Mothering Forums

Mothering Forums (http://www.mothering.com/forum/)
-   C-section Birth (http://www.mothering.com/forum/17256-c-section-birth/)
-   -   Humanized Caesarean Birth: How do we help the 5-15% who will need a c-section? (http://www.mothering.com/forum/17256-c-section-birth/1269892-humanized-caesarean-birth-how-do-we-help-5-15-who-will-need-c-section.html)

loveneverfails 10-09-2010 03:19 PM

Disclaimer: I have never had a c-section.

I've been watching the c-section threads with interest, and I'm wondering how we as a community who care about childbirth can help on a large scale to make c-sections a more humanized experience for mom and baby (or babies.) That there are too many c-sections performed is indisputable, but if we take the WHO recommendations of 5-15% optimal c-section rate, that still means that at minimum 1 in 20 women will need a c-section. That's a whole heck of a lot of women and babies who truly need to birth by caesarean in order to have the safest start to their extrauterine lives together.

Does anyone have any ideas as to how to make change on a macro level for women and babies who require caesarean birth? If we were create an "ideal" c-section scenario (blaring red light emergencies aside) what would that look like, and how do we get there?

Thank you all in advance for all your input!


TCMoulton 10-09-2010 03:35 PM

Honestly, I personally feel that the most important thing that people can do is stop judging c/s moms and trust that when they say that their c/s was necessary that it in fact was & don't feel that you need to tell her what she could have done different that would have made her c/s unnecessary. I have read too many threads here where a new mom posts about her birth & as soon as a c/s is mentioned members here come out of the woodwork here to critique what she did wrong. Unless she asks for advice on what could be changed don't assume she wants it.

GuildJenn 10-09-2010 03:43 PM

Quote:
Originally Posted by TCMoulton View Post
Honestly, I personally feel that the most important thing that people can do is stop judging c/s moms and trust that when they say that their c/s was necessary that it in fact was & don't feel that you need to tell her what she could have done different that would have made her c/s unnecessary. I have read too many threads here where a new mom posts about her birth & as soon as a c/s is mentioned members here come out of the woodwork here to critique what she did wrong. Unless she asks for advice on what could be changed don't assume she wants it.
Ditto, and also to recognize (as you did OP) that c-sections are life- and complication- saving procedures.

The goal is not NO c-sections, but an appropriate level of c-section - which may occasionally mean error on either side as well.

Annie Mac 10-09-2010 03:52 PM

Quote:
Originally Posted by TCMoulton View Post
Honestly, I personally feel that the most important thing that people can do is stop judging c/s moms and trust that when they say that their c/s was necessary that it in fact was & don't feel that you need to tell her what she could have done different that would have made her c/s unnecessary. I have read too many threads here where a new mom posts about her birth & as soon as a c/s is mentioned members here come out of the woodwork here to critique what she did wrong. Unless she asks for advice on what could be changed don't assume she wants it.
Yup. Agree agree agree. And even if you're not bashing the mom directly, there is no need to bash the procedure or question the doctors, if the mother herself is at peace with it. It's not all a conspiracy or warring political agendas. Sometimes an emergency surgical procedure is just that. I think that making it so political and so oppositional dehumanizes the birthing experience just as much as the surgeries purportedly do. FWIW, I had a section. I didn't expect it, but I was relieved to live in an era where it's an option. I absolutely believe that I and/or the baby wouldn't have made it otherwise. I don't want another one, but I would do the same if the same circumstance presented itself.

alis 10-09-2010 03:56 PM

^^ Agree 100% with everyone. I had a vaginal delivery that nearly killed or disabled the baby (severe shoulder dystocia resulting in multiple fractures) and will be having an elective C-section next time around. I fear the judgment I will face - even though people "understand" if I say why, I don't feel comfortable sharing it with every Tom, Dick, and Harry. It's not their place to judge.

For actual humanization, I'm not sure as I haven't gone through it.

