Cesarean Section Support Only Thread June 2005

My Cesarean Birth Plan

I am having a planned cesarean section the third week of June. My cesarean is being planned for mid-day. I chose to plan my cesareans because my first was a very bad emergency situation in which I felt the entire thing and felt out of control. When planning I arrange everything in advance, including who administer anestesia, my nursing care, and who assists my doctor in performing the surgery. I literally have my hand in every decision that is made, including the type of anestesia that is performed, what drugs are given to me during the actualy surgery, and what happens after the baby is born barring no complications.

Here it is:

As this is a planned Cesarean birth we are looking forward to a positive birth experience. We want to participate in this birth to the fullest. We have listed our preferences below; these decisions have been made after research, consultation, and thought. Therefore your help in attaining these goals is very much appreciated.

We would appreciate preoperative blood work and tests to be done on an out patient basis, and hospital admission on the day of the birth.

My sister, ****** , is to stay with me the entire time, even for procedures and administration of anesthesia. [note to readers, my sister is a former L&D nurse]

I would like an epidural for pain relief with continued pain relief with a PCAP. [note to readers, I had a failed spinal with my first csection. I had an epidural with my second with continued pain support for 17 hours after surgery through a PCAP that was hooked into my epidural cathetar. I was able to mover around, but did not have anything impairing my brain function.]

I would like the catheter put in after anesthesia is administered.

I do not wish to have medical students present during our cesarean.

My arms are not to be strapped down unless general anesthesia becomes necessary during an emergency. [ It is customary during surgical births in the USA to strap the arms down, like you are Jesus Christ, to the operating table. Not all doctors or hospitals do this, but it is the "norm".]

I would like the option of viewing the birth either by lowering the screen or positioning a mirror.

I welcome conversation during the delivery process. [ Some people request music, dim lights, and no talking at all. It's really up to you. ]

If my baby needs assistance during the delivery process, if possible please use a vacuum verses forceps. [ I've had one baby delivered with use of the vacuum with no visible problems or effects. I know too many babies harmed by forceps, in vaginal and surgical births, this is why I have made this request.]

We would like to take photos of the birth as it occurs. [ This will be up to your doctor or hospital, most doctors can have hospital policy waved. ]

I would like to see the baby immediately after birth if at all possible. I would also like to be given the baby or have it held near me in the OR. If at all possible, we would also like to be able to have a pillow up under Kim's head so that she can have a better view and be more comfortable during the surgery.[thank you Shannon for this tip!]

No mind-altering drugs are to be administered without Kim's expressed permission. I am aware that some hospitals routinely sedate the mom for the repair portion of the surgery. It is important to Kim not to feel drugged or be unable to remember the events of the birth. Kim would like to avoid having nausea medications administered unless absolutely necessary, Zofran is preferred if the need arises. [ Phenegran makes most people drowsy and can interfere with nursing after surgery. Also, sedative are often administered in the IV routinely before the surgery actually begins in the IV to "calm" the patient.]

If at all possible we would like that the baby's father, Jeff, be able to cut the cord. [ I am not asking that he trim it at the warming table for baby, but actually enter the sterile field to cut the cord. My OB is going to try and accomadate this request, with respect given to the sterile field.]

Kim prefers that the outside incision be sutured with stitches and not staples. [ There is a small risk of infection from sutures, however I think the benefits outweight the cons. I have had both, and the stitches left me with a nicer cleaner incision, and I felt as if I was held together better.]

Below is our birth plan geared towards the care of our baby. Some things are bolded for emphasis.

We want to participate in our baby's care to the fullest. We have listed our preferences below, these decisions have been made after research, consultation, and thought. Therefore your help in attaining these goals is very much appreciated. Our pediatrician is Dr. Dan ***** at Children's Medical Group.

The baby's father, Jeff ********, is to be with the baby at all times following the birth.

Kim wishes to have the baby with her in recovery so that she can breastfeed immediately. [ readers note that I request to recover in a Labor & Delivery Room so that I can have my baby immediately and have my husband and sister with me (or other guests) Find out your hospitals policies about recovery areas, some will not allow you to have your baby or your partner with you.]

NO EYE OINTMENT is to be administered to our baby at ANY TIME. Kim, the baby's mother has been tested for all STDs and was negative and since this is a cesarean birth our baby is at no risk of eye infection. This has been discussed prior to the birth with our baby's pediatrician.

We have refused the Hepatitis B vaccine at this time.

We do consent to having the Vitamin K shot administered to our baby.

All tests and procedures are to be done in the presence of one of the baby's parents, and with our expressed consent, barring no emergency situation.

