How quicky were you allowed up after c-section?

[Millie1]

I'm 28w and trying to decide on c-section versus VBAC. Last time I'd a section due to breech baby ... this time, I'm only due 2w before Christmas and am worried that if I go 10-14d over, then need an emergency section, that I'll be in hospital over Christmas. Anyway, that's neither here nor there in relation to my question.

With DS, I found recovery really difficult and am already wondering what I might be able to do differently this time that might change things. One thing from last time was that DS was born on a Friday at 11.15am and it was exactly 24 hrs later before I was allowed sit up and get out of bed. I was wheeled (too weak & dizzy to walk)straight to the bath which was so hot that I almost fainted. Long story, not very nice junior nurse made me bend down in deep water to pull plug out telling me that if I fell it wouldn't do me any harm!!!!!!! Okay for her to say!

Anyway, how quickly did anyone else get moving about? Would it help if I was allowed out of bed, even to sit in a chair the night of the section (assuming it was done before lunchtime)? Should I even be sitting up in bed that night? I can't remember how long it took the spinal to wear off but I think it was a good 8 hrs or so and perhaps with it being nighttime that's why staff were reluctant to get me up.

Any advice?

ps. Have read the other thread - some great advice in there but this is just a bit more specific hence the new thread

I've had 2 c-sections. 1st was emergency and was up & about on day 2 but in agony & bent over like an old woman (which I have to say I was like take for about 4wks). I didn@t want 2nd c-sec, but ds2 was breech. After reading mumsnet I bought Arnica, which i feel has really helped. With section 2 (11.10.03)I was up & about on day 2, a little dizzy at 1st, but by 11am I was walking up straight, slight pain but nothing compaired to the 1st. I was home on day 4 as my scar had started to bleed on day 3 when I had planned to go home. They said I had to stay in to rest - that was a laugh!! I was up all that night trying to settle, feed, wind & change the babys nappy( i pushed him round most of the night so as not to wake other people on the ward) - mw's were too busy to help me. I was on the phone to my dh @ 7am in tears from exaustion & was home by 9.30am.

Millie2-had 2 sections! 1st was with ds1 (now 13years) and after about 40 hours labour had emergency c/s. Had to be put under for various reasons (don't want to worry anyone) and came round to find that everyone in the world had bathed/fed MY baby!!! Spent 11 days in hospital, because of low blood sugqar (eat white grapes, it works!) and went home. Ex Dh buggered off after 12 weeks, that's another story, have to admit, couldn't sneeze, laugh or wee without creasing up but had second c/s in 1998 and was much better. Had 4th little one at midnight'ish, dh went home at 2pm and was wheeled up to ward at about 4pm. Didn't sleep because of wailing babies and catheter and at about 7.30 all the lights went on. Moaned and moaned about catheter until midwife pulled it out (and I mean pulled because I was such a stroppy cow!) and settled down waiting for the breakfast bell. I hadn't had a cup of tea/toast since having the baby, 'cos all the midwives were busy and I hadn't got the energy to moan. Next thing I know, there's a new little midwife, all cheery and bright, yelling at me (from the nursing station, which was a LONG LONG way away) that my son was on the phone. This was my oldest one, who was on his way to America wioh my ex DH and was desperate to find out about the baby. This little nurse then put down the phone on the nursing station desk and left!!! I knew my ds1 was at the airport and staggered out of bed, clutching various bits and bobs, mostly mine and waddled over to the desk. Had a tear jerking conversation of about 2 minutes, confirming that ds1 had actually chosen the name we were having for the new baby and hung up the phone. It was like one of those western movies, where there's just tumbleweed and dust blowing across a big landscape. I staggered back to the bed, by which time Mrs Cheery had seen I was up and asked me if I could take a cup of tea to the lady in the next bed, when I went to breakfast, as she'd has a section! Honestly, c/s 2 was much easier. I was driving after 2 weeks which I admit I shoudn't have been, but there's only so many friends you can rely on to cleect various offspring from school etc. GOOD LUCK>>>>>LOL

Thanks everyone for sharing all your experiences. Much for me to think about in terms of everything from start to finish!

After much debate had decided that elective c-section was way to go but scan yesterday showed baby is in frank/transverse breech position so the decision may not be mine to make! So, at the moment it's a section for definite but although my consultant says it's unlikely the baby will turn at this stage, DS went from breech to head down at around 34w and then flipped back to breech at 38w (ouch!).

I'm going to read through all these messages again nearer the time but know for sure that I'll be insisting on at least sitting up in bed much sooner and asking how much spinal I got the last time as it made me numb for hours. Arnica sounds like it's worth a shot too! And that's only the beginning of my plan!

Millie

Millie..a vbac..is the BEST way to go!..safer for you and the baby! I have done both..believe me..most times..nature knows best!

