Birth Plan for ELCS - would you mind taking a look?

[OompaLumpa]

My midwife suggested I write a birth plan for my ELCS due next week. I'm incredibly nervous about it and she thought it might make me feel a bit more in control. Would you mind having a read and letting me know your thoughts? Thanks


Birth Partner

My husband, James. Please defer to him if I'm unable to communicate my wishes for any reason.

Medical Conditions/Relevant History

Severe Brittle Asthmatic
Anaemia
Sacroilliac joint inflammation/pain
Allergic to micropore
Previous serious sexual assault

Labour

Due to my history I would prefer to have a midwife I am familiar with already and female only nursing/medical staff. I would like all medical interventions and procedures explained to me before being attempted and my consent to be sought. Vaginal Examinations to be kept to a minimum and to be carried out in a private setting.
Catheter insertion to be carried out in private We would like to discuss stiching options with the Doctor prior to the operation.

Pain Relief

Open to all pain relief but please note I am sometimes sick if I take tablets on an empty stomach especially if uncoated tablets. We would like my husband to be able to stay whilst the anaesthetic is administered.

Delivery

We would like to play our own music choice during delivery. At the moment of birth, we would ask for a quiet environment, dimmed lights with no unnecessary noises.

We would like the sheets lowered so that we can view the baby being born and for my husband to cut the cord after it has stopped pulsating. I do not want my arms strapped down or restricted during surgery.

If I have to have a GA, we would like my husband still to be present to witness the birth.

We would like my husband to discover the gender of the baby and share the news with me.

We would like my baby to be delivered straight onto my tummy for immediate skin-to-skin contact for at least half an hour after the birth whilst the operation continues. We would appreciate all support in attempting to breastfeed. If for any reason I am unable for my own health reasons to have skin-to-skin contact we would like my husband to be given this opportunity.

We are happy for a vitamin K injection to be administered.

We would like James to be able to take photos and/or use video camera for the birth.

In the event of baby having to go to SCBU, we would like my husband to go with the baby.

[shreddinghippo]

Oh congratulations Oompa not long now until you get to meet your little one! Its an exciting time for you, and I understand you being nervous (even more-so with your personal history )
I had ELCS with my first, and it was the most pleasant experience.

The only things I note from your plan are the following

Vaginal Exam - shouldnt need one at all with ELCS. I never had one.
My DH was with me throughout the op, but he had to remain seated (they didnt want to have to deal with a passed out chap while trying to deliver my baby!) and he was not allowed to cut the cord. I think this is all to do with it needing to be sterile as its a major operation after all. I could be wrong, it may have just been the policy in my hospital, so check what your MW says.
Also, I think with GA, in the rare event that you would need it, your DH would be asked to leave. Again, could be wrong on this.

Everything else sounds fine, and I wish you all the best for the safe and happy delivery of your baby.

[whitechocolatebuttons]

Good luck with that! Please be aware that the best laid plans can sometimes go awry and don't let it spoil your birth experience if anything on your plan happens differently to your expectations. An ELCS is still childbirth and can be unpredictable.

I had ELCS and the registrar performing the procedure still had to use forceps, despite this being one of the stipulated reasons I was having a c-section (last VB resulted in forceps and ventouse damage). Still, we came through it both fine and I know it was for the best.

We had a CD of our own specially chosen music on, they even provided the stereo! All the staff were very respectful and calm and methodical and showed a quiet confidence and it made our experience enjoyable.

Also, they may not lower the sheet for you to see your baby being born. Different hospitals have different rules though.

You won't need to be examined vaginally until your 8 week post-natal check and this should be done by your GP.

Hope everything goes well!

[OompaLumpa]

Hi Shreddinghippo (love your name btw) thanks for your response - good point about the VE, i will take this out. I hadn't thought about the sterile bit, I am seeing my midwife tomorrow so I will ask her about this (and the GA).

I am glad to hear that you had a good ELCS experience. I am hoping the excitement will kick in soon because as much as I already love my baby, things are really overshadowed for me by the fear of the op and being "exposed" and vulnerable. I'm ashamed to say that and I hope that I can just keep it together and make it a positive experience.

Thanks again x

[OompaLumpa]

oh gosh WCB how come they still had to use forceps? I hadn't even considered that? Do you mind me asking what music you had for your delivery? I'm trying to put a playlist together but I'm a bit braindead lacking in inspiration at the moment.

