes is not fast enough.
30 minutes from decision to incision is too long in some cases
The Perinatal Guidelines specifically state that "... examples of indications that may mandate more expeditious delivery include hemorrhage from placenta previa, abruptio placentae, prolapse of the umbilical cord, and uterine rupture." Further, in November 2010, ACOG issued a Practice Bulletin that identified serious ("Category III Electronic Fetal Monitoring") situations which also require quicker c-sections. These are serious heart rate issues that "when a decision for operative delivery in the setting of a Category III EFM tracing is made, it should be accomplished as expeditiously as feasible.” C-sections need to be performed faster that 30 minutes in these situations and other situations in order to avoid babies suffering brain damage from lack of oxygen to the brain (hypoxic ischemic encephalopathy).
Many published studies confirm the obstetrical emergencies require c-sections sooner than 30 minutes. For example:
- In a study of uterine rupture, researchers found significant neonatal medical problems when 18 minutes or more passed between the onset of a prolonged heart rate deceleration and delivery.
- Another study recommended that, if a pregnant woman experiences cardiac arrest, a c-section should be done within four minutes and the infant delivered within five minutes.
- Other investigators concur that the suggested guideline of a 30-minute decision-to-incision interval must be shortened in certain situations. For example, with complete cord occlusion, complete abruption, massive blood loss, and fixed fetal bradycardia, delivery should occur in less than 5 minutes—and no longer than 15 minutes.
Furthermore, studies have shown that timely c-section deliveries improve outcomes. For example, a 2001 study of perinatal and maternal outcomes following placental abruptions concluded that cesarean delivery reduced neonatal mortality.
In general, regardless of what transpires during labor and delivery, when the decision is made for surgical delivery of a baby, it should be done as quickly as possible to avoid injury to the mother and baby.
Potential impact of delays in emergency c-sections
When an emergency c-section is delayed, there is the possibility of a number of birth injuries to the baby such as severe hypoxia (lack of oxygen to the tissues) or ischemia (lack of blood to organs), that could cause brain damage, cerebral palsy, mental retardation and other physical and mental disabilities.
Delays in ordering a c-section, as well as in the decision-to-incision time, may be a case of medical error and negligence.
What to do if your emergency c-section was delayed
If your child was diagnosed with cerebral palsy or other severe physical, mental or learning disabilities and you believe that a c-section was not timely ordered or performed, you may be entitled to compensation for your child. It is important to have experienced birth injury lawyers review your child’s medical records and determine whether negligence exists. Reiter & Walsh ABC Law Centers has handled numerous delayed c-section injury cases and we have more than 55 years of combined experience handling birth injury litigation. Call us toll-free at 888-419-BABY or e-mail us to set up a free initial consultation.