VBAC is NOT safer if the baby is breech. Quite the reverse.

I disagree...And research backs me on this...it is not my opinion...but the opinion of much more learned people than I..

The Toronto Term study is the biggest ever international study of vaginal v c-section births for breech babies. the death rate for the babies was dramatically reduced when the mothers had c-sections, and the risk of complications for the mothers was the same. It is THE study on the issue and the results were extremely clear. The best outcomes for babies by far were with c-section IF the baby was breech. More breech babies die in vaginal births than they do in c-section births.
In general, vaginal births are safer for the mother than c-sections (though IMO not enough allowance is made for the fact that only around 5% of sections have no other medical complication involved, so naturally they tend to have more complex outcomes) but not in the case of breech babies.

As I'm no good at links, here are the result of the Toronto study. BTW, the women were followed up three months later in another study and those who had sections were less likely to be incontinent, and fared as well on all other indicators including breastfeeding.

Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Term Breech Trial Collaborative Group.

Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR.

Department of Obstetrics and Gynaecology, Sunnybrook and Women's College Health Sciences Centre, Toronto, Ontario, Canada. [email protected]

BACKGROUND: For 3-4% of pregnancies, the fetus will be in the breech presentation at term. For most of these women, the approach to delivery is controversial. We did a randomised trial to compare a policy of planned caesarean section with a policy of planned vaginal birth for selected breech-presentation pregnancies. METHODS: At 121 centres in 26 countries, 2088 women with a singleton fetus in a frank or complete breech presentation were randomly assigned planned caesarean section or planned vaginal birth. Women having a vaginal breech delivery had an experienced clinician at the birth. Mothers and infants were followed-up to 6 weeks post partum. The primary outcomes were perinatal mortality, neonatal mortality, or serious neonatal morbidity; and maternal mortality or serious maternal morbidity. Analysis was by intention to treat. FINDINGS: Data were received for 2083 women. Of the 1041 women assigned planned caesarean section, 941 (90.4%) were delivered by caesarean section. Of the 1042 women assigned planned vaginal birth, 591 (56.7%) delivered vaginally. Perinatal mortality, neonatal mortality, or serious neonatal morbidity was significantly lower for the planned caesarean section group than for the planned vaginal birth group (17 of 1039 [1.6%] vs 52 of 1039 [5.0%]; relative risk 0.33 [95% CI 0.19-0.56]; p

Thanks for the additional info ladies. Only point I would make that if baby stays in transverse breech then keeping in mind that it's lying across the way, nothing will be presenting so there is no way (IMHO or that I know of) that I could or would even attempt VBAC.

Millie - you are right.
I think a breech vaginal birth has to be handled by an experienced midwife... unbfortunately with studies like the one quoted by Aloha- less and less women are attempting it (as they are advised against it) and less and less MW are experienced enough.
So it's a chicken and egg....
I'd have a homebirth with a breech personally bu that's me
IMO - for ME - a vaginal birth beets a section any day...

People should make (properly) informed decisions and get the right support after they have made that decison.

Pupuce, but in the Toronto study all the breech vaginal births were handled by 'experienced clinicians' - that was a really important part of the trial. I think surely it would be wrong to tell women it is safer to have a vaginal birth for breech if the world's largest study says it isn't? Of course, if women have all the information but still think the small risk is acceptable, then that is up to them, but I do think that accurate information is good. I mean, I do understand that statistically a c-section has slightly higher risks of mortality for the mother than a vaginal birth, but I would personally be very happy with that as it is still vanishingly small and largely connected to the use of general anaesthesia. How you use information is up to you, but I really don't think you can knock this study.

Aloha - here is a very recent review from Cochrane.
I think there are several issues at play... and one of the key ones is whether this is a first labour or not! It makes a difference in terms of outcome. A subsequent labour is easier and more efficient and the risks are MUCH lower.
Also there is often an underlying cause to a breech (as this review eludes to) which can explain why some babies are seriously damaged or die during birth (and in some cases they would have died by section too).

• Do you have a year for the Toronto study by any chance... must not be old as it is the same team who just published the benefits of doulas in childbirth !

Planned caesarean section for term breech delivery (Cochrane Review)

Hofmeyr GJ, Hannah ME

ABSTRACT

A substantive amendment to this systematic review was last made on 22 January 2003. Cochrane reviews are regularly checked and updated if necessary.

Background: Routine use of caesarean section for breech presentation is widespread. However, poor outcomes after breech birth might be the result of underlying conditions causing breech presentation rather than damage during delivery.

Objectives: To assess the effects of planned caesarean section for singleton breech presentation at term on measures of pregnancy outcome.

Search strategy: We searched the Cochrane Pregnancy and Childbirth Group trials register (November 2002) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003).

