"natural" c-section recs?

[LittleOsMom]

I've got two stubbornly breech babies quickly running out of room to turn and in a weird position in relation to each other that makes it unlikely they will turn. I've tried everything under the sun to get them to turn (Webster, moxa, acupuncture, inversions, swimming, rebozo, basically everything on spinningbabies.com, hot cold, music, etc. I do it all regularly with no success.) 

I even consulted with the OB in town (Dr. Hall, for you Denver people) who does vaginal breech births, and he said no because it's twins, and I think having done IVF also played into it (which irritates me, but whatever.)  Anyway, if they don't turn, we're looking at a c-section.

I blogged some about some requests I have to make a c-section more Mom and baby friendly, and so far my midwife is cool with all of it.  I thought I'd ask here, though, to see if anybody has suggestions for other things I should request/avoid.

ETA: Here's the link to the blog to give you an idea of what I was thinking.  It's ok to post a blog link, right? I'm not on MDC a ton, so let me know if I need to remove it.

[tracymom1]

Just keep repeating "I want my babies in my arms as soon as possible!!" to anyone you encounter at the hospital when you are there. Say it as often as you can during the section and hopefully they will just give them a quick look over and then hand them to you. They handed DS to my DH when I was being sewed up and he immediately brought him to me and put him on my chest (much to the gasps of the nurses) but nobody said anything.

From that point on, DS did not leave my side, except for the trip upstairs to my room. He breastfed when I was still in the recovery room and stayed right next to me the entire stay. They wanted to take him for a bath when we got upstairs and I simply said 'no thank you' and they let it go. I refused the eye goo, hepB and vit K but did the PKU test before we left so that I wouldn't have to wait for a blood draw at the lab later in the week. I have to say, that for being such a medicalized birth (and one that I would never have chosen for myself, thats for sure!!) it was not altogether a bad experience. I had a very hard time recovering, but that's just my body being stubborn. After my HBAC 2 years later, I finally realized that while the c-section was not ideal, it was not as bad as I thought it would be.

Congrats!

[clutterbug]

We have a DVD in our local LLL library that you might find helpful if you can get your hands on a copy to watch (maybe you could even loan it to the hospital for a viewing by staff).  It has a section specifically geared to hospital staff.  I got this little description from http://www.ilca.org/files/Bookstore/WBW/PromoOrderFlyerForm2010.pdf

Skin-to-Skin in the First Hour After Birth:
Practical Advice for Staff After Vaginal and Cesarean Birth
(DVD: Healthy Children Project) This 40-minute DVD has three brief
but powerful sections for training hospital staff on 1) the importance of
skin-to-skin after birth 2) offering first-hour assistance after a vaginal delivery
and 3) offering first-hour assistance after a Cesarean delivery.

[LittleOsMom]

Originally Posted by bluepetals 

We have a DVD in our local LLL library that you might find helpful if you can get your hands on a copy to watch (maybe you could even loan it to the hospital for a viewing by staff).  It has a section specifically geared to hospital staff.  I got this little description from http://www.ilca.org/files/Bookstore/WBW/PromoOrderFlyerForm2010.pdf

Skin-to-Skin in the First Hour After Birth:
Practical Advice for Staff After Vaginal and Cesarean Birth
(DVD: Healthy Children Project) This 40-minute DVD has three brief
but powerful sections for training hospital staff on 1) the importance of
skin-to-skin after birth 2) offering first-hour assistance after a vaginal delivery
and 3) offering first-hour assistance after a Cesarean delivery.

Oh, that looks great! I wonder where I could track down a copy...

[LisaG]

One thing I had in my c/s birthplan (I was a scheduled c/s due to previous uterine surgery) was I didn't want to get anti-nausea meds unless absolutely necessary.  I tend to tolerate anesthesia quite well, altho I'd never had a spinal before.  When I met with my anesthesiologist prior to the surgery, he recommended routine administration of Zofran to prevent nausea.  If I refused it (which was fine with him), and then got nauseous, he told me that Zofran would not be effective at that point.  The med that they'd have to use at that point, which I think is Phenegran, makes most people drowsy and can interfere with nursing after surgery.  I ended up taking the Zofran because I didn't want to risk being out of it from the Phenegran.

I also requested that my arms not be strapped down.  As you probably know, it's common to have your arms strapped out to the side.  I didn't have any luck with getting the drape dropped because of the whole "sterile field" issue, blah, blah, blah.  No eye drops wasn't an issue.  We did opt to do the Vit. K - I was torn about that.  Altho, she ended up being taken to the NICU due to breathing difficulties so the whole Vit. K issue was small potatoes comparatively.