Please do not bathe our baby. [note to readers, bathing a baby after delivery can often lower their temperature, resulting in having to go and stay in the nursery. Cesarean birthed babies already have a disadvantage to vaginal birthed babies because they tend to have a harder time maintaining their temperature, this is why we forgo the bath, and do one later that I can participate in seeing and/or being involved in it.]

If our baby is a boy, do not circumcise.
[ we are expecting a girl, but just in case!]

Our baby will be breastfed. Please do not give our baby pacifiers or bottles.

We would like our baby to room in with us. Kim will have someone with her at all times to assist her with the baby in anyway. [note to readers, most hospitals will not allow rooming in for cesarean birth mommas unless they have help, this is the hospitals policy I am going too]

Do not come and take our baby to the nursery unless we request it. Any procedures or pediatric checks can be done in our room. This includes ultraviolent light therapy for jaundice. [ note to readers, if they tell you they can't do the therapy in your room, they are bull sh*tt*ng you. I specifically note this because my babies often get jaundice do to ABO incompatibility.]

only about 8 & 1/2 weeks til my scheduled c. It's a repeat c, but the last one was in a super bad hospital that allowed me nothing. This one will be in a brand-new family-oriented hospital. Their parent hospital even has a nursing supply store that sells handmade slings and commercial slings, and for cheap too The nurses on the mommy floor have all had extensive training by certified LCs, and there's an LC three days a week, so since my doc requires two to three days past the date of surgery for a hospital stay, I'll get to see her at least once. I am bound and determined to do things right this time. The nurse that gave us our tour agreed with us on all of our points and addressed all of our concerns. She said we are the first couple to request delaying the eye gel and vit. K, but that it won't be a problem {I hope she didn't assume I would let it fly if she said otherwise} All in all things are looking good on that end. I am a bit worried about recovering with a six year old and four year old, both super active, to take care of at the same time. My closest friends all work and have kids of their own. Depending on if I get my C at thirty eight weeks or there is cause to wait, I will probably have T's sister with me for the first week or so. She's only seventeen, and her child rearing skills and ideas aren't the best in the world, but she's good with the older two and that's what I'll need more than anything. She's also pretty good at fetching things from the store, and reading stories to the short people, and throwing stuff in the microwave. So that will help alot. I plan to hole up in my bed with Em for the first week or so, as much as possible. Daily walks and gentle stretching of course, but other than that I want to just kind of be, y/k? I'm expecting this recovery to be alot rougher than the first, except that this time I pray there will be no NICU stay to complicate things for both Em and I, the way it did Jordan's first week home.

Kids fighting. More centered posting to come

I had a c-section with my first at 42 weeks and 3 days after a fever & failed induction. I won't go into all the details, but it was necessary, I don't feel that we were pushed into it, etc. I do of course wonder however what small things we could have decided differently that might have changed teh outcome, but I feel we made the best decisions based on the info available to us at that time. However, I didn't like having a cesarean, it wasn't the birth I wanted.

I am now 41 weeks and 1 day pregnant with my second. I have set up everything to do a VBAC, but like my daughter, my son does not seem want to be born. I am rapidly reaching the point where I have to decide when we call it quits and go for a repeat cesarean. I have pondered over and over whether I should consider a pitocin only induction, but pitocin caused hyperstimulation last time and I feel it would be too risky for me. I have a midwife appointment in a few hours and I know we will be discussing this. My current thinking is that we schedule a C/s for 42 weeks (6/7) and if I go into labor before then, then great. I know if everything continues to look okay with the baby my midwife would probably let me go longer, which in some ways makes this harder as its really soley my decision. I don't know how much longer I can wait emotionally, physically, etc. Also, If I wait longer I will no longer have my inlaws to take care of my DD (and we don't have much alternative).

What I am really mourning is the loss of a clear path I can say 'this is the right way to go'. I feel like if I choose to go with the cesarean I am giving up. I am scared that if I wait too much longer I'll be sacrificing my support and will just end up with the same outcome. I didn't want to post about this to VBAC or B&B because I know I would get a whole lot of 'trust your body', etc. I don't trust it, it didn't work (go into labor) last time and every day that passes I lose faith it will suddenly perform this time. My DD was 10lb 8oz and this little one looks to be just as big, so another doubt enters my mind. I am worried too that I'll rupture during labor. All of this is weighing on me greatly and of course that isn't going to help anything.

Anyway, thanks for listening.

