planned c-section - is a wonderful birth still an option?

[mammom]

Hi all,

I am writing for a friend (Rachel) who is rarely online, so I hope I have all the details correct. She is about 25 weeks pregnant with her first and the baby has a fluid-filled sac growing under his arm. She said the diameter is about 9cm at the moment - I assume that means the baby's entire diameter, not just the sac - and the doctors are saying the sac is not part of the baby's circulatory system so it has no way of draining on its own. The baby's arm is stuck over his head because the sac is in the way, SOOO, because of the size of the sac and the fact that the baby is stuck in that position, the doctors are saying she must have a c-section.

Rachel was planning a wonderful birth at a birth center, with a midwife and now she is so completely shattered inside. She asked the doctors if she could at least allow herself to go into labor naturally and then do the c-section and they said no - that there is no benefit to it and it could be dangerous (is that true, there not being any benefit to it?).

She is also worried that the baby will come out and will look so scary that she won't be able to bond with him. I think she is freaked out that she would even have that thought, but you know how we think of every possible outcome sometimes! But the doctors are saying they will have to take the baby soon after he is born to remove the sac, so she has visions of him being grossly deformed (which she knows he's not, but "what if...")

Is it possible for her to have a wonderful, satisfying birth even though it's not going to be what she hoped for?

Thank you in advance for any help - suggestions, resources, etc. I want to help make this a great experience for her!

Melissa

[Storm Bride]

Originally Posted by mammom

She asked the doctors if she could at least allow herself to go into labor naturally and then do the c-section and they said no - that there is no benefit to it and it could be dangerous (is that true, there not being any benefit to it?).

For myself, I found my planned section to be worse in many ways than my emergency one. I also found that my milk took a lot longer to come in with a planned section. So, if I do end up going the section route this time, I've really pushed for labour first. My OB asked me what advantage I saw in doing it that way, and I explained about my milk...he found that perfectly reasonable.

I'm still very bitter and upset about my sections, so I'm not the best one to give you feedback. But, I'd recommend looking over the c-section support thread. On The Fence (the thread author) just had a planned section on the 24th, and she's very positive about it. You'll find some stuff to help your friend on that thread, I'm sure.

[jlpetitte]

Wow, I'm not an expert- just a student midwife, but I will give you my take on it. I would urge her to get second and third opinions. She will probably end up with a c-section because most doctors do them for anything and this is a special situation. Have your friend get a doula now to attend to her during the c-section and make sure her doctors will allow one in the room or switch doctors. Unless the baby is in danger, which it doesn't sound like it or they would be rushing to do something now, there should be no reason they take the baby away immediately! That WILL affect the bonding. She should make sure the doctor agrees to give her an hour with the baby to begin BFing and bonding if at all possible. Also, get a second opinion on the 'waiting for labor to begin' part. Having an accidental early baby is dangerous. Maybe talking to a counselor about her fears of bonding will also help. Your a nice friend to look out for her .

[Raven]

extract from "The Birth Book" by Dr William Sears

You may think, "Why should I go through all that work and pain if I'm going to have a cesarean anyway?" While it may be inconvenient for the hospital or doctor, it is often medically beneficial for your baby if you labor as long as possible before an elective cesarean. Besides indication that baby is ready to be born, some precesarean contractions let the baby benefit from the natural hormones of labor. Studies show that babies delivered by cesarean after mothers labor a while have fewer breathing problems in the first few days after birth than babies whose mothers were not in labor.

Also... labor causes the release of catecholamines, or stress hormones, mainly epinephrine and norepinephrine (adrenalin and noradrenalin). Both the mother and the baby release these hormones during labor. Here are some benefits of this:

- The hormones produced increase surfactant release enabling the newborn to keep his lungs expanded - this allows the baby to clear amniotic fluid from his lungs. This allows the baby to breath easily/

- The baby receives an increased supply of energy as these hormones break down glycogen in the baby's fat stores and stimulates the liver to produce glucose - this helps the baby maintain his energy levels until his mothers mik comes in after a few days.

- These hormones increse the alertness and responsiveness of the baby.

- Increased amounts of blood are sent to vital organs such as the brain and heart and kidneys

- As the hormones are released, the white blood cell count also increases, providing the baby with a stronger immune system.