Annie Mac 10-09-2010 04:16 PM

Quote:
Originally Posted by alis View Post
For actual humanization, I'm not sure as I haven't gone through it.
Here is what I think the doctors and hospital staff did right with my birth and subsequent section. I didn't feel dehumanized in the slightest.
- Communication. This is the big one. Every step of the way I was told what was happening and why. My input was welcomed.
- Choice. I have heard stories (not from the actual owners of the stories, it has to be said) about women who were in essence strapped to a hospital bed the whole time. During my labour I could walk around, go in the shower, squat, lie down, whatever. The doctor gave me some suggestions, particularly suggestions that might help move the baby into proper position, but ultimately, it was down to me. I've also heard stories about women who were denied food. This was not my experience either. If anything, they kept pushing it at me and it was me who refused it. Also with drugs. No one ever pushed anything at me. When I got pain meds, it was because I asked for them. They even gave them to me at the specific dosage (less than normal) that I asked for.
- When the situation got frustrating (for everyone), the doctors never aimed any of that frustration at me. They were super clear what was frustrating (lack of resources at the hospital which delayed the surgery by a long time)

I think it comes down to respect and communication.

Drummer's Wife 10-09-2010 04:23 PM

Quote:
Originally Posted by TCMoulton View Post
Honestly, I personally feel that the most important thing that people can do is stop judging c/s moms and trust that when they say that their c/s was necessary that it in fact was & don't feel that you need to tell her what she could have done different that would have made her c/s unnecessary. I have read too many threads here where a new mom posts about her birth & as soon as a c/s is mentioned members here come out of the woodwork here to critique what she did wrong. Unless she asks for advice on what could be changed don't assume she wants it.
Absolutely. That is by far the most important, IMO. I've had four c-sections, and you know what? They weren't that bad, with regards to the actual experience. And really, they were the best 4 days of my life, since I got to meet my babies.

I happened to have a fabulous OB, and my mom as a midwife who was there with me and DH all four times (probably made all the difference in the world, considering she knew the nursing staff, anesthesiologist, and the OB was the back-up doc for her practice). All that said, the emotional baggage comes mostly as a result from the NCB community and even those who have had medicated vaginal hospital births, who say things without having a clue what they are talking about or how it could impact others.

Support, true support, is needed.

loveneverfails 10-09-2010 04:23 PM

Absolutely, the second guessing is just absolutely not helpful, and so lacking in compassion. To me, embracing a midwifery model of care means that we stand firmly *with the woman* in however she births her child. That includes caesarean birth.

I'm wondering if maybe this is something that Lamaze could get in on, to work on a protocol process for indicated but not necessarily extremely emergent hospital births, so that women who need c-sections have the kindest approach to their births that we can reasonably offer. Like, offer a certification process similar to the mother and baby friendly certs where (true emergencies barred) mom's hands are freed so that she can apply abdominal pressure to "push" her baby out and then have the baby go straight over the drapes to mom's chest with warm blankets covering them both unless there is a clear indication that the baby needs help.

It just bugs me that once the decision that a caesarean is indicated gets made, it seems like all bets are off and you're going to get whatever you get. That isn't how it should be. Women should be able to trust that their caesarean births are going to be as humanized, respectful and as joyful as they can be, and I wonder how we can make them better for the moms and babies.

misskira 10-09-2010 04:49 PM

Quote:
Originally Posted by loveneverfails View Post
Disclaimer: I have never had a c-section.

I've been watching the c-section threads with interest, and I'm wondering how we as a community who care about childbirth can help on a large scale to make c-sections a more humanized experience for mom and baby (or babies.) That there are too many c-sections performed is indisputable, but if we take the WHO recommendations of 5-15% optimal c-section rate, that still means that at minimum 1 in 20 women will need a c-section. That's a whole heck of a lot of women and babies who truly need to birth by caesarean in order to have the safest start to their extrauterine lives together.

Does anyone have any ideas as to how to make change on a macro level for women and babies who require caesarean birth? If we were create an "ideal" c-section scenario (blaring red light emergencies aside) what would that look like, and how do we get there?

Thank you all in advance for all your input!
This is a really great question. I have had a csection. One that I would deam as unnecessary, but given the information I had at the time I would make the same decision again.

I had a positive experience. What made it humanizing for me, was that my CNM and OB talked through the decision with me, gave the pros and cons, and supported us while we made our decision. I knew the OB was in favor of it, but she still presented it as a choice. It wasn't a punishment. During my labor I was never told "if you don't do x, y and z we're going to have to do a csection on you." I hate it when I hear that women have been told that.

