What happens preceding a scheduled c/s?

[CoBabyMaker]

I've had two emergency c/s and if/when I am pregnant again I will probably have a scheduled section.  Can someone tell me what happens in the time leading up to the c-section?  It seems that they have you come to the hospital several hours prior to your surgery and I am wondering what happens during that time.  Do they just monitor you?  Start IVs with antibiotics and fluids?  Do they insert the spinal right before the surgery still?

( Seems a but silly asking when I've been through a c/s twice but I don't know what happens when it's planned!)

Thanks!

[Bokonon]

Mine wasn't exactly scheduled, as I only knew that morning that I would be delivering that day (I was already in the hospital with severe preeclampsia), but I will tell you what I remember.

My labs were drawn and I got to take a shower.  I was brought to pre-op and given antibiotics, though I already had an IV in.  The spinal was not given until I was brought into the OR.  I had to wait in pre-op for an hour or two because they were backed up, which was really frustrating because I was 34 weeks and very anxious, but it wasn't yet a true emergency.  My husband was with me except when I was prepped in the OR, after which they brought him in.

That's all I can think of for now.  Let me know if you have any more questions.

[TenzinsMama]

I had placenta previa, and had to have a scheduled c/s.  A couple days beforehand, I was asked to go to the outpatient lab to have my blood screened and typed (since there was the possibility I would need blood-- especially because two large maternal vessels at the placenta site were located right next to my cervix).  I believe I was asked to go early like that, because my c/s was to be done on a Monday and the lab was closed on the weekend.  Anyway, I didn't go beforehand, they ended up doing the type and screen a couple of hours before the c/s. 

I was told to shower that morning, and to come in a couple of hours before the surgery.  Once I was there, I put on a gown, they did the usual pre-op checks, did a quick monitor of the baby, and placed an IV in me.  I had to have two IVs-- it would have been one in each arm, but my veins weren't very good in the one so the two IVs ended up being in the same arm.  (Had to have two, because of the risk of bleeding from the previa-- they wanted to have the extra line in case they had to push fluids into me and do a transfusion.)  Since we had requested to me the anesthesiologist before the c/s started, he did the IVs.  He used the largest gauge needles; knowing that he was going to do that, I requested he give me some freezing before he inserted them.  I'm so glad that I did!

I asked the anesthesiologist about some sort of anti-anxiety medication, because I was going to hit the roof with my anxiety, and he was willing to give me something before the surgery... but when he told me that it could cause memory loss, I decided it wasn't worth it.  When it was time to go for the c/s, I walked to the OR with my OB, DH and midwife, and the team of nurses were in front and behind us as we made that trek.  DH had to wait outside the OR, while they got me ready.

I climbed onto the table, sat up, the table was raised, and the anesthesiologist injected the local freezing (same as what I had for the IVs), and then the spinal.  I layed down, and then it got really busy as the screen went up, they put in a catheter (but already at that point, I couldn't feel it), hooked up the blood pressure, heart monitor and O2 monitor etc.  I was asked repeatedly what I could feel/couldn't feel, as the bag of ice was passed along my legs and abdomen, as they were waiting for spinal to be in full effect. 

Once all that was done and they were ready to start, they brought my DH in and he sat beside me.  I don't know what my midwife was doing all that time, but once the surgery began I was aware that she was off the side also, just kind of in behind DH.  She could see the surgery take place, but DH was right there with me with the screen in front of us.  When my DD was ready to come out, the OB told DH he could stand up so that he could see and take pictures.  (Normally, the anesthesiologist we had wouldn't allow the partner to stand up and peer over the screen, but in our case he let this happen because DH is a paramedic and wouldn't faint or get upset.)

In addition to the pics, the OB also did delayed cord clamping, and we did skin-to-skin about 1 minute or so after she had been assessed at the warming table.  All of this were things we had discussed with the OB in advance, and it was agreed upon that it would happen provided that me and the baby were stable.  It was great-- I wouldn't have known to even ask for these things, had it not been for some mamas on mdc here who told me about natural or gentle cesarean births.  So grateful for that! 

That's about as much as I remember as to what happened before and during the c/s... I'd be happy to answer any questions about this, if you have any.

[rubidoux]

I don't remember a whole lot about it, but it wasn't hours for me.  I think it was more like an hour, maybe an hour and a half.  My doctor did c-sections before going into the office on wednesdays and I think he went to the office at like 9, so maybe he was under more time constraint than some.  lol   Anyhow, I think a big chunk of that time was spent checking in, like maybe half of it, and then they had me in a little exam area  --  like they have in emergency with the curtain they pull around it  --  and checked vitals and such.  And then it was on to the OR where they did the epidural.  It was all very quick and no waiting around or anything.  

