Emergency c section before labour even started properly

[Ilikepistachio]

Hi all

Sorry for the long post!

I gave birth a few weeks ago to my 2nd child (39 weeks) and I am still feeling sad and frustrated with my experience. I just want to know if anyone has experienced what I have and if what happened to me was valid.

My waters broke Saturday evening. I had no contractions or anything prior. The only sign I had that labour is imminent is losing a bit of my mucus plug. I was booked on the home birth team and so called the triage and told them what was happening. They sent 2 midwives over to my house to make sure it was my waters (at this point I wasn't sure) but they couldn't confirm so they advised me to go to the hospital and get it checked. I decided to go next morning.

When I got to the hospital, before they checked my waters they did a fetal ctg to monitor if baby is OK. Now thinking back I don't understand why they needed to do this and for some reason I failed to ask this question. They eventually did confirm it was my waters. At this point I had been hooked to the monitor for a while because the midwife and doctor were both saying that the ctg was failing to meet the criteria but at this point there was no alarm bells. At this point my hope for homebirth was disappearing. The midwife did a sweep to help things going.

As it was coming to 24 hours since my waters broke, I was told I'd have to be induced. The ctg of the baby was still suggesting the criteria wasn't being met. At this point I am still not experiencing contractions, just random braxton hicks.

They finally got a room ready for me and moved me to the labour ward. They put me back on the ctg monitor and now it was saying that every time I was having small braxton hicks, the baby's heart rate was increasing to like 176bpm. So the doctor said this baby is not going to cope with full on labour and my only option now is a section. I really didn't want this so I asked can we wait to see if things change. They gave me 30 mins and nothing was changing. The doctor said baby is in distress and we need to get baby out now.

I was so defeated at this point. I was 2cm dilated and being rushed to theatre. Things were happening so fast. My daughter was born and the recovery was brutal. I'm still not over the birth and I just can't help wonder did things get escalated too quickly. We got to the hospital at 11am and my baby was born 6pm.

I can't help but think should I have waited, was it the continuous monitoring that set me up to fail and led to a cascade of interventions. Was it the fact I was on my back for hours that distressed the baby a bit. If my waters never broke would the baby be in distress silently?

I'm going to book a birth debrief soon but I was hoping if someone here could help me make sense of this. I just feel like going from trying to have a homebirth to the other end of the spectrum with a c section is too much for me to comprehend. I'm sad most days and I just want to stop feeling like this. If I ever want another child naturally, I've now got to consider all the risks that come with vbac. If my c section was unnecessary, it makes me so upset that ive been left to deal with going down the consultant led pathway, continuous monitoring again which I cant help think is what led to the c section. I believe I'll be set up to fail again. I genuinely never want to go through a section again, it was horrible for me and I can't help feel like I was rushed into it.

Hi lovely, it sounds like this is really playing on your mind. Does your hospital have a birth reflections programme? It can be really helpful to help you understand why decisions were made. ❤️❤️

You have to listen to the professionals who thought your baby was in distress and delivered her as soon as possible so she survived.
In an ideal world you would have had your home birth but we don’t live in an ideal world and plans have to change accordingly.
It’s sad you didn’t get the birth experience you were hoping for but you do have a beautiful baby you need to focus on.
And a debrief is a good idea so you can understand why the decision was made to deliver your baby safely.

OP, was your priority the safe and rapid delivery of a baby who was demonstrating clear signs of fetal distress, or was it to have a vaginal delivery in a homely environment, and bugger the risk to the baby? Because you sound more put out about the C section, than relieved your baby is ok.
By all means ask for a debrief with the obstetric team, but be assured they don’t perform sections for fun. Nobody is looking for extra work, and if they could have left you safely with the midwives for a SVD instead, they would have done.

I completely see why you feel like you do. I was on a monitor throughout my whole (induced) labour and it really messed with my head and my feelings about it afterwards. They kept commenting on her heart rate being low but ignoring the fact every scan I'd had before she'd been asleep and it was exactly the same! I kept asking to come off it for a bit so I could move more or get into the water and my instinct was ignored. Ultimately it was all fine and I understand their caution but that feeling of 'did I ask/do the right things' and the doubt is really upsetting.

Nearly two years on and I've very much made my peace with it and I'm sure you will too. Cross the vbac bridge if and when you have to and congratulations on your baby!

Hospitals are under pressure to have lower c section rates. They would only go to a c section if they honestly thought it was the safest option. I'm not an obstetric, but speaking as someone whose job it is to resuscitate babies, significant accelerations that early in labour does not sound like a baby who is going to cope through to delivery. I would suggest asking for a birth debrief, so they can explain why they did what they did. But from the information you give, it honestly sounds like the section was necessary.

