Unnecessary caesarean? Would appreciate thoughts.

[withchipsplease]

DD was born almost 3 months ago by unplanned caesarean and I've become more and more convinced that the C-section was unnecessary, or at least very premature. I?d appreciate any thoughts or hearing about similar experiences.

BTW, I'm a first-time mum and had my baby in a country where practices are more like in the USA than in the UK.

OK, so my waters broke and were very light yellow coloured. We called the midwife who told us to come to the hospital to be checked. Just under 3 hours later she was examining me, telling me I wasn't at all dilated and talking about a caesarean saying she didn't think our doctor would want to wait (they work together regularly). She said there might be some meconium in the fluid, but it was still the same light yellow colour at that stage.

I had wanted a vaginal birth and everything pointed to that being no problem up until that moment. DH called our obstetrician who said no worries, we'll wait and see how things progress. 2 hours later, however, MW checked me again and said I still wasn't dilating and that they were getting the OR ready. We asked about trying to induce first and were told "you don't want to distress the baby. Who knows, it might have the cord wrapped around its neck or something. We're going to do a C-section". Final ultrasound had shown no sign of this and there didn't seem to be signs of distress according to the fetal monitor (standard to be hooked up here).

It was just 6 hours from when my waters broke to when DD was delivered. Can't stop thinking about the whole experience in the last couple of months and feel like the C-section was pushed on me for the doctor's and MW?s convenience. :( Afterwards I was in a lot of pain and very groggy and wasn't thinking about asking the doctor to explain why things had happened that way. I had BF problems in the weeks afterwards and only really started to think a lot about the delivery once those problems began to clear. No 6-week check-up here so no chance to talk about it then either.

Does it sound like the C-section was unnecessary or they could have waited/tried to induce? So happy to have DD here with me! But I feel sad and ignorant about it all and would appreciate any thoughts.
Many thanks.

I'm sorry your birth wasn't the way you wanted it to be. Does the hospital offer a debriefing service, can you see your notes and discuss it with them? Because it's sort of impossible to tell, from your description.

For what it's worth, which is not a lot, my waters broke two days before the onset of labour. In the end, my daughter was eventually born 5 days and 6 hours after they broke. In the current medicalised environment, my hospital was incredibly rare in having a policy that allowed me to choose not to be induced, and to manage the situation without intervention. And it was a great birth.

But every birth is different. It does sound, from your description, as if they followed a blanket policy rather than making an individual decision about your situation. I find it odd that they didn't even try induction, when in my case that was the high intervention option. It is true that induction can stress a baby, but the thing about the cord around its neck is just odd; there's no more likelihood of that in a situation where the waters had broken than in any other situation, and in that case why not just perform caesarians on every patient automatically?

If there is some way of moving forward or finding out more about your birth, I think it's a good idea, if only to make sure you feel more empowered next time. Congratulations on your daughter, by the way!

In the UK, if there are no other problems, it is usual to wait a bit to see if labour starts. The current guidelines advise offering induction if labour has not started within 24 hours of waters breaking.

This changed fairly recently, as when I had DD the guideline was to offer if no labour 96 hrs after.

So it is possible, but by no means guaranteed, that a vaginal birth could have been fine.

I waited and refused induction initially - ended up with a crash section under GA because my baby was in a very difficult position (brow) and became very distressed, but this is very rare.

Can you get a copy of your notes and pay someone to go through them with you, someone independent? I did this and it helped answer a lot of my questions about what was avoidable/what was just bad luck.

Can you talk this through with a therapist? I can't help but feel this is quite an unhealthy set of feelings to be carrying around. Not many people get what they want wrt a birth - but, most people get the healthy, beautiful baby that they planned. Please try and put your focus on your child (congratulations!) - the way your daughter arrived in the world really is such a small concern in the big scheme of things.

Having a c-section is not a negative thing. You will never, ever know what was really going on inside your uterus but I really think you should delight in the fact your daughter is healthy. There is always the "what if?" in these matters and there is at least one mner who if she had her chance again would leap at the c-section rather than "trying to be natural".

i think you really need to talk this through with someone in real life.

what post natal services are available to you?

