Elective CS - drugs etc

[ChubbyScotsBurd]

It seems there are so many experienced and wise souls in here that you might be able to put my mind at rest!

My first baby is due by elective CS in just over 2 weeks (it's big and currently footling breech, and I'm only 5'2"). I'm gutted - wanted a nice normal natural delivery, but have decided I'm not the sort of person who likes or deals well with risk so will go with the advice of consultant to have a section.

Thing is, I won't really get the chance to ask questions until the day before the op, and I'm a bit worried they're going to pack me full of opioids during the surgery and I won't be 'with it' enough to BF baby. Skin to skin and early opportunities to BF are really important to me and a CS would make it hard enough without being up to my eyeballs in morphine. Anaesthetic will be spinal unless any probs require a GA. The midwife at the hospital said "Oh, CS babies don't usually want to feed for 24hrs or so anyway, don't worry about it" but I'd like to at least offer the opportunity to the poor thing, which is going to be big and presumably hungry!

Also, as a vet it's nice that the staff talk to me on my level - I've performed plenty CS myself after all! - but I also worry that they're going to assume I know about things that I don't ... a hospital setting is very different to a sh*tty cowshed with no lights and ropes to stop the patient kicking me!

Basically I think I'm just in a panic - and knowledge is power - so any experiences/words of wisdom would be really welcome.

I've had an elective CS for footling breech. How pregnant will you be for the CS? I wish I'd had mine later, so DS1 was fully 'cooked'.

You totally want to be BFing your baby ASAP after it is born, in recovery if possible, not BFing in the first hours can be a recipe for failure at BF, tbh.

I did have a morphine shot after my CS, but it make me puke, so I didn't have it again. You should be feeling ok after a CS, if all goes well. They will be giving you lots of voltarol (diclofenac) and cocodamol, but those don't really make you dopey, and they do help with recovery.

I often get mistaken for a medical professional while dealing with medics (I'm not at all - but I am reasonably knowledgeable), and I find it generally helps. They do normally talk you through the procedure, the day before, at the last check up. They will say it will feel like someone doing washing up in your stomach. This sounds completely mad, but it is true.

Thanks for that. I'll be 39+5 so baby ought to be well done by then - it's quite possible it'll be an emergency CS before then if I go into labour.

I think I'll have a chat with my community MW about whether I should waltz in wafting a hefty CS birth plan on the day. She's been really great the twice I've seen her so hopefully she can help me get my head straight. Only problem there is she works locally and I'm having the baby in a hospital within a different region (long story) so she's not as up to speed with hospital protocol as she would be if I was delivering in this trust.

I've already agreed with OH that if I needed a GA he would do some skin-to-skin while I was recovering - they're going to think we're mad hippies!

totally agree with NQC

you can have skin to skin immediately, you should have it immediately, baby does not have to be washed and dressed, can be given straight to you...you can ask for the screen to be lowered, to watch the birth, you can bring your own blanket for the baby, you can request your own music, lots of things you can do , to make it more of a birth experience,

and baby should come to the breast as soon as possible after birth, MW wrong to say 'don';t worry about it'

do a birth plan, and make sure your DH knows how important breast feeding is and skin to skin

skin to skin should be normal practice! nothing mad or hippyish about it!

also, as you won't have been labouring, and having other drugs, you should be clear headed....

Skin-to-skin definitely possible v.soon after the CS - that was the only time my daughter ever breastfed properly! Although, interestingly, I read some research recently which said that there is actually no evidence whatsoever to suggest that early skin-to-skin helps with BF-ing at all. I can't remember where the research came from so it may be totally spurious and not based in fact at all, but I do remember reading it somewhere 'trustworthy', IYSWIM.

I had an emergency CS under spinal and didn't have (or need) any opiates. I was given voltarol suppositories for the first day (a bit embarrassing, but by that stage there were very few people who hadn't seem my nether regions)and then regular oral voltarol (which is an anti-inflamatory) and co-dydramol alternately for 7 days. I was told to take them (particularly the voltarol) even if I didn't feel I needed them as they worked better if you didn't just use them reactively. It worked really well for me - I had relatively little pain, and was clear headed (well, as clear headed as you can be in the circs!) and I'll certainly go for the same regime again if my VBAC is unsuccessful.

