Caesarean at Edinburgh Royal - any info appreciated!

[picalilian]

Hello,
I am scheduled for a C-section at ERI next week (will be 39+ weeks) but am feeling incredibly disappointed with total lack of information and slightly blase attitude of care providers. This is my first baby and my pregnancy has been low-risk, but due to baby being breech and being dissuaded from trying vaginal breech birth, I am trying to be positive about the ELCS and prepare as best as I can. (There is a brilliant book called "Caesarian Birth" by Leigh East which has really helped me get into a positive mindset).

However... I haven't had a midwife appt since 36 weeks (just scans), and also haven't been given any leaflets or a dedicated appt to discuss what a C-section specifically at ERI will involve (e.g. their protocols for preparation, the risks, advice on recovery, visiting hours on the labour ward etc etc...basically all the stuff that would put my mind at rest). I have done a lot of general reading, but I wondered whether it's normal not to have an appointment to discuss C-section specifically before the day, and whether other mums in Edinburgh have received better support/ info in the run up? If this is the case, I guess that when you arrive at the hospital on the day, this is the time for signing legal papers etc and that you get to have a chat with the consultant performing the birth before you are wheeled into theatre?

I do feel that, after 9 months of fantastic and consistent care from the community midwives, it's really gone downhill at the time I need it most! In a short space of time, I went from planning for a natural homebirth to being advised to go for a C-section, a pretty big shift emotionally :)

If anyone has any info at all, or tips related to ERI in particular, I'd love to hear from you.

Thanks xx

[KateNDAS]

I had an emergency section at the Royal. It was excellent. They are very pressured and stretched there generally because they are so busy. I think they do their best but inevitably when resources are tight they focus on clinical care, which is the most important thing, but they don't have time for quite as much hand holding as you seem to have in mind.
I am surprised they have booked you at the Royal. Most elective sections go to St Johns because of how busy the Royal is.
I had been there, and in labour for several days before I had my section - begged for single room rather than the ward, and go that, but you should assume you will have to go to the ward unless there is a particular reason for a single room. You can't book a private single room - they just allocate them on clinical need. If you phone the post natal ward they will tell you when their visiting hours etc are and will probably answer any other questions you have. If you feel you need more information have you tried phoning the post natal ward and just asking the midwife who answers?Who do you anticipate having an appointment with? An obstetrician?
If you are booked for an elective section then unless they are unusually quiet you should expect a long wait. I know a lot of people who have waited all day/until the next morning, despite being booked on a particular day, and I also know a lot of people who have ended up being sent to St Johns. The Royal is the regional specialist centre so inevitably has to prioritise complex or emergency cases.
Ultimately the most important thing is that they get your baby out safely and I would feel confident that they will do that at the Royal. There is slightly more back up there than at St Johns if anything goes wrong, but in an elective section for a breech complications are unlikely.
They usually release you after about 48 hours at the Royal so long as your catheter has come out without issue and your bladder/bowels are fine. The food is vile - I was offered cold tounge salad as my first post section meal. Get someone to bring you food from home.
Your community midwife removes your stitches at home after a few days.
Your husband or partner will be in theatre and in recovery with you the whole time. They are generally kind but very busy and you have to make allowances for that.
I don't mean to sound unkind but I think if you try and have a positive attitude and realistic expectations about what the NHS is able to offer then the Royal is as good a place to be as any. I would have happily paid for private care but there is no private obstetrics anywhere in Scotland so as long as you know you are going to a very busy NHS hospital and not a hotel you will be fine!