I gotta say, I enjoyed my first c-section, which was after 30 hours of labor and 3 hours of pushing, more than my second.  You gotta really want a c-section when it happens for it to be fun.  The scheduled one felt kind of unspectacular, there was no build up.  It was kinda flat.  I know that sounds horrible since it was the birth of one of my little loves, but it is what it is.  It was often to lay eyes on him and all that but...  I will say, though that it was nice having my wits about me afterwards.  The first time I was just barely holding onto reality, had no energy whatsoever, when they showed him to me it was a totally glorious moment that I will remember forever, but then I just closed my eyes and was just as happy for them to take him away.  After the scheduled one I was able to have him with me and hold him and nurse very soon after.  That part was really nice.  Anyway, I just mention that flat feeling because I didn't expect it at all, but now that I think about it, it kinda makes sense.  I wouldn't be surprised if other people felt that way, too.  And I think it might have been easier if I saw it coming.  

[CoBabyMaker]

Thank you all!  I really appreciate you sharing your experience.

rubidoux-  It's interesting that you said it was sort of anticlimactic.  I have actually thought about that aspect of it.  Just sort of, " Ok, get on the table and we're going to cut your baby out."  I am looking forward to hopefully being more present though, like you mentioned.  I was sooooo out of it for days after a drug-heavy 50 hour labor with my first.  I was much more present after a shorter, natural labor with my second.  I am hoping for more immediate binding in the OR this time and less stress for DH.  Poor guy is always left feeling torn between leaving his wife cut open on an operating table and going with the baby so they don't inject it with crazy things. 
 

[Storm Bride]

I've had three scheduled c/s. There were very minor variations (and one major one, as I was allowed to have dh present for the spinal for the last one - it helped), but basically:

After a pre-surgery fast (12 hours for one, and nothing by mouth after midnight the night before for the other two), I went to the hospital. I was checked into L&D, and given a gown. DH was also given scrubs to wear. They checked my vitals, then gave me a nasty anti-nausea medication to drink. After that, they hooked me up to an IV - think they kept me on until one full bag of whtever was emptied. Then, they hooked up a second bag, and I walked down to OR shortly after that.

Once I was in OR, I got on the table, turned by back to a doctor, and curled up (bent over) for the adminstration of the spinal anesthesia. Then, they got me in position on the table, put some monitors on me, and set up the drape. For the first two, dh was allowed in at this point (actually, I think they forgot him for the first one, because they couldn't find my doctor once they got the spinal into me, but they did go get him eventually). They started the surgery pretty much right after he got there.

The actual surgical experience varies from one person to another. I hated it, and much preferred being unconscious. You can't feel pain, but you can feel pressure and a weird tugging/pulling sensation. It freaks me out (not trying to scare you - but I personally handled it a bit better once I knew to expect it). I felt very disconnected from the whole thing. (I hated checking in, too - felt like I was showing up to have my hair done or something.)

Afterwards...it's been a bit different every time, but the standard protocol at my hospital is to let me hold the baby briefly in OR. Then, the baby leaves briefly, if necessary (the OR is too cold for baby) while they finish sewing me up.Afterwards, mom and baby meet again in the L&D room, and mom can try breastfeeding while being monitored during the initial recovery. WIth my first, the L&D rooms were full, so I went to the general post-op recovery ward, and dd1 went into the nursery until I was released (about an hour). With my third, I got to breastfeed while still on the OR table. So, there were variations...only ds2 went exactly the way protocol calls for.

Being able to nurse on the table was amazing. I wasn't going to be allowed to, but the L&D nurse who came in with jme (believe from a few comments she made that she'd been a midwife in the UK) said, "she sounds hungry - want to try feeding her?" and helped latch her when I said, "yes". So, dd2 was nursing - over my shoulder, with the top of her head pointed at my feet - while I was still either having a tubal performed on me, or being sewn up! (She did have to leave, though - I was in there for a long time with that one...c-section, tubal, and excision of considerable scar tissue.)

[WindyCityMom]

I had a c-section due to breech the morning of my external version at 39w6d.  It was by no means an emergency, baby was fine.

I *think* I was brought the consent forms and whatnot.  When I was admitted for the version I was put in an OB triage room.  When I was getting ready for my c/s they moved me to one of the birthing rooms.  I already had an IV started because of the version.  The anesthesiologist (however you spell it!) came in and talked me through what was going to happen.  My husband was given the gown and everything to suit up.  They then walked me down the hall to the OR.  Kept my husband out while they placed the spinal.  I sat on the edge of the operating table, I think.  They placed the spinal (hellish, but still way better than an epidural!) and laid me down on the table.  Put the curtain up, started scrubbing my belly or whatever.  My husband was invited in.. he actually saw my insides when he walked into the room, but he wasn't too freaked out, I think.  He sat by me, they did the surgery, baby was out, they put her on the warmer thing and weighed/dried/whatevered her.  They took her back to the birthing room a few minutes later, and my midwife and DH followed to ensure that no bottles/glucose/etc would be given.  They sewed me up, wheeled me back to the birthing room (recovery room now, lol) and that was that.  Nursed baby, fought off rude nurses.  They took the baby to the nursery to observe her, my DH followed and they sponge bathed me at that time.  Fun stuff...