I'm trying to go for positive stuff but not too techno! so far, I have

• Elbow, one day like this
  
• the Beatles, here comes the sun
  
• Five for Fighting, if God made you
  
• Adele, crazy for you
  
• Lou Reed, perfect day.... all DJ hints appreciated!
  

I do appreciate your point about things might still not go according to plan. i'm trying not to think about that to be honest. I'm very lucky in that my community midwife has permission to stay with me throughout so i will definitely have someone I know with me who can talk me through things, and obviously DH. Plus the consultant who i have met a few times is going to do the delivery. I've been told I will probably have to go to high dependency for a bit afterwards (asthma issues) but they are hopeful I will be well enough for my LO to stay with me.

[Finallygotaroundtoit]

Hope all goes well and you have a restful night tonight.

Mention the preference for female staff asap to give the staff a heads up i'm sure they will try to accomodate you- but if it's not possible all the male staff will be sensitive and aware

your dh will be asked to leave in the rare event you need a ga but they will bring baby to him for a cuddle asap

[shreddinghippo]

How come you are having ELCS Oompa?
Mine was because DD1 was breech.

I didnt have to have a single VE with my first whitechoc, and I actually only had them while in labour with 2nd. Never had a postnatal examination, even with GP at 6 week check.
Wasnt even mentioned??

The most invasive part of CS I found was the catheter. But luckily for me (and I'm sure the same will be for you) I had a lovely MW who did it and I couldnt feel a thing, only took a moment. They had already administered spinal block so I wasnt really aware of it. (Just the knowing they are doing it is the worst bit IYKWIM)

Regarding music- I would go for any music that you find relaxing. Of course it's entirely up to you and whatever is your taste, but I think if you are feeling anxious/nervous/wound up/stressed the best thing is relaxing music. Not too upbeat, as would 'feel' wrong.
I enjoyed things like Dido and Kinobe and similar.

[OompaLumpa]

Hi, I am having the ELCS because of my asthma which can be quite bad at times. I've had a couple of admissions during the pregnancy and a couple of chest infections and my lungs are just finding it all a bit hard work along with the usual pregnancy breathlessness plus i have been very anaemic so have just had 2 iron infusions for that. Basically they don't think i have the strength to do it myself. I have been quite upset about that but i know that they are probably right. my lung capacity is less than 50% of what it usually is and just getting round the house is becoming hard so if I was to have a long labour I am not sure how I would do it! plus they don't want me to get to the stage of needing an EMCS and a general anaesthetic, for the same lung reasons so the theory being that the ELCS will be much more controlled and my breathing should be less affected.
I'm on a bit of an emotional rollercoaster with it all, feeling like a bit of a failure for not even trying a natural birth and also really quite scared about the op and how it might make me feel (selfish i know but i'm worried about my past giving me flashbacks etc) and I really want this to be a positive experience but even yesterday when i had my pre-op meeting when they started talking to me about the day i started really shaking and crying.
My midwife has been fab though and I'm meeting with her tomorrow at the hospital and she is going to show me the theatre etc so that should be a help to keep me calm and stop me making a fool of myself!
Thanks for the warning about the catheter, the midwife has said she will make sure there is noone else in theatre and will be after spinal so hopefully it will all be done quickly. It's funny but i am more concerned about when they put the cleaning stuff on my belly and just lying there exposed before they put the sheets on me.
Lockets i am glad to hear you found your ELCS a calm experience, i hope to have that too. I hope you are feeling ok after your PPH, that must have been scary. They have promised me that the only time they will take my baby away from me is if I need to go to intensive care, as that is out of maternity so hopefully that won't be an issue at all and we can have some bonding time.
Did you ladies find bf ok (assuming you did that) after a CS? i'm not great at ringing the bell for help - always feel like i'm bothering them so just thinking about how i'm going to get the baby out of the cot and get the BF sorted.
One of the (only) benefits of insomnia is that I am reading lots of books and info about things like BF, so even if I can't do it myself, i can at least bore the baby to sleep with useless facts LOL...

[shreddinghippo]

Oh bless you Oompa. I could yack on about this for hours and hours (but I wont- I need my sleep with a 12 week old keeping me up half the night!).
I have had two babies. First by ELCS, second vaginally.
I would have to say that of the two, the CS was less exposing than normal delivery. In regards to your belly being exposed, it is barely more than when you have an antenatal check and the MW has a good feel of your tum. Honestly.
Going the natural way was so much more undignified!! Bum on display, needed stirrups so legs akimbo, screaming and swearing, (possible pooing), waters gushing, the lot.
I know when I was booked in for CS I too felt I was 'failing' in some way, but even though I felt that way, I also knew it was daft, and it is so much more important that I was safe and my baby was safe during delivery.
Oh bloody hell pregnancy and childbirth is an emotional roller coaster and a half isnt it!
The actual operation is very calm and especially if you have your OH there to hold your hand, you will get through it.
Give him the low-down, to keep talking to you all through the delivery, keep looking at him, it will help keep you calm.
It is no more than 1 hour all in, start to finish and then look at what you will get out of it. Your first cuddle!

