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Old 09-02-2009, 08:08 PM   #1
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Anyone had a scheduled c-section?

Hey mamas... I just found out today that this little guy needs to be born via c-section, for being complete breech (38+weeks) and a low lying placenta. I had an emergency c/s with my daughter, and it was a total disaster for a lot of reasons.

So I've been through it before, but it still seems like there is a lot that I'm not thinking of. I'd like to put together a "birth plan" specifically for the c/s, even though I know that most of it will be out of my control. It's more for the details, and for the postpartum period. Any ideas for me?

Also, if anyone has any tips for surgery or recovery the second time around, I'd really appreciate it. I'm kind of freaking out, afraid that things will go badly like my first one. I didn't get my daughter for 8 hours due to a 'miscommunication' at the nurse's station, never was able to successfully breastfeed because of a whole slew of infections and antibiotics, they knocked me out when they didn't need to.... etc. Not a happy experience. I need all the help I can get to make this one as positive as it can be!

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Old 09-02-2009, 09:17 PM   #2
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Re: Anyone had a scheduled c-section?

He could still turn I've known babies who have turned *during* labor. Is it possible to wait until labor begins, do an u/s to deteremine position and then go from there?

When Surgery Becomes Necessary: Planning a Family-Centered Cesarean
The International Cesarean Awareness Network, Inc. (ICAN) opposes the use of cesarean surgery where there is no medical need. Vaginal birth is a normal, physiological process, and cesarean is major abdominal surgery. Cesarean exposes the mother to all the risks of major surgery, including a higher maternal mortality rate, infection, hemorrhage, complications of anesthesia, damage to internal organs, scar tissue, increase incidence of secondary infertility, longer recovery periods, increase in clinical postpartum depression, and complications in maternal-infant bonding and breastfeeding as well as risks to the infant of respiratory distress, prematurity and injuries from the surgery. It has been suggested that cesarean section is the safer method of birth for infants. However, scientific evidence proves that infant outcome does not improve once the cesarean rate climbs above 10 percent. All physicians take an oath to "Do no harm." This means choosing the path of least risk to patients. Medically unnecessary elective cesareans increase risk to birthing women. It is unethical and inappropriate for obstetricians to perform unnecessary surgery on a healthy woman with a normal pregnancy.

Common methods to avoid cesareans include choosing a caregiver expert in natural birth with low cesarean rates (below 15 percent is recommended), and preparing to birth naturally without induction or anesthesia medication. Medications tend to disrupt the normal process of labor and birth, and can negatively affect the mother and the baby, inviting other interventions including a cesarean. ICAN supports women’s rights to accurate, complete, evidence-based medical information; women’s right to the best and safest medical care in childbirth in situations where medical care is actually needed in childbirth. ICAN will continue to work to protect women’s rights to ethical and appropriate care in childbirth.

Planning a Family-Centered Cesarean
By: Michelle Smilowitz, CD(DONA)
The birth of a child is one of the most significant events in the lives of families. It is considered a rite of passage by many women, and involves the first interaction between parents and their baby. There is much buzz today about the necessity of making birth a "family-centered" experience, where the focus is often on creating a special environment for bonding between parents and child in the first moments and days of life. But what if you are one of the one in three women who experiences your baby’s birth as a cesarean section? Is it possible to make your surgical experience into a family-centered birth?

The answer is a resounding yes. While planning a family-centered cesarean is easiest for the woman who must, for whatever reason, schedule her baby’s birth, there are a number of ways that a woman who encounters an unplanned or even emergent cesarean surgery can make her experience into a celebration of her baby’s birth.

Become Familiar with the Procedure
It is first important that every pregnant woman and her partner become aware of the procedures that surround a cesarean surgery. Many women who experience unplanned cesarean deliveries lament that, "I skipped the section of the book on cesareans, I assumed it couldn’t happen to me!" Having some familiarity with the procedure and all that it involves can help reduce much of the surprise and fear that can surround the unknown. (For an excellent explanation of cesarean section go to http://www.ican-online.org/resources..._cssurgery.htm)

If your cesarean is planned, it is important that you have the opportunity to fully discuss with your care provider the reasons for your surgery. Knowing that this surgery is the best choice for your or your baby can create a less tense environment for the delivery. If you desire a vaginal birth and feel that a cesarean surgery may be unwarranted for you, consider getting a second medical opinion that all medical consumers are entitled to.