During the operation, the ob and nurses talked me through what they were doing, and my dh was there holding my hand. The anesthesiologist constantly asked me how I was doing and was there to assure my comfort and calm. When I started getting chills he ordered warm blankets and when I started to get super drowsy he kept me talking to keep me awake.

After the csection, they took Logan over to the table and as soon as they assessed the he was stable they brought him over for me to look at. DH went with him while they went and checked vitals and trimmed the cord and all that, and they were already in my recovery room (with Logan skin to skin on dh's chest) waiting for me when I was done. I was immediately allowed to hold him and start nursing, and they had waited for me to be present to weight and measure him. There was no required nursery time, he was kept with me for the rest of my hospital stay.

In my opinion, that is what can be done. Mom's still fully involved and appreciated for the work of carrying the baby and delivering. I had planned a natural birth center birth, but it didn't work out and I ended up in a csection. Because I was treated with care and as a valued team member, I don't really have any lasting hurt from it. I am going to try to vbac this time, but I don't fear another csection in the same way as I did for my first birth.

Norasmomma 10-09-2010 05:22 PM

Quote:
Originally Posted by TCMoulton View Post
Honestly, I personally feel that the most important thing that people can do is stop judging c/s moms and trust that when they say that their c/s was necessary that it in fact was & don't feel that you need to tell her what she could have done different that would have made her c/s unnecessary. I have read too many threads here where a new mom posts about her birth & as soon as a c/s is mentioned members here come out of the woodwork here to critique what she did wrong. Unless she asks for advice on what could be changed don't assume she wants it.


My C/S with DD was necessary for both of us, in fact if anything it should have been done sooner since my 3 hours of pushing impacted her so deeply into the left of my pelvis that to get her out I had to have a T incision done on my uterus, leaving me with never having a chance of having a VBAC, since this type of internal incision is rare and more apt to rupture.

The WORST part of my experience(and mine went well, emergency and all) was the looks of pity from those who had no idea what my labor or experience was like, those who assumed I did things wrong. The worst of the worst being our local fresh out of school MW who told me the ONLY reason I had a C/S was because "I was scared". F-yeah I was scared, seeing my rock of a hubby, get tears in his eyes with every push my DD's heart-rate crash, my uterus stopping contracting and going completely soft. Umm yeah after 30+ hours of laboring, most drug free, and using all my energy pushing only to have DD so stuck, I was scared. DUH

The only time I felt de-humanized was from her blatantly rude and insensitive comments, gimme a break, I had a baby, things didn't go as planned, don't go into how holier than thou you are. Let it go and let me be, and don't make me feel badly for the decisions I made for the safety of my baby and myself.

BookGoddess 10-09-2010 05:37 PM

Quote:
Originally Posted by misskira View Post

I had a positive experience. What made it humanizing for me, was that my CNM and OB talked through the decision with me, gave the pros and cons, and supported us while we made our decision. I knew the OB was in favor of it, but she still presented it as a choice. It wasn't a punishment. During my labor I was never told "if you don't do x, y and z we're going to have to do a csection on you." I hate it when I hear that women have been told that.

During the operation, the ob and nurses talked me through what they were doing, and my dh was there holding my hand. The anesthesiologist constantly asked me how I was doing and was there to assure my comfort and calm. When I started getting chills he ordered warm blankets and when I started to get super drowsy he kept me talking to keep me awake.
This was my experience with my c-section as well.

The doctors and nurses were good to us. At no point did I feel I was forced into a c-section. DH was there right at my side. The nurses were questioning me to make sure I was doing alright. The whole experience was handled so well that I even wrote a letter to the staff afterwards thanking them for treating us with such care. That's the only such letter I've ever written to a medical professional.

Storm Bride 10-09-2010 05:47 PM

I agree with the other posters, but I don't think that issue has anything to do with the question posed in the OP.

OP: Care providers could try listening to women, but I don't see it happening any time soon. My last c-section sucked...but it sucked less than any of the previous four. The only reason for that was that people were actually listening to what I said (to some degree). My dh was there for the spinal, because the anesthesiologist listened when I told her that getting a spinal was traumatizing and I needed him there. DD2 nursed in OR, because the L&D nurse had been listening and realized that was important to me (and also felt it was important to dd2 - go L&D nurse!!). By and large, ime, medical professionals (and some midwives - this isn't all on the obstetrics industry) decide what needs to be done, and they do it. The woman's views aren't relevant. Every time I see something about "the decision to have a cesarean must be made by a woman and her doctor", I laugh. That's just not my experience.

