Planning an elective caesaerian - experience please

[jamiesam]

Hi. I'm not sure I'm going to put this very well but here goes

I'm only recently pg with no. 3. Had emergency c/s with no 1 and vbac with no 2 but 3rd degree tear. Consultant has strongly advised that I have c/s with no 3 to avoid risk of a similar or worse tear.

I believe it's normal practice to be booked in for c/s in these circumstances around 38 weeks. Has anyone experience of getting agreement to wait until they go into labour before going to hospital for c/s? Just mulling over that I want this baby to be properly cooked and no 1 and 2 were overdue by 9 and 7 days respectively.

Over to you???

I think that if you go into labour naturally, you rui the risk of an emergency c section. Which is allegedly much worse and worrying.
I'm not up on c sections but I read all the blog.
I think this is why? they use 38 weeks
Wait for Aloha or some such spectacularly knowlegeable lass to set me straight and give you proper info

I had an elective section with my 2nd pregnancy. I got to 39.3 with my 1st pregnancy and after a longish labour, I was taken for an emergency section. I didn't want the same thing for my 2nd pregnancy so I asked for a section which wasn't agreed until 36 weeks. They wanted to do it as close to 40 weeks as possible but it was in my notes that if I went into labour before that date, I would still have a section only it would be counted as an emergency.

I don't see anything wrong with waiting to go into labour naturally but one thing you may find is you won't necassarily get the section. They might have other emergencies going on and there isn't time or space for you.

I accidentally had a cs in labour with dd after having a cs for placenta praevia for ds at 37 and a bit weeks (you have to have it a bit early as the risks of going into labour are so great).
In THEORY I think it is a fantastic idea. I really do. And dd, was I think, more thoroughly cooked than ds. HOWEVER, I had a very traumatic and upsetting time because (with hindsight) I can see I was having a back labour with a spectacularly ill-positioned dd, so when I went in and said I had waves of severe back pain that were coming and going in a regular pattern, they kept me in overnight, but insisted that as I had no belly contractions and was only 2cm dilated I couldn't possibly be in labour. I kept trying to tell them that I was having a caesarian but it was a terrifying, nightmarish scenario in which I seemed to become invisible and inaudible. Nobody listened, nobody cared. I was given two paracetamol, put on an ante-natal ward and left entirely alone, in severe pain, bleeding, all night (they send my dh home as he was not allowed on the ante-natal ward). DD is 10 months and I feel myself on the verge of tears again as I type this.
It was the worst experience of my life.
A section in early labour is not particularly more difficult or dangerous (I grilled consultants on this) and it may have health advantages for the baby, but unless you go into labour in the early morning - ie 7am - it is a risky strategy imo as you do NOT want to be in the hands of the night staff who are scary and unpleasant people IME. And they almost certainly won't give you a section until the daytime lot appear. I had my dd at 11am the following day and it wasn't until my dh arrived at 8am that anyone took any notice of me at all.
Sorry to be so gloomy, but I feel that you should be warned. If you feel very confident that your babies are naturally late, then book one for 39 or even 40 weeks, and if you don't progress fast and can wait even in labour until morning, that also might be an option for you.

I was 39 weeks and 2 with dd.

Aloha I never knew that had happened this time around for you I am so sorry that you went through that

i had an elective c/s with my ds at 37 weeks because he was big. With dd i had a v long labour which culminated in an em c/s. My consultant insisted upon me having an elective at 37 to prevent the risk of me going into labour. Elective is soo much better than emergency imo. My emergency left me feeling a failure and not in control. Like Aloha i too couldnt speak about the whole crap management for a long time although a formal complaint to the hospital following by a meeting an a formal letter of apology from the hosp apologising on 5 different counts did help

I still don't know how you can just IGNORE someone who is sobbing and falling on the floor (literally) with pain in front of you. I would have had more kindness from strangers in the street.
I remember vividly going into the loo and seeing yet more blood and then looking at my face in the mirror to see if I was actually visible. It was a hallucinatory kind of feeling. I also remember in the very brief periods before the pain started again, trying to rehearse something that would MAKE them help me 'please, please help me. I am bleeding and I can't stand this pain and I think something is wrong'.
Look I'm sorry jamiesam, but I had no idea things like this happened after my lovely easy, calm section with ds. I think if you do want to wait until labour just be careful. Talk to your consultant. Ask what would happen if you were in at 3am. This was my first (and LAST!) experience of labour btw.

And whatever happens, do NOT let them send your dp/h away. Say if he goes, I go. I wish I had

agree! keep your dh within sight at all times!

Me too, aloha. Totally agree that night staff in maternity wards can be royal tossers.
Can you ask the consultant, jamiesam?

in fact if you're in BUPA get them to cover it if you can. Although the midwives were vile to me the consultant and anaesthetist and general theatre team were great. And I had my own room obv

Sorry- the me too was echoing eppifany's sympathy a few posts back, btw. Lots of posts in between.

Yes, if you have health insurance it might cover this.
And good luck. How lovely to have three.

Jamiesam, I think you'll find that the current guidelines say 39 weeks. I had DD by emergency caesarean at 42 weeks +2, and Ds was born by elective caesarean in May. They wanted very much to wait until 39 weeks and I begged and pleaded to persuade them to do it at 38 1/2 weeks. I live quite far from the hospital and did not want to risk going into labour before I arrived at the hospital for my lovely peaceful planned section. You can probably have a caesarean based on a previous one, but I would be surprised if Bupa will cover it for a previous tear... just doesn't sound like the BUPA I know.

