(Possible trigger warning) EMCS Qs

[Peanutbutteryday]

I had an emcs with my dd - went to theatre for forceps but chord was round her neck so emcs. I am very very grateful to
all midwives, doctors and the anaesthesia lady involved for making such crucial decisions as dd was delivered safely and she is a delight six months later.

Before the foreceps (and subsequent emcs) were attempted it took some time for the spinal to be administered - I think they couldn’t find the right position. It may me wonder a couple of things so I wondered if anyone had first hand experience or if there are any midwives or doctors about. I hope this doesn’t cause any triggers for anyone. I had a good experience with my emcs i just don’t know practically how it all works behind the scenes at hospital and was interested that’s all.

-What is the average time between (a) doctors saying emcs is needed and (b) being in theatre / baby coming out? Or does it really vary?

-Also presumably different emcs are different levels of emergency? Although my baby was starting to get distressed I don’t think my baby was severely distressed (I requested my hospital notes after birth) so presumably my emcs was less of an emergency than if another women at my hospital was having a prolapsed chord. Would they prioritise one emcs over another if only one theatre?

-Would a emcs such as prolapse chord follow a different prep (ir spinal etc) to my emcs or it would all be the same?

[KEG05]

There’s different categories in my hospital. Category 3 would maybe be a lady who was booked for an elective but had come in in labour. Or a lady who has had a failed induction.
category 2 are usually ladies who have been labouring for a long time and baby and mum are tired, baby isn’t moving into the right position etc. the above two are usually bleep and then phone calls to arrange. Everyone heads over for a category 2 but there’s time for spinal etc. category 3 can be ‘booked’ almost and if something is already happening could maybe wait.
category one is an emergency baby needs out yesterday. This is the cord presentation category. There’s no time for spinals it’s nearly always a general anaesthetic. I’ve been to a couple of cord presentations and in both cases from when tbe emergency bleep goes (you run) to the baby being born it was less than ten minutes.

I hope that answers some of your questions. I imagine it might differ slightly trust to trust

[Peanutbutteryday]

@KEG05 yes that answers my questions thank you.

Makes complete sense about the categories.

I didn’t realise some emcs would be done under general due to time constraints but this also makes sense given I’m sure we spent about twenty minutes faffing around with the spinal (no complaints it just made me wonder what would happen if we didn’t have the luxury of 20 mins).

Ten minutes is very impressive!

Thank you.

[SockQueen]

@Peanutbutteryday

I had an emcs with my dd - went to theatre for forceps but chord was round her neck so emcs. I am very very grateful to
all midwives, doctors and the anaesthesia lady involved for making such crucial decisions as dd was delivered safely and she is a delight six months later.

Before the foreceps (and subsequent emcs) were attempted it took some time for the spinal to be administered - I think they couldn’t find the right position. It may me wonder a couple of things so I wondered if anyone had first hand experience or if there are any midwives or doctors about. I hope this doesn’t cause any triggers for anyone. I had a good experience with my emcs i just don’t know practically how it all works behind the scenes at hospital and was interested that’s all.

-What is the average time between (a) doctors saying emcs is needed and (b) being in theatre / baby coming out? Or does it really vary?

-Also presumably different emcs are different levels of emergency? Although my baby was starting to get distressed I don’t think my baby was severely distressed (I requested my hospital notes after birth) so presumably my emcs was less of an emergency than if another women at my hospital was having a prolapsed chord. Would they prioritise one emcs over another if only one theatre?

-Would a emcs such as prolapse chord follow a different prep (ir spinal etc) to my emcs or it would all be the same?

Obstetric anaesthetist here. As the previous poster said, there are 3 categories of emergency CS (cat 4 is completely elective). NICE has targets for "decision to delivery" time for all of them.

Category 1 is "immediate threat to life of mother or fetus. Target is delivery ASAP, or at most within 30 minutes of the decision.
Category 2 is "maternal or fetal compromise which is not immediately life-threatening," and the target is delivery within 75 minutes.
Category 3 is "No maternal or fetal compromise but needs early birth." Usually we aim to do these within a day, but can be much shorter or a bit longer depending on what else is going on.