Write a Birth Plan
Next, plan this birth just as you would a vaginal birth. Write up a birth plan including your preferences for the surgery as well as for yours and the baby’s postpartum care (See second article attached below, written by Connie Banack). In the case of a pre-planned cesarean, it is usually possible to schedule an appointment ahead of time with your anesthesiologist. He/she is the person who actually controls the environment of the operating room. For example, generally, women’s arms are strapped down for their surgeries, so that they do not dislodge IV wires or sully the sterile surgical field. Ask if you can have at least one of your arms free – or have your support people hold your arms in place.

Discuss the pros and cons of both epidural and spinal anesthesia as well as the effects of various other medications you may receive both during and after the surgery. Some of the medications that treat specific symptoms such as trembling and nausea may cause extreme drowsiness or amnesia. You may decide that you would rather tolerate these symptoms than be asleep for the first few hours of your baby’s life.

When you write your birth plan and discuss it with your care providers, there are a number of things you may want to consider. Many women negotiate to have two support people with them in the operating room, generally their partner and a doula or friend and family member. Doulas are a great addition to a cesarean birth team. They are familiar with the process and can reassure you and your partner. Additionally, if you and your baby need to be separated at any point, your partner can accompany the baby while your doula stays with you. Doulas also often have some expertise in post-cesarean breastfeeding and can help with this.

Many women ask for (and are given) the right to play music of their choosing for the birth – this can soothe you and serve as a pleasant way to welcome your baby into the world. Feel free to ask those at your birth to refrain from extraneous conversation, and request that if possible someone (generally a member of the medical team) narrate for you exactly what is going on throughout the birth. Ask if you can take photographs or videotape the birth – many women enjoy the opportunity to “see" the birth later on. Sometimes black-and-white pictures are preferable for this – they preserve the drama of the birth while eliminating a direct view of blood.

Many women feel a disconnection from their cesarean baby because they did not actually see or feel the baby born. If you are interested in actually seeing your baby as it emerges from your body, you can ask to view this by having the drape across your abdomen (that blocks your view) lifted for the actual delivery or by using a mirror.

Before the cesarean, ask that the medical personnel not announce the sex of your baby, instead allowing you or your partner to discover this. Request that all necessary newborn exams be done in your line of vision (or even on your chest), and to make physical or verbal contact with your baby as soon as possible. Your baby has been accustomed to hearing yours and your partner’s voice for the past nine months – even if you cannot touch your baby, you or your partner can soothe your baby with your voice. With the help of an excellent nurse or doula, some women are able to nurse on the operating table, while others wait until the recovery room. Regardless, ask to touch your baby as soon as possible, and to keep the baby with you in recovery if all is well.

Get Help after the Cesarean
During the immediate postpartum period you are going to need a lot of help! After a cesarean surgery, women are often confined to bed for as much as a day or two. Once you have been given permission to get up, even such simple movements as rolling over in bed can be quite painful. Clearly, trying to take care of yourself as well as a new baby is generally too much. Having a partner, friend or relative stay with you in the hospital can help ensure that your baby will room in with you. This person can help with changing diapers, bringing the baby to you to nurse (and positioning the baby at the breast), as well as assisting you with your needs.

Once you are home, extra help will enable you to have a more rapid recovery, as well as giving you the opportunity to nurture yourself and bond with your new baby. Many women find that they need extra help with breastfeeding after a cesarean, and there are a number of resources for this.

Not all of these suggestions will work for every situation, and of course, in the case of the emergencies that can occur during surgery, plans may need to be changed or abandoned. Nonetheless, using some (or all) of these suggestions can help your surgery feel more like your baby’s birth!

Michelle Smilowitz is the former leader of ICAN of Seattle, founding editor of “Birth Journeys", and a certified doula. She currently lives in Beit Shemesh, Israel, with her husband and three children. Her oldest was born via unplanned cesarean surgery and her second two children were born vaginally at home. Michelle can be contacted at msmilo2@msn.com.

