Delayed Emergency C-Section

Under certain circumstances, delivery must take place immediately because of the presence of a dangerous maternal or fetal health issue. There are standards of care in place for when this occurs, and doctors must follow these standards.

The American College of Obstetricians and Gynecologists (ACOG) states that an emergency C-section should occur within 30 minutes of a decision-to-incision. (1). ACOG also states that many C-sections should occur much faster than 30 minutes, such as in cases of placental abruption, uterine rupture, placenta previa, and umbilical cord prolapse (2). In addition, ACOG has explained that any time fetal monitoring shows a baby is not getting enough oxygen, a C-section should be performed “as expeditiously as feasible” (2, 3). As it relates to oxygen deprivation, one study found that C-sections should be performed in the realm of 10-18 minutes in order to protect the baby from irreversible hypoxia and hypoxic-ischemic encephalopathy (HIE) (4).

If an emergency C-section takes longer than 30 minutes to perform (depending on the circumstances) or if doctors prolong a labor for longer than is reasonable, a baby can suffer a brain injury for not getting enough oxygen (5).

There are many critical situations that can occur during labor and delivery that require an emergency C-section. Once recognized, the medical team must take immediate action to deliver the baby via C-section. The most common complications include (6):

• Fetal distress: Likely the most common indicator that an emergency c-section is necessary, fetal distress occurs when the baby experiences oxygen deprivation, which if not very quickly addressed, can lead to a form of brain injury called hypoxic-ischemic encephalopathy (7). Signs of fetal distress include meconium in the amniotic fluid, decreased fetal movement, and changes in fetal heart rate on the fetal monitor showing a baby is not getting enough oxygen.
• Placental abruption: Placental abruption occurs when the placenta separates prematurely from the uterine wall (8). When this happens the baby may not be  receiving adequate oxygen, so medical professionals must perform an emergency C-section to prevent brain injury.
• Uterine rupture: In cases of uterine rupture, the uterus tears during labor and delivery (9). A uterine rupture can lead to hemorrhaging and a lack of oxygen to the baby, so  prompt delivery is needed.
• Cord prolapse: This happens when the umbilical cord exits the birth canal before the baby. Cord prolapse increases the chance of cord compression, in which the blood and oxygen supply to the baby is cut off (10). Prolonged cord compression can lead to permanent brain injury and therefore often necessitates an immediate delivery.
• Prolonged or arrested labor: Sometimes labor fails to progress, meaning that dilation of the cervix ceases and/or the head does not move down the birth canal. This can lead to infections and hemorrhaging in the mother, as well as oxygen deprivation and permanent brain injury in the baby (11). If labor is arrested, medical professionals must be prepared to move on to an emergency c-section.

If medical professionals delay in performing an emergency c-section, or if they fail to recognize the signs that an emergency c-section is necessary, a baby can suffer a brain injury from not getting enough oxygen. Brain injuries like hypoxic-ischemic encephalopathy and cerebral palsy can result. If these injuries occur because medical professionals failed to uphold the standards of care, it is medical malpractice.