You weren't 'set up to fail' because you have not failed. You have had a beautiful and most importantly, healthy baby. If the babies distress hadn't been picked up on the monitor, then maybe the baby would have been born virginaly and been fine, but maybe it wouldn't have been. Better to do 9/10 sections too early then 1/10 too late.

A debrief would be good but it sounds like everything was done correctly. The fact it happened relatively fast probably reflects the concern they had for baby. A baby distressed by a few Braxton hicks won't cope with labour. They were right. They were already unhappy with the ctg tracing when they first put it on so the monitoring didn't cause this to happen.

I’m sure you’ll get a better explanation during your debrief. Staff aren’t very good at explaining what’s going on while they’re doing it.

My baby’s heartbeat was dipping (rather than accelerating) with each contraction and that’s why I ended up with an emcs. They said he would be unlikely to cope any better with stronger contractions.

I’m also not sure about this but I believe there is such a thing as your baby being at more risk if your waters have broken for more than 24 hours.

I hope you feel better soon. There is nothing wrong with needing a section.

My birth 7 weeks ago was similar however I know the doctors were right as my son did end up in nicu and had sepsis, breathing difficulties and low sugar levels. So it made it a bit easier for me.

do you hospital do a birth reflection service as it would be worth booking one to talk through the trauma.

Also just to add that your chances of VBAC are better if you’ve previously had a successful vaginal birth.

Please try and reframe this- the monitoring did not lead to an unnecessary cascade of interventions, it quite possibly saved your babies life by getting them out early. It’s easy to say, but the intervention would not of been done if the staff did not think it was necessary.

I had several CTGs. I had one for reduced movements, I had one just before my induction when I was happy but the midwife wasn’t happy with my answer and I had several during induction of labour. DD met her movements with all of them and her heart rate was fine. The machine picked up that I had low O2 but they could clearly see I was fine (although every time they checked that out). If your baby didn’t meet the threshold, they were in distress. This is confirmed with the heart rate. At a time that maternity services are stretched and people can’t get onto labour wards to start a much needed induction, the fact they’ve gone from monitoring to c-section is 7 hours says it really was needed. You weren’t set up to fail but they picked up on the worrying signs quickly and escalated it appropriately. The other option could have been a lot worse.

You gave birth to your baby. They are safe and healthy. So are you. It doesn’t matter how they arrived.

I read that story as thank fuck they did the ctg at the beginning and noticed baby was in distress. Baby was in distress before you even started - and luckily it was picked up.

Maybe an alternative way of looking at it is thank god you called when you did, thank god they monitored baby when they did and didn’t send you home. Thank god you didn’t begin a home birth and then not make it to the hospital when baby was in severe distress.

I hope you get the answers you’re looking for and I completely understand that feeling of it all running away with you. I hope you’re able to process all of the reasoning and enjoy this time with your baby. X

I'm sorry to hear that your birth didn't go the way you planned. An EMCs can be really traumatic, things happen so quickly and it is completely normal to question why happened
Unfortunately NCT classes and the like have led us to believe that a 'natural' birth is preferable and easy to attain and we should resist continuous monitoring and the cascade of interventions - this is a big fat lie that leads to women blaming themselves and medical professionals when things don't go to plan.

I've been where you are. It took me a post birth debrief and several months (possibly years?!) to make peace with it all.
I'm able to see clearly now that an EMCS happened because my baby was struggling and that it was the right thing for both of us. The alternative wasn't a water birth with calming music it was more likely a dead or brain damaged baby. Harsh but true.
Time is a healer and you will move on from this and be able to look at things more objectively eventually.

I’m an anaesthetist who works on Labour ward. From what you have written there is no way your baby would have coped with labour, there were signs of distress so early on and no matter what the outcome would have been a c-section (or worse as others have said).

Please please stop thinking you were set up to fail, you honestly weren’t. What happened is the best thing and in time I hope you come to terms with that. I have seen the other side of it and it is truly devastating for everyone involved.

Be kind to yourself.

I'm sorry you feel this way but you need to understand that the monitoring saved your babies life and that's the bottom line

I’m really sad you are feeling this way - they possibly saved your baby’s life. He wasn’t ‘a bit’ distressed …. He possibly wasn’t going to make it. Please reframe this in your mind. You did not ‘fail’ you succeeded - in having a live child. Try to talk through the birth with your health visitor or midwife to shift your viewpoint.