So, honestly, I can't see an answer to making the experience better. I see a lot of suggestions out there, but most of them still fall into the major error of assuming that one size fits all. (For example, I frequently see the "have the doctor drop the drape, so that you can see the baby being born" thing. I'd puke. I very much appreciated the OB lifting dd2 over the drape, so that I could see her asap, but I have no desire to see the process. Music is something else that gets mentioned a lot, and it's just not really on my radar at all.) The same things aren't going to work for all women.

ETA: See if you can find anything online about Joni Nichols. She has an amazing approach to cesareans.

Storm Bride 10-09-2010 05:54 PM

Quote:
Originally Posted by loveneverfails View Post
Like, offer a certification process similar to the mother and baby friendly certs where (true emergencies barred) mom's hands are freed so that she can apply abdominal pressure to "push" her baby out
My question is...how long would it take before that went from something a woman could do into something a woman was pressured to do? I can easily see someone putting pressure on the mom to do that, and I'd have had a panic attack if someone had suggested it to me. The last freaking thing I wanted to do was touch anything anywhere my abdomen.

Quote:
and then have the baby go straight over the drapes to mom's chest with warm blankets covering them both unless there is a clear indication that the baby needs help.
And, this. In the abstract, it sounds awesome, and I've missed out on it. But, during my surgeries, I've had a hard time keeping myself from puking (almost all from emotional factors, panic, and the smells). If someone had put my baby on me, while they still smelled like blood, I'd have probably upchucked.

Quote:
It just bugs me that once the decision that a caesarean is indicated gets made, it seems like all bets are off and you're going to get whatever you get.
Yeah - that's pretty much my experience. IMO, even my last one wouldn't have been as good as it was, if I hadn't showed up saying, "I need a c-section" and they played good patient for the whole rest of the pregnancy.

Storm Bride 10-09-2010 05:57 PM

It's funny how different we can be from one another.
Quote:
Originally Posted by misskira View Post
The anesthesiologist constantly asked me how I was doing and was there to assure my comfort and calm.
Quote:
Originally Posted by BookGoddess View Post
The nurses were questioning me to make sure I was doing alright.
This drives me absolutely insane. They're just in my face every five minutes. "How are you doing?" "Doing okay?" "You're doing great." (That one's my pet peeve. I'm not doing anything.) I just want to scream "shut up and leave me alone!!".

Multimomma 10-09-2010 06:04 PM

ICAN has a very well written article about the 'family centered caesarean' here
I thought it was very well written and addresses many of the issues the OP brought up.

loveneverfails 10-09-2010 06:05 PM

Thank you so much, Lisa! I'm googling Joni Nichols now. And yeah, I think that if I were to have a c-section, I would not want the drape lowered. That'd be a recipe for me freaking the heck out. Applying pressure on abs to "push" the baby out? I would probably appreciate that, but seeing incision would probably not be good. I could be wrong, though.

Really good points about avoiding "one size fits all" approach. Thank you!

mmaramba 10-09-2010 06:24 PM

I agree that the second-guessing needs to go.

However, there's a circular nature to this discussion that I think may be less-than-productive. We have women judging other women for their C/S, and then we have those women focusing on the first group's judgment as the major problem to be solved here.

(And if we go back even further, we see that the first group is often judgmental-- or appears so-- in part because they feel judged by women who tell them they "just want a medal" for NCB, etc., that C/S are good for vaginas and always necessary, etc. Women who have to live with the threat of CPS or the cops being called on them for VBACs and HBs.)

All of the above are misdirecting their energies-- in my frank but loving opinion. The primary problem is not being caused by other birthing women. The problem is the system, in which the vast majority of birthing women have little if any power.

This is a crabs-in-a-barrel mentality on all sides, IMO. (One crab tries to escape and the others pull her back down.) This is exactly what the crab seller likes to see.

I think we help C/S moms by pushing to humanize the process-- which goes right along with humanizing all birth. We advocate for better, more evidence-based practices in order not only to eliminate or drastically reduce the number of unnecessary C/S, but to make necessary C/S more humane. What does that look like? I'm sure more experienced people can speak to that, but off the top of my head, at the very least:

-INFORMED CONSENT. This is crucial. Making sure each woman understands exactly why the C/S is necessary, what the risks will be, what she can expect during the procedure and in recovery.

