Obstetrics is a highly unpredictable field, and a lot can go wrong — sometimes quite quickly — during pregnancy and labor. Often, women know a C-section is in their future well in advance. In other cases, the surgery is performed in the event of an emergency, sometimes when the fetus is experiencing serious distress. However, there's a third category of cesarean surgery, in between the carefully scheduled and the rush-to-the-OR crisis. What's an urgent C-section, and how is it different from a true emergency?
"In an emergency C-section, you have to get the baby out very quickly," Daniel Roshan, MD, a maternal-fetal medicine specialist at Rosh Maternal Fetal Medicine tells Romper. "If it's an urgent C-section, the patient can wait their turn. You don't have to rush in." Roshan goes on to explain that most hospitals reserve an operating room for the really scary emergencies, so that babies struggling during the birth process can be safely born within minutes. However, many mothers deliver babies by C-section without the hectic rush to surgery, and if operating rooms designated for urgent or scheduled C-sections are full, they may be in for a short wait.
The United Kingdom recognizes four categories of urgency for C-sections, a continuum of risk that dictates how long doctors can wait between deciding a C-section is necessary and actually performing the surgery. The Royal College of Obstetricians has attempted to implement a color scale, from red to green (or 1 to 4). A category 1 situation (red), means the mother or baby's life is at immediate risk. Categories 2 and 3 mean there is no immediate threat, but an early delivery is required to prevent the situation from worsening. Category 4 (green) situations mean that surgery can be performed when convenient for the hospital and the mother.
However, it's a bit different in the States. "The American College of Obsetricians (ACOG) leaves things up to individual doctors and hospitals to make their own protocols," notes Roshan.
Protocols ACOG has set pertain only to emergency C-sections, according to Dr. Jamil Abdur-Rahman, board-certified OB-GYN from Twin Doctors TV. "Basically what ACOG says is that if you have an emergency, the rule is 30 minutes from decision to incision. 30 minutes to have the baby out," he tells Romper. Hospital policies may require doctors to live within 30 minutes of the hospital, and if doctors don't follow the decision-to-incision protocol in emergencies, they're left open to legal liability. "Typically there aren’t any policies dictating timing for non-emergent C-sections," explains Abdur-Rahman.
So what does all this mean for you? In 2015, 32 percent of births were cesarean births, according to the Centers for Disease Control and Prevention (CDC). That means that even if you've planned and practiced for a vaginal delivery, things might not go your way — but you shouldn't imagine that every C-section performed results from a terrifying emergency either. A C-section might be quickly scheduled if you go postdates, meaning you've gone past your due date without going into labor on your own, according to WebMD. Another reason you might wind up with a surprise C-section is if the baby gets too big to be delivered vaginally.
Likewise, if labor doesn't progress after a certain number of hours, your doctor might schedule you for surgery, even if the baby is doing fine for the moment. In those cases, doctors perform C-sections as quickly as they can, but "you're not on the clock," notes Abdur-Rahman. Women who have previously had C-sections and go into labor on their own are also considered urgent, but not emergent cases.
These days, with C-sections rates sky high nationwide, the decision to go forward with surgery isn't made lightly, and doctors always consult the patient first. In fact, your consent is essential, according to Roshan. "Doctors explain to patients what they think, and patients are always an active participant in the decision-making process," he notes. When surgery is deemed urgent but not an emergency, you'll likely have a calm conversation in a doctor's office or hospital, during which your OB-GYN will explain why they think the procedure is the safest choice for you and your baby.
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