Question about crash C-sections

[MrsTittleMouse]

I hope that this isn't an offensive question to those who had crash sections. But...

Last time I gave birth I really wanted a C section over an instrumental birth (if things went wrong). I ended up being bullied into an instrumental, which was a disaster (DD is OK now, but I'm still not after 2 years). I've been through my notes with a senior midwife who confirmed that an instrumental delivery wasn't actually a good idea and that I was a good candidate for a C section. She did tell me however, that a situation could arise where there wasn't time for a C section, and I would have to have an instrumental, due to foetal distress.

So the question is - how can a situation arise where there isn't time for a section? Is it due to the anaethesia and how long does it really take to get you prep'd and ready in theatre?

Not really sure of answers to your questions but in my emegancy c section they decided at 15:30 to give me a section and dd was born at 16:16 and her heartbeat was dropping drastically every time I stood up.

I'm sure more knowledgable(sp) mners will be along shortly to answer better

May not be the best person to answer this, as my one and only cs was elective, but last time round before I had a vbac I asked the consultant what my chances were and how quickly they could get me into theatre if it all went wrong. He said they could get the baby out in less than 5 minutes in a true emergency. Most of the prep would take place when I went into labour as a precaution, so IV ready, etc. Then in an emergency a GA would be used and that would be that. Not great, but I personally would prefer the certainty of having the baby out than faffing about with instruments.

I had a crash section with DS1.

I had an epidural (sp) already as had been in labout for 3 days when I had a placental abruption. This happended at 11.55am and DS1 was born at 12 noon.

I was operated on at the end of a corridoor in an emergency theatre on the delivery suite and was warned that they didnt have much time to top up my epi and that if I had to be put to sleep I would wake up with a tube in my mouth as I was vomitting.

My Neice also had a crash GA section with her baby (who has since died) and it was an unmittiaged disaster.

I would never opt for a trial by labour after the horrow that she encountered

I have a friend who talked about one in less than 5 minutes TBH it was probably 5 because it takes a certain amount of time to do things!!

sorry for your neice madhouse how awful

How can a situation arise where there isn't time for a c section?

Maybe when you don't really need one.

How long does it really take to get to get you prep'd and ready in theatre?

In a life and death situation, not very long.

Madhouse - your poor neice.

Did your epidural hold out? Or did you have to have GA? I hope that you and your DB were OK.

I had a crach c-section - decided at 12:55, dd born at 1:05. I had an epidural in anyway, so they topped me up, raced me along the corridors and got her out.

I had placenta praevia and was in hospital in case I had a big bleed and baby needed to be born immediately. I asked what would happen if the placenta started to come away, and I was told the baby would be born in less than 10 minutes. That would be with a general anaesthetic, though, and I'd never choose to have that unless it was absolutely life-or-death.

Obviously this isn't 100% relevant to your question, though, as there was no option of an instrumental delivery in my case.

Luckily, I got through to 36 weeks and had an elective section. IIRC (it was 8.5 years ago now) I went down to theatre at about 9.00 and dd was born just before 10.00.

I can see that if you were fully dilated already then an instrumental delivery might be faster than a c-section, just from a practical point of view.

But a crash c-section can happen very quickly. Someone I knew on another forum went into hospital with a "baby not moving" niggly worry and found herself going immediately from let's-just-have-a-look-then scan to being-wheeled-down-corridor-with-gas-mask-over-face-as-they-cut-off-her-clothes, which was quite speedy.

I had crash c section after being induced over a week with no action. DD's heart rate dropped drastically and luckily I had the epidural line in already (you may want to consider this given your fears/concerns) and was in theatre within 3 minutes. DD took a little while to get out because of complications (which is why she didn't come out after a week of various inductions) but the process was swift. It takes a little time to prep you - shave you, paint you with the sterile stuff or whatever, but believe me, those guys work FAST when it is a crash situation. I cannot imagine how instrumental would be any quicker unless the baby was already down the birth canal considerably (this happened to a friend of mine) because they then have to figure out a safe way to pull the baby back up if they are going to deliver by section.

Hi - My epi did pretty much hold up and TBH I was vomitting so much that I missed most of the pain. I had two nurses with suction things getting the sick - TMI

I was just so happy to have a healthy baby.

Thanks for the thoughts for my niece, we are all truely devistated.

MrsTittleMouse

There are a few fairly specific situations where it would be better to have an instrumental than a c/s purely from a time factor.