Selection criteria: Randomised trials comparing planned caesarean section for singleton breech presentation at term with planned vaginal birth.

Data collection and analysis: We assessed trial eligibility and quality.

Main results: Three trials (2396 participants) were included in the review.Caesarean delivery occurred in 550/1227 (45%) of those women allocated to a vaginal delivery protocol. Perinatal or neonatal death (excluding fatal anomalies) or serious neonatal morbidity was reduced (relative risk (RR) 0.33 , 95% confidence interval (CI) 0.19 to 0.56) with planned caesarean section. The reduction in risk of perinatal or neonatal death or serious neonatal morbidity was less for countries with high national perinatal mortality rates. Perinatal or neonatal death (excluding fatal anomalies) was also reduced (RR 0.29, 95% CI 0.10 to 0.86) with planned caesarean section. The proportional reductions were similar for countries with low and high national perinatal mortality rates. Planned caesarean section was associated with modestly increased short-term maternal morbidity (RR 1.29, 95% CI 1.03 to 1.61). At 3 months after delivery, women allocated to the planned caesarean section group reported less urinary incontinence (RR 0.62, 95% CI 0.41 to 0.93); more abdominal pain (RR 1.89, 95% CI 1.29 to 2. 79); and less perineal pain (RR 0.32, 95% CI 0.18 to 0.58).

Reviewers' conclusions: Planned caesarean section compared with planned vaginal birth reduced perinatal or neonatal death or serious neonatal morbidity for the singleton breech baby at term, at the expense of somewhat increased maternal morbidity. Information on long-term consequences of caesarean section, such as reproductive function and emotional adjustment, is limited. The option of external cephalic version is dealt with in separate reviews. The data from this review cannot be generalised to settings where women labour and birth at home, or where caesarean section is not readily available, or to methods of breech delivery that differ materially from the clinical delivery protocols used in the trials reviewed. The review will help to inform individualised decision-making regarding breech delivery.

Citation: Hofmeyr GJ, Hannah ME. Planned caesarean section for term breech delivery (Cochrane Review). In: The Cochrane Library, Issue 3, 2003. Oxford: Update Software.

Millie 1, I had a c-section with dd (failure to progress) and no2 is breach at the moment so another looks like it is on the cards. My MW said that even if I have a natural birth, they won't let me go beyond my due date so as not to put any additional strain on the scar from last time

The Totonto trial has been discredited world-wide. There is a difference between babies delivering spontaneouly and those being 'extracted' by doctors. Doctors perform breech extractions where the baby is manually delivered by the breech and that is when problems occur.
Those people who are skilled in helping women deliver breeches vaginally (Michel Odent, Mary Cronk, a midwife) all agree that if labour is progressing well then the breech should deliver well. If however, the labour is not progressing on it's own, a C/S should be performed.
The Toronto trial had women with breeches on syntocinon (a drug to stimulate contraction) and inexperienced doctors attempting breech deliveries. The other thing is that doctors make women lie in the lithotomy position (lying on their backs with legs in stirrups) to deliver the breech. Those midwives skilled in breech birth tend to assist a woman who is standing.
What is needed is a study showing the outcomes of spontaneous breech labours.

There are quite a few independent MW who will do breech at home.

I think most people who go for an IND. MW have "special" needs/desires/requests. That is alos why the MW become very good at dealing woth special cases.

Hi Allatsea ... my consultant pretty much agrees with your midwife in that whilst he will let me go past due date he won't induce so it has to be spontaneous labour and then nothing to help speed things up along the way ... 2 hrly checks and if things aren't exactly on target at each check then it's straight to theatre.

How many weeks are you now? Wonder whether these little ones will stay breech? I keep thinking mine has moved and then feel what can only be a head digging into my ribs - so maybe it has rotated round a bit but certainly not head down.

Millie

Your baby can easily turn until at least 37 weeks.
There are many things you can do to try to get the baby to turn...
Chiropractors, homeopaths, accupuncturists all have sime degree of success.
Millie - is he willing to let you labour for a breech after an elective section ? I am impressed !

Pupuce ... I wouldn't even consider asking to try labour if the baby was breech!! (DS was breech and 'elective' so I didn't try labour with him). I don't think he's a great believer in trying to turn the baby as we didn't even attempt it with DS - although I know people who have had success in turning them. This time, I wouldn't be keen to try.

BTW, DS was consistently breech (at 4 wkly scans anyway) from 22w to 34w, then turned, then at 38w flipped back to breech - was convinced I was in labour that night cos it was so uncomfortable when he turned - it was only a few days later when I had a scan that I realised what all the discomfort had been!! So yep, I wouldn't be surprised if this one turns again - we've still got 8w and some room in there for somersaults!! That aside, for reasons mentioned further down thread, I think I'd probably opt for section even if this one does turn.

Millie