Had she not gone to the NICU, we were told by the pre-op nurse that once I got to recovery she'd be taken to the nursery to be "checked over".  The other hospital we toured told us the same thing.  This time around, hopefully we'll avoid the NICU and I'll be happy to invite a nurse to come to us to check the baby out

Best of luck with everything!

[LittleOsMom]

That's good to know about the Zofran.  I got  nauseus from my laparoscopiess (but not my sinus surgeries), so I'll just stick with the zofran.  I've taken it once and don't recall it making me drowsy.

[LisaG]

Yeah, I didn't have any problems with the Zofran.  My biggest problem was I almost fainted a couple times.  Fortunately a friend had warned me about that - guess it's not unusual for your BP to go down, I think because of the anesthesia.  When I told the anesthesiologist I was feeling a bit woozy, he looked over at the monitor and said "well, yes you are".  It happened again not too much later and then I was fine for the rest of the procedure.

[Ammaarah]

I'm not trying to rain on anyone's parade, but that sterile field has a serious purpose and I don't blame OBs for not wanting to drop the drape.  After dealing with three MONTHS of healing and wound packing due to a seroma after my first cesarean (not even an infection - those can be far worse), I really respected that drape during my second cesarean, even though it obscured some of the stuff I wanted to see. 

Otherwise, it's great to get the baby nursing ASAP, for sure!  It didn't work out that way during my recent second c-section, and nursing has gone swimmingly anyway.  Great thread and best of luck with your upcoming birth!

[Storm Bride]

Originally Posted by Ammaarah 

I'm not trying to rain on anyone's parade, but that sterile field has a serious purpose and I don't blame OBs for not wanting to drop the drape.  After dealing with three MONTHS of healing and wound packing due to a seroma after my first cesarean (not even an infection - those can be far worse), I really respected that drape during my second cesarean, even though it obscured some of the stuff I wanted to see. 

I have absolutely no desire to see anything about a c-section, so I don't care that they've never dropped the drape. (my last OB did immediately lift dd2 up to show her to me over the drape, though). However, while mine haven't been super serious, I've had an infected incision twice, even with the sterile drape. So...yeah - the drape may help, but it's not guarantee, and I really think if a woman is willing to take the additional risk of infection, that should be her choice, not the doctor's choice (signed informed consent, of course).
 

[MeepyCat]

I really had no desire to see myself cut open either, and the idea of dropping the drape practically made my husband faint - we didn't even ask for it, and I was fine with that.  My DD needed to go the NICU very soon after birth, but they brought her to me before that, and held her so that our faces touched for a few minutes before she had to go.  If I was doing this over again, I would definitely specify that I wanted the baby in my sight as soon and as much as possible.  Obviously, she couldn't be with me in recovery (had she been full-term, hospital policy would actually have been to have her go to recovery with me, and have me hold her as soon as they could verify that I wasn't having aftereffects from the surgery that might make me drop her), but they wheeled me to the NICU as soon as I was out of recovery, before they even got me to my room.  I would ask for these things if I could.  They mean a lot more to me than seeing the moment of birth.

[Friday13th]

I've had two unplanned csections and I think the benefit of knowing that you're having a surgical birth is that you can really go over your options and preferences with the doctor.  Rather than a random surgeon who thinks your some crazy HB transfer and doesn't care what you want at all.

Anyway, I would not have wanted the drape lowered and my husband would have vomited and passed out if that happened.  (as it was he got woozy with DS2 and had to be taken out of the room during the close-up) I really wanted to see the baby, as soon as they came out (didn't happen with DS1 but did with DS2) I would have loved to held and nursed the baby right away, as in, while the were closing me up but that didn't happen either time for a variety of reasons.  I would also push for no seperation, baby goes right with you from surgery to recovery and not to the nursery.  That was supposed to happen with DS2 but since DH got woozy he couldn't hold the baby and he ended up going to the nursery.  (note: make sure your support person has food and fluid in them, watching a surgery on an empty stomach and no sleep apparently doesn't work well)

Hopefully your doctor is open to your wishes and maybe you could talk to the head nurse ahead of time to kind of get them on your side.  Good luck!

[LittleOsMom]

I've had so many procedures at this point to get pregnant that I don't think seeing the surgery will bother me.  Plus, I'll be flat on my back so don't think I'll see much of the incision anyway?  I had a camera in my uterus at one point and my RE was pointing out the anatomy of my uterus, the tubes, etc, and I think all I got for that was some numbing spray.   I'm more worried about my DH, but I think he'll just not look and be fine if it starts to bother him.    My vaginal delivery was pretty bloody because of where I tore (up into my labia towards my clitoris), and he handled that ok. 

I'm the type that watches knee replacements on Discovery Health while eating breakfast :)

They can drape away after the babies are out. 

