What can I expect from a CS?

[9DonkeysAndABoy]

So, having found out that I may have ELCS due to medical reasons (the fibroids noone else seems to have ), can someone tell me what the procedure is? I read stuff about catheters and such, but I hardly even know what that means? Could someone tell me a bit more about what the whole procedure entails?

Also, is there any difference between private and NHS CS? I am a private patient at Chelsea and Westminster - but CS was not a reason, quite the opposite, I thought it would be a natural birth until yesterday. Now, with a medical reason, I feel like I would be getting exactly the same consultant lead care whether I was on NHS or not!

[Trinaluce]

Lengthy answer alert!

Can't speak for the private v NHS part but:

Assuming you choose to have/are medically safe to have an epidural...

• You will come into theatre or the anaesthetic room for your epi (hospitals vary). This is an injection into the spine, done between two vertebrae. Don't worry too much about this, I had MASSIVE needle phobia and handled it fine :)
  
• You will be laid back on the trolley with a wedge under one side to tilt you over a little - this can feel a little unnerving but it's just to make sure that your arteries aren't being squished by your uterus and so the dr doesn't have to stretch so far...
  
• The anaesthetist should at some run some tests to check the epi is working. One I used to work with did this by holding cold cans of drink onto the skin to see how far up the block was working, another did it with the tip of a ballpoint, others tended to just stroke or poke with a finger. They will not allow anyone to get further into the op than this until they are happy you are completely without feeling from the point of epi downwards. This being said, people are different and some can take longer for it to work on than others and in some cases it can start to lighten. The anaesthetist (or at very least an ODP/ODA) will be at the 'head end' all through the op and if you start to feel more than you could a few minutes before, TELL HIM. He's not going to tell you you're being silly, he's going to do something about it, or at the very least, monitor it to before doing so if it's necessary. The spinal canula (sp? - also not sure of its correct term) will stay in place and there will be a spot just by your head where it can be injected into. In my case, it was August and HOT and the drugs were very cold going under my back and it was bloody lovely
  
• Once they are certain you're good to go, the scrub nurse(s) will prep you. This will involve swabbing over your abdomen with sterilising solution (usually Betadine, sometimes Chlorhexidine, can vary by doctor's preference), then draping you to make you a 'sterile field'. You'll be covered in green/blue sheeting which at the head end will be tacked up onto two drip stands so you spend the op staring at about a two foot high wall of sheet, if that makes sense! You can ask for this to be lowered when they get baby out, it just depends how much you want to see! You really can't see much from the head end anyway, sheet up or down - don't worry, you're not going to be looking at your innards! Over your abdomen they'll fix a sticky see-through sheet so they can see where they're cutting. Never did figure out why they bothered though...
  
• An incision is made (assuming you're having what is called a lower segment caesarian) across the top of your bikini line. They cut down through the layers (could be more explicit here but will only do so if asked) until they get into the uterus. A machine called 'diathermy' is used to help - this is electrical current applied to cauterise and cut at the same time, limits bleeding. It can whiff a little, but it's nothing to be alarmed about. Once they get into the uterus, anyone standing at the foot of the trolley gets soaked in amniotic fluid (I was that soldier - you only stand there once...) and they then dig the baby out. If it can be done by hand, great, but it's quite common to use forceps to get a good grip. All you should feel at any point is pushing and pulling - it's quite peculiar, like all the kicks and somersaults you've felt since 20ish weeks being done by about 100 people, but shouldn't be any sharp pain. Again, anything that's not a dull tugging sensation, tell your anaesthetist.
  
• Baby should be out, and here's where I can't speak on ELCS. I've seen plenty but in every single case the baby is handed straight to the midwife to take over to a resuscitaire (don't freak on the resus part of that name, it's just a little heated table with resus kit in it) to be checked over, make sure s/he's breathing etc, in case the airways need a little suction to clear them, stuff like that. This is normal, doesn't mean there's anything wrong, and the baby won't cry immediately 100% of the time. That knowledge doesn't stop the few seconds between baby coming out and hearing the first scream being the LONGEST in your life! People on here talk about being able to do skin to skin straight away, but I honestly have never seen it done. I only worked in the one place though, so it may just have been local policy - or no-one ever knew to ask!
  
• Baby will be handed to you all nicely bundled up in a blanket or two and you will be stitched up (some doctors prefer to use stitches for the top layer, others staples, others glue). Again, here's where I can't speak for ELCS - for my EMCS I was taken down to the postnatal high dependency unit, with baby wheeled down in a hospital crib, while they made sure I was ok - but this may be EMCS only. You will (or should) need three injections over the next few days of anti-coagulant to stop unnecessary clotting. They will want to keep you in a good few days to administer these injections and to make sure there's no post-operative complications.
  

As far as the catheter goes, I can't remember at what stage of the prep this goes in, but it will be in place before they operate. A tube is inserted into your bladder and a tiny balloon at the top of this is inflated to stop it coming out. It basically means that you don't need to pee while it's in, all urine just goes straight into a bag at the end of it. This serves two purposes: it makes sure the bladder is empty and therefore not in the doctor's way when they're digging around, and it also means that they can check for blood in the urine post-op without asking you for a sample every ten minutes. I can't recall how long mine was in - but my abiding memory of it is 'don't hang the bag off the door of your bedside cabinet and then walk off forgetting you've done that because it bloody well hurts!'