Article originally published in “Birth Journeys" a newsletter of ICAN of Seattle, Summer 2004.

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Old 09-02-2009, 09:23 PM   #3
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Re: Anyone had a scheduled c-section?

As for breastfeeding usually you can nurse through a variety of infections, pain meds, narcotics, anesthia, etc. I've nursed while on morphine, the hours after surgery requiring general anesthia, and a variety of infections.

Nursing after a Cesarean Birth
By Kelly Bonyata, BS, IBCLC

These are a collection of suggestions for nursing after a cesarean birth. You can do it!

Educate yourself and arrange for breastfeeding helpFind a La Leche League group near you! Try to attend at least one meeting before your baby is born. Ask questions!

Talk to the lactation consultant (LC)--assuming your hospital has one on staff--and ask that she meet with you as soon as you get out of the operating room. She can help you position your baby as painlessly as possible. If an LC is not available, ask one of the nurses and/or have your partner or another helper available to help out.

What about anesthesia and medications?
The anesthesia and any pain meds you are given should not affect your milk. There are many pain meds that are compatible with breastfeeding, so be sure to ask your doctor for one that is commonly used for breastfeeding mothers. Do try to use medications only as needed, to reduce the amount of sleepiness in you or your baby. Excess sleepiness can make breastfeeding challenging in the beginning. Here are suggestions for waking a sleepy baby.

A low grade fever in the mother is common during the early days after a cesarean birth, and should not be a reason to separate the mom and baby. As long as the mother washes her hands well before touching the baby, there is no reason for separation, even if the mother has an infection.

First nursing after birth
If possible, the time immediately after your baby is born is a great time to start breastfeeding. You will still be under the effects of the spinal/epidural and probably not yet feeling any discomfort. You will likely have to nurse lying on your back, because of the epidural. Since one arm may be restrained, it may get a little tricky. Try positioning baby lying face down across your breasts (similar to cradle hold, but baby is higher up and away from your incision, and mom is lying flat). When nursing in this position with a newborn, have someone nearby to make sure baby's nose doesn't get blocked, since you both may be groggy from the meds. Have your partner or a nurse help position the baby, and use lots of pillows around you to help with support.

Nurse Early and Nurse Often
Ideally, you'll want to put your baby to breast within the first hour, but definitely no later than the first 4-6 hours. Studies show that when time to breast is longer than this, babies have more difficulty breastfeeding and engorgement is more severe. If something prevents the baby from being put to breast within the 4-6 hours, you should begin pumping with a hospital-grade breastpump.

Breastfeeding at least every 2 hours during the day with a nighttime span no longer than 4 hours is highly recommended--you're aiming for 10-12 feedings per 24 hours during the early weeks. As long as baby is nursing well, there should be no need for any supplements of any kind (i.e. formula or sugar water).

Nursing Positions
Once you can turn over, try turning to one side and nursing in a side-lying position (see below). Have your partner or a nurse help you with positioning pillows.

Another position that may be more comfortable is the football hold. Sit somewhat upright in the bed and place the baby on a pillow, between your arm and your side, with your hand cupping the underside of his head.

You may find at first that it’s difficult to find a “comfortable” nursing position. Try experimenting as much as possible to get the most comfortable position, and don't hesitate to ask for help getting positioned from your partner, nurses, or the hospital lactation consultant. Whichever position works best, make sure the baby's tummy is towards you. You might want to bring a few extra pillows from home (or a nursing pillow), as hospital pillows are pretty small and flat.

Many moms find the side-lying position the most comfortable during the first day or so. It’s an easy way to nurse and rest at the same time. Using a small blanket, or pillow - even a rolled up towel - can help protect your incision while you nurse lying down.

Below are step-by-step instructions on getting into the side-lying position (in a hospital bed) after a c-section:

Begin with the bed in a flat position and side rails up.
Use extra pillows behind the mother's back for extra support.
Carefully roll to one side while grasping the side rail and relaxing the abdominal muscles. Move slowly to avoid strain.
To protect the incision from the baby's kicking, cover the abdomen with a small pillow or towel.
Place a pillow between the legs to minimize the strain on the stomach muscles.
Lean back into the pillows behind the back.
When using side-lying position, baby should be placed on his side, facing your body, chest to chest, so he doesn’t have to turn his head to nurse. Baby’s feet should be drawn in close to your body with his head either lying on the bed, or on your arm, whichever feels most comfortable to you. You can either roll your body forward to latch, or pull the baby toward you.

