Tips for avoiding an emergency cesarean?

[CityDweller]

Is it even possible to do anything to off-set an emergency cs? I'm 15 weeks with my first and very much planning and hoping for a home water birth. I guess my worst case scenario (aside from stuff being wrong with the baby) is labouring at home for ages and then having to be rushed to hospital in an ambulance to have a cesarean. Like many things during pregnancy, this concern is beginning to occupy me irrationally. Perhaps because I don't know anyone (first-hand) who's had an emergency cs, so I'm convinced the law of averages means that it will happen to me.

So, my whacked logic aside, is there anything I can do to optimise my chances of a natural birth at home? I'm going to do hypnobirthing classes and an active birth class and will aim to keep moving in last weeks, with walking and swimming and bouncing on a birthing ball. I'm healthy, relatively fit, used to do endurance sport (!) and pregnancy has been uncomplicated so far. But perhaps nothing I do, or about me physically, will make the blindest bit of difference... Is an emergency cs just a case of (bad) luck that you can't do anything about?

It sounds like you know what you're doing already tbh. One thing - let your birthing partner know how important it is to you to stay active during labour. Some MWs are very insistent about you getting on the bed and being strapped to a monitor. Unless there is actually something going wrong, or your baby is unwell, this is totally unnecessary and is only for the MW's convenience. When you're in labour it's very easy to be bullied into doing things you don't want to do so make sure your partner is up to speed and ready to stand up for you if necessary.

Emergency caesareans are only given when they are absolutely necessary so rest assured that if you do end up needing one it won't be because of anything you've done. Do what you can to guard against it but please don't beat yourself up if you do need one - it won't be your fault at all.

You're doing the right things but I'd say also focus on what you want in labour. Do you know about the cascade of interventions and all that stuff? Make sure you're aware of the potential knock on effects of the choices you make, and make them accordingly. Of course there's situations where it's beyond your control but there are also situations where there is control. Have you heard if doulas? You could consider having one of them too.

Alice I have heard about the cascade of interventions, and that's one of the reasons I'm choosing a home birth. I'll read up more about it though, as I'm sure interventions can cascade at home too.

I thought about a doula, but money is tight, so we thought our funds would be better spent on the classes + hiring a birthing pool + all the other crap babies seem to need

Don't let the "cascade of intervention" scare you out of accepting help (including pain relief). One of the biggest regrets I have about the birth of my first child is, that all the guff about the cascade of intervention terrified me so much, that I chose pain over pain relief for way too long, and that didn't help anyone involved. FWIW, I didn't give birth vaginally in the end, and as the consultant said, my daughter would have never made it out that way.

I think you should keep an open mind. An emergency section is not generally possible to avoid as they are an emergency !

Especially with your first try not to put a lot of pressure on yourself. It's an unknown how you will react.

My second baby was supposed to be a very straight forward elective section and I ended up having undiagnosed placenta previa !! It all went tits up. But ds was fine. I was fine.

Birth is a means to an end. Not the end of the world.

Round my way doulas don't want anyone to be without one who wants one. So if you have financial problems but want one, don't rule them out. Speak to them. Student doulas are cheap.

Try not to worry too much. I really didn't want a section but by the time the decision was made in all honesty if someone had given me a knife I would of cut her out myself.

My lo was in distress and seeing her heartbeat go down and down then back up again for 6 hours When it dipped the last time I nearly broke down and was so relieved when they said they where going to do an emergency section. Despite my fears I was calm and happy the section was a walk in the park in all honesty. I was up and about within three hours and can honestly say I recovered really well, very little pain and all normal activities resumed within a week.

Baby is 4 weeks old now and my scar is pretty much healed.

Sorry for the ramble it's just I spent all my pregnancy focusing so much on what I wanted and didn't. Nothing went to plan but it was fine. Main thing was she was ok in the end and my recovery was quick.

I genuinely wish all the very best for you, but do you think that all the very many women who have had emergency or crash caesarians could have done anything to avoid it?

"But perhaps nothing I do, or about me physically, will make the blindest bit of difference... Is an emergency cs just a case of (bad) luck that you can't do anything about?"

Yep, you've got it. If you are young, healthy and lucky enough not to have a breech baby (or other pregnancy complications) or not require induction then you probably do improve the odds in your favour. But not by all that much.

The only way to guarantee not having an emergency section is to have an elective one. It is your first baby. See how it goes! And do not get too hung up on what birth you want. So long as you and baby are ok, nothing else really matters.