AlpinePony speaks very wise words. I had an emergency section with my first baby which was not a nice op and my baby went to SCBU while I was shipped off to HDU. I spent a little while wondering if, given different circumstances, I could have had a natural birth. In the end I decided to adopt the attitude 'that which doesn't kill me, makes me stronger.' about the whole thing, and while I don't think I will ever be able to say the CS was no bad thing, I can take pride in is as the way my beautiful daughter came into the world.

Try not to dwell on whether your CS was unnecessary, but instead focus on what it has brought you. Use the experience to make any future births go more the way you would like them to be. Do talk to someone about it. (I spoke with a private MW about mine)

I would agree that getting hold of your notes and getting someone to go through them with you might be helpful. I wonder though, in a culture where CSs are done routinely, if they will tell the full story or will be a bit sparse along the 'failed to progress -> CS' line?

I always felt that hospital procedures had caused me to have forceps - which yes, was necessary by then, but what if they hadn't messed up in the beginning?

I couldn't go back and undo that birth, but what did help was really researching all my options for the next birth, and shopping around for HCPs who were more in sympathy with the sort birth which would have been right for me. Would this help you at all withchips?

You can only talk about unneccessary in retrospective, and that's an really unneccessary

This article is by an American obgyn, but I think it explains the reasoning rather well.

I'd also recommend contacting your PALS and ask for a debrief, where you can discuss all the questions with someone looking at the notes

How will it change things for you if people agree it sounds hasty?

I don't think saying that birth is a small part of the whole experience, and be happy your baby is healthy helps to be honest.

I really struggled to come to terms with DD's birth - and yes, I am bloody grateful that DD is healthy,and no, the birth itself might not be a particularly long event in a lifetime, but it is a significant event, and I spent months unable to get past the fact that the birth wasn't what I wanted, and that I felt my body had failed at the last hurdle (induction and forceps delivery, retained placenta. Couldn't even deliver the placenta without bloody help)

I have struggled with the fact I had a emcs with my 3rd child after having two vaginal deliveries.
It does sound rushed, I had 4 days of induction, followed by them breaking my waters then 12 hours of labour not progressing well and ds2 showing some signs of distress.
Try and have a look at your notes, although don't expect it to answer all your questions.
Some counselling or medication may help, which is the road I've had to go down now

withchipsplease - could you request a copy of the notes, and perhaps pay an independent midwife for a couple of hours of her time to go through them with you?

Might shed some light on what happened to you, which is important for your peace of mind.

From what you describe, there was no clinical indication for a c/s, but you'd need to go through the notes in detail to get the clearer picture of what your doctor's rationale was for doing surgery on you.

Don't think you should go for counselling before doing this. You need some answers.

Thank you all very much for your responses. I?m not aware of a debriefing service and have found no info about PALS or equivalent on the hospital website, but I?ll look into the possibility of getting any notes and having someone else go through them with me, thanks.

Margles, I suspect you may be right about any notes being a bit sparse. The more people I?ve spoken to since the delivery, the more it seems like C-sections are done rather routinely in this country. This will all make me extremely cautious should I ever decide to try for another baby as now I?m pretty sure I?d have to search hard for someone here who is pro-VBAC.

Flisspaps, I?m sorry to hear about your experience and I would have to agree with you. When my DH told me just to be happy our baby is healthy I felt pretty guilty. Of course I am extremely grateful! And of course I wanted our daughter to be delivered in whatever way best ensured her safe arrival if things were looking complicated. In my case I?m just trying to gauge if the situation seems like it could have been avoided so I am better prepared in any possible future pregnancies.

WidowWadman, thanks for that link. I?m afraid he didn?t do much to convince me of his argument, but the comments made for interesting reading since things here do seem to be more similar to the US than UK.

Who knows whether or not the C-section would have been necessary later had they held off and allowed us to see how things progressed. I wish we?d been given the chance to wait a bit longer because, in the absence of that chance and any talk of complications - besides the insensitive hypothesizing by the MW -, I can?t help but think it was performed hastily for the doctor?s convenience. I guess it?s a case of live, learn and don?t take things lying down next time!

SoupDragon, it will reassure me that I?m not being paranoid in wanting to find a new obgyn!