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Minutes Matter: Emergency C-Section
Posted by: Craig A. Knapp
June 03, 2011

In some hospitals studied throughout the U.S., one emergency cesarean delivery was performed for every 159 deliveries, or one per every 40 cesarean sections (also known as c-sections).

According to the 2007 Guidelines for Perinatal Care, published by the American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP), it states that "all hospitals offering labor and delivery services should be equipped to perform an emergency cesarean delivery" within 30 minutes of the decision to operate (known as the decision-to-incision). However, in some cases this may be too long.

Why is the decision-to-incision interval important?

Deciding to have an emergency c-section stems from a complication with the fetus or mother. When this procedure is called, the shorter the time it takes to deliver the fetus, the less likely the fetus or mother is prone to injury or death.

What risks are fetuses and mothers exposed to if not operated on within 30 minutes?

Babies: Risk is dependent upon the circumstance at which the decision-to-incision was called. For example, a common circumstance to call a decision-to-incision is when the fetal heart rate (FHR) drops down to 60 beats per minute. If not delivered as quickly as possible, the fetus can develop brain damage or die because it's deprived of adequate oxygen (hypoxia) and blood flow (ischemia), both of which happen with a low FHR. The faster the fetus is delivered, the lower the amount of brain damage.

Mother: Again, risk is dependent upon what happened that caused the emergency cesarean. However, with the above circumstance where the fetal heart rate drops to 60 beats per minute, the mother is prone to placental abruption, excessive vaginal bleeding, uterine rupture, cord prolapse, amniotic fluid embolism, trauma, excessive uterine activity, infection, and severe preeclampsia.

Why is 30 minutes too long?

Since time is so crucial in delivering a baby during an emergency c-section, some professionals are saying this time is too long, for this time starts from the time the decision-to-incision is made. Therefore, a nurse may find that the mother needs an emergency c-section, but he/she may not call for a decision-to-incision until a doctor arrives and confirms it. Therefore, in the time it takes a nurse to find out the mother needs an emergency c-section, call the doctor, wait for the doctor, have the doctor determine an emergency c-section needs to take place, and having the doctor call the decision-to-incision, a good amount of time is already spent going through this process. Depending on how readily available the doctor is, this process can add an extra 5 to 15 minutes to the 30-minute prep time to perform an emergency cesarean delivery.

Can the time be shortened?

There have been many studies that have shown that this time can be shortened significantly in some places depending on how well the hospital prepared for the emergency. In these studies taken, various emergency c-section circumstances were tested to see how quickly the procedure could take place. Through these studies, they found that a 20-minute decision-to-incision time standard was not only more successful in results, it was achievable.

What steps can hospitals take?

There are many steps hospitals can take to lessen the likelihood of injury to their patients in the delivery room. By having mock emergency drills, a well-trained and well-educated staff, prepared hospital, available room, and readily available surgeons, surgeon team, anesthesiologists, and neonatologists, operating time can be optimized and lessened to 20-minutes or shorter.

Until the ACOG and AAG review the Guidelines for Perinatal Care, hospitals are currently only required to operate 30 minutes after the doctor's decision-to-incision. However, hospitals can still be delayed in proper treatment and response.

If you feel as though a hospital or doctor was not properly prepared, and thus, not following Perinatal Care guidelines, resulting in injury to you or your child, give the attorneys at Knapp & Roberts a call to find out your rights. New borns and mothers-to-be deserve to be safe and be and recieve proper medical care when delivering a baby. Knapp & Roberts can help.  

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