-Allowing women to have their feelings, whatever they may be. If they are disappointed, sad-- that's okay. They're not "selfish" because "a healthy baby is all that matters." If they're relieved or happy, that's okay, too.

-Postpartum support for C/S mamas, who average longer recovery times, more postpartum pain, etc. This is something we can do on a micro level, too, helping out friends and loved ones.

-And of course, many of the "family-centered" suggestions already made.

JMHO, YMMV, etc.

Fyrestorm 10-09-2010 06:28 PM

Mine was awful

Nothing would have made it acceptable under the circumstances, but a few things I would suggest -

1. Don't treat me like a piece of meat being butchered while I'm cut open on the table. I am awake and still in the room and thing you are yanking out of my belly is not a tumor - it's a baby, my baby and I want to see her and touch her.

2. Let my partner in the room while you are sticking that needle in my spine. It was among the scariest things that has ever happened to me in my life and his support instead of just a room full of strangers would have added a bit of comfort.

3. Do not keep my baby away from me for hours unless it is truly medically necessary.

4. Allow someone to accompany me in recovery while I grieve the loss of my ideal birth. While my DH needed to be with the baby (no way I was going to let her alone with them) My doula and BFF were there. Why was I left completely alone in recovery for over an hour?

5. Send someone with mental health up to discuss the trauma with me. Do I need to debrief? Tell me where to go to get help dealing with the PTSD I am left with. Warm me that PPD and PTSD are common under these circumstances and help me find support.

6. LC LC LC Do you know that having a child in NICU after a section makes BFing more difficult than usual?

7. DO NOT under any circumstances utter the sentence "The baby is alive and that's all that matters"

8. Admit that an unnecesarean was unnecessary...don't make me sue you to get you to admit it.

9. Listen to me! When I say I do not want X, Y or Z administered to my child, I mean it.

10. Get the damn catheter OUT ASAP! As soon as I can fell my legs, I don't need it anymore...get it out!

11. Cover me. There is no need to leave all my stuff hanging out everywhere on the way to recovery.

If I think of more, I'll add

mmaramba 10-09-2010 06:38 PM

Just clarifying my thoughts-- it IS political at this point-- no getting around it. It is great to say, "yeah, we know most C/S (in the US and elsewhere) are unnecessary, but how can we make the necessary ones better?" But that's a big "but."

Fortunately, the fundamental things that will make all C/S more humane are the same things that make them far less common.

We're talking about basic respect for laboring mothers as human beings with brains and options.

Turquesa 10-09-2010 07:56 PM

Quote:
Originally Posted by Annie Mac View Post
Here is what I think the doctors and hospital staff did right with my birth and subsequent section. I didn't feel dehumanized in the slightest.
- Communication. This is the big one. Every step of the way I was told what was happening and why. My input was welcomed.
- Choice. I have heard stories (not from the actual owners of the stories, it has to be said) about women who were in essence strapped to a hospital bed the whole time. During my labour I could walk around, go in the shower, squat, lie down, whatever. The doctor gave me some suggestions, particularly suggestions that might help move the baby into proper position, but ultimately, it was down to me. I've also heard stories about women who were denied food. This was not my experience either. If anything, they kept pushing it at me and it was me who refused it. Also with drugs. No one ever pushed anything at me. When I got pain meds, it was because I asked for them. They even gave them to me at the specific dosage (less than normal) that I asked for.
- When the situation got frustrating (for everyone), the doctors never aimed any of that frustration at me. They were super clear what was frustrating (lack of resources at the hospital which delayed the surgery by a long time)

I think it comes down to respect and communication.
ITA with all of this. The OP's question has a twofold answer. The first addresses how we as laypeople can provide a supportive, embracing, and non-judgmental community for CS moms. The second addresses what care providers can do, and this aspect is really important.

A lot of birth plans contain some disclaimer about understanding that an emergency can arise and plans can change. That is all true, but even in a high-risk situation such as abdominal surgery, a woman needs to be able to have a say and have her decisions honored.

Storm Bride 10-09-2010 08:02 PM

Quote:
Originally Posted by mmaramba View Post
We're talking about basic respect for laboring mothers as human beings with brains and options.
This.

lovebeingamomma 10-09-2010 09:37 PM

I think it would help some births if surgeons didn't ban doulas from attending c-sections.

