Reluctantly planning a C-section. What questions should I ask? - Mothering Forums
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#1 of 13 Old 04-16-2013, 07:41 AM - Thread Starter
 
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So my dd was born at home, but with some birthing complications (funny position, double should dystocia).  Baby's fine, I tore very badly and ended up with a recto-vaginal fistula.  The fistula has been successfully repaired, hooray!  But my anal sphincter muscles had some lasting damage, and every health care provider recommends a c-section for me, lest a vaginal birth permanently destroy my pelvic floor.

I am not excited about this.  It feels stupid to be put on a c-section path not for the sake of the baby but for the sake of my compromised muscles.  On the other hand, the thought of increased fecal incontinence or the fistula reforming is also kind of scary.  So I'm not yet at peace with the thought of a c-section, but it's still pretty early on in my pregnancy, I have time to think and process, and when everything's said and done I'm pretty sure I'll be in the OR seven months from now.

Anyway, can those of you who have BTDT give me some pointers on preparing for a good c-section? (is there such a thing?nut.gif)  What questions do I need to ask?  I have some vague recollection of advice to request a three-layer repair stitch as opposed to a single layer--is this still an issue?  Any advice would be really appreciated!

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#2 of 13 Old 04-16-2013, 08:12 AM
 
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My main concern would be waiting for labor to start on its own and not scheduling prior to full term (for me and my babies, full term is 42+ wks) for convenience of the doctor.  It seems to me that in your case, the main "danger zone" would be pushing, so a couple of hours of labor wouldn't be risking your bum and it would be nothing but beneficial for the baby.

 

Best wishes to you from a csecx2 mama!


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#3 of 13 Old 04-16-2013, 08:12 AM
 
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First off, I'm sorry that you went through that with your first baby, and that you're in a less than ideal situation now. greensad.gif *HUGS*

Secondly, there's nothing wrong with needing a c-section to preserve your own health / bodily integrity. Even with the advantages of vaginal birth, a c-section is still a relatively safe way to give birth, and it can be a positive experience. I don't know much about your condition, but if the choices really are between a controlled surgery and a high chance of uncontrolled (and possibly permanent) damage that will cause you to require repairs and suffer through other problems after the birth, it sounds like a c-section is a good choice for both you and your baby.

The first thing I would do is look into a c-section birth plan. There are some good templates out there that will help you think about things that will be important to you during the birth. A lot of the things you would be concerned about during a vaginal birth still apply. For example, what kind of anesthesia will you have? Not just during the c-section, but in recovery. Do you want to avoid anything that will make you sleepy or out of it, or impair your memory? If you're planning to breastfeed, you'll want to make sure that the anesthetics don't interfere with that.

Who will you want with you during the surgery? Can your partner be with you the whole time? How about a doula? (If you would have wanted a doula for a vaginal birth, it's still a good idea for a c-section!) Do you want your doctor to remove the screen so you can watch your baby be born? Do you want your baby placed on your chest immediately; do you want to try to nurse while the doctor closes you up? Does your hospital allow the baby to stay with you in recovery? After my last c-section, my son was placed in my arms right away and never left my side. Some hospitals take c-section babies to the nursery by default -- if your hospital does this, can you get around it? If the baby can't stay with you, can he stay with daddy (or a family member) instead?

As for the double layer suturing, I think that's just good practice. Mainly it's a concern in case you want to VBAC in the future, but there's no reason not to ask for it. Also consider whether you want stitches or staples on the outside. I think stitches are supposed to be better.

Also, March of Dimes recommends waiting for labor to start naturally before having a planned c-section. That way baby gets to choose when he or she is ready to come into the world, and you have less concern about iatrogenic prematurity. Less convenient for the doctors, but better for baby.
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#4 of 13 Old 04-16-2013, 08:21 AM
 
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Here are a few examples of a c-section birth plan. I'm going to be writing one up myself, just in case my VBA2C doesn't go as planned:

http://adventuresindiapering.blogspot.com/2009/09/example-of-c-section-birth-plan.html
http://birthwithoutfearblog.com/2012/09/18/a-family-centered-cesarean-birth-plan/
http://empoweredbirth.typepad.com/empowering_birth_blog/2007/06/cesarean_birth_.html
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#5 of 13 Old 04-17-2013, 02:40 PM
 
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Michelle, Thank you for posting the sample birth plan links.  Even going into my 3rd c-section (the first two were NOT planned) those were really helpful.
 


