Cesarean Birth and Recovery SUPPORT Thread 11 (MAY 2004) - Page 6

[applejuice]

What, if any, science is there behind the "four hour rule"?

[wombat]

Originally Posted by tammylc

Had my 6-week postpartum check up today. Everything looks good. I'm still having this painful "pulling" sensation on my right side. Dr. says it might be adhesions. Alternately, he said that sometimes a nerve gets stitched up in the uterine stitching, and it can cause some pain. If it's still bothering me in a month, I can go in for a steroid shot that should fix it up - he called it a "trigger point injection." Anyone know anything about that?

I went through 2 weeks of absolute hellish pain before the docs found out they'd sewn a nerve into my sutures. It was worse than labor and I had a painful back labor. I had trouble lying down, standing up and moving. Breathing hurt sometimes. If I just sat hunched in a chair and didn't move, that was ok. Looking after my newborn was hell. And 2 weeks pp I was needing to take more painkillers than when I was in hospital. Anyway I think it's a matter of ruling out other probs before they decide it's a nerve stitched into a suture - I had pelvic exams, blood tests, even a CAT scan, was admitted into hospital before they figured it out.

I got the shot - a local anaesthetic followed by the steriod shot. Don't remember the shots hurting - maybe because to find the right spot, they had to poke me so it hurt. And um that pain made me forget about anything else they could possibly do to me. I would have let them do absolutely anything to take that pain away.

And the result was pretty well instantaneous - no pain. I could move, bend a bit, sleep lying down at night.

But I was 2 weeks pp. The docs told me that the stitches dissolve in 6 weeks and then the problem would resolve itself anyway. I wasn't going to endure another 4 weeks of this pain so I got the shots. I'd check with your doctor why he thinks you'd be having the 'nerve sewn into a suture pain' at 6 weeks pp. Haven't your stitches dissolved by now?

[Kiki Runs]

applejuice - I must have missed something. What's the "four hour rule"?

Kinsey

[Henry's_Mamma]

Originally Posted by mamasarah

btw, amy, did you get yours yet?

I got my records from my OB's office but they're pretty skimpy (accurate, though, near as I can tell). It was an uneventful pg so I didn't think I'd find anything there. It is missing page 2 of the Operative Report (the page with all the important stuff, of course), and I just keep forgetting to call them to have them send it. I figure I'm due to get the hospital records any day now (I sent the $$ a week or two ago), so I'll just see it in there, hopefully and avoid making the call (I just don't feel like talking to anyone at the OB's office, yk). I really don't know if I'll be able to stomach reading them any time soon, though. I started flipping through The VBAC Companion last night (in a moment of more rational feelings about my c/b I inter-library loaned it from my library and I just got it) and had to stop b/c it just depressed me. There was this whole section on posterior presentation and what to do about it and NONE of those things were done to/for me. I so wish I had had a doula or had done more research on malpresentation. But I have to let that go ...

AnaNicole, congrats and to little Greysen. Hope you are both doing well.

My external scar itches like mad nearly everyday. Is this normal 7 months pp? I've tried Vit. E, lotion, etc. and nothing helps. Some days it really drives me crazy.

Anyway, I hope everyone is doing well.

[Icequeen_in_ak]

I'm almost 8 months PP, and from what I've read, the itching is nerves repairing/reconnecting. They say the symptoms vary from itching to sharp pin poke pains. I know I still have some numb areas and I've also read it can take years for all of the nerves to repair, or they may never. Encouraging huh?

[OnTheFence]

Originally Posted by jess7396

OTF- notice anything new under your name?

I was going to tag IOF with hers, but someone beat me to it, so Cynthia asked if I wanted to get anyone else- and I thought of you our resident "rebel".

Thanks so much!
I just came to check the boards. My work is taking me away from here and I do not have time to post, but wanted to say thanks and HEY! to everyone.

[Peppermint]

OTF-

I am so glad to "see" you, I was starting to worry that you were mad about the DDDDC. I was going to tag you Cesarean Goddess, but was hoping your senior member title would be up already.

[Henry's_Mamma]

Originally Posted by Icequeen_in_ak

I know I still have some numb areas and I've also read it can take years for all of the nerves to repair, or they may never. Encouraging huh?

Joy! Its so embarrasing sometimes b/c it itches so intensely, and usually when I'm in the most public of places (oh, the checkout at the grocery store or something). And its not like its a discreet place to scratch, yk?

