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Saturday
Jul012006

If a Scheduled Cesarean is Necessary

Because scheduling a cesarean is absolutely something women do and will continue doing, whether by need or desire, I offer some ideas that make the experience more tender and with a small amount of control. These ideas have helped many women choreograph their own cesareans and have been adopted for the cesarean portion of many a birth plan.

One of the most difficult aspects of a cesarean is the total loss of control over the experience. Finding even very small places where women can know what might be coming down the pike helps keep them in a much calmer place and gives the birth an aura of partnership instead of being acted upon.

Each woman will have her own needs and desires. One woman might despise having her arms tied down while another might feel suffocated by the oxygen mask. I encourage women to pick their battles and negotiate with the doctor to remedy what is most important to them.

The doctor who leads the way in the Operating Room (OR) is the anesthesiologist. All visitors, changes, needs... all are directed by the anesthesiologist. S/he is responsible for your life - that one person deserves to be amused and taken care of. And respected.

An easy request tends to be the choice of music playing during the surgery. All ORs have cd players and can accomodate your music during your baby's birth. I haven't ever known this request to be turned down. (Doesn't mean it couldn't be!)

Because many women feel claustrophic with being strapped down during surgery, asking if you might have one or both arms free might be able to be negotiated. I explain it to women that the anesthesiologist cannot risk your touching the areas that are in the sterile field. Your OB would have a fit if you did - and your subsequent infection might make your family a tad distressed, too. If you want to talk about your arms being free, you might have to PROMISE not to touch anything but your partner and your baby. I've also found it helps to say, "If I move somewhere you don't want me to, you are free to put the straps on then." This discussion might help, but the anesthesiologist (or nurse-anesthetist) has the final say and it might seem cruel, but it is the interest of your safety.

The other claustrophobic area is the oxygen mask and depending on how your baby is faring depends on whether you are able to negotiate having the nasal canula instead of the mask. If the baby is having any sort of an issue, it really might be a better idea to forego asking about the mask until after the child is born, then perhaps asking for it to be removed. Some women do better with the mask, knowing they are getting a lively dose of oxygen to supplement their own breathing... and for women who feel like they are so nervous they are hyperventilating, the mask acts like the "paper bag" into which you breath to slow down and find your head again.

A blog reader reminded me to ask everyone to not have extraneous conversation during the birth. There is nothing more disconcerting than having people talk about football scores or where they are going for dinner while you are in the middle of having a baby.

The other request is to not state the baby's gender. This is habit for them, so will be the most challenging request if it is seriously important to you. As they say the baby is coming out, your partner/doula can remind them you or your partner wish to state the gender of the baby. The sound of "It's a boy!" and "It's a girl!" resonates in our minds forever.

More and more, I am hearing about fathers or partners cutting the umbilical cords right as the baby is born. I haven't ever seen this - mostly what I've seen is the dad re-cutting the cord in the warmer. This might be something to ask about, but don't be surprised if you get a funny look from your OB.

I know how many of you all want to see your babies naked and smell them right out of your body, but for a variety of reasons, including the comfort of the surgical team, the OR is kept so cold, your babies could have some serious distress if they were naked in that temperature. In these cases, ask them NOT to bathe your baby at all... no rubbing off of anything (but meconium)... and then have someone unwrap your baby in the Recovery Room so you can replay the moments of seeing your naked child and smell him or her in all his/her glory.

Babies are bathed because nurses have to wear gloves with un-bathed babies (they are considered "dirty" or "contaminated"), but they can just wear gloves until your baby is ready to be bathed by you or your family - or if you want them to do it.

Anesthesiologists are able to put medication into the epidural or spinal that can significantly lower the first couple of days' pain. Duramorph is but one of the options for them to use.

Pre-op, making sure you and your baby will be back together the moment it is feasible is vital for most women. Most scheduled cesarean moms aren't as exhausted as post-labor unscheduled moms, so they tend to be talkative and wide awake, delighted to interact with their newborn. If your baby isn't ill, it shouldn't be difficult to have you both together, even nursing if that is your desire. All that is necessary is someone to help you with the baby... holding the baby to your breast, adjusting the pillows to protect your belly and holding the baby when you are tired. Letting your pre-op team know you will have support post-op can go a long way towards getting you your baby sooner.

