Two high risk C-sections scheduled for same day - how do they prioritise who will go first?

[yogaballl]

My c-section was booked quite a while ago and I was told I would be first in due to a certain risk factor.

It’s now come to light that thanks to a mix up at the hospital, another high risk lady has been booked in for the same day, and also told she would be first in.

It’s not this, but as an example, let’s say we both have gestational diabetes, and the protocol for the actual issue means we should both ‘go first.’

There is only one theatre available.

Does anyone know what they are likely to do, or how they are likely to prioritise? I’m wondering if one of us will be told we have to change the date?

Even in a small hospital with one theater one would be booked for 0800 the second at 1000. Drs and staff would decide based on a range of factors including the Dr’s other commitments.

Different, but I was "going into surgery this evening" then " too many emergencies, you are bumped to tomorrow" followed by "you are getting the next theatre slot"

They will look at the risks of both of you and prioritize accordingly. You won't know why you are first or postponed. This is literally what they do all day - prioritizing who gets limited resources, and they will be used to doing it.

It’ll depend on your vitals that morning, things like blood pressure heart rate.
when I arrived for my section I watched a very healthy looking couple race up the hill to maternity ward. We were told all to arrive at same time and it will depend on the situation in the morning on who goes first. I heard them asking through the curtain within the ward why she wasn’t going first as they ‘got here first’. She was raging but my vitals weren’t as good.

Leave it to the doctors and don't worry.

There are a million factors that help the decision making - more and more sections are high risk now so it’s not at all unusual to have a whole day of ‘high risk’ electives to do (partly because more women are having them for personal choice reasons and partly because more women that might not have been able to have babies in the past now are able to). It’ll depend on things like (to continue your example) diabetic control, other maternal risk factors for surgery and anaesthesia, fetal concerns, implications if labour were to happen spontaneously, the need for special equipment, the need for paediatric resus, and so on and so on and so on. It shouldn’t be that hard to get two sections done in a day though, and neither customer should really know enough about the other one to know why the list order is as it is. Hope it goes well.

This is what they do all the time

as it happens I had GD - three couples got there for 7.30 and I went in at 9 - first. But the other three couples were done by 11 or so

so you won’t get bumped to another day if you are high risk

Whatever your time to turn up at hospital is, go slightly earlier! I've had 3 sections and each time we arrived slightly early and were met with "great you can be 1st on our list". Our hospital does 4 planned every morning. Obviously medical reasons trump arriving early, but if there are 2 of you in v similar circumstances, earliest will likely go 1st in my experience.

I had two high risk CSs at King's. For both, I was told I'd probably be early on but they could never say who would be first - what if an emergency comes in?

The team decides the order on the day. If an hour or so really made a difference you would of course be first, but that's presumably rare for a planned CS.

They'll decide when writing the list. It then may all change if other emergencies come in (I was first on the list for my second C section and he ended up being born at 7pm!)

The condition of the mother and child and the condition of the child are assessed and prioritized accordingly.
None of you are emergency patients when the date is set in the future. So it can easily be random.
Emergency surgery will take place first before planned and a hospital can do more than one c- section at the time if needed.

I’m always first for any surgeries as I have type 1 diabetes , Autism and a blood pressure issue. I think if you both had the same issues they’d just go by vitals on the day ?

If both of you had the exact same reasons for going first, i would imagine they would then look at the gestation, babys vitals and those of the mum to be, maternal age and bmi.

If everything was basically identical (which is highly unlikely), it would probably just end up as whoever arrives first or whoever's name is written on the list first.

And that's assuming an emergency doesn't come in which bumps you both off the top spot.

I was high risk in my last pregnancy for medical reasons and then also got pre-eclampsia. I was already in hospital so there as early as could be and still didn't have my section until mid afternoon.

The consultants had a meeting and chose me as the only non elective case. Obvs would’ve bumped me if an emergency had come in.

Depends how high risk- this can mean a multitude of different things. The decision will be made taking into account how well the mum is on the day and what the risks are to mum or baby if the c section is delayed. Also if there are risks to mum from staying fasted for longer that will usually trump most other things.
It is also worth baring in mind that emergencies can trump any elective cases so even if there is 1 dedicated elective theatre, if you get 2 emergencies they will bump anything else so always good to go into it being open to the idea that it is not guaranteed to go down by a certain time.

I was 'high risk' in that I had an unstable transverse lying baby (I'd been in for a week, just in case my waters broke). I was bumped for a really serious tear emergency. The 9am planned start moved to 12.15!

Best laid plans and all!

We have an elective only theatre so emergencies don’t affect it.
Things like insulin, allergies, complexities etc influence our list. Both high risk our first two electives would be done by 1100ish.
Also it’s a case of neonatal and recovery rooms. I can’t start my 4th elective of the morning until the first leaves recovery, as only 3 bays. Which means postnatal has to have space for that person, which usually means someone discharged etc.
Either first or second is fine, they are unlikely to have to change the day for either - one or other may already have delivered by the time it comes around.

Thanks all that is all useful to know, and interesting info @UncharteredWaters! We will definitely arrive in very good time if that might give even the slightest advantage 😅

Tbh if you are at risk and have section scheduled few h will not make a diccerence.
If you start labour and your mwdical condition indicates you should not be in one you will be taken to emergency theatre.
Most hospitals have two, one for scheduled and one for emergencies.