Emergency Situations, C-sections, and Our Rights « Back to Group Discussions

[writermama12]

Hi Mamas, 

I am trying to find info. on my rights in different birth situations to prepare in case something unexpected occurs. I realized in the middle of night while trying to go back to sleep that if I were told by medical staff that I needed a C-section or that I needed certain interventions, I may not know how to respond knowledgeably. I don't know much about C-sections in general. Do you have any good info, experiences, or resource titles I could use to gain some footing? 

Some immediate questions I have is what happens to a baby immediately after a C-section? Is the baby taken away or can it room in and nurse normally during the stay? What can happen if I refuse to take medical advice? 

[Chapsie]

After a c-section, the baby should be able (and encouraged) to room in with you normally. Once in the recovery room, Breastfeeding should be initiated and frequent nursing should be encouraged. Sometimes milk production can be delayed (about 24 hours or so) after a cesarean because the body is focused on healing from surgery... After my cesarean, (also my first baby), milk came in day 4.

The baby does not need to be taken anywhere if the baby is healthy.. If your partner is with you, baby should be able to stay all the time.

If the doctor orders something you don't agree with and you decide to sign out against medical advice (AMA), do not believe them when they say that if you sign out AMA that insurance won't pay... It's not true. This is a disgusting way to manipulate patients that I've seen way too often. Remember that you have a voice and are allowed to say no!

The "brand" acronym is helpful:
B: what are the benefits to this procedure?
R: risks?
A: alternatives?
N: what if we do nothing?
D: "please give us a minute in private to discuss and decide."

[cabbitdancer]

I've heard that it really depends on the hospital and the doctor. With my c-section, I got to say hello to my daughter before they whisked her and my husband out of the OR. If I have to have another c-section, I will insist that I have a second person to stay with me, this time. My experience after my husband left was... less than stellar. However, we were reunited as soon as I was wheeled into the recovery room where I would spend the next couple of days, and encouraged to try breastfeeding.

You can refuse any treatment that is recommended. They can say "need" and "have to" until they are blue in the face but the decision is, ultimately, yours, and they cannot turn you away for refusing to take their advice.

[GranolaMama09]

I had an emergency section with DD.  I was conscious for my surgery since I'd had an epidural in place.  My DP at the time came with me and sat next to my head holding my hand.  When DD was born he was able to hold her so I could see her for a few moments but then they were both whisked out of the OR and I didn't see them again until about 20 minutes later in the recovery room where I was able to nurse before being wheeled back to my room.  DD roomed in with me although several nurses pushed me to send her to the nursery.  My milk did take a bit to come in but it was also my first baby.
We are having a repeat section this time at a different hospital.  We met with them yesterday and they were VERY clear and informative on what would happen.  Baby will be born and wiped just a little by the doctor and held over the curtain so that we may see then handed to one of the nurses who will clean him up a little better and then put baby on my chest so that I can hold him.  I am welcome to latch if I wish.  Baby and DP can stay with me until they are finished stitching and we all go back to my room (not a recovery room) together.  If I need assistance with latching at any time the nurses are trained and happy to help with the LC on call 24/7.  I'm allowed to drink water immediately in small amounts and if I'm doing well that evening I may start eating non gaseous foods in small amounts (HUGE difference from the first time).  Baby is encouraged to room in but is welcome to go to the nursery if we choose.  The only bummer is that I will have to be alone for the spinal placement and that DP cannot cut the cord.  The other ladies had fantastic advice as well!

[writermama12]

I am very curious, if anyone can comment, about what one can insist upon or refuse...if every hospital does it differently, then there must not be a medical reason for certain routines. If not, then wouldn't it make sense that one should be able to refuse to hand baby over and insist on skin to skin, nursing in OR if baby wants to and delaying tests and check ups? 

Cabbit, do you think one can refuse the "treatment" they may routinely give to babies like washing him and swaddling him and taking him to nursery? 

I am trying to get a clearer picture of what is realistic and possible to fight for. 

I also have a question about your opinion. I feel like the possibility of my baby choosing to be vertex and engaging before labor is pretty slim. He changes position (breech, oblique, transverse) every few hours. I would like to avoid a c/s. IYO, is it safer to try to catch him vertex, belly bind and induce w/ waters broken w/ the hope that I will be able to deliver vaginally or is it safer to wait for labor w/ the chance of cord prolapse and/or Emergency c/s as outcomes? Any opinion is valid and welcome. I am just so unsure and need to have an idea of a plan soon to propose to MW and consult.