Hugs to you mightymoo - I sent you a pm.

kaitnbugsmom - you and I are in similar boats - I'm 6 weeks away. I'm hopeful that this will be a much different experience than the first.... and the feedback I'm getting from my Dr. re: my birth plan (which I basically plagarized from Kim - THANK YOU OTF ) is very positive. Why are you expecting a rougher recovery? I've read the opposite - that a repeat, non-emergency c/s results in much easier recoveries than emergency c/s.....
just curious.

Quote:
Its to help get the uterus down back to its normal shape and size. It is kind of hard to do "biscuits" on a belly that has been cut. After a vaginal delivery for the next few days you are supposed to massage the uterus to help it go down. Breastfeeding also helps with this.

I think you really need to get two birthplans going and discuss it all with your doctor. It's better to know ahead of times what they are willing to do and not do. You may also want to talk to him or her about anest. If you do VBAC do you want an epidural? etc. I have to say my aunt got more drugs after her vaginal delivery than I did before, during and after my csection. They gave her a sedative to help her sleep, phenegran for nausea, and morphine for pain. She was a total loon and out of her mind. She never asked for these drugs, they were just given to her because her doctor (not the one who delivered her baby mind you) ordered them. She is still angry about this happening to her, so be sure to say something now and not then.

Dd just wiped out my post...

I don't have a full birth plan written down, but I have taken some notes. I've been waiting for my OB appointment (today) because I don't really want to discuss these things with my regular doctor. My OB seems more supportive of the VBA2C attempt than she is.

I've already made up my mind that if my attempt to VBA2C goes through, I'm not accepting any medications offered to me. If I want pain relief, I'll ask for it. The nurses on our L&D ward have a strong "we know what's best for you better than you do" attitude, and this time I'm ignoring them to the best of my ability. I'm definitely not accepting morphine. The only way that stuff is ever entering my body again is if I'm unconscious when it's administered - I'd rather be in ten times the pain than have to put up with the itching!! (I agreed to the morphine last time, because I was feeling too overwhelmed to even think about it.)

I was given a sedative after my first section, but not after my second one. I have no idea how much of my fogginess was from that, because the general anesthetic had already knocked me back pretty hard. I'm not finding these things a lot easier to think about ahead of time than I do in the OR, unfortunately.

Has anybody been able to keep their spouse with them while the stupid needle is administered? I find the epidural to be almost as terrifying as knowing that I'm being cut open, and for some stupid "hospital policy" reason, I have to face that with no support at all. I swear hospitals go out of their way to make the whole thing as grim as possible.

I definitely have to talk to my OB about keeping the baby with me after the surgery. I don't know if I'll get anywhere - I've known quite a few women (co-workers and such) who have had c-sections at this hospital and I've never heard of anyone not having the baby taken away while they "recover" in post-op.

My DH was not present the first time, but was the second (as were students). I insisted that my sister stay with me -- I could care less about my husband being there. Luckily my sister is well known at the hospitals because of her work and she knows several of the anest. I have to say the IV was the worst thing I got last time, second the epidural but not the epidural itself, the shot that deadens your skin -- ugh.

I have an OB appointment today too! I hope yours goes well.

Hi all, I've had a c-section, followed by 2 VBAC's and then another c-section. I am by no means trying to influence anyone's decision, but I would like to note that my 2 vbac's were pitocin induced and were successful. Induction does not always mean a failed vbac (though I know it does increase the risk )

I would like to have another vbac, but I'm certain I won't find any ob any where within 60 miles to do one. I wish I could, I really really do. But driving 2 hours in labor is also not something I'm interested in doing, if I could even find someone within 120 miles to do a vbac here in nebraska.

My last child was going to be a planned section (against my wishes, the ob "fiddled" around for a few months whenever I asked if a vbac was possible, then announced mid pregnancy that his office no longer would do them for insurance reasons. And then told me no one in town will do them, and that the hospitals themselves were going to ban them). It turned out I needed an emergency c-section at 37 weeks anyway, for terribly high blood pressure.

I'm glad this thread is here. I sometimes feel like an anomaly because with all my previous problems, regardless of how much I want another vbac, a midwife or home birth is just not an option for me. Some people think its ALWAYS an option and its just not.

I'm pretty relaxed about students. I don't like having anybody there (eg. nurses, pediatrician, etc.) so the students don't particularly bother me. I figure they have to learn somewhere. Dh will be there for the surgery, of course...just hope he can be there for the needle.

The last person I'd want there is my sister. She's the one who told me I'm pathetic because ds was born by section.

