ELCS at Chelsea & Westminster... the process

[katiegolightly]

I' ve been back and forth to the midwives & obs and it's still not very clear what happens and feel like I'm holding them up when I try to ask. I'll hold in my rant (despite being very frustrated and stressed about the lack of joined up thinking and AWFUL miscommunication between teams... breathe) in an effort to figure out exactly what happens next week!

Here's what I now believe happens and a few questions I have:

1. I've had a 'pre-op' chat (didn't realise that was it until I was in it) and signed a consent form, 8 days pre-op. (The info in the form gave different stats and info to what I was told in the meeting, stupid me for not reading it until I got home...)

1. The ELCS is booked for 1 week today (39+1). I asked about anti-sickness drugs the day before. Consent form says I'll be given them, the obs told me I wouldn't have any. Will I or won't I? When do I get them, from who?!

1. I have to have blood tests 4 days before. I'm presuming in case I need a transfusion. Any other reason? They already know my blood type...

1. I have to call at 630am on op day. Not sure what they plan to tell me at this point?

1. I have to go in a 730am. I join a queue of booked ELCS and 'at some point' in the morning speak to the surgeon and anaesthetist to ask any questions I have. Ops start 'about 9am', max 5 booked ELCS in a day (I am 4th booked in I think). I've not been told a time but told to expect all scheduled ELCS to be done by 1pm ish if no EMCS comes in.

1. They scan just before the op. If she is no longer breech they cancel the op. I've had so much conflicting info here. Bottom line, I DO NOT want to be sent home after getting my mind in the zone for weeks that this is what is happening. I'm told now that it is SOLELY up to the consultant on the day and there is 'nothing I can do to influence or help my chances of going ahead on the day' if the baby does a last minute flip (which is unlikely anyway). WTF? C&W apparently no longer support maternal request. Help! Surely it's clear that this is quite distressing?!

• What happens if overrun with EMCS, can they push me back if I'm not in by a certain time in the afternoon? Is this likely? They seem booked to the rafters every day?

• Do I just go hungry until post op even if that means fasting from the night before to 3pm or something (I'm not good without food, and no water allowed either!!)

Basically I'm just really surprised there's not a friendly FAQs for your hospital for all those questions I assume a lot of ladies WHO HAVEN'T DONE THIS BEFORE probably all have.... sigh

• anyone know if C&W allow you to have immediate skin-to-skin, lowered lights, delayed cord clamping or no screen at all?

• Must I take a CD or my iPod and my own docking station? I'm not sure what is available at this hospital and I think if I ask they will look at me like this is really not very important in the grand scheme of things...

Feel quite let down after being such a strong NHS and C&W advocate, this is really disappointing treatment so far and I'm NOT looking forward to being in for several days.

Hi Katie, I can't help you specifically with the questions that you have asked as I have no experience of C&W. I am though, booked in for an ELCS on the same day as you at Birmingham Women's Hospital! I thought maybe what I can share might help you out, even if only a little bit.

I'm very excited, but am absolutely bricking it at the same time. My ELCS is beig put down as 'Maternal Request' (unlike yours), but that statement doesn't adequately reflect my reasons for making the request. I developed a problem with my back with DD1's delivery in 2009, which I'm keen to avoid via a repeat labour and delivery.

Anyhow, the way that BWH do it is that I will go in for my Pre-op the day before the birth (18th). I have already spoken with the OB (from my 36 week appointment) who answered some of my questions, but I'll get to speak with the anaesthetist on pre-op day and direct other questions to him/her. I'll have a blood sample taken to check iron-count as well as blood type in case blood products are needed on the day. All sounds frightening, but anaemia can develop following VB, too, as well as heavy blood-loss. Slightly more chance of bleeding post-CS, but lower statistical chance of early PPH.

Sorry, can't help you about the anti-sickness pills. I know that I will be given Ranitadine (antacid) to take the night before and on the morning ofthe birth.

I don't know why you'd have to call ahead on birth-day. I'm not sure if I'll have to. Maybe this is something I'll be informed about on Pre-op day?

ELCS timing sounds the same as at BWH. Might get bumped and the birth happen later than 1 in the afternoon if EMCS come in. I've been told that there is the slight chance that they get so busy that the electives are rescheduled to another day, but this doesn't happen much.