[Terion]

I really glad this board is here, but why do we have only one thread, is c-sec so frowned upon here at mdc, some of us dream of natural births but for one reason or another it doesn't happen that way....my first c/s was because I was young and scared too much so to fight the doctor on it, the second was because I was pre-e and though we tried a two day induction my baby was stuck, come to find out she was turned a little sideways, so I had c/s #2, now I'm preg. again with #3 and would love a vbac but can't find a doctor or midwife that will let me try because my last c/s will have only been 15 months from this birth....

[Kiki Runs]

terion - good to see you. c/s is not "frowned upon" here at MDC (at least not to my knowledge - I can't imagine the caring ladies here being unsupportive of a mama who needed one). However, MDC is a great resource for natural birth, and I think it's fairly common knowledge here that a lot of c/s are NOT needed. The c/s rate in the USA is ridiculously high, and I see MDC as a place where women are more educated about birth than more "mainstream" sites, so therefore are more able to avoid unnecessary c/s.

Maybe the reason there is only one thread regarding c/s is because there isn't a lot of need for another one? TBH, *I* don't see a need for more than one ongoing thread. What exactly were you looking for? In this one thread we've got support, sympathy, knowledge, experience, all in one place!

If I were planning another c/birth, I could come here and have any questions answered (or be pointed in the direction to find my own answers). Or if a mama has questions while recovering from a c/birth, she can come here for support as well.

Were there specific questions you had? The mamas here are very helpful.

Kinsey

[AnaNicole]

Just venturing back after many days just staring at Graysen. He's so perfect, and starting to develop a little attitude as well!

Thanks to everyone for your kind thoughts and congratulations. All went well, considering. I can't believe it's already been 11 days!

I'm still working up Gray's birth story--not there yet. There's so much to process, so much to think through. I keep asking Chris for details to fill in the gaps of my own memory and I am SO thankful that I was able to ward off the overzealous anesthetist who INSISTED that her standard of care was to give me something to help me "relax" after Gray was born, though my birth plan specified that I didn't want anything like that (thanks, OTF--I think it was your birthplsn I drew that from).

"Sweetheart" she said, condescendingly, "You are going to be cut from here to here (demonstrating on her own abdomen). You NEED this."

I was loopy from the Vioxx they gave me and was unable to form a cogent rebuttal except to say I don't want it! I'm not happy about that! My midwife mentioned this to my OB who apparently talked to her and told her that if I didn't want it I shouldn't have to have it! So, I didn't get it and I DO remember all that happened after he was born and whisked away. I am SO grateful for that, it really helped me with my emotional recovery.

To the anesthetist's credit, I didn't feel a thing when she gave me the spinal!

Cranky babe, more later!

[its_our_family]

Terion-- The thought of a c/b forum has been tossed around MANY times. It isn't going to happen for the good of the ENTIRE board. yes, it is looked down on by some. But just to save you time (since youa re new) asking about it on the boards will only stir up strife and resentment (many have tried and many have failed )

I do not think it is needed either. Yes, it would be nice to have more of a forum where we could have stickies on what drugs you can have, birthplans, and the most natural things for repeats and first time c/bs. But it does nothing but cause judgment on everyone's part.

If it makes you feel any better about it. MDC has become more accepting of it. Since it seems that more of the c/bs are from women who were planning a natural birth and ended with a c/b for one reason or another. It seems to me that fewer of them here at MDC are happening from mis-information since both sides (those who have had c/bs and those who haven't) are insistant that anyone with questions be answered.

You can feel free to post a c/b question on the Birth and Beyond forum and they will be answered truthfully and, more often than not, respectfully.

[Henry's_Mamma]

Well, I Got My Records ...

Only a few minor errors. It appears, though, that if anyone knew ds was posterior, they didn't bother to note it until I was pushing, which is the same time they bothered to tell me.

Also, it appears that I was spilling lots of protein and ketones in my urine, and that got worse as labor progressed and after the c/s. My bp also was increasing as labor progressed and post-c/s. Is that indicative of pre-e/toxemia? I know I was retaining a ton of fluids the last 6 weeks or so of my preg., and I was very swollen (especially, feet, ankles, hands, & face).

Anyway the big blah in my records ... I read the missing page 2 of the operative report and I'm trying to figure out single vs. double layer sutures. I'm fairly certain I asked for double layer, but I just can't remember and when I think I asked, dh wasn't yet in the room (by the time the c/s occurred I'd been awake for about 36 hours and in labor for 23 of those -- was not functioning well). In any event, here is what my recs. say ... I'm thinking single layer, which makes me .