For all cesarean mamas, I highly encourage women to do this exercise as soon as you think about doing it:

Pull your abdomen in as far as you can - towards your spine - and then relax. Do this 5-7 times at first, and then up to about 10 times in a few minutes' time. No need to do a belly dancing fast back and forth movement, just pull in, relax... pull in... relax.

This exercise "massages" the intestines and helps get them moving faster. You know, farting so you can entertain the nurses and fellow patients. Intestines being active is a great sign of inner healing. Any help you can offer is great. I've also seen women walk sooner and be more comfortable doing this exercise. It might not feel fantastic the first few times - only pull in to comfort! - but just keep at it. Your body will thank you.

Getting up and walking is a distinct challenge after a cesarean. Do it anyway! I had an abdominal surgery that opened my belly from hip to hip and refused to get out of bed for two days. The nurse came in and took the IV and catheter out threatening me with putting them back in if I didn't get up. It was horrible! I passed out the first two tries. Years later, with another 13 inch abdominal incision, I was up 4 hours post-op and made myself pace the halls with all that I was worth. It made a world of difference even though I was 100 pounds more the second time. MOVE! Your body will thank you. (It also can save your life as you minimize the possibility of a DVT.)

For some women, the choice of hat is very important - bring a selection of washed and soft baby caps and give ONE to the pre-op nurse to put on the baby in the OR.

Bring your own pillow to lay on during your pre-op and then post-op healing time. Just make sure there isn't a white pillowcase on it or it can end up in someone else's room or the pillowcase taken down to laundry when your bed is changed.

When I had my abdominal surgeries, I had a small "woobie" pillow made for me. My woobies were half the size of a regular pillow and had a cover that could be removed and washed. The woobie was a lifesaver when I needed to cough or sneeze or when my crazy family made me laugh at terrible jokes about how funky my hair looked.

Laughing, coughing and sneezing are great physically, by the way. Coughing is a requirement, often with an "Incentive" Spirometer to help the lungs clear and cough measurements calculated.

Those are my most common recommendations... any other providers or post-cesarean mamas have ideas? Please share them!

Reader Comments (18)

Buy a small travel pillow to put between your belly & seatbelt when you go home (and in case you *have* to be in the car any time in the first few weeks post c-sec)!!!

July 1, 2006 | Unregistered CommenterNOLABarb

The woobie is good for this, too, but great reminder. The trip home can be challenging and painful!

July 1, 2006 | Unregistered CommenterNavelgazing Midwife

Arrange for a pre-surgery consult with the anestetiologist, if possible. It's great to go over your history with her ahead of time, and talk about what her standard medication is and what you'd like.

I think it's important to bring something that makes you feel good about the way you look. It might be time to get an old-fashioned bed-jacket or a pretty robe with a zipper instead of a tie. Anything that hangs from the shoulders is better if the incision is sore. People will be taking your picture, so if it makes you feel like you look good, that's so much the better

July 1, 2006 | Unregistered CommenterJ

I am one of those Aussies wanting to fly you out ;)
I had a c-section 2.5 years ago when my twin girls needed to be delievered very fast and very early (29 weeks) due to TTTS. Although I am still disapointed that I didn't get to birth my babies I recognise I was very lucky to have an awesome OB who not only saved my girl's lives but who knew how disapointed I was to have a c-section and made every effort to make the surgery as easy on me emotionally and physically as possible.

Looking back I should have taken time to be more informed about it rather than trying to deny it would ever happen (I knew from 25 weeks I would have to have a casear). So the one suggestion I have is 'get informed'

Wish I'd have had this blog to read back then!

July 1, 2006 | Unregistered Commenterkatef

Thank you so much for this, it really helps!! And thank you for putting it up very quickly. I will do that ab exercise right away so I can eat, b/c the only good thing about being in the hospital is having food brought to you 3 x a day. :)

July 2, 2006 | Unregistered Commenterclara

Will you give permission for me to print this for my files, as a possible handout for clients - properly attributed, of course?

July 2, 2006 | Unregistered CommenterJ

I would love to have permission to use this as a client handout as well. Pretty please!

July 3, 2006 | Unregistered CommenterAnne

j: Oh, yes! A pre-op consult with the anesthesiologist is a grand idea, but they won't always do that because you do talk with them right before the cesarean. The good news is, for those that schedule a cesarean, they are coherent and able to ask rationally what they are wanting and needing in the OR.