[slightlyinsane]

I didn't have a section but had my twins there 6 wks ago. Completely back up what Kate has said with regards to how busy they are. Although this is the case the care and attention we got was fantastic from the minute we got there until we left a wk later. I would rather have the care and support for when it's really truely needed for the health and well-being of baby and you, rather than time spent with appointments that really could be done by your mw.
I know this is easy saying it when it's not me having one but having been on the receiving end of care by many different people I am beyond grateful that they were there to help us and not stretched thin by having to do appointments aswel, I've been on the receiving end of far too many appointments to know how long they all take, if you multiply that by number of sections, the amount of time needed would be shocking. Its one of those things you can't fully understand and respect until you've needed.
You say you're not going to see mw again give her a ring for a chat that's what she's there for. She can talk you through everything before you go in and then you'll be more comfortable when they go through it at eri. Good luck

[slightlyinsane]

Oh sorry forgot to say from what I can remember visiting is 2 till 4 then 7 to 8 for relatives and other halves is pretty much 9 till 9 ish depending on staff. Dh stayed with me one night till 11 while we were waiting for some test results.

[theborrower]

Hi, I had an EMCS there 4 years ago and another baby last weekend (VBAC).

I was going to have an ELCS if I went overdue, and the only info I had specifically regarding an ELCS was a letter about complex cases being at the ERI and emergencies taking priority, as well as an appointment letter for my ELCS.

However, I was under consultant care so had many regular appointments to monitor growth and discuss what would happen (with regards to a VBAC, as I suppose I knew what to expect with regards to a CS). I was told to fast from midnight the night before.

Visiting hours are 1430-1600, 1900-2000. Daddies are allowed on the ward between 0900 and 2200.

First time round I was in ward 211 (?) which was super busy and noisy. This time I was on ward 119, which is a mixed ward (antenatal and postnatal) so there were ladies who were being induced or monitored because of suspected early labour, as well as people like me who had their babies. It was so much quieter on this ward, although I don't know how the antenatal patients felt! There was one visiting session though that I asked if we could borrow a public room because my 4 year old was visiting - there was a lady contracting in the bed next to me who was quite upset (her induction seemed to be working very speedily and she was waiting to be transferred to labour ward). I felt awful for her.

Midwifes were all lovely.

Tip - take a CD for the theatre. We had a playlist on our iPod but theirs was broken or something, so they just had a CD player. Take both just in case.

For my ELCS I wanted the screen lowered to see baby being born and for skin to skin in theatre. Consultant was ok about it but explained it might not be possible for skin to skin, but the midwife at the VBAC clinic was much more supportive. Have a think about your CS birth plan too eg do you want screen lowered, daddy to announce sex etc.

I'm part of a VBAC support group on Facebook and they have a sister group which I think is called Planned caeserean section uk. If you can't find it I'll look it up. You may find it really informative.

[TooExtraImmatureCheddar]

Am booked for my second ELCS at St John's on Wed. As they are both NHS Lothian I assume many things will be the same. (Have elected for St John's as my first baby was stillborn at the Royal and I just couldn't go back there.)

Be prepared for emergencies taking precedence. I was first on the list last time, was on the table at 9.15 bending forward for them to start the spinal when the phone rang and we were rushed out. That first emergency was immediately followed by another and my section wasn't until 12.30 as a result. I'm really hoping that this time there will be no emergencies and I'll be done on the day - it will be awful if I get sent home to come back later!

Will post this and then swap to the laptop so I can type more easily.

[TooExtraImmatureCheddar]

Ok - preparation. I have to go in tomorrow and Tuesday for steroid jabs to help develop the baby's lungs (will be 38 weeks on section day). This is standard for babies born by ELCS before 39 weeks, but if you're going to be more than 39 weeks then I don't suppose you'll have them.

Tuesday's appt will also include my pre-op checks. From memory, the last time (2 years ago) they took a blood sample to check if I was anaemic, they weighed me (to see how much anaesthetic would be needed) and they carried out the normal ante-natal checks (blood pressure, baby's heartbeat, fundal height and palpated to see where the baby was lying). They explained the risks to me then and I had to sign a form saying that I understood and accepted the risks. The consultant did my form with me this time, 2 weeks ago - she said there were risks to me from the spinal, that there was a chance that my bladder or bowel could be ruptured, but don't worry, they'll fix it if it is (!!), and that there was a chance that the baby could be cut when the incision is made, but if so it would be a very slight cut and babies heal fast. Honestly, those were her exact words! I can't say I was massively reassured.