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#6 of 13 Old 04-18-2013, 07:11 AM - Thread Starter
 
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Thanks for the replies.  It's so helpful to have a starting place.  I've grown up with babies born at home and felt super-comfortable with a hands-off, trust-your-body approach to pregnancy and birth.  And my labor did go very smoothly until the end when my baby was stuck at crowning--it was just a pile-up of rare complications and that happens sometimes.  Now here I am, facing a highly medicalized birth and I've been feeling kind of lost at sea about it.  So again, thanks for the advice and guidance. 
 

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#7 of 13 Old 04-18-2013, 07:24 AM
 
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CoBabyMaker and Sristi, good luck to both of you! smile.gif

Michelle, wife to DH, and momma to DD16, DS15, DS12, DS10, DD9, DD7, DS5, and baby girl born Christmas Eve 2013!
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#8 of 13 Old 05-30-2013, 08:13 AM
 
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"Secondly, there's nothing wrong with needing a c-section to preserve your own health / bodily integrity. Even with the advantages of vaginal birth, a c-section is still a relatively safe way to give birth, and it can be a positive experience. I don't know much about your condition, but if the choices really are between a controlled surgery and a high chance of uncontrolled (and possibly permanent) damage that will cause you to require repairs and suffer through other problems after the birth, it sounds like a c-section is a good choice for both you and your baby."

 

 -- So True!!!!

 

You are not making a choice between what is good for the baby and what is good for you.  A happy healthy mother is always BEST for the Baby!!  I think you would find it hard to keep up with a baby/toddler and deal with incontinence or the fistula.   The benefit to the c-section is that you will be avoiding any extra surgeries or injuries after the birth.  You can focus on recovering form the c-section and not have to worry about any surgeries down the road to fix a fistula or incontinence.  

 

I had a really wonderful 2nd c-section and I think you will find a planned c-section to be a far better experience than your previous birth. 

 

The best advice to prepare for the c-section is just to know from your Dr. & hospital what to expect.   

 

"Thanks for the replies.  It's so helpful to have a starting place.  I've grown up with babies born at home and felt super-comfortable with a hands-off, trust-your-body approach to pregnancy and birth.  And my labor did go very smoothly until the end when my baby was stuck at crowning--it was just a pile-up of rare complications and that happens sometimes.  Now here I am, facing a highly medicalized birth and I've been feeling kind of lost at sea about it.  So again, thanks for the advice and guidance. "

 

--It does take time to change your mind set about what is best.  I think you are being really open and honest about how you feel and when the time comes you will be at peace with your choice/circumstances.  Life is never predictable and sometimes we just have to adjust our expectations and move on!

 

 

---And for my last section I didn't have stitches or stables...some kind of glue...it was really cool.  I liked it better than the staples in the first section.

---As for going into labor, there may be some benefit.  However, I will say that planning an exact date if the baby doesn't arrive on the due

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#9 of 13 Old 05-30-2013, 09:38 AM
 
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I don't know if it's too late to post on this thread (when are you due?) and so much good advice has been given here.

 

The only thing I wanted to add is if you are going to let labor start naturally, get yourself checked in ASAP. especially since this is your second labor and things move along much faster (much faster!) 

 

The reason I mention this is because you want to do everything you reasonably can to have an epidural/"local" and not general anesthesia.  This is going to put you in a better position to nurse as soon as you can--and feel generally more alert and more capable of mothering your newborn in those first hours.  You can include a local anesthetic in your birth plan, but know that when the time comes, you might be pressured into taking a general because it acts faster.

 

And just in case, I would stipulate that a pump be made available in your room.  If you weren't able to wait for labor to start, then you might need some extra assistance getting your milk supply starting its production.  I had trouble with my first daughter in this regard (induced, c-section), but then she had a really weak latch, probably due to an overbite (and also I had flattish nipples, a problem which was corrected by the time my second was born.)   Still, nice to have that ready and waiting in case you feel you need it.