Great idea about the pretty something to make you feel better afterwards.

katef: I wish I could impart to ALL women the necessity of paying attention to cesarean information. Unfortunately, the grand majority do not pay attention until after the fact.

How do we change that?

July 3, 2006 | Unregistered CommenterNavelgazing Midwife

Clara: You are most welcome.

Some hospitals/docs "allow" women to eat even before bowel sounds are heard, so be sure to ask what the policy is with your hospital. Many feel eating is preferable to waiting and even have food brought in when they won't feed you before bowel sounds are heard.

J: You are more than welcome to use what I wrote. I will put my email address up so you are able to attribute it to me - the real person. ;)

And my partner said she would LOVE LOVE LOVE to go to Australia for a birth! She's assisted me before, so there ya go... a midwife and assistant - all for the price of two plane tickets, a place to stay and food. Wouldn't that be a hoot?!?

July 3, 2006 | Unregistered CommenterNavelgazing Midwife

Anne and others, let me put my email address up... email me and I will gladly offer the information.

Thanks so much for asking!

July 3, 2006 | Unregistered CommenterNavelgazing Midwife

It was really important to me, with my second c-section, that the OR staff and the doctor didn't speak loudly during the c-section, and also that he didn't announce the gender of my baby (I didn't find out during my pregnancy either). It meant so much to hear "It's a girl!" coming out of my husband's mouth than from some stranger in the OR.

July 3, 2006 | Unregistered CommenterLili

Lili!

You are right... let me add that, too.

Thanks for the reminder.

July 3, 2006 | Unregistered CommenterNavelgazing Midwife

"And my partner said she would LOVE LOVE LOVE to go to Australia for a birth! She's assisted me before, so there ya go... a midwife and assistant - all for the price of two plane tickets, a place to stay and food. Wouldn't that be a hoot?!?"

We would love to have you if we can get organised to conceive in unison :D Can you email me at azure@internode dot on dot net to have a chat when you have time? :)

July 3, 2006 | Unregistered CommenterLeah

It's always interesting to hear about the standards in different places. I've never heard music in an OR unless it was being cleaned. I'll have to add that idea to the birth plan outline I give my clients. (But then I've never attended a scheduled c/s - I've only had one or two clients who had one. Usually they're urgent surgeries. So perhaps that makes a difference.)

OTOH, you talk about "the" oxygen mask, as if it was inevitable. I don't see oxygen in the OR very often, and when I do it comes off if the baby's heart rate stabilizes. I'm seeing very few arm restraints these days, too, fortunately.

Something I'm beginning to see is the wrapped-up babe going onto mom's chest rather than staying in the partner's arms. I've seen a photo of a babe skin-to-skin in the OR, and I've been discussing that option in prenatal classes lately. It would mean the mother getting her arms out of the sleeves of her gown pre-op, I think. I don't see why a cold operating room would be a barrier - what's the difference between a baby wrapped in blankets and a baby on its mom covered in blankets? On mom there's a radiant heat source, whereas in blankets in the other parent's arms it's mostly just retained baby-body heat.

Thanks for the ideas.

Rean

July 3, 2006 | Unregistered CommenterAnonymous

My post-c-section advice: Minimize the pain meds. I had an emergent c-section (meconium, bad fetal trace, no progression of labor, fever of 105, and, as it turned out, a malpositioned head).

The day of surgery I had a PCA pump and used it fairly regularly. The next day it came out and, although I didn't really feel much pain, I took a Percoset, because I had been told that post-c-section pain was worse than labor pain and my labor pain was the worst pain I'd ever felt (more on that below.) Anyway, the Percoset made me constipated and sleepy and I got dehydrated because I didn't wake up enough to drink regularly. As a result my baby couldn't nurse adequately and got dehydrated, got mildly febrile from dehydration, and almost ended up in the NICU for suspected sepsis.

Fortunately, a little pedialyte got the temp back to normal and, thanks to my midwife's encouragement, I figured out the breats feeding thing so all was well. But after that I stuck to Tylenol and really didn't need it any more after another couple of days. Maybe I was unusually lucky in not having much pain, but I would suggest that women who have had c-sections take pain meds only when they actually have pain, not because they are told that they might. And push fluids.

