In this episode of the St Emlyn’s Podcast, Iain Beardsell and Simon Carley talk with Caroline Leech at the BASICs Conference about resuscitative hysterotomy following maternal cardiac arrest.

This is a calm, evidence-led discussion of a rare, high-stakes intervention that most clinicians will encounter once, if at all — and still need to get right.

Why the term resuscitative hysterotomy has replaced perimortem caesarean section

The physiological rationale: relieving aortocaval compression to improve maternal resuscitation

What the evidence actually shows about timing, maternal survival, and neonatal outcomes

Findings from Caroline’s systematic review of out-of-hospital cardiac arrest in pregnancy

Why the “4–5 minute rule” does not reflect real-world pre-hospital care

Neonatal survival at far longer timelines than traditionally taught

Practical decision-making in pre-hospital and emergency department settings

Who should perform the procedure, and why speed matters more than seniority

Aftercare challenges: open abdomen, placenta management, bleeding (or lack of it)

Team cognitive load, role allocation, and when termination at scene is appropriate

The emotional and professional impact on clinicians and families

Maternal survival after out-of-hospital arrest is rare, but not zero

Neonatal survival is higher than often appreciated, even with prolonged timelines

Delaying purely to reach hospital or a specialist may reduce benefit

The hardest part is not the incision — it is the decision, coordination, and aftermath

Training should focus as much on judgement and communication as on technical skill

This episode is not about heroics.

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