Difficult ELCS due to un recognised transverse lie.(7 Posts)
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I am not sure if this is the right place to post this, and will happily report and request it to be moved if not, but I need some advice from others who might have been in this situation as it is playing on my mind. I had an emergency c section in 2010 following a failed instrumental delivery. (Long story here too, but unrelated to this.) With my second pregnancy I had an ELCS due to breech presentation and the previous section.
On the day of my section I explained to several HCPs that I was not sure my baby was still breech, and asked for a scan as I wanted to know how she was going to be born. As I would still have gone ahead with the section even if she had been head down I was told there was no point. I had two different midwives, one who felt skin to skin would be possible after birth and one who felt this would be a problem. Both reassured me of what a calm procedure the ELCS is in relation to the EMCS.
Unfortunately no-one palpated or scanned me prior to the section starting. It turned out my baby was transverse breech and my baby became stuck. The paediatricians were called and the surgeon advised that he may have demaged my baby's legs as that was the only way she could be born. He also cut up into the upper segment of my womb, which means I could not have a natural birth in the future. My baby needed resuscitation via oxygen and had an apgar score of 5 at 1 minute. I did have a debrief a week after she was born where I was only concerned with knowing her oxygen levels etc. The senior midwife said that nothing had been done wrong.
It still really bothers me though. I wonder if I should complain, but I don't know what I want to achieve from this? I guess really I just want some acknowledgement that it shouldn't have happened. I am so grateful that my baby is here, and safe but feel that the initial trauma at her birth could have been so easily avoided? Would they have done anything different had they known she was transverse?
I think this "Would they have done anything different had they known she was transverse?" is the key question.
If you were going to have the section anyway then I'd doubt there was much that would have changed (although possibly you could have cancelled the c-section until finding out more/getting a surgeon experienced in these... not to say yours wasn't, just I assume you don't know... I await correction.)
Scans/palpitation would only have made anything better if there was another realistic option. Before you complain I'd verify what would have been different if you/the surgeon had known in advance.
Congrats on the new baby btw!
I think you need to go back for another debrief as you seem confused with the events. You say you asked for a scan as you were not sure she was still breech and wanted to know how she would be born but that you would have gone ahead with the CS anyway. What do you mean by "How she would be born"? If you had a scan which showed she was transverse she would definitely have needed to be born by CS.
You say you want acknowledgment that it shouldn't have happened and that the initial trauma of her birth could so easily have been avoided. Why do you think this? CS is not always a straightforward procedure - babies can be head down and then move away and twist around. Breech babies are often difficult to manouevere out of the normally small incision and can turn transverse or oblique without any warning making delivery awkward and sometimes necessitating another or extended incision. All that handling can be traumatic but it sounds like your baby responded well after some oxygen which is not unusual after a CS.
Without having been there, none of us will be able to tell you if anything could have been done differently but what you have described does not sound like anything was done wrong or should have been done differently. The only thing that I find unusual is not having a scan as a routine but you said you would have had the CS anyway so that isn't an issue. Knowing the baby was transverse would not have altered the procedure.
Go back and ask for another debrief so you can have a full explanation again and hopefully make peace with what happened. Even the most straightforward birth can be traumatic. One with an unexpected event such as yours would upset most people and you deserve to know exactly what happened and why.
I had a CS in November and my baby was transverse. He was wedged in and wasn't going to be able to be delivered naturally. The EMCS was straightforward and quick however he still needed to be resuscitated, had difficulty breathing on his own and ended up on oxygen in the incubator for the first few hours. The oxygen in his cord blood was normal so he didn't have any hypoxia but he still had a difficult start. So your baby's breathing/agpar may not be too unusual.
I had a very difficult delivery resulting in ECMS with my first and it took me years to get over it to the point where I could talk about it without crying. I think you need support to discuss what went wrong and whether any other outcomes were possible. Hopefully you'll get more help on MN but it sounds like a proper debrief might help.
How's the leg now? Was it damaged during delivery?
I agree you need a proper debrief. A scan may / may not have made any difference- the surgeon would have been more prepared and would have known which way to look for the head/legs and could have told the assistant to push in a particular way to encourage the baby to turn. Going in unprepared probably lead to a delay in birth. Also you don't know the experience level of the surgeon. It may hve been a very junior person which would have been inappropriate in transverse lie. All questions to consider. But ultimately, nothing can be done now about it. More important is your health and baby. How is baby??
Thanks everyone for your replies. I will try to answer the questions- the surgeon was experienced but he said that he was not expecting the baby to be transverse. He put his hand in and all he could feel was a hand. We went well over the time that is recommended for C-Section babies, and there was a feeling of panic, obviously from us, but also the staff in theatre. I honestly thought that the worst had happened. I knew the risks of a C section, but had chosen the ELCS as my previous EMCS was very scary, (I was told it was too late for a C section, as twin 1 was too far down the birth canal so consented to forceps which I had previously said I did not want for twin 1, although would consider for twin 2- which was ultimately not true as the forceps failed to work and both babies were born by EMCS.) Despite a 4 day induction, forceps, blood being taken whilst still inside and being 4 weeks early my twins were in a much better condition at birth than my singleton. For some reason it is playing on my mind. I absolutely know that the most important thing is that she is OK- her leg was bruised, but no lasting damage- but I so wanted her birth to be as calm as possible- I felt guilty having the section, and wanted to know how she would be born, as in head or bum first just so that I knew and could kind of imagine it if that makes sense. If they had palpated me they would have known what position she was in- then they would have at least been prepared, or even said to me to come back on the Monday, or maybe tried to turn her. I think the error happened because the midwife was changed half way through. The second midwife was more worried about the fact that I had been told I could have skin to skin with baby than checking what position she was in.
I seriously cannot describe the pressure that was used on my tummy to push her out towards the end, I felt breathless and as if someone was standing on me. The surgoen was shouting that the baby was stuck and to call the paeds, who came running in. I still get pain too, so maybe that serves as a reminder, I don't know.
Maybe I just need to go back and ask my questions. I just felt when I went last time that my questions were avoided, and it was far too soon for me to really think about it. Thanks again.
God poor you, it sounds like a dreadful experience My first delivery was similar - baby was undiagnosed back to back and got wedged into my pelvis after 35 hours of labour (two hours pushing) it took two surgeons 45 minutes to get her out and they had to do a vertical T incision to get at her. One surgeon was pushing (still don't like to think about where from) and the other pulling. Fortunately as she was face up she was never deprived of oxygen so ws absolutely fine but I was distraught afterwards until I had a full review with a really experienced midwife who talked me through everything that had occurred during the labour and delivery. That was about a year after she was born. I was amazed at how much I had misunderstood or missed but enormously reassured by how little could have been done differently. I did have a most helpful elderly midwife point out that if it had been 50 years earlier we would probably both have died <helpful>
on the upside I've had two lovely elective sections since - my second was particularly lovely, had the most amazing midwife. It is possible to move past the traumatic experience you've had but you need to understand exactly what happened and why, and what could have been done to avoid it.
I think another review would be a very good idea. Ask for the most senior midwife at the hospital, speak to her and see if you like her - if so, see if she'll do it with you. I think it would be best for you to do it with someone who will be sympathetic to your ongoing distress at the circumstances of the births - if she sounds like she's going to be unhelpful ask for someone else.