The actual c-section went reasonably well. My only complaint was that it seemed to take forever for anyone to tell me how the baby was doing. It was probably less than a minute, but at the time I didn't know if the baby had meconium below the cords or an infection or even if she was alive. Give the mother details quickly. Even if the news is bad, suspense is worse.

One slightly nonsequitorish comment, if you don't mind, about labor pain. My labor pain, from the onset of labor, was the worst pain I ever felt. Worse than a second degree burn. Worse than ripping my nail off by accidently shutting my finger in a car door and (unwisely) trying to pull the finger out without opening the door: most of the finger came, the nail stayed behind. (Sorry, I know that was gross.) Labor's nasty. On the pain scale, for me, labor was a 10, c-section recovery was a 4 at the worst, a 2 by day 2. Has anyone else had this experience?

July 4, 2006 | Unregistered CommenterDianne

LOL Leah and Kate, how funny! I think that sounds like a bargain NVM, I might hound you about it too if I get pregnant and all the local midwives are deregistered (I live in a very unenlightened state).

Dianne, I had an "emergency" c-sec after many hours of labour and I found the c-sec recovery to be far worse than the labour. But my greatest issue was with my postnatal care which was sorely lacking.

Maybe that's something else to add, make sure you have someone to come and help in those first few weeks. Even if they don't stay, just come daily, it is a tremendous help to not have to worry about anything other than baby care and recovering.

July 5, 2006 | Unregistered Commenteranastasia_wolf

Maybe that's something else to add, make sure you have someone to come and help in those first few weeks.

Definitely! My mother stayed with me for the first few weeks and my partner took off work for the first two weeks after the birth and that helped enormously. (Despite the occasional clash we had with each other...don't be too upset if you fight a little. Birth is a stressful, emotional time.)

Make sure that the person staying with you is someone who is coming to help, though, not someone who needs to be entertained. That's another problem I had immediately after the birth: A number of friends and family members showed up who were all nice and well meaning but weren't the slightest bit of help with a newborn. Trying to entertain them was a strain. Keep that sort of visit down a bit until you feel better. Get your partner or other helpful friend or relative to be the gatekeeper and tell people to visit later when you get too tired.

July 6, 2006 | Unregistered CommenterDianne

Earplugs. Don't forget earplugs. They let me wear them in recovery so I could catnap. Didn't have them for my first section and nearly 'got up from that bed' to kick some inconsiderate nurse butt! I also wore them in my room at night so the 'hospital noises' (aka inconsiderate staff who hold 'old home day' right outside your door at 3am) didn't bother me.

Diet appropriate snacks. I'm diabetic and the hospital food damned near killed me. What's up with feeding a diabetic rice, corn, pancakes, GRITS! (the worst for most diabetics sugar levels), and oatmeal? Geeze. Then they'd come around 2hrs later with 'let's check your sugars...'. I can't imagine what my sugar levels would have been if I'd eaten all that starch. So I brought a bunch of protein shakes and hubby and my mom brought me salads and grilled chicken wraps and stuff. I'd have damned near starved to death if they hadn't allowed me 'outside food'.

Cook and freeze meals beforehand, especially if you know you're going to be having a section. You will NOT feel like standing up to cook and eating out every meal gets expensive. Besides, you don't need all that take away junk when you're healing from major surgery!

Bring your own gowns. Ditto for the kiddos. Those little footed sleepers are SO cute. It's cold in those hospitals and you may have the temp set as low as possible because your hormones will be playing tag!

I never used my woobie. I did buy one of those postpartum support belts. Can't rave enough about it! Made a really big difference in recovery from the first section. Then again the first one was a crash section and the second was more relaxed (although at midnight since I went into labor before my scheduled date).

Do chat up the anesthesiologist and your OB (although s/he will be busy busy busy!). We had a great chat about what we majored in in undergrad and how did fared in organic chemistry and calculus at my second section. I asked the anesthesiologist what I had been given and why he felt that was a great thing/etc. Duramorph rocks. Asked my OB what my uterus looked like (scar wise) and what the 'adhesion situation' looked like. I actually had a 'brain' rather than 'OMG get the baby out NOW NOW NOW!'
Much less stressful for everyone than the first section.

January 26, 2007 | Unregistered CommenterAnonymous

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