[writermama12]

And thank you all for your input so far. Really helpful.

[Melany]

Originally Posted by writermama12 

I also have a question about your opinion. I feel like the possibility of my baby choosing to be vertex and engaging before labor is pretty slim. He changes position (breech, oblique, transverse) every few hours. I would like to avoid a c/s. IYO, is it safer to try to catch him vertex, belly bind and induce w/ waters broken w/ the hope that I will be able to deliver vaginally or is it safer to wait for labor w/ the chance of cord prolapse and/or Emergency c/s as outcomes? Any opinion is valid and welcome. I am just so unsure and need to have an idea of a plan soon to propose to MW and consult.

Even  in the event of catching baby in vertex and binding your belly, he can still move around during labor. My MW had a woman who was head down and engaged at her appointments for weeks. She came in time for the birth and baby was crowning butt first. The mom had been aware of the position change and delayed calling the MW to avoid a C/S. Pretty sure I'd never have the guts to do that one, but being that baby was butt first and coming like a freight train and not 1 foot out, the MW was able to deliver the baby. It sounds like she (the MW) didn't appreciate the surprise at the last minute. Anyway, my point is even by binding baby in a good position, he can still move around. 

You're safest bet would be to encourage him to get into a good position by how you position yourself. Also, talk to your MW about an external version. My OB was very much for trying that when my daughter was still presenting as breech at 37 weeks. She eventually turned somewhere after the 38 week mark and there was some significant hands and knees time put in by me. Our kitchen floor and dining area was scrubbed daily for about 2 weeks. It has never been that clean, since.  My OB had already gone over the External version turning process for me at my 38 week appointment and then he felt for baby's position at my next appointment and told me she was head down and we wouldn't need to do that. SO, baby can turn very late. 

I don't remember if you were using the hypno-babies techniques. You might consider the turning a breech baby CD if you are familiar with the techniques.

[cabbitdancer]

I had a surprise BPP at my OB appt, yesterday, and discovered that baby has flipped breech. I about burst into tears, but managed to keep it to a few. I'm trying really hard not to freak out, because I know it won't help any.

writermama, as far as I am aware, you should be able to refuse any treatment, but I don't know how much they'll listen "in the moment," kwim? I think baby is also considered something of a grey area. They are more likely to respect refusal of something for yourself, but, depending on the hospital, may consider doing something against your wishes, "in the best interest of baby." Your best bet would be to go in with a birth plan, and to go over all your wishes with your practitioner and the hospital, in advance, if possible. Let them know how strongly you feel about this or that, and find out what you/they are willing to compromise on. The OB that my midwives turned me over to was not the compromising sort and told me that I shouldn't be upset, because I was going to have a healthy baby. Typing that, I find that I'm still angry at his callousness, after all these years. If I had known better, I would've dropped my midwifery practice and found an OB who would at least consider what I had hoped for in a c-section--or one who would have delivered breech. My daughter was in the perfect position for a breech delivery. Another thing you might consider is getting in contact with your local ICAN group. They might be able to tell you more than I can, since most of my "knowledge" is based on the research I've done in the years since my cesarean.

My mom told me, the other night, that she was talking to a woman at her doctor's office who was stunned that I was attempting a VBAC. She was told that they "don't do that anymore, around here." Which means that a great many women in the county in which I grew up are being told that VBAC is not an option.

[velveeta]

Writermama, what makes you believe so strongly that baby won't turn, and that your birth will not go normally? Is it a strong intuition? How many weeks are you?

I am planning HBAC, and my baby is breech right now. I am 32 weeks. I am going to chiro for Webster technique twice weekly. Next, I am going to try moxabustion plus an inversion table plus the other spinning babies stuff. If Baby still doesn't turn, I would consider a repeat C. There are no doctors here who would do a breech birth for a VBAC mom. I did have two normal home births before the C section. It took me by surprise. I was in transition, at home and the MW diagnosed breech then. My MW said that if the birth had progressed normally, she would have felt fine about breech at home, and I would have, too. But it stopped and started so much, different than my usual pattern.