A crash c/s can be done very quickly, but in most situations it will not be less than 10 mins, as there is the physical transfer to OT, cannulate, pre-oxygenate, administer the GA and intubate and catheterise, plus a minute or two to get baby out. Forget the shave and a quick splash of cleansing fluid will do to cleanse. If you are fully dilated and baby has been well into the birth canal, a midwife may even have to put a hand into the vagina during the c/s to actually push the baby back up into the pelvis.

Obviously the risk of complications such as bleeding, infection, 'collateral damage' to other organs increases significantly with such a quick prep and c/s and if the alternative is a forceps delivery, in most cases that would be better. If the woman is pushing, a forceps can be done between a few seconds and a couple of minutes.

Specific examples I can think of are - severe fetal distress while pushing for example an abruption, if the babys FH is 50-60, 10 mins can be the difference between a damaged baby and a healthy one. Another example is a cord prolapse when pushing.

If you get to fully dilated and baby has descended well through the pelvis, an instrumental will be best for most women, however, with hindsight, sometimes a c/s would have been better.

Please dont take this the wrong way, as I know from your previous posts that you are someone who would have been better with a c/s, and Im just trying to answer your opening question!

Thank you very much for all the replies.

The reason why I asked this question was because we were going through my birth plan last night, and while we knew that there would be a few specific circumstances when an instrumental would be the best option, DH wanted to be clear exactly what those circumstances would be. So that he knows when to fight my corner against an instrumental, and when we just need to get the baby out no matter what, so that we have the best chance of having a healthy baby.

It wasn't supposed to be a pro-section thing, honest. And the reason why I was such a bad candidate for instrumental was because DD1 hadn't descended at all, and her head was bulging from the pressure of all the pushing (can't remember the medical name). So there wasn't a good contact for the ventouse; which is why they had prep'd me for a section, why it was so difficult to get her out even with ventouse, and (I'm guessing) why they ended up doing such a whopper of an episiotomy even though in theory a ventouse delivery shouldn't need an epi.

It wasn't just in hindsight that I should have had a section (knowing that I have healed so badly), it was always a stupid idea.

Hi MrsTittleMouse, agree that in some cases, csection is better than instrumental.

I had dd by crash section. I was induced and continuously monitored but midwife did not notice that dd had been in distress for 15 minutes because she had her nose buried in her book. The awful realisation on her face when she discovered her error.

I was 5 cm dilated, so baby no where near descended. No epidural or pain relief yet.

Dd was born within 11 minutes of the doctor's decision to have a cs. I was instantly knocked out by GA when I got to the OT.

I think the medics have a coding system for the urgency of cs: Red being the most urgent as in pull-all-stops, running in corridors, scrub up NOW, jump up all queues for OT/surgeon/anaesthetist. Amber less so (within 1 hour?), and green really when an OT becomes available. I think if instrumental is a viable option, you would be graded less urgent. I don't know but they have to triage these things.

Definitely speak to the obstetrician - they will be able to advise much better than the midwife.

I wouldn't worry about being graded as "less urgent". In fact, it would be very reassuring as I would know that DD2 wasn't in distress.
By the way, my previous instrumental delivery wasn't done in an emergency situation, I was in the CLU for 2.5 hours after transfer. And I got copies of my and DD1's notes to make sure that she wasn't in any distress.

We're working really hard to make sure that we balance the desire for a healthy baby with the desire for a hands-off delivery and the least amount of further damage to my body. It's not always easy, is it?

I know what you mean, MrsTM. In the days where I was considering a VBAC, I never really managed to get comfortable that I would be able to a cs instead of an instrumental delivery, in the limited situations where it is better for cs v. instrumental.

That depends on a certain amount of trust in the person who is managing your case, how busy the hospital is, how honest they are with you. If push comes to shove, a medic tells you that your baby is in distress and the fastest and safest way for the baby to get him/her out is instrumental, I would never object.

You and your dh will never know the situations when it is best to have a cs. That is medical judgment applied to a subjective intepretation of your situation ie how far along are you, how much is your baby at risk, how much longer can you/baby wait. And on top of that, the practicalities like do they have resources to do a cs v, other emergencies out there? If they try to fob you off, you are at their mercy.

It could all go very well and the odds are in your favour. But things can also go pears very quickly. In hindsight, I was glad I chose an elective second time round because the hospital was so busy that day it closed to new admissions and were ambulancing ladies to the next hospital. That is just my experience.