(Thanks to Kathy Kuhn, IBCLC for these tips)

Avoid supplements
Be sure to let the hospital staff know they shouldn't give any supplemental bottles or pacifiers, as these artificial nipples can cause problems with breastfeeding. If you are told that supplements are medically necessary, request that they be given via cup or feeding syringe rather than a bottle to avoid the risk of nipple confusion.

You can request that your doctor provide written orders that the baby is to be breastfed, and have no artificial nipples of any kind (no pacifiers or bottles) and that IF supplements are medically required, they should be given by an alternative method rather than by bottle.

When will my milk come in?
The abrupt hormonal shift that occurs at the separation of the placenta from the uterus is what signals your milk to come in. Thus mom's body will get the same signal whether she has a cesarean or vaginal birth. Moms who have stressful births (cesarean or vaginal) tend to have their milk come in a little bit later.

Your milk may come in anywhere from day 2 to day 6 (usually around days 2-3). If your milk is slow coming in, try not to worry, but put baby to breast as often as possible and stay in contact with your lactation consultant so she can monitor how baby is doing. Using these tips on how to be sure baby is getting enough milk will also reassure you. Baby can do quite well on colostrum alone in the early days, as nature intended.

To encourage an abundant milk supply:

Nurse as soon after birth as possible. If something prevents the baby from being put to breast within the 4-6 hours, you should begin pumping with a hospital-grade breastpump. Get the okay from your doctor/midwife ahead of time to nurse your baby in the recovery room - this shouldn't be a problem unless you or baby are having medical problems.

Nurse frequently. Breastfeed your baby at least every 2 hours (from beginning of nursing to beginning of the next nursing) during the day, with no more than 4 hours between nursings at night. You're aiming for at least 10-12 nursings per 24 hours. More frequent nursing results in greater milk production at one week and thereafter.

Avoid unnecessary supplements. Do not supplement baby with anything (formula, water, etc) unless it is medically indicated. Supplementing will do two things - missing feedings will reduce breast stimulation and milk removal (both needed to increase milk supply), and babies who are supplemented tend to need to eat again later than if they had nursed - so again you're losing much-needed nursing time.

Ensure that baby is nursing well. If baby is not latching well and transferring milk well, then it can affect milk supply and the speed that your milk comes in.

Going home
If all is going well, some moms prefer to ask for an earlier discharge so they are not at the hospital an extended length of time. If you do this, be sure that you have some help at home, and try to get as much rest and nourishment as possible - especially fluids. Do see if there is a lactation consultant (IBCLC) at the hospital (or another local lactation consultant) who will make at least a couple of home visits to be sure all is going well with breastfeeding, and help you (if necessary) to fine-tune positioning and latching.

Get help around the house postpartum. If possible, have your partner take a few days to several weeks off work (as much as you can afford!) to help out. You won't be up to housework at ALL at first. Even accomplishing basic tasks for your own and your baby's needs will be tough. This is major surgery. Your body will need time to recover. If taking time off is not an option for your partner, look into getting others to help. Do you have friends or family who can check in on you? Someone to help with the laundry, dishes and cooking? Can you pay a professional to clean up once a week (this will make you feel better)? You could hire a local 13+ year old to help out. Ask at church (if you attend), your local school, or even your local Girl Scout troop. It will be very helpful if you can find someone who can come for an hour or two every afternoon to do dishes, laundry, straighten up, and maybe even keep an eye on the baby while you shower or potty or nap.

http://www.kellymom.com/bf/start/con...c-section.html
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Old 09-02-2009, 09:30 PM   #4
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Re: Anyone had a scheduled c-section?

Does 3 days notice count? My DD was in a footling breech position, and I have a long thin shaped uterus making turning impossible without tearing, so I understand what you're going through.