I think that's it all covered. Obviously if you have a GA, all the prep's the same, you're just asleep! Also, I think it varies by hospital, but to the best of my knowledge most will allow your DP/DH/SO/Birth partner in with you if you have an epi - but not if you have a general. Anything else?

[bloom123]

Trinaluce - what an informative reply - thank you (from another lady due to have a first time ELCS).

[Cheria]

What a great reply. I had EMCS but it was just the same.
After the baby was out and had been checked we both went into a quiet recovery room where we were both checked on several times over a couple of hours (was able to hold and feed her here) and then moved up to the ward.

[planks2short1s]

Erm can we ask mnhq to put that reply up in the info section? Its great!

[9DonkeysAndABoy]

I agree with everyone else, great reply! It's so good to be informed, thanks Trinaluce. So did the whole thing take about an hour?

[Cheria]

The baby is out in about 10 minutes. The sewing up takes up to about 45 - though you'll not notice as you'll be high on meds and on the pure relief of baby coming out :)

[Cheria]

And good idea planks, it should go up in the advice section!

[missnevermind]

Thank you Trinaluce I have had my pre med today for an ELCS on the 14th and you have condensed what they have told me exactly. It was like reading back over my meeting

[missnevermind]

The catheter goes in after you are numb but before the incision.
With mine I will be given the anti coagulents for at least 5 days - they will teach me to do this on the ward if I prefer that.
They will stroke the baby on my face on the way to the resuscitaire if possible, but if they do not show me the baby at all I am to tell them too.

[TrinaLuciusMalfoy]

No trouble (scuse name change) - I've been on both sides of the drapes so I know EXACTLY what goes on - at least in theatre! It was a great comfort to me when I had my own that I could picture exactly what was going on at each stage, even when I couldn't feel it.

There's extra stuff - if you're having a pre-term CS (eg, preemie twins, that kind of thing) there will be a paediatrician in theatre too, and with multiple births one midwife (at least!) per baby. It can be a packed old procedure!

As Cheria said, once they start cutting the actual 'baby removal' part takes just a few minutes, it's the prep (particularly the epi) and the stitching that take the time. Some anaesthetists are slower than others too - doesn't mean they're making a hash of it though. We had one who we knew would take AAAAAAAGES to get the epi done - but all the nurses agreed we'd want him to do ours, because he'd never have to top it up or re-site it.

[missnevermind]

While I have the ear of somebody who knows what they are talking about
What happens about my glasses? I am nearly blind without them and I will need them to see the baby.

[TrinaLuciusMalfoy]

Wear them [hgrin]! I wore mine, no trouble. Any jewellery needs to be taken off, as does nail varnish, but glasses aren't a problem. Check with your consultant though if they're metal frames: off the top of my head I can't remember if this can be a problem with the diathermy (you have a metal plate stuck onto you, usually on your thigh, which is plugged into the diathermy machine to 'earth' you (!) but I can't remember if there's an issue with metal frames that you might get a burn where the metal touches your skin. I'm sure I'd remember something that crucial, but better safe than sorry!)

[lynn1]

hi, i had my glasses on, and it was fine.
just to reassure you, my c/s was calm and i felt nothing. not even a tugging like many people describe. the entire procedure took maybe 40 minutes after i had the epi, which also hardly took any time. it was so fast i could not believe it. and i held the baby right away after they stitched me,- i didn't feel like i lost any time with baby. happy with the experience.

[missnevermind]

They are metal. I will wear them. Thank you it would not have occurred to me not to wear them but it was just one of those things that you randomly think of. As they will not be sterile, they probably won't even be clean!

I spent an hour this afternoon in A&E having my wedding ring and a bangle cut off. The Anaethatist (eek sp) phoned them up an insisted they do it.

[missnevermind]

Thanks Lynn I cross posted with you.

[MerryMarigold]

I had a 'natural labour' with Ds1 and a ELCS with twins. I can safely say the ELCS was absolutely wonderful!!! (And the natural labour with forceps was certainly not). Yes, it feels a bit odd, but it is not painful in the slightest.

The only bit I didn't like was not eating for a looong time. This is where the private and NHS will vary. I was supposed to be ready from 9am so was not allowed to eat or drink from 9pm previous night. In fact, I had the CS at 2pm . I was soooo hungry. I ate very soon after coming out and promptly threw it all up. Yes, you may vomit some food, and you may feel a bit 'high' anbd 'woozy' (I did but I am quite sensitive to drugs). The catheter was a delight. Not having to get up for the loo after getting up every 30mins for the past 4 months, was absolutely FANTASTIC!

[LisMcA]

I had an EM-ELCS, decided on Friday afternoon after a failed induction that I'd get a CS the next lunchtime. So on my notes it's EM, but really it was all fairly laid back, discussing the Royal wedding from the day beofre!!

