Birth plan and SPD with elective cs - any midwives out there??????

[jacksmumto1]

I am seeing my midwife on sunday to discuss and write my birth plan for an elective cs.

Does anyone know about suitable birth positions for ceseareans? If I was having a "natural" birth then I know about not seperating legs too far etc.. (not that my requests were followed last time.....) how do I ensure this for a cs delivery???

Any advice would be appreciated! Thanks!

Please help!!

From what I gather, operating tables are quite narrow, so you're pretty much flat on your back, legs together.

I'm also having a CS, and I've asked the OB to introduce me to all the theatre staff before I go in. If you do this, then EVERYONE is aware of any special requests (don't assume that everyone will have read your birth plan).

If you have a plan, get your OB consultant to sign it (make multiple copies); that way it's easier to 'persuade' staff to do what you want. (get your DH to keep a copy with him in theatre).

Most importantly, ask for a pre-admission consultation with the anaesthetist that is scheduled for you on the day. Make sure you do get him/her instead of a random consultation - you want him/her to remember you! The OB will be very busy (obviously) and it will be the anaesthetist that you'll have closest contact with.

A CS is no different to any other birth - don't be put off asking for what you want e.g. the baby is brought straight to you (after a quick paediatric 'inspection' with no weighing etc. Bring your own blanket/hat that you've slept with the night before, so if he gets cold or if you get uncomfortable and your DH has to take the baby to the recovery room - then he'll still be wrapped in your smell.

anyway, now I'm waffling...........

erm - concentrate more on the what you want to happen after the birth - e.g. re:skin to skin contact etc - don't think there will be a vast amount you can dictate as to surgical procedure. are you going to have a spinal rather than a general?

sorry - just noticed u wanted a midwife rather than semi-informed ramblings!

I had two C-sections (1st baby breech, after her I was hooked!) and wasn't aware that you could have a birth plan. I just turned up and it all happened!

I don't quite understand "suitable birth position". You are flat on your back once the epidural has been given and that's it. The shaving of pubic hair was done in the room by a nurse before being wheeled to theatre. The OB has to insert a catheter before the op starts and then it's all systems go. I remember the very odd feeling of watching my legs being opened and seeing two pairs of legs as as they were opened, as I could still see them when they were closed if that makes sense. ? It must have been the drugs but it was a weird feeling. The brain must slow down.

I was talked through the op by the anaethatist and was told if any time I felt nauseous to let him know so that he could add something to the drip. Just before the OB lifted out my baby, the curtain was pulled down and I could see the first moment of life (I'm getting a lump in my throat and tearful now) which was amazing. They wrapped up my baby and put her on my chest but as the epidural had reached quite high, it was quite uncomfortable.

Back in the room, I was given a bed bath where they really rub hard to get rid of the iodine which is painted on before the cutting begins.
The catheter stays in for 24 hours and feels like a tampon being removed when it's taken out (ie doesn't hurt) and you are then told to get out of bed S L O W L Y. Abdominal muscles feel a bit stiff but walking is possible as long as you take it easy. You stay attached to a drip anaesthetic for 3-4 days.

The midwife will ask you for clothes for the baby which she will warm up before you go down to theatre. I remember thinking how weird it was to buy clothes for a baby I hadn't even seen/met! It's easy peasy so please don't worry. HTH. Feel free to ask any more questions. When is the op?

Just read your posting which was posted during my effort! Your legs are together and flat so that the OB can easily get to your lower tum. No stirrups!

One thing that I would suggest jacksmumto1 is to have your catheter put in before your spinal anaesthetic. This is to prevent your legs going to far apart because you need to be in the same position as for an internal examination. Usually it is put in after the spinal so that you do not feel it as much. It is not a painful procedure and is often dome without any anaesthetic anyway. After that there is no reason for you legs to be apart really. You could ask that if they are clearing any blood clots form the vagina after the caesarean that they do not over abduct your legs. Not all surgeons do that so perhaps that is worth mentioning.
Does that help?

I'm with chicpea on this. I've had 2 CS. Never made a birth plan. I walked to the theatre, sat on the edge of the table for the spinals, both times. Lay flat with a pillow. Catheter inserted just after, one leg just rolled slightly outwards while the spinal took effect. They 1/4 turn you on the table, legs very much together, towards the OBS, when it all starts. The anaesthetist checks the level of effect of the sp/epi with v cold spray, the green sheets go up and you're off. I did ask to see the baby being born but watched everything in the overhead lights up til then. It acts like a big mirror.