The vast majority of Caesareans are done under either spinal, or a topped-up labour epidural. But as you have experienced, this does take a bit of time. I'm pretty slick now, and my average time from the woman arriving in theatre to actually injecting the drugs into the spinal is about 12-15 minutes - can be longer if it's tricky for whatever reason. Then another 5-10 minutes for it to take effect before surgery can begin. For the surgeons, if the woman has had no previous surgery on her abdomen, it's usually about 3-5 minutes from knife-to-skin to delivery of the baby. So you can see it is pretty tight to get a baby out in less than 30 minutes, even before you consider things like transfer time to theatre, getting a cannula in if not already sited etc. For this reason, many category 1 CS are done under general anaesthetic - can't remember stats for my current unit but my previous one it was about half - but historically was a lot more. In your example of a cord prolapse a GA would be most likely, which does shave off a good few minutes but is HIGHLY stressful and carries different risks for mother and baby.

Regarding two emergencies happening at once, it would depend on that particular unit. We are able to open a second theatre if it's truly life-threatening, but it may mean diverting staff from other emergency operating, or calling people in from home, which takes time in itself.

Hope that helps!

[Florencenotflo]

I had an unplanned c section with dd1. I'd been in labour for a long time, meconium in my waters, DD's heart rate was dropping with contractions and not progressing. So it wasn't an emergency as such but needed to happen quickly. From me agreeing to dd being born was about 50 mins I believe.

My SIL had some serious complications including a cord prolapse. She was supposed the be an elective c section due to very quick labours (3 labours all under 60 mins!) but my nephew didn't want to wait. She was put under GA and nephew was born within 10 mins. Quite stressful I'd imagine but amazing that they can get a c section started that quickly!

[Peanutbutteryday]

@SockQueen

Obstetric anaesthetist here. As the previous poster said, there are 3 categories of emergency CS (cat 4 is completely elective). NICE has targets for "decision to delivery" time for all of them.

Category 1 is "immediate threat to life of mother or fetus. Target is delivery ASAP, or at most within 30 minutes of the decision.
Category 2 is "maternal or fetal compromise which is not immediately life-threatening," and the target is delivery within 75 minutes.
Category 3 is "No maternal or fetal compromise but needs early birth." Usually we aim to do these within a day, but can be much shorter or a bit longer depending on what else is going on.

The vast majority of Caesareans are done under either spinal, or a topped-up labour epidural. But as you have experienced, this does take a bit of time. I'm pretty slick now, and my average time from the woman arriving in theatre to actually injecting the drugs into the spinal is about 12-15 minutes - can be longer if it's tricky for whatever reason. Then another 5-10 minutes for it to take effect before surgery can begin. For the surgeons, if the woman has had no previous surgery on her abdomen, it's usually about 3-5 minutes from knife-to-skin to delivery of the baby. So you can see it is pretty tight to get a baby out in less than 30 minutes, even before you consider things like transfer time to theatre, getting a cannula in if not already sited etc. For this reason, many category 1 CS are done under general anaesthetic - can't remember stats for my current unit but my previous one it was about half - but historically was a lot more. In your example of a cord prolapse a GA would be most likely, which does shave off a good few minutes but is HIGHLY stressful and carries different risks for mother and baby.

Regarding two emergencies happening at once, it would depend on that particular unit. We are able to open a second theatre if it's truly life-threatening, but it may mean diverting staff from other emergency operating, or calling people in from home, which takes time in itself.

Hope that helps!

Thank you for taking the time to reply. That’s really clear and interesting to know how it works

[Peanutbutteryday]

@Florencenotflo

I had an unplanned c section with dd1. I'd been in labour for a long time, meconium in my waters, DD's heart rate was dropping with contractions and not progressing. So it wasn't an emergency as such but needed to happen quickly. From me agreeing to dd being born was about 50 mins I believe.

My SIL had some serious complications including a cord prolapse. She was supposed the be an elective c section due to very quick labours (3 labours all under 60 mins!) but my nephew didn't want to wait. She was put under GA and nephew was born within 10 mins. Quite stressful I'd imagine but amazing that they can get a c section started that quickly!

Glad your dd and nephew were both delivered safely. Both sound stressful. Your sil sounds like the hospital moved incredibly fast when they had to!