I had a spinal block rather than an epidural, but much and such the same. I was told to it was ok to wear my glasses, but the OB told the anethsitist(I can never ever spell it) to take them off me while he was operating.

My cathater was meant to be in for 24 hours, but the lazy arse MW took it out after 16.

One thing I need to tell you, after your CS you may get after pains. These are like contractions, but as I never had a contraction I had no idea what they were and thought my innards were exploding. The MW looking after me didn't even explain, just flung some painkillers at me. The girl inthe next bed kindly told me.

I got to have skin to skin once out of the theatre and in recovery.

When they wheeled me back to the ward I got sick going backwards (I get sick going backwqard on the train tho').

And finally, don't refuse any painkillers when offered. It is major surgery, it will hurt!

Good luck! It's so exciting!!

[Highlander]

Ask the anaesthetist for Volterol (Diclofenac) 75mg up the bum at the end. It's absorbed v quickly. Get paracetamol as well.

Ask when you're painkillers are due and make sure you get them. You may be happy with Volterol for 48 hours then step it down to Ibuprofen plus paracetamol.

Keep taking paracetamol for a week - don't be tempted tostop. paracetamol is an excellent painkiller as long as you keep taking it, but it's crap for initially getting on top of pain.

[LisMcA]

Oh yeah I'd forgotten about the up the bum painkiller!!

Painkillers I got were diclofenac 3x day with paracetamol, and dihydrocodiene up to 3x per day!! Some MW do like to give you everything you have been prescribed for some reason. I just made them give me it! and I had very little pain.

[Georgimama]

I am having an ELCS in 3 weeks. Thank you so much for that explanation it was brilliant. I was told at our hospital they don't give anti coagulants as standard, only if you meet certain risk criteria. I will be wearing special support stockings during the op and for a few days afterwards though. I have also been told not to wear any make up or nail varnish (I think they want you au naturel for hygiene and also so they can see your real complexion). Apparently I will be discharged the next day which makes me a bit but we will see. I will dig in if I feel too ill to leave.

[TrinaLuciusMalfoy]

Yes, the voltarol's pretty standard - AFAIK it should be administered as routine at the end of the op. The spinal canula will stay in place for a good while after the op too so they can top you up on pain relief if needed. I think mine was in for about 6 hours after. I really didn't feel that I needed anything stronger than ibuprofen after, but again everyone's different.

Something I just remembered: some people get the shivers as a side effect of the epi - I did and it was very odd! It's a perfectly well documented side effect, nothing to be concerned about, but it is irritating at the time and took a good half hour after the op to dissipate. Just like your body's decided it's freezing so starts to shiver but you don't feel cold so don't know why it's happening [hconfused]

[TrinaLuciusMalfoy]

Hm, maybe I met those criteria then! Yes, being asked for no make up/nail varnish is so they can monitor you. The oxygen sensor that they'll put on your finger won't work properly if it's got to fight past undercoat, french manicure and overcoat [hwink]

I'd be interested to know if you did get let out that early - anyone I've ever known who's had a section has had a minimum stay of two nights. DD was born 4am on a Tues so I had the first anti-coag around 9am, so I was able to go by Thursday afternoon as I'd had all three doses. I wouldn't have wanted to leave any sooner - and if I end up with a section this time round I'm actually quite looking forward to those couple of days just me and baby and no toddler climbing on me!

[bloom123]

Just a quick question about the metal issue and the machine on the thigh - I have a metal plate in my leg - will that interfere with the machine ?

[9DonkeysAndABoy]

Just wanted to say thanks to everyone - this has been a great thread! Bloom, sorry I have no idea, but I am sure they have ways of dealing with this, just make sure you tell them! (Maybe even before so it's in your notes.)

[thursday]

i refused the volterol up the bum, i felt like that particular doctor had spent quite enough time poking about down there after holding her head of the cord on the way to theatre and then when i had a PPH and he snook a volterol in while i was not with it. he thought i was mad to refuse it, and he's quite possibly mad, but then he had to forcibly wrestle the gas n air off me about 10hours post op, and i'd had it in labour too. i'd convinced the MWs to give me it back twice already

after that, my fave painkiller was the liquid paracetamol in a drip. that's really expensive apparently but my bum invasion embargo made them nice about it.

i cant comment on sections really as mine was a crash one and my experience is not the norm but i can share some post op info:

1. the first 24 hours afterwards i honestly thought i'd never walk again, the first time i tried to sit up it took me about 45 minutes to get upright, when they took my catheter out and made me walk to the loo at 3am i wanted to kill everyone, BUT then you come on really fast and i was showering myself by day 3 (god that was good!). i felt 80% better after a week.
   
2. try and stand up straight. a mw showed me how to get up and unfurl myself to full height, i found i slipped into walking hunched over because i didnt want to stretch, but you need to.
   
3. peppermint tea. make sure they have some or take your own in. i had trapped wind in my abdomen on day 3 or 4 that was agonising. i could see this huge bubble of air moving across my stomach and i couldnt shift it. peppermint tea helped.