I had an elective 4 weeks ago and got to have skin to skin while they sewed me up and I successfully breastfed for 30 minutes in the recovery room too. I was totally "with it" at all times. My DS did breastfeed a few times during the first 24 hours. My milk didn't come in until about day 4 though so be prepared that if yours is a bit late coming in too then your baby may well feed constantly (and I do mean constantly!) for the second and third day. This was ok though and I am still breastfeeding now. I wrote a mini birthplan before hand to take with me on the day which I've pasted below (might give you some ideas about things you might want / not want). Everyone was very accommodating and I got all my wishes! Can't ask for more really.

Good luck!

Birth Plan

· I would like to be conscious for the operation.
· I would like the catheter to be inserted after the spinal if possible
· I want my husband to remain with me as much as is possible.
· I have already had a caesarean operation; please use the existing transverse scar.
· I wish to breastfeed as soon as possible after delivery.
· I would like my husband to be with the baby whilst it is being checked and if possible be able to have a photograph taken of the baby on the scales etc so that I can see this later.
· I wish to have skin-to-skin contact with my baby as soon as possible after birth, please leave one arm accessible/unrestricted.
· Please do not have the screen so high across my chest that I cannot have my baby lying across my chest.
· I would like dissolvable suture of my incision, not staples.
· I am willing to have students present.

RedFraggle, can I ask why you wanted dissolvable stitches instead of staples? I was fine with my staples last time but I've got another section coming up in September and I'm now wondering whether there's a reason I should ask for the dissolvable stitches instead? Or is it just the thought of having the staples out (which I was icky about in theory but in practice it didn't bother me). Thanks! Also, I see you mentioned asking them to use your existing scar - I hadn't even realised that might not be a given!! So thanks for pointing that out, I will add the same to my birth plan too now!

I had dissolvable stitches with my first section and liked the fact that I didn't need anyone else to poke about doing things to my body after the section. I just felt that there had been enough poking about down there and it was nice not to have to even think about the stitches. Also - don't know about other peoples scars from other methods of stitching (obviously) but my first one was beautiful (according to all doctors etc who saw it) and could hardly be seen, even after an enthusiastic tidy down there!
My new scar is also looking great and very neat already. As I say, don't know how other methods affect the scar quality, but I was delighted with what I got and therefore decided to request the same again.

Re: the using the same scarline, my hospital told me this wasn't an issue as they always do it, but I mentioned it just in case. In practise they removed all my existing scar tissue and made a new scar where the old one had been (if that makes sense) the registrar did say he'd give me a tummy tuck too but it is clear from my current state that he was fibbing

Hope that helps!

I had an emergency cs. Had no choice about anything that went on at all.

I had morphine up the bum at the end of surgery. Then some random pills about and hour later and a morphine injection about 2 hours after that. But DS was in NICU and so didn't need to be breastfed but I did express later that evening before the next dose of morphine. I then had daily voltarol and paracetamol which did bugger all for me except cause more pain as I don't tolerate anti inflamatorys well. I never felt out of it on the morphine, you're far too hyped up for it to knock you silly.

Oh and if you can avoid the flippin disolvable stitches, mine didn't disolve, my wound healed over them and then rejected the remaining stitches causing massive swelling infection and pain (and an exploding scar) very messy.

Things you can do to improve your chances of BF:

• make sure the fact you intend to BF is all over your notes.
• if they want to give your baby formula, ask for it to be given by nasal tube or cup, rather than bottle (or refuse formula)
• take a pump with you, if you have one - in case your baby ends up in SCBU (mine did, due to CS side-effects, I think - he's fine now, though), being able to pump is good.
• find out about your local BF support now so you know where to go if you run into trouble. There are four BF support groups in the UK, all are the same really, but different areas are better for different ones, iyswim. If you say where you live (vaguely - county or borough), we may be able to help. Your MW may know which support group is best, locally.