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#10 of 13 Old 06-06-2013, 07:36 PM
 
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Everyone's been giving good tips, so I don't have much to add there, but I do want to emphasize that a planned c/s can be a very positive thing. With DS#1, I was planning a "natural" birth, but was talked into induction attempts, argh. 16 days late and on the second induction attempt, DS got stuck and wouldn't descend into the birthing canal, and when his heart started decelerating, we were whisked into an emergency c/s. Not fun. Nothing went wrong, DS1 is healthy, and we got started just fine on breastfeeding and everything, but the multiple induction attempts and sudden shift to c/s were very stressful for everyone.

 

This time around (last Friday, in fact!), we had scheduled the c/s. I was going to be allowed to VBAC if I went into labor ahead of time, but because of "advanced maternal age" and a prior emergency c/s, they wanted me not to go over my due date. Well, we got to the scheduled c/s date and there was no labor starting, so repeat c/s it was. It was so much less stressful. I knew what was going on, got to talk to nurses and anesthesiologists ahead of time instead of right there in the moment, I was lucid, not shocky, for the whole procedure (I was given a spinal for my anesthesia) and got to see my son as soon as he was pulled out (yelling his little head off--his lungs definitely work!). DH was there in the room with me and was calm himself since he hadn't been woken out of a sound sleep and handed scrubs. As soon as I got into recovery, we started working on nursing. It was, honestly, incredibly relaxed for major surgery, and DS2 and I have had no problems bonding or BFing (my milk came roaring in about 36 hours after the birth). So yes, I'd say that it's very possible to have a positive c/s. smile.gif Just set your mind to it, get informed, and work with your doctors!

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#11 of 13 Old 08-15-2013, 12:49 PM - Thread Starter
 
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Thank you all so much for your input!  I've just started my third trimester and now I have to really start thinking about this.  I've been getting prenatal care from a midwife, who is referring me to an OB in the practice for the C-section.  I meet with that OB next week, and I'm getting together a list of questions and concerns.  This thread has been so helpful in that regard. 

Thanks also for the positive stories.  Just for kicks I checked out a library book about preparing for your best birth and flipped to the c-section chapter, hoping to get some pointers for a planned cesearean.  Nope, instead the whole chapter was basically a list of all the reasons why c-sections are risky and undesirable.  Of course it freaked me out (again), and I had to remind myself of all the reasons a planned c-section is a good idea for me.  When I was preparing for my homebirth I was careful to stay away from birthing horror stories; a good reminder that just because it's a planned c-section, I still need to seek out the positive stories and avoid the negativity.  Worry is not going to help me or the baby.  And most of the time, I feel pretty good about the upcoming birth.  Hopefully after I meet with my surgeon I'll feel even more confident.
 

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#12 of 13 Old 08-15-2013, 02:30 PM
 
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Sristi, I am getting to this thread kind of late, and I agree with everything said above. I just want to add 2 suggestions:

 

1) After you meet your OB, if you have doubts about his/her support of your wishes, consider seeking out an OB that regularly practices family-centered cesareans. I will be trying for a VBAC in Dec, but I chose to go with the practice whose back-up OB automatically provides a gentle cesarean. This provides me with a certain amount a relief that I will not have to argue for what I want.

 

2) I strongly recommend requesting to play music of your choice during the surgery. It helps with idle chatter, prevents the surgical team from playing their music (which I have read does happen sometimes), and allows you to have some control of the atmosphere during the birth. I had Coltrane playing during my son's cesarean birth, and it was awesome.

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#13 of 13 Old 08-15-2013, 02:40 PM
 
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Great advice and links above.

I would only add that you research / ask about what to do for your muscles, and body following the section. And have a plan for that too.

 

I was given no advice on stretching, massage, exercises (or not to do certain things) - and my (unplanned) section has resulted in what feels like internal tightness, knotty scaring and maybe adhesions - which, while it isn't major...makes for uncomfortable, more painful periods then previous, and discomfort after spicy-gassy type foods.

 

Different experience entirely as I had labour troubles for a day and a half beforehand - but by the time I was in surgery...I was so blissed-out that I practically fell in love with all the staff surrounding us. Was a great time!

 

I don't know how they do things where you are - but I wasn't allowed to look at it happening - there was the ubiquitous sheet hanging in the way...which was the only thing I thought a little, not odd as I can see why they do that...but, well, I could've easily looked during proceedings... and it did make me feel very divorced from it all. My partner was told off for taking photos too - but we managed to get one.

 

Best of luck.

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