Hope that helps

[daekini]

I had a very satisfying scheduled c-section, and I'm pg now and planning a VBAC because those complications (ironically, a fluid-filled lymphatic cyst on myself as well as breech position) are not present during this pregnancy. I think that if you are in a situation like hers (I didn't have a choice, either, if I wanted the best possible outcome), you have to make the very best of your options. There may be other factors that led to the OB saying she shouldn't labor, doctors aren't always forthcoming with info, are they? It is true that there are benefits to laboring before the c-section, but maybe there are risks, too, in her case. (please don't flame me! ) Just so you have another perspective, this is actually a quote from another post I made but I thought it might be appropriate here:

"I just wanted to let you know from my personal experience with a scheduled c-section, no labor, at 39 weeks that I had a wonderful delivery and recovery. I want you to know that there are wonderful outcomes so that fear won't be the only factor in your decision-making process. My OB let me try to nurse on the table, which was unsuccessful, but she sewed me up quickly so that I was able to make another successful! attempt within 45 minutes of dd's delivery. My milk came in 20 hours after delivery - dd "roomed" with me and I nursed every hour or so to make it happen quickly (once again I must mention that I never had a single labor pain and my cervix was totally closed and in the OB's words - "a mile long and hard"). I took nothing stronger than ibuprofen for pain. A long-acting (22 hr) morphine dose was placed in the spinal block, and I felt absolutely no affect from it other than a lack of pain because it targeted only that region. After that initial dose wore off I really had nothing more than discomfort. The baby was out within 20 minutes of my spinal and had none of the signs I was looking for in a baby exposed to epidurals/spinals - she was totally alert like babies are supposed to be for a while after delivery."

If you ask a hundred women about their experience with this, you'll get a hundred different answers, but I've actually heard more postive than negative - especially if the mother accepted the fact that this was her only option for a healthy baby (of course she should make absolutely sure that it is truly the only way first!) and embraced it, and found a provider who would work with her needs.

best of luck to Rachel, I hope she'll be able to have the wonderful birth she deserves!

[JSerene]

One thing to be aware of if a c-section is in your future is what is standard for post-op pain management at the hospital. This makes such a difference! Women who are in very little pain can move around a lot more, breastfeed more easily, and recover faster than those who are hurting. If she chooses a c-section, recommend that she discuss this with her M.D., then research the answer given to make sure it is satisfactory. FYI: Post-op pain management varies WIDELY by doctor.

[JanetF]

It really depends on the staff she can access. Try this link for some possibilities.
http://www.eheart.com/cesarean/oliver.html

We currently have a midwifery programme here which gives women support to bf in the OR and have the baby never leave them. I too feel strongly that some labour is necessary to avoiding the kinds of things that would allow a hospital to separate the mother and baby. She needs lots of support and very good advocates to make it a positive experience.

[Storm Bride]

Originally Posted by JSerene

One thing to be aware of if a c-section is in your future is what is standard for post-op pain management at the hospital. This makes such a difference! Women who are in very little pain can move around a lot more, breastfeed more easily, and recover faster than those who are hurting. If she chooses a c-section, recommend that she discuss this with her M.D., then research the answer given to make sure it is satisfactory. FYI: Post-op pain management varies WIDELY by doctor.

If this one goes to c-section, I'm going to get as little pain management as possible. I haven't found that anything really makes a difference, anyway.

I think it does need to be said that a planned c-section doesn't necessarily mean a better recovery or less pain or any of the rest of it. That does seem to be the way it is for many women, and maybe I'm just really weird. But, my second section hurt every bit as much as my emergency section did - I had pain at the incision site for months, and was taking painkillers for weeks just to get through the day...despite having more help at home than I had with my first. The pain from my first was gone in about six weeks.

[Amylcd]

My planned csection was wonderful. Of course, I had my birth plan all ready and made sure the doctors and nurses went by it *even though it wasen't standard procedure* (baby never left my side, no "recovery" time alone for me, no pain medication after surgery, i gave baby first bath, baby co-sleep from day one, etc).

My planned section did not hurt at all. I had no trouble holding my 10+ lbs baby on my belly, I was walking within a few hours with NO pain medication (not even tylenol). However, this varies greatly from woman to woman

Wanted to add: I went into labor 2 weeks before the birth was "planned". I don't know if the 4 hours of labor was beneficial at all, but I don't see how it was dangerous.

[OnTheFence]

Please check out the Cesarean Support Thread in this Forum. I have had two virtually pain free WONDERFUL planned cesarean sections. I had good doctors and attendents and had well thought out birthplans (posted on the above mentioned thread).
I find that a planned cesarean section is better than an emergent one or one after labor has begun. While beginning labor may have benefits for baby it may not for mom. There are conflicting reports and literature on this. I will say that in my personal research, more moms and babies have had better outcomes from planned csections, especially if there was a special needs issue at hand.

I had a horrific emergency csection and never believed that you could have a beautiful birth in an OR but I've done it twice now and know many others who have too.

Also, as for breastfeeding -- my last two csections I had my milk come in fairly quickly, 36 hours and 48 hours. My first csection took a little over two days.

Kim

[FrumDoula]

One thing I noticed is that we are all giving the typical advice about labor and birth via c/section for moms who have uncomplicated births and healthy babies.

Since this baby appears to have an abnormality, does that change the situation? Are our recommendations medically appropriate to her particular case?

Just wondering ....

[aisraeltax]

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