[TenzinsMama]

Storm Bride, I just want to say that I can totally relate to what you were saying about the checking in part beforehand... I didn't like that part either.  And although I had anticipated the pulling and tugging, because I had read about that, I was in no way prepared for the pushing that the OB did, as he was getting the baby out.  He told me just before he started that I would feel some pressure, and wow-- that was the strangest thing... I didn't like that one bit.  The pulling and tugging were like several small sensations but the pushing was such a big one... I wish someone had told me about that.  I had a good experience with the spinal catheter insertion, though... Maybe if I had been in labor for a long time beforehand, I wouldn't have experienced the sensations the way I did... I don't know.  They felt really heightened to me, because I was totally in my 'normal' state walking into that experience (i.e. not affected by the hormones of labor, any meds, or hormones in response to pain).  Actually, having said that, I was under major stress hormones... I would guess that being in that heightened state of alertness about some things causes one's brain to block out other things, during and after...

I also forgot to mention that while I was really looking forward to the skin-to-skin afterwards in the OR, it was only for a short while because as mentioned earlier, the OR is cold... DD was returned to the warming table and wrapped up in a thicker blanket, and returned to me-- she was laying beside me, DH was holding her at my head area while I was getting stitched up... but then I actually asked for him to take her away from me and hold her-- she was crying so hard, right beside my ear!  lol And once I was ready to leave the OR, after being placed on the stretcher bed, I was able to hold DD in my arms as we rolled down to the recovery room.  I was elated that I could that-- I remember thinking that if it was any other kind of surgery it would have been nice to have closed my eyes and sleep, because I was so drained from it all, but I fought it all off because I really wanted to hold her as much as I could right afterwards.

[Storm Bride]

Originally Posted by TenzinsMama 

Storm Bride, I just want to say that I can totally relate to what you were saying about the checking in part beforehand... I didn't like that part either.  And although I had anticipated the pulling and tugging, because I had read about that, I was in no way prepared for the pushing that the OB did, as he was getting the baby out.  He told me just before he started that I would feel some pressure, and wow-- that was the strangest thing... I didn't like that one bit.  The pulling and tugging were like several small sensations but the pushing was such a big one... I wish someone had told me about that. 

The pushing isn't always the same. It was brutal with ds2, but nowhere near as bad with my other two.I think it depends on the baby's position or something...although ds2 was vertex, and dd1 was breech. They mostly just pulled her out, though - not much pushing.

I had a good experience with the spinal catheter insertion, though...

I handle the spinal very, very badly. It scares me at least as much as the surgery itself. I'm not generally needle-phobic at all, but having one in my spine just freaks me out. I also hate the numbness.

[CoBabyMaker]

It's interesting to me that you both mentioned the pushing and pulling feeling.  It certainly is odd but it's not anything that has stood out in my memories of my sections.  It's interesting how everyone has a different take on things.

I had an epi with my fist but the second we were a homebirth transfer.  I don't think I cared that they we putting in the spinal- I just wanted relief since at that point i had been trying not to push for a while (except my body was pushing anyway).
 

[Storm Bride]

Originally Posted by CoBabyMaker 

It's interesting to me that you both mentioned the pushing and pulling feeling.  It certainly is odd but it's not anything that has stood out in my memories of my sections.  It's interesting how everyone has a different take on things.

Definitely. It freaks me out to a point that I almost panic, and when it started with my second conscious section, it caused a sensation similar to a flashback. But, I really hate altered sensation like that, anyway - having my internal signalling (pain) system put out of comission like that weirds me out. I get dental fillings done without anesthetic, because I'd rather feel the drill than the numbness. 

Edited by Storm Bride - 7/22/12 at 7:50pm

[TenzinsMama]

Stormbride, good to know that the pushing isn't the same each time.  If I should ever be pregnant again (which I really hope I will be) and have to have another c/s (oh goodness, I hope that is not the case)...  I know that my baby was very low down-- she even came out with her molded a bit-- so maybe that is why there was so much pressure with the pushing.  Ugh.  It was like the OB knew that I was going to experience it the way I did, because he warned me about it just before he started.

[WindyCityMom]

I had a lot of pulling and tugging.. DD's butt was apparently extremely wedged deep down into my pelvis.  Makes sense seeing that I was in early labor!  

[Storm Bride]

Originally Posted by CoBabyMaker 

It's interesting to me that you both mentioned the pushing and pulling feeling.  It certainly is odd but it's not anything that has stood out in my memories of my sections.  It's interesting how everyone has a different take on things.

I answered this, but forgot to mention that the pushing particularly registered with ds2, because my GP (assisting) was almost rocking me right off the table. DH was shocked (it was the second time he'd been there, and there was nothing like that with dd1). I was astonished that my rib cage and upper abdomen weren't covered in bruises, because they felt that way. But, that was the only section that was like that.