I will be given antacids on Tuesday as well - one to be taken when going to bed and one to be taken first thing in the morning of the section. You have to fast from midnight before the section. The antacids were bliss - first time in weeks I had been free from acid reflux! These are because there's a syndrome associated with all operations where stomach acid can back up into your lungs, so the antacids reduce the risk. I forget the name of the syndrome but they'll probably explain it to you at your pre-op check.

I've to be at St John's at 8am on Wednesday. Last time we were told to go straight to the ward, where they allocated a bed. I had asked if I could have a single room if at all possible (was told it is luck of the draw) and I got lucky and one was free. I was asked to change into two hospital gowns, one forward and one backwards to preserve my modesty, and then walked down to the delivery suite. They had a room there where they run through the risks of the operation again, and I think they put a cannula into my wrist at that point too. DH was taken off to change into scrubs and his clothes and my flipflops were put into a sterile bag.

There will be a dedicated midwife for you during the operation, and s/he will introduce themselves at this point. The consultant will probably also come in to meet you.

In the theatre there will be a lot of people. I think there were at least 6 or 7 medical staff there - midwife for you, one for the baby, anaesthetist, surgeon, assistant, theatre nurse...They were all very careful to introduce themselves, but tbh that could have been to do with my previous history and the complaint we had running against NHS Lothian at the time.

They sit you on the bed and ask you to bend forward to insert the spinal, then get you to lie down sharpish before it can take effect. Then the anaesthetist will check whether it has worked or not - she was really thorough. It is weird because you can feel sensation but not pain or hot/cold. She sprayed something on my side and asked me if I could feel it, and I said yes, and then she sprayed it on my shoulder and it was icy cold, which I hadn't been able to feel at all on my side. She then asked me what she was doing, and I said she was touching me on the tummy, and she asked DH to look and tell me what she was doing and he said she was pinching me hard, but I couldn't tell that at all - no pain! Then they did the catheter as well.

Then it's all a bit of a blur - I know it really didn't take long from them starting to DD2 being delivered. Maybe 5 or 10 minutes. I remember hearing her cry, and DH cut the cord, and they showed her to me and let me stroke her head, and then took her into a side room to weigh her, wrap her in a towel and do the APGAR check. I could hear her crying at the cold scales and then DH laughing because she'd peed on the MW. Then they brought her back and tucked her onto my chest. I'd asked for skin to skin if at all possible and the MW had made sure she'd tied my gown loosely so DD would fit. I don't remember anything much else at all - I think it took another half hour or so for them to sew me back up and then we were wheeled into the recovery room, but honestly, it's all jumbled up in my head. I think it was the sheer relief that DD2 was there and okay and obviously alive. I think at some point they gave her to DH to hold instead and he had skin to skin with her.

I was in the recovery room for about an hour and then they took me back up to the ward. We basically just sat there in blissed out silence until visiting hours started at 2.30 and everyone piled in.

Aftercare: you aren't allowed to eat until they can hear bowel sounds from you again, which took quite a long time - 5 hours or so. The spinal wears off gradually - at one point I could suddenly feel my knees again! Because DD was delivered at about 12.30, they left me in bed with catheter until the next morning, but I think sometimes they get you up the same evening. You lie on incontinence pads for the bleeding and they come round and check on them to make sure they don't soak through. Because I was still bed-bound, they had to hand me DD at night. When DH left she was asleep in her fishbowl, but I had to ring and get a MW to hand her to me when she woke up. The MWs came in a few times to check us during the night as well, and advised me on breastfeeding - I wound up just sleeping with her on me because it was too much to have to ask the MWs to keep putting her back and fetching her for me.

