OB-GYNs Explain The Differences Between A Scheduled & An Emergency C-Section

by Kelly Mullen-McWilliams

There are two types of C-sections in this world — the emergency kind, and the kind you schedule weeks and sometimes months in advance. Any emergency during labor is stressful and frightening, and women will inevitably experience the two procedures differently. But what should mothers know about these surgeries in advance? What's the difference between a scheduled C-section and an emergency C-section in terms of recovery time, pain control, and the procedure itself?

Daniel Roshan, MD, a maternal-fetal medicine specialist at Rosh Maternal Fetal Medicine, explains the biggest distinction: in scheduled C-sections, patients know what they're getting when they enter the hospital, usually early in the morning. Emergency C-sections, on the other hand, are just that — life-threatening emergencies for which modern hospitals are, luckily, extremely well equipped. "An elective C-section is usually done if a patient has had a prior C-section or surgery that doesn’t allow them to go through labor," Roshan explains. Other conditions — placenta previa is one — might also require a scheduled birth. Most cesareans are set for 39 weeks.

Mary O’Toole, M.D., an OB-GYN at Saddleback Medical Center in Laguna Hills, California, explains you'll be asked not to eat or drink before a scheduled C-section to reduce your risk of aspirating stomach contents, which can lead to pneumonia. Not eating is especially important for pregnant women because they digest food more slowly, according to Dr. Cherie Richey of Columbus Women's Care. Staff will start a IV, and may remove lower pubic hair with clippers, explains O'Toole. Next, you'll speak with an anesthesiologist, who will administer an epidural. You'll also receive a catheter, which remains in the bladder for 24 hours, and wraps around your calves to promote circulation during the procedure. It's calm, orderly, and routine.

"The patient is checked for good anesthesia before surgery is started and repeatedly told you may feel touching and pressure, but no pain," O'Toole explains. All in all, the scheduled surgery takes 45 to 60 minutes to complete.

In an emergency, the entire hospital comes to life. Anesthesia and the neonatology unit are called right away, as is an assistant surgeon. "It all happens very quickly," O'Toole explains. "The patient will receive more medication in her epidural or she may she may have to be put to sleep." While no one wants an emergency cesarean, it's still an OB-GYN's "best tool when it comes to circumstances like breech delivery and fetal distress," notes O'Toole.

Being awake is preferable because women can protect their airways if they're sick, and of course, they're able to see their baby immediately after, according to Richey. However, in an emergency, there simply might not be time to start an epidural if you don't have one already. As for the procedure itself, Richey tells Romper that because comsetic issues aren't a priority in a crisis, you're more likely to receive a vertical incision, rather than an "bikini" incision. Amazingly, OBGYNs can often get the baby out within one or two minutes, according to Roshan.

Doctors know that an unplanned C-section can make for an emotional journey for birthing women. "There can be fear, mistrust, and anxiety over the unexpected," Kenneth James, MD, OB-GYN, of MemorialCare Saddleback Medical Center, tells Romper. "This is where birthing classes prove invaluable. Just knowing that this is a possibility makes the transition easier and acceptable."

Because an emergency C-section is possible for anyone, it's very important to know and trust your healthcare provider, who will be there for you when the going gets tough. "Holding a patient's hand and being kind is the best anti-anxiety medicine out there," notes Richey.

What about recovery? Patients receiving an emergency C-section have often been in labor long before surgery. "That can make it harder to recover than if they just came in for an elective C-section," according to Roshan.

Justine Roth, MS, RD, of Justine Roth Nutrition in New York, describes her emergency C-section as "defeating and upsetting," in an interview with Romper. She remembers the pain she felt before surgery as being terribly frightening. "We pushed for three hours and I just couldn’t get her out," she explains. "She was right there but couldn’t get through my pelvis." The doctor let her keep trying, but eventually, they decided a C-section was the safest route.

Afterwards, Roth didn't anticipate the sadness she'd feel. "I had a vision of how things were going to go, and when they didn’t go that way I didn’t know how to feel. But I let it go because she was here, and healthy."

For Roth's next birth, she sought out a VBAC — vaginal birth after cesarean —but was told it wasn't safe in her case. She hated having her surgery date on the calendar in advance, because it felt somehow unnatural. "Births are supposed to unexpected, exciting," she says.

In the end, it was still pretty exciting — Roth didn't make it to the calendar date. At her final doctor's visit, she was 6 centimeters dilated, so she headed to the hospital early. "This time it was all very calm. Chatted with the anesthesiologist (who was a new mom back at work after six weeks) until the doctors said, 'Hello, we are ready.'" She reports feeling some heavy pressure, and then her baby was greeting the world with a cry.

If you come to the hospital expecting to have a vaginal birth, a C-section is a serious deviation from the plan. But as O'Toole notes, obstetrics is unpredictable, so it's best to be ready for anything. Understanding the differences between an emergency and scheduled C-section in advance might help you to feel more prepared, however your baby ends up being born.

Check out Romper's new video series, Romper's Doula Diaries:

Watch full episodes of Romper's Doula Diaries on Facebook Watch.