I managed to successfully BF my CS baby, I fed in the recovery room, so maybe half an hour after birth. Fed her for nearly 5 months. Tricky start but we persevered and got through (just go to the BF threads for masses of help and support)
During my stay in hospital I too felt like a nuisance if I rang the bell for MW to pass me baby, but for goodness sake do it! They would rather come to you 50 times during the night, than you risk picking baby up on your own and doing damage to one or other of you.
Anyway, you dont have to put baby back in crib immediately, whats wrong with having a couple of hours of cuddling after a feed?

They will also get you up on your feet the following morning, so from then on, all being well, you will be able to see to baby on your own.

I am so excited for you oompa, please please please come back and tell us how it all went.

Keep hold of that hand!!

[NurseSunshine]

Be aware that, as others have mentioned, you are having a major operation, dimmed lights won't be possible, and neither will having the sheets lowered or having your husband cut the cord as to have anyone who wasn't scrubbed up near your open wound would be a HUGE infection risk!

Other than that I think it all sounds reasonable and I really hope you have a stress free delivery :) Best of luck

[melrose]

You can have the sheets lowered if you ask (I was talking to someone the other day who had this done). It is also perfectly reasonable to ask for quiet and no uneccessary chat so that the first person the baby hears is you or James.

Emphasise the skin to skin bit, and perhaps add that you do not want the baby to be cleaned or weighed before being given to you (there is no reason weighing cannot wait an hour)

LOts of luck

[OompaLumpa]

Thanks ladies. I am seeing my midwife later so will check the policy at my hospital for lowering the screens and see what she says. Midwife did tell me baby would be taken away quickly for clean and check and then handed straight back to me but I will talk to her and see if that is necessary.
Thanks again for all the good luck wishes!

[whitechocolatebuttons]

Oompa - I didn't know about the forceps til after. Apparently he was more engaged into my pelvis than was thought (he must have shifted quickly!) and needed a hand to be got out. I'm glad I didn't know the full details at the time as it would have really freaked me out. I hope I wasn't coming across as negative, I just wanted to point out that you will help yourself by being open to possibilities you might not have considered yet, of course everything will most likely go swimmingly!

My DP and I were up at the other end, very calmly listening to our cd. One of the lovliest pieces of music we had and the one that will stay with me as the soundtrack of our sons birth was 'Lark Ascending'. We also had some Elbow and Wake Up by Arcade Fire (DS2's choice!). Your music choice sounds gorgeous!

I hope you are able to go into your ELCS calmly and positively and with as little worry as you are able as I really believe that this will have a direct outcome on your birth experience and provide happy joyful memories for ever! - Good luck!

[happywheezer]

I had my 2nd ELCS 4 weeks ago, there's no need to put anything in you BP about GA or vaginal delivery, I haven't experienced either.

The cathether you prob would know about I could see what the MW was doing and couldn't feel it either because they do it after the spinal, which I didn't feel either.
It took three goes to put in my drip though which left horrible bruising.

Have consideration for who will change your pads after the baby is born, perhaps ask the same mw to do it. They do read your bp so they should take note of anything you say.

They did offer to lower the curtain but I refused!
My hospital would have given the baby to me straightaway but I wanted him cleaned too.

I was given anti sickness injection in my drip after 2nd section as I drunk water too quickly after having baby and was sick, but this didn't happen first time around.

Make sure they give you good pain killers after the birth on the ward, my hospiatl were money saving bastards, and only gave paracetamol and voltrol. You will need morphine! It's great and will help you recover quicker.

[whitechocolatebuttons]

Just read your bit about bfing. Its such an amazing thing to do, its hard and you will need help from your midwife who will be able to get you started. She will most likely want to give you a literal hand to get your baby latched on and this can seem somewhat indelicate (I never realised how much you have to smoosh a newborn into the breast!) so its best to think of the ace nutritional start you're giving your baby over anything else.