I've had 2 elective CSs. I was separated from DS1 for 3 hours before I could hold him, but it had no bearing on our bonding or him BFing. It was a mind game - I knew the separation was coming and I was determined it would not interfere with BFing. DS1 was BF for 18 months.

DS2 is 9 months and still fully BF.

With an elective you have a spinal anaesthetic that has no effect on your brain, or your baby's ability to feed. They may put some morphine in with the spinal that shouldn't affect your brain but will give you some pain relief. At the end of your CS you'll also be given a diclofenac suppository.

Analgesia - you know how impt it is to keep on top of the inflammation. Ask when your next diclofenac is due then buzz for it 15 mins before you need it. I would keep taking it for 48 hours, then step down to 50mg or switch to 800mg Ibuprofen. Codeine is also useful for the first night and before your shower first thing next morning. However, it slows your bowel so I don't advise any longer.

Your midwife is WRONG about her comments about BFing a CS baby. Having an elective CS has no effect on your baby's ability to feed (see NICE guidelines). Emergencies are different, since mum may have had a pethedine injection for pain during labour, which is known to produce a sleepy baby.

Skin to skin - you know how impt this is. You can have this on the table, but the table is very narrow and you'll need a lot of help for the baby to stay secure. With DS2 I just waited until we were in the recovery area - it was only 20 mins and DH just paced the OR room with him whilst I was stitched. He went to the boob straight away and fed on and off for the next 2 hours. Magical Your movement is restricted with the spinal at this stage, but don't be frightened to keep at the recovery staff to help you wriggle into a position that is comfy. Don't worry about ideal latching, how long your baby feeds for etc - just get your baby's gob round the boob and let him suck. Newborns get knackered really easily so don't be surprised if he is on/off a lot. You'll be in recovery for 2-4 hours so its an ideal time to just lie and bond/feed. Keep trying to move your legs, clench your buttocks as well to get the blood flowing. Oh, you'll be wearing a BP cuff so take an extra receiving blanket to wrap round it as it's scratchy on the baby.

Lochia - pretty mental for the first 24 hours and you might feel a bit stranded, leaking all over the bed. TRY to get off the bed onto a chair as soon as the spinal wears off, if your BP is OK.

Bowels/Pee - in the first 12 hours drink as much as poss (we're talking litres), especially fruit juice to enusre a nice soft poo!. Don't hold back on food.

I found the midwives, even in a baby-friendly hospital, were too keen to offer formula to mums who had a complicated delivery and were struggling to get comfy to feed (It's tricky sitting up in bed with nothing to brace your feet against). Time and time again I heard, 'he does seem a bit fretful. You've had such a rough time - would you like to try some formula to settle him so you can get some sleep?' Yes, the first night is very hard, but you've just got to steel yourself to offering boob as much as poss. However, just because your baby is fretful does not mean he's starving! Wind may take a while to come up, he might just need cuddled and not enjoy being in the fishbowl.

Take control, set out your needs in a birth plan to ensure a good start with bonding and BFing and don't take no for an answer from uninofrmed midwives.

I could go on - Good Luck

If you're BFing you should NOT be offered a morphine IM or IV after the CS.

i had emergency cs under general, i dont remember much of the rest of the day as i had lots of lovely morphine - people who saw me tell me i was very happy so that is nice

anyway bf took a while to get going, baby latched on fine but didnt gain weight very quickly i think my milk didnt come in as quick as usual. he took over 3 weeks to regain birth weight, but i persevered (despite horrid mw telling me to give up and ff) and he is now 4.5m exclusively bf.

so i suppose im saying that whatever happens it wont be that bad, i had no skin to skin, dh had no skin to skin, it was a total surprise so no birthplan (home birth i had planned obviously a bit different!) and it still worked out fine. good luck, try not to stress

Oh, and the voltrol suppository is your friend. Anaesthetic is constipating, and morphine and codeine are constipating, and the postnatal midwives have a most unseemly interest in your bowel movements - so the sooner you make one, the sooner they'll STFU about it. (Seriously, anaesthetic can cause gut problems, so their interest is sensible.)

Please dont worry about this too much, I never saw/held DD until she was a week old and bonding has never been a problem with us.