In the morning they got me up and they tell you to go into the shower, soak the edge of the dressing and then pull it off! I was petrified. It's like a big clear plaster. I did as I was told and it was okay and my guts didn't fall out. You'll still be bleeding heaps vaginally at this point and the shower floor may well get messy. I think they must have taken the catheter out before they got me up. You'll be stiff and sore but it isn't horrendous. I was more scared than actually sore, I think. You have to pee in a jug so they can measure your urine output after the catheter! Then they helped me get dressed again in proper pants with maternity pads, and my own nightie, and got me back onto the bed. After that you have to get up to pee, so you're forced to move about a bit.

I was in for 2 nights and then on the third afternoon they suddenly asked if I wanted to go home that evening, so I said yes and was discharged at about 5pm.

Sorry this has been such a long rambling post - there's heaps more I could say about it all as well! Is there anything else you'd specifically like to know?

[aussieandrea]

This has been a great thread! I'm booked to go in for my third planned c section in 2 weeks time but this will be my first in Edinburgh. Like the initial poster i'm now beginning to worry as i haven't been told the basics of what happens at ERI even down to how long my husband can stay with me for. Its great to know that some of you have had skin to skin in theatre as well as having the screen brought down to see the birth of your baby. I was told that this wasn't allowed but i have had that in my previous births.
My community midwife hasn't been overly helpful and didn't want to go over my birth plan instead saying that i could discuss this with the staff on the day. Does this happen?
How did you find the postnatal ward? It seems like women get discharged extremely early here though with noise etc that may be for the best?! I previously have had major problems breastfeeding so ended up with 2 x 6 day stays so feel a little nervous about the support I will receive re breastfeeding. What were your experiences?
On my appointment letter it says i'm booked in for 1030am but is this when i should arrive or the planned time for the c section? I realise that emergencies get priority and i could be waiting hours which again isn't great as i have bad pelvic girdle pain and sitting isn't the best but at least i've been forewarned!
Thanks again for all your advice.

[theborrower]

aussieandrea with my DD1 (EMCS), she was born early Tuesday morning and I was discharged Friday evening. With DD2 (VBAC, no complications), she was born lunchtime Sunday and I went home Tuesday afternoon. It was in my notes that I needed support BFing following a crappy time first time around, and I was never pressured to leave, they encouraged me to stay an extra night, and it was me that asked to be discharged.

Re your wishes for the screen, skin to skin etc, it was the midwife at the VBAC clinic that told me to remind them and discuss it on the day with the midwife and consultant/surgeon assigned. Both had said that sometimes skin to skin can be difficult because of your position etc, but when I said could I at least have a cuddle she said yes, they'd help me, and if it was too difficult Daddy could do it instead. Be sure to request it, otherwise it may not happen (DD1 was wrapped like a sausage and handed to DH).

Re the good - err, I actually thought it was ok considering! Do take snacks and cartons of juice though.

Re the noise - they are good at minding the babies if you need some sleep, so if that's the case and you need a break, take some ear plugs if you need a rest.

[theborrower]

Oh, and re the time for admission, I think they said I'd be phoned the night before to confirm the time I would have needed to go in.

Hope all goes well!

[picalilian]

Hello.. been away from the internet for a week because... my little one decided to arrive early, and I went into labour on Sunday! Will post properly about the resulting EMCS which was an incredibly positive experience. I just wanted to say thank you so much for all your messages and taking the time to write! You're all awesome

xx

[theborrower]

Oh congratulations! Hope you are both doing well

[aussieandrea]

Congratulations! Would love to hear your experiences when you have the time! I've got 8 days to go but in the midst of painful Braxton hicks and calling the hospital worried I'm going into labour. Feign quite stressed about it l so any reassurance would be fantastic. Hope the last week has gone well x

[TheDayOfMyDoctor]

I had DS at ERI - it was six years ago, so may have changed. I stayed on the post-natal ward for 3 days for help with bf and tbh I would have been better going home as the bf support was dire. The ward was very busy and noisy and I really struggled to get some sleep.