You will be given a hand held buzzer to summon a nurse or midwife and honestly they would much rather you do that than try to reach baby yourself. This will only be for the 1st day anyway, after that you'll be encouraged to get up and about. Ooh I'm excited for you, a newborn baby is the best thing in the world.

[coccyx]

Have had 4 sections.
The suture choice/closure is often down to surgeons preference.
Doubt hubby will be allowed within sterile field to cut cord.
All our babies were quickly checked over and then given to me or hubby to cuddle. Had skin to skin in recovery room which was fab.
There were several male staff in room but they were very kind and professional. Had a male anaesthetist who was brilliant and a young male operating dept assistant. I vomited over the instuments and he made me laugh about it.
We were told hubby would not be allowed in if ended up with a GA, would be an emergency and needed to concentrate on mum and baby, not a worried partner.
I was asked if ok if they administered a voltarol suppository. To be honest i was so overwhelmed looking at baby that it was done before i knew it.
Had no issues with BF.
Do use callbell and ask for help, I remember struggling to pull baby crib towards me and getting baby out for a feed. told off by midwife.
TRy to see it as a positive experience. You haven't failed , you are making sure the baby you have nutured for 9 months is safely brought into world.

[diyqueen]

Congratulations and all the best. I haven't much to add to the above, just some sympathy as I can well remember the sheer terror I felt before my ELCS - I didn't sleep for 3 nights before. I read everything I could lay my hands on, NICE guidelines on the procedure, everything, but strangely didn't make a birth plan as I think I was kind of in denial and hoped the baby would still turn (was breech). I was shaking and in tears when we got to the ward, and waiting to go to theatre was awful, but in the end the cs was so much better than I expected - the staff were really kind and respectful, and made the experience as pleasant as it could be. If it helps you to feel in control to have a birth plan, go with it, but please don't be too disappointed if you don't get everything you want - and you may find on the day that it doesn't matter too much to you, once you have your new baby in your arms. I would make sure that the staff on the ward afterwards are aware of your history, this is where it'll really make a difference I think as the staff can be quite busy.

[kiwijesta]

Hi there,
I too had an ELCS and honestly it was great. My main though about your plan was the female only aspect. My surgeon and anaesthetist were both male, they were great and it was whoever is rostered to work that day. Afterwards my community MW said I was lucky to get Mr X as he is considered the best. The op itself was the most surreal thing I've ever done and I was quite concerned about being naked, catheters etc but everyone is so professional it didn't matter.
After DD was out the checks took 1min and DH went with her and then they brought her too me and laid her on my chest (it's the only bit of space) but I was a bit shakey so after a couple of mins DH held her beside me. We also had a camera and a screen so I could have watched the whole thing (I didn't, tmi for me) but DH stood up to watch her come out. The screen was my gown and it would have been impossible to lower it anyway. I also had no VE's, not even at my six week check.

TBH put it all in, and if they say no, ask them to explain why, there will prob be a good reason.

Good luck, and like the others said, use your bell to ask for help, take the drugs and don't hesitate to ask for BF support if you need it, these all make the world of difference!

[beamel]

Hi Oompa,
I had an ELCS and it was a lovely experience. Just a few points which may help:

No vaginal exam neccessary for ELCS. I also didn't have one at my post-natal check, you don't need one if you have had a C section.
Don't think they will allow DH to cut the cord initially, as this is done with the baby still within the sterile field. They may offer him the opportunity to trim the cord once the baby is on the resuscitaire (where they take them to check over, dry off etc.)

I also sure he won't be allowed to stay if you have a GA, although thats unlikely with your asthma - they will avoid that option.

Don't expect no one else in the room when the catheter goes in. I would be very surprised if the anaesthetist will leave the room after administering your spinal block. They need to be there to monitor you for your own safety. However they will be positioned at your top end so away from where the catheter is happening.

If you want to do skin to skin ask them to take one arm out of your gown before they start the anaesthetic, this makes it so much easier. My baby just needed a quick rub down then I able to have her for skin to skin whilst they finished the op. It was a bit tricky as there wasn't much room as she did slip it little bit but the anaesthetist helped reposition her. DH held her whilst they took me off the table then she was straight back on me in recovery where she stayed for the next three hours.

Finally, look at the positive side of being stuck in hospital. The midwives are there to help you and that includes passing your baby to you and helping you BF. Don't be afraid to ask, its their job. The hospital I was in had cots which bolted onto the side of the bed so worth asking if they have those.

I was able to eat pretty much straight after the op, so by the time the spinal started to wear off I had eaten so taking painkillers wasn't a problem.

I hope this helps and you have a lovely experience too.