My stepsister had a planned CS in March and is still breastfeeding now, she has had recurrent mastitis but has managed to continue.

I didn't have a CS but sadly failed on the bf as I didn't learn to latch him on properly or fully understand what would work, and he had to return to hospital after a week, when he came off tubes he was put on on formula through bottles. So I would agree with the suggestion that you contact the best local to you group who can support you in bf'ing, that you read up on it beforehand and that you/your partner not only make clear that you want to breastfeed but try to avoid interventions that will prevent bf'ing.

Hope all goes well.

Wow, thanks so much for the responses.

I'm glad they won't be spacing me (or potentially baby) out with opioids - that was my main concern. I suspect the important thing is that OH is fully informed and up to speed with these things just in case in the whirl I don't make myself clear.

And the birth plan ideas are fab. I guess I feel like I'm being pushy by asking for things to be done my way (classic first timer by the sounds of things) and I don't want to alienate anyone by being demanding, but at the same time you hear enough stories from people who have regrets that I would prefer to be proactive.

Life can be an uphill struggle when you're a control freak!

Having had two CSes, I was more bolshy about my wants the second time around. Well, I didn't want my own music the second time (I cannot listen to the music that was playing when DS1 was born. ), but I wrote 'needle-phobic' in big letters over all the paperwork.)

I had an em-cs with no labour and was given an morphine drip that I could control myself (can't remember what the proper name is); when I went back on the ward the next day I had oral morphine. The morphine drip made me feel unpleasantly odd every time I pressed the button, a bit like suddenly feeling very very drunk for about a minute, but the oral stuff was lovely , made me feel a bit "fluffy" but definitely still in control. Ds went straight to NICU but I was expressing for him and the mws told me the morphine wasn't a problem. All this skin-to-skin stuff sounds lovely but I didn't hold him for 5 days and didn't start bf for a couple of weeks (he was tube fed), he is now 11 months, still bf and definitely no problem with bonding. So I hope everything goes the way you want but don't panic if it doesn't!

I had an elective c/s, had tons of morphine and dd was in SCUBU for two days (she was prem) and I still managed to breastfeed successfully. Don't worry.

I had a morphine drip and didn't feel spaced out. I felt great, had no pain and managed to breast-feed successfully. you'll be much more likely to breast feed well if you are relaxed and not in pain.

Not read whole thread so sorry if repeating anything...

I had an emergency section with ds and didn't need morphine afterwards. The key is to take milder painkillers (paracetamol / codeine / diclofenac) regularly rather than waiting for the pain to kick in as they work better like that.

Ask for a diclofenac suppository to be put in when they have finished stitching you up (put it in your birth plan / ask before they start for this) - not dignified but works wonders!

When you want to move afterwards once your spinal has worn off press on your scar till it hurts before you move - this supports it so its not as uncomfortable to move.

Get a Widgey breast feeding pillow (loads of stockists on internet or John Lewis sell them) as this supports the baby at exactly the right level for breast feeding and avoids prfessure against your scar / lo kicking it.

Good luck - can understand your disappointment but its not as bad as you think - I had a very straightforward recovery and its meant to be easier after a planned one.

i have a really low pain threshold and i had as much morphine that they would give me - a shot every 2hrs, as i was in agony
didn't stop me feeding dd in recovery and pretty much solidly for the first 24 hrs of her life! she always has been a very hungry baby! so even if you need to take all the drugs you can to get you through, you should still be able to breastfeed ok.
hth

Wow what an experienced bunch!

I would agree (3 c-sections later) that a birth plan is a must but also see how you feel at the time. I had a self-administered morphine drip after the first 2 but found I didn't really need it and paracetamol was enough. Number 3 was born in a different country where paracetamol was all that was offered!

I would agree with whoever said to be prepared for the milk coming a day or 2 later than with a normal delivery, especially after a planned section with no labour. My 3rd was elective and I noticed a difference in the time it took to get the bf going. It was a short term thing but we had a couple of very difficult days and nights of basically sucking or screaming. After saying no formula I was almost begging the midwife to give her 10mls in a syringe to give me an hour off! Good Luck - you'll be fine.