C-section trauma

[sunstarsrain]

Wanted to know is Bi-manual compression common on the operating table for PPH straight after an elective c-section?

Found it humiliating and violating and would never of had a second elective section if I knew this was a thing they do? Was ironically having a section due to past trauma and this by far has now been the most traumatising thing that has happened to me.

Everything I have seen is that it is only normally performed in a low medical setting such as a home birth until you get to the hospital?

It didn't work and had to be re-opened anyway!?

yup, well within the realms of normal. It may help fix the problem or buy some time while medications do the job/they consider whether a Bakri balloon might help or whether they need to re-open. Am sure they'd be happy to talk through the decision making process they went through. It's not terribly common to end up needing to use it but it's far better to do it in theatre while the anaesthetic's still working than to go back to the room and have a big bleed there.

Well was not warned about this before an elective section? Most people say it was so peaceful? Also not having just given birth caused me damaged that I feel contributed to more bleeding!? In fact I really crashed after this had just been done, I just feel it is so brutal and could have been avoided.

So it’s not a routine part of a caesarean, but is often done in case of heavy bleeding, which you presumably had if they had to open you back up again. I’m sorry you feel violated, it’s not a nice thing to go through but was presumably necessary to try to control the bleeding and like pp says, buy time for medications etc to work.

I would definitely second the advice to ask for a debrief, if you’re still under a midwife you could ask her how to arrange this (it’ll be different in different trusts), or if not the secretary of the consultant you delivered under. It could be useful to understand why things happened and so you can ask all the questions you have.

Probably should have shifted sentences about in my original post... it's not terribly common to need to do it, but it definitely forms part of the standard management when someone is bleeding.

An elective section is surgery on a very vascular organ and can get every bit as hairy as any other sort of mode of delivery - until the point that nothing did go wrong, it can and occasionally does go wrong. All other things being normal they won't have been expecting to need to do it (though it would be unusual to have not mentioned bleeding as a possibility during the consent process for a section), but once it's clear that someone's still bleeding they can't just ignore it - the blood supply to the pregnant/just delivered uterus is so high that there's really not much room for dithering (it's about 750ml/min so if you're really bleeding hard it doesn't take that long to deposit a large amount of blood on the floor).

As PP suggested a birth debrief might be a useful thing for you to a) help understand the rationale & what might have been the consequences of not doing it b) to allow them consider your feedback re the consent process (it may be that they'd consider going into more detail about the management of PPH on the table so it's not a complete surprise to anyone else).

It’s just that I’ve heard and read a lot of cases of pph and they have never had this done, just had a transfusion. Also I don’t know anybody who has come out of an elective c-section with below stitches!?

As regards to consent on the before operation brief they said very rarely they might ‘need to get something up there’. I thought they meant a swab or something, very different than what happened. Was no real consent at the time.

So sorry you're feeling traumatised, that's really hard, especially if you were really aware of everything that was happening to you. Unfortunately as the other posters have said, this is a life saving procedure that was done to stop you bleeding, so whilst it was unpleasant, it would have been necessary. It is done regularly in major PPH settings (in the UK), alongside giving medications, and often will avoid you needing to be re-opened, but sadly not in your case. Just because people don't mention needing it, doesn't mean it didn't happen! Often, I suspect in a CS the patient isn't too aware of what's happening as there is a drape blocking their view (maybe yours had come down already?). But to need stitches down below after is a shame, that does sound quite traumatic.

As the others have said I think a debrief would really help you to process what's happened as it's obviously been upsetting for you. I think it was an appropriate thing to happen, but it sounds like they didn't explain things to your properly or debrief you about it afterwards, so a bit of space to discuss this and process it all could be really helpful for you to deal with it in your head. Especially if you're thinking about next baby. If you still feel upset about it after the debrief, it might be worth organising some private counselling so you can discuss it in a more neutral setting.

Does not appear to be common in the US at all, so what’s different in the UK? I still think it’s an outrageous procedure.

I'm guessing they carried out the procedure to save your life.
As pp have said, ask for a debrief to ascertain why they took that course of action and what would the outcome have been had they not done so.