After care at Kings college hosp(London) was excellent in the post op bit but crap in the post natal wards. Left completely to my own devises including closing a window whilst still attached to my drip and catheter despite buzzing continuously. Fortunately I had no probs with lifting my baby out of the cot and feeding and changing. Made sure I had everything to hand before dh left next to the bed.

Catheter and drip out next am, up for shower, anti d and heparin injections. Follow up from anaesthetist and OB and paeds dr before d/c 48 hrs after arriving in hospital.

Cushti as they say in Peckham.

Just hope to god I get a similar experience in Pembury hosp(Kent) this time. Newcastle girls are v v lucky to have got Maggie Blott up there now, my fantastic OBS consultant. She's my hero!! Just wish I could pinch her back again for this one's arrival. Not forgetting my lovely anaesthetist, Phillippa. It was like being at a little tea party 2nd time around. All the same team, comparing notes on our children's development, and being told that by Maggie that she was keeping it all neat and tidy down there incase of a third!!

Meant to say shave off the top third of you pubic hair(about an inch or so down from the top, IYKWIM) before you go in. NHS razors are lethal. dh did mine the night before with his mach3, much kinder to your skin!

Some consultants do open your legs afterwards to swab out blood clots, - I could see mine were wide open, but I could still "feel" them perfectly straight which was very wierd - so it is worth mentioning this.

chicpea ... couldn't help having a giggle at your 'two pairs of legs'
Jacksmumto1 ... I had 2 c/sections that weren't planned so I didn't do birhtplans for them but I think you are doing the right thing by doing one.
My second c/section was attended by the same midwife that did all my antenatal appointments (in NZ you get to see the same one throughout) and it was great having someone there who knew my history ... She made sure of things like making sure I was the first to hold my baby (that was really important to me as I had 'bonding' problems with DS ... ) although it was for one millisecond before DD was taken off for weighing etc.
My midwfe also ensured that DD was put to the breast as soon as was possible (again very very important to me as DS was not put to the breast for 2 hours after birth) ... DD was breastfeeding in the recovery room less than half an hour after her birth ...
One thing you might ask for is to not have the screen up .... I didn't have a screen for DD's birth and I felt a real part of her birth, again something I missed out on with DS's birth. It was wonderful. I didn't see any blood or gore as my head was at such an angle that even if I had tried to look 'into' the action I wouldn't have seen anything.
Finally, don't worry about the SPD ... I had it pretty badly too and although I still have twinges (DD is 6 months old) I don't think it had anything to do with the op ... my legs were pretty much together the whole time ....
HTH ... and good luck

Thanks for all your advice....

I am going to ask to have the screen down so I can see baby coming out - I remember last time not knowing what was happening and whether he was ok etc.. - would like to know asap this time! I'm also going to ask for skin-to-skin contact. However baby might be even earlier than planned so not sure whether this will be possible.

Thanks again for all advice

Honeybunny, just read this thread and see you're having a CS in Pembury. I've had 2 CS there - first emergency after my planned whalesong-and-candlelight homebirth didn't go to plan, and second one 3 months ago elective. Ironically, even though the first one was totally rushed, the registrar found time to introduce herself to me before starting and I was pleased with the experience overall. This time round, I had loads of time to plan but was much less happy. I was told the anaesthetist AND surgeon would come and meet me on the ward beforehand. The anaesthetist did, but the surgeoun didn't. I ended up having to ASK the anaesthetist, in the operating room, if the procedure had begun, to which the reply was Yes! The registrar had just walked in and got started without so much as a hello! All very odd and afterwards I was horrified to discover that I had not one, but TWO scars. I was specifically told I would end up with only one scar. The registrar who did the op never came round to see me afterwards so I never got the chance to ask him why (although, for the record, I remember his first name was Gideon, so if you get him, start asking questions early). But at my 6 week check my GP seemed really shocked and said the only reason he could think of as to why I now have the start of a noughts and crosses board on my tum was if the registrar hadn;t realised I'd had a previous section (e.g hadn't read my notes). He suggested I should write to the consultant, which I will.
Overall, though, the care at Pembury is great. Midwives v v helpful. Filthy dirty place though so take your own Dettol wipes and flipflops to wear in shower , plus a good supply of biscuits as food is vile!

just while this thread is active (sorry to hog jacksmum) - how low should my bikini wax go? Do I have to have it all off?!

Have just checked distance between scar and growing-back hair, and I think (allowing for room each side of scar where the dressing goes) you should take at least one and a half inches off. Better safe than sorry, as that tape they use to stick the dressing on really is very sticky indeed!

I agree with lulpop.

mears - could u look at thread on conception posted by "stupid" called have i hurt my unborn baby