Definitely make a plan just like a regular delivery and give copies to family, nurses, doctors, etc. As soon as possible get up and walk around. And continue the walks a few times a day. I brought a pump with me and started pumping between nursings to encourage my milk to come in. DD was getting something, due to lots of poo dipes, but it didn't feel like my milk really came in until day 4. So don't get discouraged. Get help, especially for the first week. This is major surgery and even if you feel fine you need to give your body some rest time to properly heal. Best wishes for a happy and safe delivery.
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Old 09-03-2009, 12:30 AM   #5
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Re: Anyone had a scheduled c-section?

I was also going to ask why schedule? If it's just position that's the issue, you could always wait until you go into labor....it wouldn't hurt anything, and it would ensure that your baby was ready to be born (remember, due dates are only an estimate, and scheduling your baby's birth date can lead to NICU babies take it from someone with a preemie, you don't want your baby early!)
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Old 09-03-2009, 06:02 AM   #6
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Re: Anyone had a scheduled c-section?

Well, you guys make a good point about the scheduling. I guess the way I see it is this- if I have to have a c-section, the least I can do is know that it's coming. My section is scheduled for the week AFTER my due date (found out too late for the hospital to get me in the 39th week like they usually do), so I figure it gives baby plenty of time. My hubby is deployed and I don't have a lot of local support, and if I'm having a c-section, I am going to need help. So at least this way, I can ensure that I have my mom out here to help me out with DD and afterwards.

Cindy, thanks so much for all that info. That's very helpful!
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Old 09-03-2009, 08:48 AM   #7
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Re: Anyone had a scheduled c-section?

Quote:
Originally Posted by stephie_j24 View Post
Well, you guys make a good point about the scheduling. I guess the way I see it is this- if I have to have a c-section, the least I can do is know that it's coming. My section is scheduled for the week AFTER my due date (found out too late for the hospital to get me in the 39th week like they usually do), so I figure it gives baby plenty of time. My hubby is deployed and I don't have a lot of local support, and if I'm having a c-section, I am going to need help. So at least this way, I can ensure that I have my mom out here to help me out with DD and afterwards.

Cindy, thanks so much for all that info. That's very helpful!
If your husband is deployed you qualify for a FREE doula through Operation Special Delivery! Check their website to see if there are any doulas near you that participate in the program!
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Old 09-03-2009, 09:03 AM   #8
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Re: Anyone had a scheduled c-section?

The info from ICAN is great. I also suggest making it very clear to everyone involved that you plan to breastfeed (nurses, CNAs, Docs, Med students if there are any, EVERYONE) This will help avoid any confusion. Also don't be afraid to call the nursery to ask for the baby if you feel they are taking too long to do their assessments at shift change. Don't skip pain meds. it makes is so much more uncomfortable to have a baby on your belly if you do. Try the football clutch if you are having pain so you don't have the babe on you (many bf'ing mamas do this after a c/s.) If you live near base ask some of the other wives for help. You all are a family and support for each other while your SOs are gone I'm sure a few of them would be happy to help. I also would recommend freezing some dinners so you can just toss them into the oven so you will be more likely to eat healthy when you get home. I am the lazy cook and if I am the only one requiring food I don't eat or don't eat well. If I can just toss something together though I am more likely to eat a good meal. Good luck with you delivery. I am two weeks post op after my second c/s with a vertical incision so I know how anxious you can get. I do think that this c/s was easier than the first, but I also knew how things were going to go.
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Old 09-03-2009, 09:07 AM   #9
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Re: Anyone had a scheduled c-section?

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Originally Posted by meeshkasheeba View Post
The info from ICAN is great. I am two weeks post op after my second c/s with a vertical incision so I know how anxious you can get. I do think that this c/s was easier than the first, but I also knew how things were going to go.
Why did you have a classical incision? I haven't had a c/s but I have had an an open appendectomy at 6wks PP, my incision is about 10inches long. I can very much relate to the recovery of a c-section.
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Old 09-03-2009, 02:59 PM   #10
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Re: Anyone had a scheduled c-section?

Cindy- I have endometriosis and had a HUGE endometrioma and had a huge surgery with an incision bellybutton to pubic bone when I was 18 and I did not want to have a cross on my belly. The first c/s I had he also did a scar revision because I had a bad reaction to steroid injections for a keloid scar.
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