I think that doing all you can as you have outlined will help you feel in control and focused but it may not make one jot of difference!
Whilst I ended up with an emcs doing lots to try to have the best birth experience possible helped me to feel in control of something totally out of my control. If you can afford a doula get one. You can get trainees much cheaper £250 IIRC. My doula was still a godsend to me even though I didn't actually get to give birth.
Although I felt very upset at not getting my natural birth, the emcs really wasn't bad and I recovered quickly and of course DS is alive.
Good luck

Don't think of your birth plan as a plan but a wish list. Having a fixed idea of how the birth should go and ending up disappointed can contribute to the development of PND.

I don't think anyone even looked at my birth plan which was also for a water birth - my DS was distressed and it turned out the cord was wrapped around his neck three times. I count myself lucky that I went to hospital promptly and he got out quickly rather than trying to stick to how I thought things should go. An EMCS that ends in a healthy baby being born is a good thing, not a shame or a fail in any way.

There sadly isn't too much you can do to avoid it.

I would definitely look in to hypnobirthing, homebirthing, doulas and everything else you have mentioned that makes you feel calm and in control. Getting stressed and fighting the contractions doesn't help if you have a long early labour, so you will be helping yourself by being relaxed and following your body's lead.

Having said that, if you feel very strongly and negatively about an emcs then it would be worth addressing those feelings and thinking through having a cs. My SiL didn't consider anything going 'wrong' with her first birth and as such was so blindsided by an emcs, and so shocked and disappointed that she didn't have the birth she expected, that she seems to have suffered a lot with her emotions since then. It convinced me, going in to my pregnancy, to have an open mind and be prepared for any eventualities. As someone has said above, labour and birth is just a means to an end and even if it doesn't go how you planned it still gives you a beautiful baby at the end of it.

And as signet says, I was so exhausted and frankly off my tits on G&A, sleep deprivation and lack of food that I would have tried to perform the cs myself if I could have! I just remember thinking - oh, thank god, this means I don't have to faff pushing now (FWIW, I am a bit of a wimp and G&A made me high as a bloody kite, so don't take my experience as standard!)

Lots of the ideas above are brilliant. But the thing I would like to add is that an emergency caesarean while it can be scary because it implies that things have 'got out of hand' is frequently more scary because women know so little about this mode of birth. You may find the more you know about caesarean birth and how to prepare for such an eventuality the less terrifying the actual procedure may seem. All the knowledge in the world obviously can't remove the fear associated with knowing something might be going wrong, but if you pile on top of that a fear of the unknown of caesarean birth then the whole thing is going to feel a whole lot worse.

There is a great book on Amazon Caesarean Birth: A positive approach to preparation and recovery by Leigh East which has pretty much every angle covered in lots of detail. www.csections.org In particular it talks about what to expect and how you can influence your caesarean experience. It even talks about deciding when to switch to a caesarean rather than continuing with a vaginal birth attempt. In my experience it certainly seems to be the case that some emergency caesareans are conducted as absolute last resorts when every other intervention has been tried, mother is now totally exhausted, terrified and feeling totally backed into a corner. There are periods during some labours when it is possible to retain a feeling of calm and control by looking at the interests of yourself and your baby and switching to a caesarean hours earlier.

I think you have to be pragmatic. I had a thirty two hour labour and two looong hours of hard pushing but dd's head was bent to the side - there was no way she was coming out naturally.

I had spent weeks on a birthing ball, laboured for hours in a hot bath, focused on my breathing, walked around during labour but the simple truth was that I needed forceps or a C section.

I am not trying to scare you. The C section was lovely - no pain, calm operating theatre, awesome baby.

Sometimes things just don't go to plan and you should not be scared.

Hi everyone. Thanks for all the responses. It's not that I'm scared of cesarean, it's more, I realised especially after reading some responses, that I'm pre-empting any 'disappointment' that the birth won't be as I hope it will. (And I don't think it's unreasonable to plan and hope for the birth situation that makes me feel most comfortable and positive).

Luckily, I have six month to manage my expectations, and at least become familiar with what's involved in a cs and the situations that demand an emergency one.

I really dont think that you can do very much to avoid these things because unless you have a crystal ball and can predict the exact situation at the actual time, then what will be will be.

C sections are done for good reason. They are controlled, and usually thought out and the decision is not made lightly.

There was absolutely nothing i could have done to prevent mine.

I ended up with a general anaesthetic, so was put to sleep for the birth of my son.....nothing i did wrong.

But even in this situation, i felt safe, well cared for, i felt it was managed efficiently and that my child was going to be fine.

This despite going from pushing actively to...ooh eck this baby is breech..to general anasthetic and waking up the next day.

I could not have predicted nor planned for this, evidentally, the midwives do plan and prepare for eventualities like this and deal with them well.

I seriously doubt that you can do anything, what will be will be.

