Historically, hospitals have utilized a 30 minute decision-to-incision time, or the period of time within which a C-section should begin after an emergency complication presents.
Two medical associations, the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) recently co-authored a volume entitled Guidelines for Perinatal Care, which dives more deeply into the intricacies of this issue (1). The textbook states that the 30-minute rule is still appropriate in certain situations, such as when there is a failure for labor to progress but the baby is tolerating the process well. However, the Guidelines recognize that in other situations, 30 minutes is not fast enough.
30-Minutes ‘decision-to-incision’ is too long in some cases
The Perinatal Guidelines specifically states that “the decision-to-incision interval should be based on the timing that best incorporates maternal and fetal risks and benefits” (1). Furthermore, there are “examples of indications that may mandate more expeditious delivery,” such as:
Furthermore, in November 2010, ACOG issued a Practice Bulletin stating that “Category III Electronic Fetal Monitoring” situations, or certain instances of severe fetal distress, require C-sections to be initiated much sooner than 30 minutes (2).
Delayed C-sections and oxygen deprivation
C-sections need to be started before 30 minutes in situations of fetal distress in order to avoid babies suffering brain damage from lack of oxygen to the brain (hypoxic-ischemic encephalopathy). In one study, it was found that C-sections should be started more in the realm of 10-18 minutes in order to protect the fetus from irreversible oxygen deprivation and brain damage (3).
This study also explains that in instances of fetal bradycardia, delivery should occur in five to 15 minutes (3). Another study recommended that if a pregnant woman experiences cardiac arrest, a C-section should be initiated within four minutes and the infant delivered within five minutes (4).
- Furthermore, studies have shown that timely C-section deliveries improve outcomes for the mother and baby. A 2001 study of perinatal and maternal outcomes following placental abruptions concluded that cesarean delivery reduced neonatal mortality (5).
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 afflicting the baby, such as severe hypoxia (lack of oxygen to the tissues) or ischemia (lack of blood to organs). Either could cause brain damage, cerebral palsy, cognitive impairments, and other physical and mental disabilities.
Delays in ordering a C-section, as well as in 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 or intellectual disabilities, and you believe that a C-section was not ordered or performed in a timely fashion, 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 occurred. ABC Law Centers (Reiter & Walsh, P.C.) has handled numerous delayed C-section injury cases and we have more than 100years of combined experience handling birth injury litigation. Please contact us in any of the following ways:
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- American Academy of Pediatrics. (2017). Guidelines for perinatal care. Elk Grove Village, IL.
- Practice Bulletin No. 116: Management of Intrapartum Fetal… : Obstetrics & Gynecology. (2010, November). Retrieved October 16, 2019, from https://journals.lww.com/greenjournal/Citation/2010/11000/Practice_Bulletin_No__116__Management_of.53.aspx.
- Leung, T. Y., & Lao, T. T. (2012, October 29). Timing of caesarean section according to urgency. Retrieved October 16, 2019, from https://www.sciencedirect.com/science/article/pii/S1521693412001587.
- Jeejeebhoy, F. M., Zelop, C. M., Lipman, S., Carvalho, B., Joglar, J., Mhyre, J. M., … The American Heart Association. (2015, October 6). Cardiac Arrest in Pregnancy. Retrieved October 16, 2019, from https://www.ahajournals.org/doi/full/10.1161/cir.0000000000000300.
- Witlin, A. G., & Sibai, B. M. (2009, July 7). PERINATAL AND MATERNAL OUTCOME FOLLOWING ABRUPTIO PLACENTAE. Retrieved October 17, 2019, from https://www.tandfonline.com/doi/abs/10.1081/PRG-100106969.