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?

[newyearsday]

I second getting a doula (Doula UK has a hardship fund BTW). There's only so much you can learn at antenatal classes, a doula will help with the unexpected, have lots of experience, and have lots of 'tools' to try if, for example, labour stalls. My DH was wonderful but he felt totally out of his depth at our home birth. I ended up transferring in due to 'failure to progress', nobody was in any danger and we both wished afterwards we'd had a doula with us to talk common sense/ask questions/make sure we totally understood what lay ahead! Also read up about induction to prepare yourself if you go 41wk+ because you will probably be put under some pressure (I resisted). And hypnobirthing is a great idea because it will help you to relax.

I'm 21wks pg and have found a wonderful doula.

Good luck!

[MoonHare]

Hi citydweller

Obviously you've had lots of responses from women who've had emcs seeking to reassure you that the experience is not necessarity a bad one, and as long as you and baby are well it doesn't ultimately matter how this is achieved. This is true. But having had 2 straightforward vaginal births, one of which was a planned home birth I'd like to offer you some words of reassurance too.

Planning a home birth and a positive attitude to birth are both great ways to end up with the kind of birth that you want. The MWs who attend you at home will keep a close eye on how you're progressing and will arrange for you to transfer to hospital if it's necessary, sometimes an emcs is unavoidable, sometimes it is avoidable.

The most common reason for first time mum's transferring into hospital during a planned home birth is for pain relief so I would recommend JuJu Sundin's book "Birth Skills; proven pain management techniques for your labour and birth". This book helped me hugely and got me through my last 2 births with just TENS and the techniques, didn't even need g&a.

My first birth was straightforward and in hospital. 2nd was a planned home birth, so much more relaxed and calm. Am planning a 3rd home birth for sometime in the next few days hopefully. I know several women who have sucessfully had their first baby at home with no problems at all.

I'm sure you've already found //www.homebirth.org.uk and also //www.tellmeagoodbirthstory.com both great websites offering positive views about birth.

The fact that none of your friends have had an emcs does NOT mean that the odds stack towards you. Remember a straightforward birth is normal, not lucky.

[halloweeneyqueeney]

btw the actual CS was fantastic, such a happy memory, they're not scary! But the labour itself was shite because I wasn't relaxed and happy and feeling in control

[halloweeneyqueeney]

sounds like you're already doing the right things

I had am emcs and lots of things contributed to it, I was stressed in early labour and that meant I couldn't cope well with pain which meant I had an epidural which meant I was on my back which meant my pelvis didn't open and I needed a CS

IMO what happens in early labour is REALLY IMPORTANT. being happy and calm and feeling in control starts things off well

[Ozziegirly]

I was also healthy, fit and having a straightforward pregnancy. Then I got gestational diabetes which quickly became uncontrollable except with insulin.

This meant that I was induced on my due date. At this stage I still hoped to have a natural birth - I had been out in the bush a week or so earlier and had said to DH "I would love to just labour here, under the stars with nature all around me, imagine how magical it would be bringing a child into the world out here"

Well, 6 hours into a labour consisting of constant, back to back contractions, when I had dilated 1 bloody cm, with my precious DS's heart rate decelerating with each contraction, as soon as my obstetrician mentioned the word c-section, I almost bit her hand off (except that would be weird as then she wouldn't have a hand which would have made doing the c-section a bit tricky).

THe c-section was the best bit! Very quick, painless, no drama. DS delivered onto my chest.

And now 2 years later, I basically never think about how he came into the world, although I do sometimes stop and think how lucky I am to live in a country with access to superb medical care which means that my wonderful boy is actually here.

So basically, it's lovely to plan for a natural birth, but once it's all over, if you're a bit calm about how it's all going to happen, you probably won't think about it much once it's done - but if you do attach a lot of importance to the event of birthing the baby, and then it's not how you imagined, you probably will feel a bit sad and let down. But it really doesn't matter how they come out, as long as they and you are healthy at the end of it.

[TransatlanticCityGirl]

Keep an open mind and be positive. Hypnobirthing etc may help. But rest assured that even if it ends in an EMCS as it did in my case, it will be alright.

I was terrified of the prospect, and I cried when the decision was made. But it was surprisingly ok, and next time around I might (gasp!) actually prefer to have a CS.

I had definitely over dramatised it in my head. Try to relax!

[Emerald6]

Good luck & good for you for knowing what you want.

Birth plans are great but also be prepared to go with the flo...in all honesty its impossible to have a set plan when you go into birth. Do bear in mind that birth can be really unpredictable and if your plan changes then so be it. I have lots of friends who had first time home births.

I'd totally recommend a tens machine - helped me so much I was reluctant to take it off and get into the water first time round.

I still ended up in theatre & heading for an elective this time round but its all about getting baby here the safest way possible for both of us and I didn't know I had problems with my pelvis till I was at the pushing stage last time.

[NellyBluth]

(Sorry to hijack OP ) Phlebas, can I ask what were the symptoms and the effect on your baby of chorioamniontis? I'm just wondering because there was some infection of my waters - not meconium - and so I was rushed for an emcs and DD was in NICU for the first few days. They never gave a diagnosis but this sounds possible. And I'd quite like a diagnosis because I'd really like an elcs next time

[girliefriend]

tbh there is no point worrying about it as if you need an emcs you will just want your baby out and in one piece. I had a lovely birth plan however dd had other ideas and was born via emcs, all I cared about at that point was that she was alive, couldn't give a flying fig about the stupid birth plan!!

[phlebas]

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.

[mayhew]

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.

[Nevercan]

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

[Meglet]

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.

[CityDweller]

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.

[iguanadonna]

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.

[givemeaclue]

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

[NimChimpsky]

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.

[crosscupcake]

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.

[CityDweller]

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.

[OpheliasWeepingWillow]

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.

[MsMoo]

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.

[NellyBluth]

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!)

[noblegiraffe]

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.

[NorthernNumpty]

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