I hope your appointment goes well, too. I think my OB's going to schedule an ultrasound, and then I'll have one more appointment before the baby arrives...however/whenever that is.

mightymoo-- hyperstimulation....my problem as well It sucks doesn't it? I don't know if my c/b would have happened anyway or if the pit is the reason. I didn't go into labor with Bryce either and neither baby dropped or engaged (B did for about 2 weeks but then went back to floating). I was VBAC until I hit 38 weeks I changed to a repeat then. I had Bryce the day before his due date. I didn't want to risk pit. NOt only because it is bad for VBAC but because I was super sensitive to it the first time. I didn't want to hurt myself or Bryce...that and my ob agreed it was best to leave it. If I had gone into labor we would have attempted VBAC but I was supposed to schedule at 42 weeks if I didn't go on my own.

OB update.

My appointment today went pretty well. He wants me to schedule an ultrasound next week, to check the baby's position - he can't tell for sure where the head is, either. (This is strange - neither doctor can tell, and they're both good at this.)

If I go to section:
He's okay with waiting for labour, but has the usual concerns about "how do we handle it if you're late". *sigh* I'm still thinking on this, because if it's a section, I want him to do the surgery - not whatever doctor is on call. I just found out that my OB is away the last two weeks of June, which makes me very nervous.

Having the baby with me while I recover is no problem. Apparently, policy has changed on this. DD would have been with me, except that the ward was too crowded - they couldn't keep me in the L&D room, or the OR, and had to send me to the general post-op ward. So...unless it's super-crowded again, the new baby can be with me right from the start.

That means my biggest concerns are mostly addressed, and the outcome looks good. I'll refuse morphine this time, so that's all the extraneous stuff taken care of.

If this goes to section, I still have a lot of "stuff" to deal with about having the surgery at all. But, at least all the "little" things are looking better.

DAMN! I just realized I completely forgot to ask about dh being with me while I'm anesthetized!!! Next appointment, I guess. (I wonder if I blocked that one out, because I'm the most pessimistic about it. What a coward.)

Storm,

I am so glad that it looks like if you do have a repeat csection that you will have some of the things you want to make it a better experience. I am glad policy has changed and that you can also keep your baby with you this time.

My OB is out of town all next week, making me a nervous wreck because I have so many contractions regularly but so far my cervix is closed. Its not as high as it was last time but its closed. I wish it would open just a bit since I am getting that IUD.

My csection could not be done on the 23rd at the time I wanted so it was moved to Friday the 24th at 12:30. I've already arranged child care and my sister has made arrangements to be with me that day for surgery. The anest. I wanted is also going to be there. I hear he is the best, so I guess I will find out in 22 days. My next and last OB appointment (I hope) is June 15th. My DH is going with me and we are going to go over the birthplan one more time. O, and the nurse called me the Queen of Csections today in the office. She said she had never seen a patient that knew more about csections and what they wanted from their surgical birth experience. Hopefully this is a good thing for other patients who may not have a choice.

I also asked my OB about glueing the top incision. She said it would be a cold day in hell before she did that. She said that the underlying stitching has to be different than the regular stitching that they do and that infection risks are greater, not to mention the incision site opening back up. She said a lot of OBs will not do them on women who have had multiple csections or surgeries, nor on women who have gained a lot of weight or are over weight to start with. Some how this plays a part in the incision site opening back up. Yuck. Anyway she said a lot of surgeons/OBs are not going to take the time to stitch all the underlying layers correctly, and then when they use the glue you just have problems on your hand.

O, and I am getting double layered sutures this time just in case I change my mind and decide to have another baby. (yes I am crazy) :LOL

Quote:
I found a good bit of my info on medscape/medline about the drugs they give during csections. Also I looked in some actual textbooks years ago. (tto long to remember... I live near a medical school)
This is what happens typically -- they give you a spinal or epidural, this causes your blood pressure to drop, the patient often will feel nauseated -- in come the anti-nausea drugs and ephedrine. The antihystamine(sp) phenegran often is uses for the nausea AND sedative. The thing is, the reason the patient gets nauseated is from the blood pressure drop, and often will subside after ephedrine is given. In my experience YOU have to request zofran for a csection, which does not give the sedative effect. Other drugs that may be used are sedatives/anti-anxiety medications during a csection. These are administered in your IV, often without your permission. This is standard surgical proceedure, especially during the suturing phase. This is to help relax you and make you "compliant". I specifically said "do not give me sedatives, valium, verset, etc. in my IV". Also, other things that are given to you are morphine and demerol during the suturing phase, especially if you have a spinal -- its up to you to say "don't give me that" or to request duramorph in your spinal.

I just wanted to say there was lots of stuff "left out" of my surgical report from my first csection. Somethings are just "understood" as well. Also some drugs, like phengran are not classified as narcotics yet cause the patient to have a hazy, dreamlike effect.

I will see if I can find a link for you, but its been awhile since I looked!