High-risk pregnancies are more likely to lead to cesarean births, as a vaginal birth can pose a higher risk for mother and baby. For pregnancies affected by complications of obesity, maternal high blood pressure, diabetes, preeclampsia, genetic conditions or blood disorders such as hemolytic disease of the fetus and newborn (HDFN), preterm delivery by cesarean is common.
What is HDFN?
Hemolytic disease of the fetus and newborn (HDFN) is an immune-mediated red blood cell (RBC) disorder that occurs when a baby’s RBCs break down quickly, which is called hemolysis. HDFN is caused by a mismatch between a mother’s and her baby’s blood type (A, B, AB, or O) or Rhesus (Rh) factor (Rh-positive or Rh-negative) during pregnancy. Numerous antibodies to RBC antigens can be linked to HDFN, such as those from the ABO and Rh blood group systems.
When a pregnancy is affected by HDFN, the fetus is closely monitored to determine the best treatment pathway during pregnancy and post-delivery to ensure the best outcomes. Key concerns during an HDFN pregnancy include timely intervention by intrauterine transfusion (IUT) to treat fetal anemia and continuing the pregnancy until the fetus has sufficiently developed to survive in the neonatal intensive care unit (NICU).
Learn more about HDFN testing and diagnosis
The two types of cesarean births
There are two kinds of cesarean deliveries – emergency and planned (or elective). Your maternal-fetal specialist may schedule you for a cesarean at 38 or 39 weeks, on the basis that your baby will be big enough and strong enough to be delivered. In this case, you will have the time to prepare for the operation. You will be given clear instructions to follow, including how and when to fast. It will depend on your hospital, but in most cases, you will be able to have one support person by your side throughout the procedure.
However, if the fetus is in distress or if HDFN-related complications would be better treated outside the womb, an emergency cesarean may be performed.
What to expect during a cesarean delivery
You will receive an anesthetic before your cesarean. Spinal anesthetics are most commonly administered for planned cesareans, with general anesthetics given for emergency cesareans.
Spinal anesthetic: a needle inserted in your spine will deliver local anesthetic, blocking pain from the chest down. You will remain awake and breathe normally, but your experience will be pain-free.
General anesthetic: when there is no time to lose, you will be put to sleep and given an oxygen mask to breathe comfortably, while your baby is delivered.
A cesarean delivery is major surgery, as it involves cutting through the abdomen and uterus. In most cases, it can take 30-60 minutes. The operation will take place in a sterile environment, with great care taken to avoid infection.
The surgeon will make the incision and lift the baby from your uterus. The health and well-being of your baby will be checked, the umbilical cord will be cut and your placenta removed. You will receive an injection to help your uterus contract, as well as antibiotics against infection. The surgeon will then close the incision. Usually, skin to skin contact with your baby will be possible just after delivery, however this may depend on the health of your baby and how urgently extra care is needed.
If your baby is born preterm, he or she will most likely be transferred to the NICU. Your HDFN-affected newborn will receive specialized care and tests will be carried out to determine the levels of bilirubin in the baby’s blood and the best HDFN treatment.