It's the quickest way to reduce the hemorrhaging in an emergency and save the woman's life whilst other options (such as drugs, sutures are being prepped, this can take precious minutes).
Dignity often goes out the window when a PPH happens, for a very good reason.

a blood transfusion doesn't stop the bleeding, it just replaces what's been lost. If surgeons think that someone is actively bleeding they have to do something to stop it and if, in a c-section, they've got to the point of having the surgical incision closed before the bleeding becomes obvious then the options for stopping it/slowing it down are rather limited (the immediate options at that point are essentially the same as they would be after a vaginal delivery). Often compression and some more drugs given by the anaesthetist is enough to sort out the problem, but sometimes it isn't and then there are other techniques (that come with their own risks) that they work through. The longer they don't try to tamponade the bleeding though, the more likely someone is to have a massive haemorrhage, develop abnormal clotting, need a hysterectomy, have a big transfusion, go to intensive care, etc.

I wasn't consented for this before a section tbf so if you weren't, you could discuss with a midwife if it's helpful. You wouldn't really have grounds for a complaint or claim but if it would help you, then ask to discuss!

Point being I would not have chosen an elective section if I knew this could be on the cards so to speak. ECS is even recommended for people with previous trauma?! I also would say if you had just delivered naturally if would have been easier. Just don’t see how it’s considered a normal option for a ECS.

It’s life saving OP.

We do it after vaginal birth if needed too. The speed of blood loss in some PPH’s is terrifying to see and sometimes drugs don’t work fast enough and alternative ways of slowing and stopping bleeding are needed.

I am sorry you feel traumatised by your birth and I would suggest a birth debrief from your midwife

Yes I can see what your saying but after this I actually bled more and I saw a comment from a doctor a while ago saying in some cases it can actually increase bleeding which is what I felt happened.

What do you wish happened instead?

You need to speak to a Dr, OP. They can give you the reasoning and the biology behind the reasoning.

It doesn't sound like you completely grasp what happened; you can't just replace lost blood with a transfusion you have to stop the blood loss too.

A C section, however routine or elective is still risky surgery and things can and do go wrong. I'm sorry you feel traumatised, it's worth talking to a medical professional or having a birth debrief to better understand what happened.

What do I wish happened? Well I actually feel they wasted time doing this twice, reopen me and correct the problem like you would in any surgery, which they had to do anyway.

It could have worked, and so avoided second surgery.

I don't think you quite grasp how quickly and how dangerous a PPH is. Women die in minutes. You can't predict who will haemorrhage, and how fast it will happen, or how much will be lost.
You just need to act.
Bimanual compression is the first line in stopping bleeding if initial drugs and 'rubbing up a contraction' doesn't help.
It saves lives.
Yes it's not pleasant. It's painful, undignified. But do you really think it's done for fun. It's done because it's necessary at saving your life.
PPHs happen in vaginal births too, and they too may need Bimanual compression.
Blood isn't a treatment for PPH. It doesn't stop the bleeding. Blood is a treatment for the anaemia that follows a serious haemorrhage. If a reservoir was leaking you wouldn't keep topping up water, you need to fix the leak.
By all means, go through birth reflections. It may help you, but having been through many PPHs, including a fatal one, it seems the medical team acted appropriately.

Well all I’m saying is I’ve never heard this mentioned by any midwife. I’ve also heard women ask what it is.

I may add I previously had a pph and this was not done. I have had a debrief and notes retrieved.

They were also really rude and horrible and one midwife said ‘if I wasn't going to breastfeed they had to do this’ which felt like a punishment. I now understand the mechanism for it but again never knew not breast feeding could be life threatening!?

I think you need a debrief. Your treatment was to save your life and I'm not sure you are seeing that.

It's not a normal.option. However , sometimes it becomes necessary Arrange the debrief OP.

I think perhaps once things have settled you might be able to see things more clearly. They saved your life OP. It sounds like it was absolutely necessary.

Ok you didn't realise the bi manual was a possibility when you opted for a c section but you know bleeding is a real possibility. And with that can arise a complicated, time constrained urgent response.

Would you have preferred they let you bleed out ?