An emergency c section can be a horrible experience, I have been there more than once and I know how awful it can feel. However it is absolutely not a failure, I am sure you don’t consider other women who have had one as having failed.
It sounds like baby was in distress and they rightly didn’t want to risks with either her or you.

It can take time to heal mentally from a lo emergency c section as well as physically and it’s still early days for you. Definitely have the birth debrief and be kind to yourself.

I can’t believe what I’m reading in all honesty. You have a healthy baby in your arms.
my close friend has a disabled child who suffered a brain injury due to distress not being picked up quickly enough.
who cares about your desire to have had a home birth? I mean that seriously. Births can be problematic, it can be risky for women and babies.
just look at your precious child and be glad all is ok. Many women don’t get that.

With kindness, can you really not consider the alternative to what happened to you and your baby? I would be full of gratitude in your place. Sorry if that's harsh but it sounds like something you need to hear! Birth plans are worth less than the paper they are written on.

Thank God you were in hospital OP. I had a crash c-section 22 years ago after a text book pregnancy. Most days I have a moment's thought about how lucky we are to have her.

This!!!!

A few things.

They spent two midwives to your home to check you. They were perfectly happy and had the staff to facilititate a homebirth. They were not anti-homebirth or cutting corners.

They gave you control of when you went to the hospital to get checked. They were happy for you to do this.

You were almost at 24hrs after your waters were broken and you had no contractions. There was therefore only a short window left before medical intervention with induction was going to have to happen. At this point your chance for a homebirth were slim to none.

Add to that, the heart rate monitoring were showing a problem. That means you were always destined for a hospital birth with some degree of significant medical intervention needed.

They listened to your request to wait for 30mins. They didn't dismiss you or say it wasn't possible. Instead they monitored the situation. You say: They gave me 30 mins and nothing was changing. The doctor said baby is in distress and we need to get baby out now. The situation actually WASN'T no change in the situation - the situation was getting worse with the baby showing continuining distress which was unsustainable.

I was 2cm dilated and being rushed to theatre. Things were happening so fast. This is telling.

I refer to this from the NICE guidance:

• Use the following standardised scheme to document the urgency of caesarean birth and aid clear communication between healthcare professionals:
• Category 1. Immediate threat to the life of the woman or fetus (for example, suspected uterine rupture, major placental abruption, cord prolapse, fetal hypoxia or persistent fetal bradycardia).
• Category 2. Maternal or fetal compromise which is not immediately life-threatening.
• Category 3. No maternal or fetal compromise but needs early birth.
• Category 4. Birth timed to suit woman or healthcare provider

and

Category 1 caesarean birth is when there is immediate threat to the life of the woman or fetus, and category 2 caesarean birth is when there is maternal or fetal compromise which is not immediately life-threatening.

1.4.3 Perform category 1 caesarean birth as soon as possible, and in most situations within 30 minutes of making the decision.
1.4.4 Perform category 2 caesarean birth as soon as possible, and in most situations within 75 minutes of making the decision.
1.4.5 Take into account the condition of the woman and the unborn baby when making decisions about rapid birth. Be aware that rapid birth can be harmful in certain circumstances.

Your own words: 'rushed to theatre'. Looking at the classification criteria you were classified as CAT1. Not CAT2. Your baby was demostrating persistent fetal bradycardia. You were in the HIGHEST risk group. It couldn't wait any longer. You were allowed to wait for 30mins before this point.

As for this:
was it the continuous monitoring that set me up to fail and led to a cascade of interventions

My local maternity unit was briefly put into special measures because of a higher rate than normal of problematic births. They identified that a lack of cfm WAS the problem.

In the context of multiple maternity unit scandal - which consistently highlight LATE intervention and a drive towards natural birth at all costs, you need to think very seriously about just how much you've been almost radicalised into the hype of a homebirth / natural birth by birth evanglists who have been found to been in no small part responsibl for harms to women and babies.

It sounds like they did everything RIGHT and its YOUR expectations and desire that you have a natural birth that is the problem here.

Your baby is healthy. You are struggling and that shouldn't be minimised. It is NOT true that 'all that matters is a healthy baby. A woman's mental health is important too. However there is a problem with expectation management: women who have a very fixed expectation of birth and then have an experience which is very different are MUCH more likely to experience birth trauma than women who have a more flexible / less set expectations of childbirth - regardless of how they actually give birth. And thats where you are at and what you will need to reflect on most if you want another child.

You sound like you ARE experiencing trauma - which isn't something to just ignore. But it needs context and you need that debrief. But from what you've said, it very much sounds like they did things perfectly for the situation that was arising and it would have been extremely foolhardy to wait for labour (which may not have even come). The risks were simply too high.