I'm not in the same situation as you in the sense that my baby turning will not influence the CS happening or not. I would HATE to be refused on the day, though. You do have to get your head around what's going to happen; baby turning and you being sent home means that you have to mentally prepare for VB then. I'd speak with someone in the know at the hospital before next Thursday. If this is C&W's procedure, however, Terry might not e a lot that you can do, short of bailing out and demanding to go to a hospital that does support Maternal Request.

I think that you will have to fast until after the op. There is the chance that you'll need a general anaesthetic and this carries the risk of you 'inhaling' the contents of your stomach. Don't know how this works, I just know that this is te reason why it's better for you to have an empty stomach on birth-day!

I don't think that I can help you with your other questions. Some of them are ones that I've saved for the Pre-op appointment a my OB tols me that photography, music, etc, was for the discretion of theatre staff. Again, might be worth contacting C&W. FWIW, I found an 'Elect Planned Cesarean' leaflet on BWH's website - if you haven't done so already, might be worth checking if C&W do the same?

I totally sympathise with you - this is not the time to be stressed and chasing for answers. I hope that you do acquire all the info that you need, an good luck with the birth :) Would love to know how it all turns out x

Not 'Terry', but 'there'. Damned iPhone touchpad!

Hi
I can see you have lots of questions and I might be able to help with some of them. I had an ElCS due to placenta previa a couple of years ago. Mine went brilliantly with no problems whatsoever.

1. What stats are you worried about? Would it change your decision for a section? I had some scary stats but there was nothing I could do anyway so just had to cross my fingers.

2. I don't know about antisickness drugs. Do you mean rantidine for reflux?

3. They need to match your blood type and order in a few units. It lasts only a few days, that's why you have to do it then.

4. I assume you have to call at 0630 to make sure all is going ahead as planned - if it has to be postponed then you can go back to bed!

5. That's what happened to me. It's no bother really. Bring something to read!

6. I think that's something you might just have to suck up on the day I'm afraid. :(

And very gently... :) Although dimmed lights, music etc might seem vital I might just let you know that it took just 6 minutes from the first incision to my son being born. So it might not be worth it? Also the anaesthetist talked me through the whole thing as it was happening, would you prefer that to your music?

Hope that helps a little.

Thank you both - really helpful info, thanks for taking the time to detail! I think it's one of those situations where the experts know the drill, it's their day job. But to a control freak who likes to just 'be in the know' it's really disconcerting to go with the flow on a lot of this.

Sounds like I should expect to wait about for a while on the day and I'll dig out a good book and make sure I'm 'into it' before I go in. Will need to be absorbed I think!

Yes it was the rantidine I was thinking of Panzee - perhaps I'll just ask when I go in for the bloods if I'm given something to take home. WRT to the stats, it was just things like 1 in 200 in the form re potential bladder/bowel damage when she quoted 1 in 500 in the meeting. There were a few things like that which, although won't have any bearing on my decision, are somewhat frustrating - I just wonder where are they quoting this from - the form has basically more than doubled the risk she explained to me!' None of these were (imho) huge risks but this was just one more thing really :-(

But 6 minutes! Good grief! I guess once you are in the actually delivery bit doesn't take long at all. I will ask them for a commentary though as I don't want to feel removed from the whole process. Perhaps these will just have to be 'on the day' questions, lest they forget in their long queue of ladies on the table.

Ok, bloods stuff all makes sense now. I guess I'll also ask them if I should just continue every day pre/post with the pregnacare too to keep iron levels where they should be.

Lunarlyte Shared birthday, lovely! (I hope so anyway!) It would be awful to go home but I'm going to put all my energy into staying put and if that does change, well, I've maybe got a week to focus HARD on the original no-drugs -water-birth plan (which seems so long ago now). Which would be fine, it's just a bit like turning the titanic getting the mind round to that again. I really prefer proper 'sinking in' time whichever way. Good luck next week, hope yours goes brilliantly and you have a speedy recovery

Thanks again both, really helpful!

Someone needs to complain about C&W - there have been a lot of posts about there 'anti-caesarean' policy. They seem to be more interested in getting their caesarean rates down than providing a good service.

There is a good site where patients can post opinions and it is widely read by health care professionals.

This is the link to the Chelsea and Westminster maternity comments:
www.patientopinion.org.uk/opinions?nacs=RQM01&tag=maternity#

Good luck