I planned a homebirth. I was fit and healthy, had a perfect pregnancy and was v prepared. I was active, upright, mobile and used hypnobirthing techniques for 31hrs. I pushed for 8hrs. I was rushed to hospital for an emcs.

I ended up with ptsd and pnd, not because of the mode of delivery but because of the gap between expectation and reality. I decided on the birth I wanted and laboured in the face of a nagging feeling that something was wrong, indescribable pain which I should have asked for help with (there was a significant problem with my pelvis which I didn't know about and dd was in a really awful, stuck position and it caused pain which my body was screaming at me to listen to but I refused). Looking back, the emcs was the least traumatic bit of the whole thing but the feeling that I'd failed, the transfer to hospital, confusion, regret, guilt etc stemmed from my own inability to understand one sure and certain fact of giving birth: you have no control over the essentials.

You can nudge and encourage and make informed decisions but only with what you're given. If you have an unbirthable baby, if events develop and you need intervention, you can't simply unwish it. You are handed a set of circumstances, you and the baby together and you make decisions based on what's best for you and the baby in that situation.

When I had my second I entered it with a more positive attitude. Instead of seeing the hospital and the theatre as a looming enemy, the route to giving in and failing, I saw it as this wonderful, brilliant, clever place which meant that both dd and I were alive to know each other and it was there waiting in the background should ds and I need help to meet each other too.

I ended up with another emcs (like I said, I didn't know about the problem with my pelvis at the time) but I was laughing and smiling as I went into theatre and smiling when I came out.

I can't give birth. But modern medicine can allow me to be a mother. The only way I would have avoided an emcs was either to not get pregnant in the first place or not survive the labour and delivery of my two babies.

There's probably every chance that you will get your lovely, calm homebirth. But arm yourself with information and decide now what you will do in every eventuality. Because if you do end up with an emcs, then the way you will enjoy it is by knowing you thought it through beforehand and made decisions and felt in control of the birth offered to you. So you can ask for the screen to be lowered, ask for skin to skin still, request that they don't reveal the sex etc. There are options in every scenario and they are YOUR options.

Congratulations. Don't make emcs the enemy. It's a wonderful, lifesaving procedure.

And in the event btw, you'd perform surgery on yourself to make sure your baby is okay. Your focus contracts down entirely.

My emcs was great. Would rather that than a home birth any day! But everyone is different -you need to de-stress about this. Births cannot really be guaranteed to go the way you want . If the result is a health baby and health mum it does not matter how baby gets here. Try not to worry so much -all these classes you are doing should helitat anyway. e. Good luck

It sounds like you're doing everything you can to prepare for a straightforward birth. Statistically, having an experienced woman friend/relative/doula with you is a very good way to reduce cs risk.

But please don't get too hung up on the birth. It's not the important bit. Spend time planning and visualizing how you are going to look after this baby, how your life is going to change, how you're going to look after your partnership and yourself.

NimChimpsky Thanks for sharing your story - it's incredibly helpful as that's the way (re. your first birth) I could have imagined me reacting to an emcs. I'm so glad to hear you're reconciled to your experiences and can look on the experience positively now.

Having a planned cesarean!

I had am EMCS with my first, all the pregnancy yoga, gym sessions and NCT classes meant nothing when they realised there was a problem with my cervix and DS had to come out fast.

But they were lovely in theatre, truly great. If things go wrong and you do need one just make sure you are looked after properly for a month or so. Swot up on what happens as I found it helped when everyone swooped into action and I knew what they were all there for.

Don't be induced - that is what caused my emergency c-section. Although I know that is not he case for everyone

An emergency cs is any cs that hasn't been pre-planned (elective). Only a small proportion of these are grade 1 (very urgent) and the scary kind. As the posters above have said, most cs are not a bad experience and the urgent ones are usually coped with as scary but necessary.

Planning a home birth, as a low-risk woman, is already the most effective way to avoid a cs.

The most useful things you can do to avoid going into hospital (which increases the chances of cs)
: be very clear that any offer of induction is soundly based and that expectant management has been considered. Spontaneous labour is less likely to end in cs.
:Manage your latent phase well. Eat, drink and rest. Distract yourself so that you don't get anxious and frustrated. It can go on for days?..

But you cannot control all the events that can affect the sort of birth that will happen. Give it your best shot and a positive attitude and you'll do well.

Ha Meglet! I was going to say that - only sure fire way to avoid an emergency section is to have an elective.

With my first I went for a stand alone midwife unit, OFP, no pain relief, active birth, aromatherapy, pool etc. Ended up with chorioamnionitis after prolonged rupture of membranes & was transferred for an emergency section. I had elective sections for the next three. They were lovely births :) dd1's was pretty traumatic.