I definitely agree that consultants are the people you want to talk to. And don't be surprised if the midwives try to persuade you to go for VBAC.

Good luck. What hospital are you going to? Some are more willing to perform caesareans than other?

I had emergency with ds and induction failed completely (4 doses & no movement) so my consultant advised that I could try VBAC but said he wouldn't allow me to go overdue.

having said that, he said that planned sections are usally at 39 wks + these days because they want to leave baby as long as poss.

In the end, because I wanted to try VBAC, I negotiated going to 41 weeks and ended up having an elective at exactly Term + 7 days when dd showed no sign whatsoever of making an appearance of her own accord.

So, I guess it depends on your consultant but you should be able to influence the decision.
Incidentally, I founf the elective section very different from the emergency. Much calmer atmosphere and despite me being much more aware of what was going on, still more relaxed and 'happy'!

Good luck

Wow, thanks for all the advice chaps. Dh dragged me to bed shortly after I started this last night (have been unreasonably tired with this pg).

I guess that since I had an em c/s with ds1 it doesn't hold any great fears for me to have another. Although I was scared during c/s, it was because ds was in distress, and because he was stuck (ie had to call in stronger dr to get him out!!)And yet I've read enough on MN to know that c/s don't always go so well. Since this section is not required for any reasons relating to the baby, I'm interested in the medical reasons for booking it 'early'.

I'm really sorry about what happened to you Aloha. As is happens, my worst MW was the one who looked after me (hollow laugh) from 2pm - c/s. (My favourite comment from her was 'it will hurt dear, you're in labour'. Hate her SOOO much I swore I would walk out of labour suite if she walked in when I was in for ds2) My best MW was the one who was with my for the first 7 hrs of my vbac. Also, my em c/s was at 9 o'clock at night - although medics prob. thought I was heading that way from about 7pm. At least I can ask my consultant what would happen if I rang in the middle of the night for my c/s.

As it happens, I am seething about having to have a c/s at all. My hospital is Hallamshire in Sheffield (often called Jessops), and consultants and MWs were very supportive of my request for vbac last time. This time around, I feel that consultants have take unreasonably cautious approach to Royal College of Obs and Gynaes advice that 'the option of elective caesearean section should be discussed' in circumstances like mine where after tear I had some anal incontinence (sorry, tmi ). They are interpreting this advice as 'though shalt have a c/s or on your own head be it'. There is a known risk (studied to be between 17-24%) that I will develop worse symptoms if I have another vaginal delivery. Interestingly, studies have also been done to establish if giving a prophylactic episiotomy would prevent a worse tear (results inconclusive). But no studies have been done to investigate what role the MW could have in reducing the risk of tear - eg labouring position, perineal massage, water birth.... (IE studies done by surgeons, not by MWs whose (in my mind, sorry if I put this badly) job it is to stop you going down the route of medical intervention...

God, I do go on don't I. Thanks to anyone who's made it this far. Last question - is it harder to establish breast feeding after planned c/s? I'm wondering about the labour hormones not kicking in?

Re. b/f - can only speak for myself but had no problems whatsoever. B/fed in recovery room straight after op. & continued all flippin night! (Both babies - both sections)

Thanks Witchycat and Lol! Ds1 was like that (then slept all day and missed all his visitors!!!)

I breastfed both my caesarian babies - ds for over a year, dd 10months and going strong. Fed in recovery.

I have to say, the results of having another, even more severe tear would send me rushing to the operating theatre, but we are all different. It's quite a risk though.

My cs second time around went very well indeed. It was just the midwife 'care' that was so traumatising.
If I were to have another baby (which would be a miracle and a mistake!) I would think about a more holistic one though - no screen, dimmer lights, slower birth, delivered directly onto my chest. I tried to get this last time but nobody seemed to know what I was talking about and by the time I actually came to get my caesarian, I was too distressed to discuss any of it.

Thanks to you too Aloha, I don't know where I got the idea from, but it's reassuring to know that bf can be straightforward after planned cs.

Yes, I know that I'd be taking a risk, I just wish they'd 'let' me take it. Dh made me promise that if I had another baby, I would agree to a c/s on drs advice.

I read a great article in Guardian last week/end about 'natural caesearian' - pretty much as you describe. Shall definitely discuss with my consultant (ha ha - I'm going to make their life hell! I can just imagine the conversation after I've left. 'First she wants to risk another tear, now have you heard what she wants.....'

I would have loved one jamiesam, and it might be a compromise that makes it work for you.

jamiesam, I had a third degree tear with ds and so was advised to have an elective section with DD. My hospital would not book and elective earlier than the 39th week of pregnancy due to the small risk that the baby's lungs would not have matured fully. I was left with the only vacancy being at 39 weeks and 5 days (the times at which my ds arrived naturally!) I had a nerve-racking weekend hoping that my DD would hold on- thankfully she did! The hospital were not at all concerned about the prospect of performing an emergancy section had I gone into labour!

Chipkid - that is pretty much exactly what I wanted to hear! Thanks a lot. (Hope your tear healed well.)

..also jamiesam I found the whole experience totally wonderful! everybody was so nice and relaxed-they delivered DD straight onto my upper chest where she remained whilst they repaired me. It was just fantastic-very emotional not at all cold and clinical as I had expected

Stop it, I'm going to get all emotional now!! That really does sound too perfect! Presume dh didn't get concussion from fainting at sight of all your innards