Everything was ok at the hospital. I have processed this a lot. Of course, I was very sad, at first, but things went as well as a surgical birth can go, so, I am happy enough. And I am also not afraid, no matter what happens. But, my intuition says Baby will turn in plenty of time, and I will have a fast, easy HBAC.

I also think there are many things you can do to turn Baby, don't give up!

[writermama12]

Velveeta, Thanks for your post. I hope your intuition is right!

My baby's habit or way of being is unsettled. More so than the average baby at 34+ weeks. According to everything I've read, the majority of babies settle into a beloved general position by about 30-34 weeks (Spinning babies site said 28-30 weeks I think). Especially my babies who settle in and give me no trouble from like 27 weeks on. Having a breech baby or a transverse baby even is a different situation. You can work to get baby to turn and can have an ECV that might work. That is the opposite situation to mine in many ways because getting my baby to turn is not the issue. It's getting him to stop that I have to deal with. There isn't really a way to do that besides belly binding, which is temporary and mildly effective. 

I know most of the malpresenting babies do end up turning vertex (hurray!), but most of the unstable lie babies do not because they have the room to move at any time, which is also why an ECV is not recommended unless followed by induction. But I am aware that sometimes (in a few cases I've read about) it works out well. I do HOPE he will change gears but I feel it would be irresponsible of me to not prepare and plan for the possibility of having to intervene for his safety. Most unstable lie babies are delivered c/s because of risks and /or complications that arose due to labor with malpresentation (transverse, oblique). I am all about natural childbirth unless it posses risks that I have the duty to find the best solutions for. 

Cabbit and Melany, Thanks for your responses! I scrubbed my floor two days ago and just bought a ball. It is worth a try of course. An ECV won't help in my situation unless my baby decides to pick a position first. I hear you about the binding not really helping anyway. True, at the last moment baby can flip. Especially one in a very weak tummy!

** For now: I think what I might do is try to stay at the hospital from 38 weeks on to have position monitored and to be there if I go into labor and he is not in a good position. If he is, then I can walk right over to the birth center across the street! There will be more options for me and baby if I am right there with medical staff on hand. If he turns head down and engages for a few days, then I'll go home, birth at the BC. I don't know if my hospital will allow this arrangement or not but it is worth a try. 

[withlittlelungs]

This is totally not on topic of the thread, but it has to do with c-sections. For moms that have gone into the hospital for labor and ended up with a c-section, what happens with your stuff that you brought with you? Does it stay in your labor room? I will be delivering in an OR no matter what. I'm worried about leaving my stuff unattended in a labor room for god knows how long. 

Now to be on topic, writermama, (I know I have responded in another thread about babies turning, but I'm not sure if it was to you. I apologize if I repeat myself!) My Baby A was breech until 32 weeks and Baby B was all over the place but never vertex. At my 34 week appointment Baby B was vertex, too. I had been told all along that after 32 weeks it was pretty much hopeless and that they wouldn't have room to turn. But she did. Try not to focus so much on the time frame. I know it was driving me crazy and I was hopeless. I seriously used my birthday wish and threw a penny in a fountain in hopes that Baby A would be vertex at my following appointment. 
My MFM doctor told me that he had a baby flip at the last possible second in labor. I'm going to be sending positive vibes your way!! How far along are you?

[GranolaMama09]

WLL - my belongings stayed in the room I labored in and returned to after the OR.  If you're worried perhaps leave it in a locked vehicle and have DP go down and get it once you're back in your room?  Or perhaps have a trusted friend or family member hang out in the room?

[writermama12]

Granola, good ideas!

W/littlelungs, I am now 34.5 weeks so I know I have time. But my Birth Center is going to have me make a plan after my 36 week appt. So it's not that much time. And your baby B having been a flipper and then suddenly turning vertex and staying put does reassure me that it is possible. Thanks for Sharing that. From what I've read, that doesn't seem to be the norm though. It is just confusing and scary. Each day that passes by, this baby doesn't get any more stable and so I think about it more seriously. There are all these "what ifs" hanging about in my mind all the time and I am trying to pick the best plan of action IF he doesn't settle in and engage. None of my options seem good though and that is where the anxiety comes from. The very best I can do I think is to check into a hospital and wait for labor, but that could take so long it wouldn't really be an option to stay for more than two weeks. So I then have to decide if I have a elcs on my EDD, or if I induce. Inducing seems pretty awful for me and baby if I do it without being "ready" for labor. So I don't know. I appreciate your positive vibes!!! And I hope I don't have to make these tough choices and that Rowan will decide he wants to be born LOA!