The uterine incision was then repaired with 0 chromic suture in a running locked fashion. ... The uterus was returned to the abdomen ... The rectus muscle was reapproximated with 2-0 Vicryl suture in an interrupted fashion. The fascial incision was closed with 0 Vicryl suture in a running fashion. The subcutaneous tissue was closed with 3-0 Vicryl suture in a subcuticular fashion.

What do you think?

[Terion]

single or double why...

guess I'm not up on c/s technical stuff hope you don't mind me asking, about the difference between the single or double sutures, and why double is more desirable...

[Henry's_Mamma]

Originally Posted by Terion

guess I'm not up on c/s technical stuff hope you don't mind me asking, about the difference between the single or double sutures, and why double is more desirable...

No problem.

This is my understanding ...

Back in the old days (pre-1980's?) all surgeons stitched back the uterus using a double layer of sutures b/c it was believed to be the best suturing technique available. The problem with it was it elongated surgery time and could lead to add'l blood loss. So, drs. developed a single layer suturing technique which decreased surgical time and purportedly, blood loss. At the same time single layer suturing became "the norm", VBACs also rose in favorability as well as medical inductions w/prostaglandin gels and pitocin. Well, low and behold, the uterine rupture rate went way up and VBAC fear with it. So the question became, why the rise in rupture rates?

The answer is two-fold ... all of the induction techniques increase the likelihood of uterine rupture. In addition, a smallish study suggested that the single suture technique also contributes to a greater likelihood of uterine rupture. So, even though it isn't conclusive that double layer sutures are substantially better than single layer, it is typically recommended that women who desire VBACs in the future have double layer sutures as sort of an extra precautionary measure. In addition, they should avoid all induction or labor augmentation techniques (i.e., pit or p/gels) to decrease the risk of rupture. That said, the rate isn't all that different (I don't think -- someone correct me if I'm wrong) between fully natural VBACs (no pit or p/gels) with single or double layer sutures, although double is considered "better" and seemingly less "risky."

Did that make any sense at all? :

[applejuice]

Four Hour Rule:

the arbritrary rule that hospitals have for taking the healthy baby born by caesarean section away to the neonatal nursery for observation for four hours while the mother is in recovery.

My only question is - on what scientific evidence is this routine based on?

[Kiki Runs]

applejuice - I've never heard of that. I can't imagine (given the lack of evidence-based medicine regarding childbirth) there needs to be any evidence for this to happen.

My personal experience was that DS was taken to the newborn nursery (I wouldn't say "for observation", since they didn't) while I was kept in recovery. I was supposed to be in recovery for an hour - it ended up being longer, due to the nurses' laziness. I was brought DS immediately upon my return to my room.

Considering how restrictive my hospital was, I have to think that if this rule was very common (ie, they'd ever heard of it), they would have tried to enforce it. Evidence supporting it or not!

Did this happen to you? I call BS on that rule!

Kinsey

[wombat]

Originally Posted by applejuice

Four Hour Rule:

the arbritrary rule that hospitals have for taking the healthy baby born by caesarean section away to the neonatal nursery for observation for four hours while the mother is in recovery.

My only question is - on what scientific evidence is this routine based on?

This happened to me. I birthed at a major military teaching hospital - the L&D was quite progressive (had rooming in, no formula ads or gifts, LCs and midwives on staff....) but they had this stupid hospital policy that all babies born by c/s HAD to go to the Observation Nursery for 4 hours. I think the reasoning is that c/s babies have more fluid in their lungs because they didn't get 'squeezed out' for want of a better way to put it. But this didn't apply to my dd - I was in labor for 24 hours before they did the c/s. And her Apgars were 8 and 9.

I was told pre surgery that after 1 hour in Recovery, I could go see my dd. Well no one would take me. Suddenly there were no nurses anywhere to be found. I was dumped in an ante partum room (post partum rooms were all full) and didn't see my dd again for 5 hours.

I'd really love to know what scientific evidence this rule is based on. God forbid I ever have to birth in a hospital again but if I do, I want to be prepared.

[Kiki Runs]

I'm so sorry, Wombat! That's horrible (and disgusting). So six hours from birth to seeing your daughter? What were they thinking?

Kinsey

[applejuice]

No, kinsey43, this did not happen to me - I was fortunate that things worked out for me in this department of my life and I was able to have my four at home. Praise G-d for this one blessing!

However, my three younger sisters who are mothers did have caesarean sections and I was a childbirth educator for a while.

I always have felt very bad for mothers who have had to fight off hospital regulations and interventions to just hold their own baby ater carrying the infant in their own bodies for so many months.

So sad.

It is a sad commentary on our culture.