I'll ask them about the sterile field. I'm sure they won't agree to anything they don't think is safe, and I don't plan on sticking my hands anywhere they're not allowed.  I just want to see my babies come out and handed up to me right away, even if somebody else has to help hold them there.

My Mom will be there along with my DH, so hopefully between the two of them they can deal with both babies if they're stable.

[tracymom1]

I just wanted to add that they may not be able to drop the sterile drape, but they should have a mirror that can be used so you can watch the babies coming out. Talk to the Ob about this beforehand if you can so they know to be ready. There is usually a circulating nurse who is not sterile and she can do this for you (if there are enough nurses to begin with).

[PiggyPiggyOinkOink]

I didn't want to see my c-sections, but I had my camera at my last birth, and the anesthesiologist took some (non-gory) pictures of my daughter being born. I treasure them, and wished I had them from my son's birth. (There was 2 anesthesiologists at my last c-section, which is why 1 of them was taking pictures lol.) The hospital I deliver at is wonderful anyway, and I didn't have to fight for anything we wanted. Good luck to you, and enjoy your birth as much as possible.

[Storm Bride]

OP: You can also ask about breastfeeding on the table. I was told by the OB that this wouldn't be possible, because there isn't enough room above the sterile drape. But, I had an angel of an L&D nurse my last time through, and she got dh to help her, and they held dd2 over my shoulder - with her feet pointing away from me - to nurse while I was still being sewn up. Aside from having dh there for the spinal, that was the single thing that made that section less traumatic than my other four.

[LittleOsMom]

Originally Posted by Storm Bride 

OP: You can also ask about breastfeeding on the table. I was told by the OB that this wouldn't be possible, because there isn't enough room above the sterile drape. But, I had an angel of an L&D nurse my last time through, and she got dh to help her, and they held dd2 over my shoulder - with her feet pointing away from me - to nurse while I was still being sewn up. Aside from having dh there for the spinal, that was the single thing that made that section less traumatic than my other four.

Just picturing the angle on this latch is making me smile :)    Maybe between the nurses and midwife we can get both babies latched on.  Somebody will have to a picture of that!

[Storm Bride]

Yes - if I'd known it was going to work out that way, I'd have made sure we had the camera ready...but I'll never forget it, anyway.

[anj_rn]

So, I do not want to be Debbie Downer, but there will be more to consider because of the twins.  Most hospitals have a neonatologist or pediatrician in the OR for delivery of twins.  If that is your hospital policy, once the babies are out, your OB is no longer in charge of them.  If you know what hospital you will be delivering at, ask for a one on one OR tour (you can usually call and ask to talk to the charge nurse on a Sunday since they are not as busy).  Ask what the norm is for the c-section of twins.  The L&D nurses will be very honest and let you know what the docs will give on and what they will not.  Docs & hospitals vary, so you might want to look at more than one hospital.  If everything you want is against their norm, you might want to pick your battles.

Good Luck.

[wombatclay]

congrats on your twins and wishes for a head down babe miracle.  :)  You might want to check out the Natural Family Living cesarean resource thread (here) and the Cesarean Voices website.

[MeepyCat]

Originally Posted by anj_rn 

So, I do not want to be Debbie Downer, but there will be more to consider because of the twins.  Most hospitals have a neonatologist or pediatrician in the OR for delivery of twins.  If that is your hospital policy, once the babies are out, your OB is no longer in charge of them.  If you know what hospital you will be delivering at, ask for a one on one OR tour (you can usually call and ask to talk to the charge nurse on a Sunday since they are not as busy).  Ask what the norm is for the c-section of twins.  The L&D nurses will be very honest and let you know what the docs will give on and what they will not.  Docs & hospitals vary, so you might want to look at more than one hospital.  If everything you want is against their norm, you might want to pick your battles.

Good Luck.

A lot of hospitals have a neonatologist or a pediatrician in the OR for all c-sections, period.  The hospital I delivered my son at had a pediatric team in the room just because he was a vacuum extraction.

If there's going to be a neonatologist or ped involved, you can ask for for a consult with that department in advance.  Ask what their procedures are, what treatments and examinations they usually do and where they do them, and how they can help you get your arms around your babies as soon as possible.  If your pediatrician has admitting privileges, or works at the hospital, find out if there's anyway that *she* can be the ped in the OR.  (Sidebar:  I found out that my pediatrician's practice had one ped doing neonatology, circulating between the local NICUs, and that she - sad to say - was kind of a nut.  Ask your pediatrician who will be consulting on your children if they wind up in the NICU.  If you don't like that one, opt to go with the hospital neonatologists.)

I agree that it's totally reasonable to look at more than one hospital.  If you live in a location where multiple hospitals are an option, you're already in a pretty good situation - the competition for obstetrical patients can get pretty fierce, and they have a lot of incentive to make you happy.