Harmony08 10-09-2010 09:42 PM

great thread

AlexisT 10-10-2010 06:41 PM

Quote:
Originally Posted by lovebeingamomma View Post
I think it would help some births if surgeons didn't ban doulas from attending c-sections.
It's often not the surgeon, it's the anesthesiologist. They don't want too many people in the OR.

lovebeingamomma 10-10-2010 07:55 PM

The case I'm thinking of, they didn't allow anyone to be with her. That just seemed wrong.

TCMoulton 10-10-2010 08:51 PM

The only times I have heard of no one accompanying the mom into the delivery room is when general anesthesia is used. Otherwise, the normal is 1 person is allowed to accompany her during delivery. Was there a reason given to the mom you are thinking of that she wasn't permitted to have support with her?

rainbowmoon 10-10-2010 09:02 PM

Um wow, this thread makes it sound like the woman who has a csection is doomed. Sure it can be dissapointing but dehumanized? Really? (Yeah I could tell from the OP you haven't had a c/s!!)

Personally my c/s done w/ the utmost respect and care as far as I could tell. My Dr's and MW did not dehumanize the experience for me or my babe in the least. No need to feel pity for us! I really pity those who feel they need to waste their energy onjudging someone else's experience!

Quite frankly this board all by it's lonesome made me feel like crap though about it all quite personally. Something I could have done without. All another part of the mommy wars though IMHO and who is doing what the "right" way..sigh.

I really truly am disgusted by threads like this.

Furthermore, I find the title of this thread really offensive and ridiculous. How about a halt on the judgement and pity that us c/s moms feel from those within the natural birth community? Support will go a lot farther in helping the poor c/s moms!

If you're REALLY worried about it why not trying to do something worthwhile like addressing malpractice insurance & hospital policies, etc. Stop victimizing the MOTHERS! It's not helpful!

texmati 10-10-2010 09:11 PM

Quote:
Originally Posted by TCMoulton View Post
Honestly, I personally feel that the most important thing that people can do is stop judging c/s moms and trust that when they say that their c/s was necessary that it in fact was & don't feel that you need to tell her what she could have done different that would have made her c/s unnecessary. I have read too many threads here where a new mom posts about her birth & as soon as a c/s is mentioned members here come out of the woodwork here to critique what she did wrong. Unless she asks for advice on what could be changed don't assume she wants it.
ditto. and I'd go a step further and add that judging not just whether the section was necessary, but how having a section makes a woman less of a mother needs to stop. Why do women do this to one another?

As for the procedure, having had a crash section with GA I would have appreciated someone sitting with me soon after the surgery and giving me a run down of wth happened. My first birth experience is just a big, black hole.

For recovery, I really felt the staff at the baby friendly hospital, and the on que ball helped my recovery tremendously. The on que ball let me do with very few painkillers.

texmati 10-10-2010 09:14 PM

I also wanted to add, I felt abandoned by my natural birthing community after my section. My midwife didn't want anything to do with me post section, and when I walked in for my pp checkup, she seemed not to remember that I had even had a section. (asked how my vagina was healing?). She did not speak to my husband or I after the section, until the next day.

mum4boys 10-10-2010 09:17 PM

What a great thread. I have had 5 c-sections. My first was absolutely unnecessary. I am thankful of the outcome, my son is alive and well but because of the mistakes that were made I always had to have a c-section. All of my births were by different providers. The wiser I got, the better the outcome each time until my 5th was as perfect as a c-section birth as you could ever ask for.

The thing that was the number 1 was all my providers treated me as a human being with a brain in her head that only wanted the best for her baby even if that differentiated with what their personal beliefs were. I think this is so key. They honored every detail of our birth plan. They listen to me. This late in the ball game I know what works for me and what does not work for me.


All times are GMT -7. The time now is 07:37 PM.

Powered by vBulletin® Copyright ©2000 - 2014, Jelsoft Enterprises Ltd.

vBulletin Optimisation provided by vB Optimise (Pro) - vBulletin Mods & Addons Copyright © 2014 DragonByte Technologies Ltd.
User Alert System provided by Advanced User Tagging (Pro) - vBulletin Mods & Addons Copyright © 2014 DragonByte Technologies Ltd.