[cabbitdancer]

writermama, is waiting for labor to start, regardless of baby's position, an option for you?

[writermama12]

Cabbit, I would love to feel that was a safe route because waiting for labor to start would feel the most natural...But there is danger in that if he does not settle into a position. DH and I have agreed we aren't willing to just wait and have "faith" that it will work out. I think that in this case if there is a risk then doing so is irresponsible (I would love it if anyone has another opinion AND evidence to back it up). Ruptured uterus and cord prolapse are real risks and I am a good 25 min. from a hospital. The amount of time it would take to get me there if I had SROM would be dangerously long AND complicated since I stay at home with my 21 mo and don't have anyone nearby that could help. But also what if I were out getting groceries or something? Dropping to the ground and putting my butt way up in the air in the middle of a grocery store is not appealing either, KWIM? 

And as far as I know, my hospital and MW take a more active approach with unstable lie. But I am looking for something in between active (c/s) and inactive (wait and see).

[cabbitdancer]

To be honest, there is risk in any decision you make, at this point. A c-section is major abdominal surgery and while it is widely accepted as safe, the complications that can and do arise can be pretty serious for mom. While you might be in the hospital at the time, a ruptured uterus is a real (if not common) risk for induction, which I can imagine they'll want to do immediately after a successful ECV. And you may be avoiding SROM and cord prolapse by accepting a c-section on your due date, but that date *is* an estimation, and what if baby *isn't* ready? Or, conversely, baby could come early, with SROM and cord prolapse. It all boils down to what risks you are willing to accept, but I don't think any choice you make, at this point, is going to be risk free. For that matter, I honestly don't believe that pregnancy is ever risk free. There is always the chance, however small, of something going wrong, but we make the choice to get pregnant and have babies, because we believe the risks are worth the outcome.

Unstable lie is very different from a "simple" breech and I can understand your concerns. I hope that baby decides to pick a position (vertex being preferable, of course) and gives you some peace of mind--soon!

[Melany]

Originally Posted by cabbitdancer 

Unstable lie is very different from a "simple" breech and I can understand your concerns. I hope that baby decides to pick a position (vertex being preferable, of course) and gives you some peace of mind--soon!

Agree!

Has your MW said anything to calm your fears?

[writermama12]

Cabbit, I really appreciate your thoughtful responses although I have to admit they are making me more confused and unsure about a course of action. I suppose that is a good thing since it will inevitably lead to greater reflection and a more confident decision. 

Melany, My MW is the one who began all of this by telling me that if baby wasn't head down and staying that way by next week then I have to have a fluid scan and either arrange an ECV + induction or C-section. I think it is because unstable lie is technically high risk and my BC doesnt' deliver high risk pregnancies. I am nearly 35 weeks now. I am hoping to get a whole lot more information next week at my appt. 

I WANT to believe I can wait for labor and check position then. I hope I find info that could reassure me that it is less risky to wait for labor, but I haven't found any yet. Only anecdotal. Anyone have any info? A link? Perhaps anything other than an opinion at this point? 

[cabbitdancer]

I'm sorry, writermama! I think I lost most of my links when I fried my laptop so all I have to offer is what I can remember from them, personal experience, anecdotal evidence, and so on, which means I don't feel like I have enough to offer you a definitive answer, other than to tell you to weigh all of your options. If birth providers did the jobs that they ought to, we would be armed with all of the information we need to be capable of making our own informed decisions. :)

[Melany]

Writermama: I had to look up what the term actually meant. The name is pretty obvious, but the medical definition according to one site is:

Unstable lie refers to the frequent changing of fetal lie and presentation in late pregnancy (usually refers to pregnancies > 37 weeks) (MacKenzie, 2011)

So, technically, you still have time before it really is "unstable," right? 

Under the management section on the one link I came across was this point:

>  85 % of fetal lies will become longitudinal before rupture of the membranes or labour (MacKenzie, 2011)

The site also suggests an ultrasound to make sure there isn't anything going on that is blocking baby from staying head down. Any chance you could do that, or did you want to avoid an ultrasound? It might help you to calm some of your fears.