A C-section delivery refers to the delivery of a baby through surgical incisions in the abdomen and uterus (womb). C-section deliveries can be classified as primary (first C-section delivery) or repeat (after a previous C-section birth). In the U.S., over one million C-section deliveries are performed a year, and they account for approximately 33% of all births.
Indications for C-Section Delivery
C-section delivery is performed when the physician and patient feel that it is likely to provide a better outcome for the mother and/or baby than a vaginal delivery. If vaginal delivery is dangerous to the mother or baby, C-section delivery is typically indicated.
The three most common general indications for primary C-section delivery are:
- Failure of the baby to progress during labor (35%)
- Nonreassuring fetal status (24%) (abnormal fetal heart tracings)
- Fetal malpresentation (19%) (e.g., face or breech presentation)
Specific indications for C-section delivery include the following:
- Uterine rupture: Uterine rupture refers to complete disruption of all uterine (womb) layers. When uterine rupture occurs, there often is maternal hemorrhaging (severe and rapid bleeding) that can cause the baby to be severely deprived of oxygen.
- Placenta previa: This is a dangerous condition in which the placenta covers all (“complete” or “total” previa) or part (“partial” previa) of the opening to the cervix. The cervix is the lower part of the womb that joins the vagina. Placenta previa increases the risk of hemorrhagic bleeding during labor and delivery.
- Vasa previa: This is a complication that occurs when fetal vessels are crossing or running close to the inner opening of the womb (cervical os). These vessels are at risk of rupturing when the membranes rupture (which is the “water breaking”). Rupture of the vessels can deprive the baby of oxygen-rich blood, and when vasa previa occurs, the baby is at risk of death or severe brain damage.
- Placenta accreta: This is when the placenta is deeply attached to the middle part of the uterine wall. When this occurs, the placenta doesn’t detach easily during delivery and the mother is at great risk of hemorrhaging.
- Placental abruption: This is when the placenta separates from the uterus. Bleeding will occur, although it may not be visible. The severity of the bleeding and oxygen deprivation in the baby depends on multiple factors, including the location and size of the separation. This can be fatal for the baby.
- Maternal infection: Maternal infections such as herpes simplex virus or HIV have the potential to spread to the baby during vaginal birth.
- Multiple gestation (delivery of twins or more).
- Umbilical cord prolapse: This occurs when the cord exits in front of baby and becomes impinged upon, thereby depriving the baby of oxygen.
- Nuchal cord: A nuchal cord is characterized by the cord becoming wrapped around the baby’s neck. This is an indication for C-section if accompanied by a nonreassuring fetal heart tracing.
- Suspected macrosomia (unusually large baby)
- Cephalopelvic disproportion: This is a condition in which the baby is too large for the size of the mother’s pelvis
- Mechanical obstruction to vaginal birth (for instance, displaced pelvic fracture and hydrocephalus)
- Other tissue trauma related to cervical dilation, the descent and expulsion of the baby, or episiotomy.
- The mother has a brain hemorrhage or aneurysm: Most neurologists feel that a C-section is indicated when the mother has a brain hemorrhage (bleed) or an aneurysm (weakening of a large vessel, making the vessel at risk of rupture). This is because any second-stage bearing down effort is usually contraindicated.
Some data indicate that very premature babies do not withstand the stress of labor well. Accordingly, physicians should typically perform a planned C-section delivery when the baby’s gestation is long before term, but the baby is still able to be born alive. This is especially true when tracings on the fetal heart rate monitor indicate significant umbilical cord compression, which can deprive the baby of oxygen and predispose the baby to a brain bleed (intracerebral hemorrhage).
Contraindications to C-Section Delivery
There are no absolute contraindications to C-section delivery. In contrast to other types of surgery, the risks and benefits of the procedure need to be considered as they apply to two patients, the mother and baby.
In some circumstances, it may be necessary to avoid a C-section. These include the following:
- When maternal status may be compromised (e.g., mother has severe pulmonary disease)
- The mother has a pelvic or abdominal wall infection: C-section is dangerous when infection is present, and if there is sepsis (whole body inflammation and infection), C-section is especially risky and the mother may have a difficult time healing.
- If the fetus has a known abnormality (trisomy 13 or 18) or known congenital anomaly that may lead to death (anencephaly)
Emergency C-Section Delivery
Many of the indications for C-section delivery are emergencies. When required, an emergency C-section should be performed as quickly as possible, and many times it should be performed within 10-18 minutes or less.
When a baby is oxygen-deprived, the hypoxia (decreased oxygen in tissue) can worsen progressively. Mere minutes can make a difference in how much damage hypoxia inflicts on the brain. Small amounts of time can make a difference when fetal distress and other complications are occurring, which is why it is imperative that hospitals be fully prepared to timely deliver a baby by C-section. This means that the facility must have proper anesthesia and surgical personnel to permit the start of C-section delivery within 30 minutes of the decision to perform the procedure, according to guidelines set forth by the American Congress of Obstetrics and Gynecology (ACOG) and the American Society of Anesthesiologists (ASA). Furthermore, ACOG and other experts state that in certain cases, a C-section must be performed in a matter of minutes, such as when the baby is high-risk and has a nonreassuring heart rate.
Legal Help for Birth Injury and C-Section Errors
When a hospital designates itself as a birthing facility and is not properly prepared to perform an emergency C-section, it constitutes negligence. It is negligence when standards of care are not followed, informed consent is not obtained from the mother for every procedure, or timely performance of an indicated C-section does not occur. If negligence causes permanent injury in the baby, such as cerebral palsy, it is medical malpractice.
Reiter & Walsh, P.C. is one of the only law firms in the United States specifically and exclusively handling birth injury cases. Our niche focus equips our legal team with the knowledge and experience necessary to handle and win these complex cases. Additionally, our in-house registered nursing team provides crucial insight into the case evaluation process. Our nurses are particularly valuable in cases involving C-sections injuries, fetal monitoring mistakes and hypoxic-ischemic encephalopathy (HIE). Contact our birth injury team today for a free legal consultation, and we will determine the cause of your child’s injuries, identify the negligent party, and inform you of your legal options.
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