Possibly a really silly question about baby starting to breathe after a c-section

[aerotwirl]

I am having a c-section in about six weeks’ time. I’m fine with all of it but the one thing that is causing me anxiety is the thought of baby not starting to breathe. I know this could easily be the case with a vaginal birth too, but the odds are higher with a CS. So it is stressing me out.

Now for the silly question.

Once the baby is taken out, they are still connected to the placenta via the umbilical cord, yes? So, even if the breathing reflex doesn’t start, would the baby still be getting enough oxygen through the umbilical cord?

If so, can they leave the baby connected to the cord for as long as it takes to get them breathing?

I feel like I’m missing something obvious. I’d love to hear from anyone who can explain how it works. Thank you.

normally if there's concern about the baby that doesn't respond quickly to vigorous stimulation then they cut the cord and transfer the baby to the MW/paediatrician who's in theatre so they can support breathing/oxygenation. Once the cord is exposed to room air the cold makes the vessels constrict and reduces blood flow and the placenta may start to detach pretty quickly too so it cannot be safely assumed that a baby's getting enough oxygen just from the cord. It's pretty unusual in a bog standard elective section for a baby to make no respiratory effort, but they sometimes need a bit of support because they often have more fluid in their lungs than a baby that's been squeezed through a smaller space (slightly different of course if the section's being done because there are concerns about the baby).

They also cut the cord as part of the operation (and I believe, remove the placenta - in mine someone was checking the extracted placenta while I was still being sewn up), so the baby won't be attached to you for very long. The actual extraction of the baby is extremely quick, I thought they were still prepping and making initial cuts etc and they'd already done it!

There are people in the room just to deal with the baby (rather than being part of the operation on you) and they have all the equipment that they will need to deal with different emergency situations laid out ready, so they could sweep into action immediately if anything extra was necessary.

Greybeardy sums it up quite nicely. On contact with the cold air the blood vessels in the cord will constrict, cutting off blood flow. Which is also why a cord prolapse is so dangerous. So baby has to start breathing on their own before too long as the cord is no longer performing its function.

Some babies will have a cry or shout as they're coming out, or shortly after. Others might just need a bit of stimulation (i.e. vigorous rubbing with a towel) from the midwife who will be monitoring baby in the seconds post delivery. They evaluate the baby's Apgar score. So checking baby's heartbeat, overall condition, and if they are attempting to breathe. If they have any concerns whatsoever, then the cord will be cut, and baby taken immediately across to the resuscuitare to get some assistance. If they are fine, then a minute of delayed cord clamping can occur.

As PP says, even in elective cases everything is ready in case baby comes out with a low Apgar. While there might not necessarily be a pediatrician present (there isn't for most elective cases in my trust) all midwives are trained in neonatal resuscitation. And once the alarm is sounded senior midwives who have more in-depth training in resuscitation will come in, and not far behind them will be the emergency bleeped paediatrician team.

I had a planned section and that was something I did prepare myself for. Sometimes it can be due to excess mucus since they don't get the same squeeze on the way out. Ds was squealing before he was even fully out though! If that does happen though, they will be able to assist your baby to clear their airways to help them breathe easier. If you're worried speak to your midwife/ consultant about it so they can explain exactly what would happen and why. I did a birth plan for my section and I included that eventuality in it and that helped me feel more prepared.

Thanks so much everyone for explaining. I knew there had to be a reason that my logic wasn’t quite all there! I do feel more reassured by what you’ve said.

I wish I knew the statistics regarding what the likelihood of breathing difficulties will be. I’ll ask my consultant at my next appointment.

@Greybeardy I think I recognise your name as an anaesthetist from another thread I read, so thank you for taking the time to provide an expert view!

I'm sure you'll be absolutely fine OP

I had a planned section and had such a calm, positive experience from start to finish. My little one was only small and was screaming loudly as soon as they started lifting her out.
Everything was on hand ready just in case and I felt safe and reassured.

She was more blocked up with mucus in the hours after birth but that was easily sorted.

Ask for a gentle section the surgeon births the head aslong as positioning is ok then baby squeezes itself out is it meant to mimic how they get squeezed down birth canal in a vaginal birth and get that mucus out their lungs

ive had 3 csections, first full term baby came out roaring the room down, second let out what sounded like a meow and rarely cried even as a baby. My preemie was approx 5 minutes old before we heard the tiny little cry ☺️

I had delayed cord clamping with my elective section. Baby was taken to be checked but the placenta was kept beside him in a bowl for a couple of minutes until it stopped pulsating and my husband was allowed to cut the cord. Baby cried immediately even before the cord was cut.

Oh goodness that sounds stressful @McGregor33, that must have felt like an eternity. How is your little one now? Were there any problems as a result of it taking them five minutes to breathe? 💐

Usually all it takes to get them breathing nicely is a good rub down with a hospital towel. But in the rare event that this doesn't do the trick, there will be staff poised ready at the resuscitaire to give the baby breaths, if needed, until he/she gets the hang of it. But that is only necessary a fraction of the time, as usually just the shock of cold air on wet skin generates a cry.

My ELCS, baby was born 37.5 weeks as I had pre eclampsia.
She screamed the place down straight away. My partner cut the cord and I got skin to skin straight away.
It was a very positive experience