Agree that the food was pretty grim too!

Having said all that, I wouldn't worry too much about other people's experiences - I know plenty of people who found it absolutely ok and a friend who had a difficult birth received exceptional care. I would just try and get home as soon as you are able to so you're more relaxed and comfortable.

[TheDayOfMyDoctor]

Oops, that'll teach me to read the whole thread! Congrats OP.

[picalilian]

Hi, and aussieandrea especially.... You were all right re ERI staff being great and supportive. From the theatre staff to the nurses on the labour ward, I found everyone to be very calm, reassuring and considerate, even at midnight! They explained everything before it happened and left no doubt that this was something they did every day. (especially the anaesthetist who sits at your head throughout the operation, and discusses in detail what is happening and why you are feeling what you're feeling, I had an intense and scary headache as a result of the spinal but she talked me through it.) I was incredibly nervous going into the theatre ( i knew the lights would be bright, but they are BRIGHT!) and they communicated with me and partner throughout to make sure we felt as at ease as possible. We'd grabbed a cd in the rush to leave for the hospital, which was reassuring to hear in the background. They did delayed cord clamping, immediate skin to skin for me and then my partner while I was being stitched up, and we had an hour in the recovery room where the midwife patiently helped me to breast feed.

Once on the ward, I was encouraged with breast feeding positions, they checked regularly to see if we needed extra support. I think everyone in there had had a C section, too, so we were at the same stage. Also, I have an arabic name, and my partner joked that we were on the "ethnic mums" ward, which thinking on it might be something they do, as we were certainly a mixed bunch of non-caucasians! staff were really busy but always there even in the middle of the night. The ward at night was noisy and hot, and it was impossible to sleep, but with four mums trying to suss out new babies, I don't think there's any avoiding that. It was actually reassuring to be around other mums, and you can close your curtain whenever you want privacy. The routine of meal times, visiting hours etc gave some structure to the day. I was encouraged and helped to take a shower on the first day, and though uncomfortable and slow, I was glad to be up out of bed. The woman opposite me had had a v different experience to me, emcs after long labour and attempted forceps delivery, and said her experience was much less positive, and she found it hard to get mobile, so this is just my experience.

I found that they weren't too strict about visiting hours, there was no rushing to get everyone out when the time was up. Likewise with partners, if they arrived earlier or stayed an extra half hour it was fine. I stayed 2 nights and was given the option of staying a 3rd night, but I felt ready to go home.

I think my anxieties were due to never having spent time in a hospital before, and it's my first baby, first operation, first time on strong drugs etc etc. i think I had associated hospitals with negative times, visiting sick relatives etc. I really think the staff at ERI do a fantastic job, especially given how busy they are. I wanted to hug the nurse who offered to butter my toast for me on the first day... With the stitches, it was really hard to sit up without help,so make sure you have water, food, whatever you need within easy reach.

Lastly, although it was technically an emergency c section, there was no sense of panic... I had written a birth plan for my elective section, and found it reassuring to go through this very briefly before going into the theatre, to see what was still reasonable given the change in circumstances.
I was also a bit worried how it would work since I was having strong regular contractions, but the staff obviously just waited for them to pass before carrying on talking, and once the spinal kicked in I felt nothing.

Sorry for the essay, but hope it helps someone.

Six days on I'm feeling really positive about the experience, and recovering well... At the end of the day I was probably over-anxious, but for anyone going in, just go with the flow, be positive, ask questions, ask for help, take the painkillers, take some music and crap magazines, take the shower (I felt so much better for it) and go at your own pace. Those first hours and days with your baby will be magical no matter where you are.

[picalilian]

And best of luck aussieandrea,you and your baby are in safe hands. If you have an other questions, give me a shout xx