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!?

The thing is they need to stop the bleeding. No point in giving you a transfusion if you’re still losing 700mls a minute. Bi manual compression is a recognised step in managing a pph regardless of place of birth or mode of delivery. Including vaginal birth. Normally less invasive stuff like rubbing up a contraction works but if it doesn’t then this is a text book step to move onto. It’s very effective and life saving and probably isn’t done quickly enough in many cases and that could lead to poor outcomes.

you would have been told of the risk of a haemorrhage as part of the consent for a section. They do not need to go through every step in the potential management of such an event. Consent is never that detailed. If they told you every possibility they’d have to give you a thirty min lesson in how to manage a pph, all the different drugs, etc.

I don’t understand the breastfeeding comment, yes breastfeeding can help the uterus contract but never has that much of an instant effect to make a difference in a pph or for me to think it would make a difference to management/treatment options during a pph. If you didn’t have it happen last time then your pph was stopped earlier before needing to get to that stage.

imagine you have a massive wound on your leg and you’re bleeding, you would press down on it. This is basically what the bimanual compression does, you have a big wound at the placental site inside your uterus and pressure needs applying. Definitely ask for a birth debrief.

Don't be obtuse.

Op is clearly traumatised by such an invasive procedure and is trying to get her head around it.

I get that you were taken by surprise OP, that you didn’t realise what some of the implications are of some of the potential complications and their treatment.

But you really need to think about how you are talking about this to yourself.

A Caesarian section is a major surgery with lots of risks. That’s why vaginal birth is the first choice unless contraindicated. And ALL births are prone to not going to plan.

They were trying to save your life, they did save your life. if you had been somewhere or sometime else, they might not have.

It wasn't effective in my case, appeared to actually increase bleeding. But anyway thanks for your opinions.

I genuinely don’t see how it could increase the bleeding, not from the placental site anyway. It either works (and it normally does) or it doesn’t.

Potentially if they then accidentally tore your vagina while inserting a hand you then also had additional bleeding from a tear. You say you had stitches down below so it sounds like that may have happened. Which is really unfortunate but not bad practice. They would have wanted to try this first for speed as time really is of the essence. Reopening several layers of freshly stitched tissue to gain access abdominals is time consuming, invasive and not risk free and would have been the last option.

I may add I also heard/felt a strong popping sound which I assume was when squeezing with all their strength a large ballon full of blood that has just been sewn up it must of caused it to ruptured.

This is why I think it’s ridiculous to do it after a section. Which why I assume partly why they reopened.

Did have brief debrief but they did not admit to this.

It sounds like you had a truly dreadful experience OP. It isn't usual to experience bimanual compression after an ELCS but that's because the percentage of women that experience PPH in general is something like 3-5%. That's including the less severe ones. Unfortunately it sounds like you had a life threatening bleed and the only way to buy time to slow that level of bleeding whilst deciding on further management- drugs, whether to reopen surgical site is to use bimanual compression. It is written in all the PPH clinical guidelines for staff to follow, regardless of whether the delivery was c section or vaginal. It's best practice in this scenario. There is no clinical evidence to say that bimanual compression increases blood loss- other than as PP said potentially causing some vaginal trauma but it unlikely that a tear of this nature would contribute to life threatening blood loss. Horrible though, I appreciate that.

In terms of the popping sensation/noise you felt, it could be that the surgeon was placing a bakri balloon which is essentially a balloon filled with water used to compress the placental site and slow bleeding and that's what popped.

When you had your debrief, did the midwife/obstetrician or whoever you had it with explain why the technique was used in your case and they decided not to reopen immediately after the bleeding started?

No assuming being the NHS it was time/moneysaving.

It was some time ago and I’ve since found out they damaged my sacrum/L5 and pudental nerve but can’t 100% prove this caused it but I know it did as I had immediate hip/back pain after. After much back and forth it now shows on MRI.

Being of an extremely slight frame felt this was not the right course of action for me.

Anyway a cautionary tale for anyone considering an ECS.

No obstetrician when faced with a potentially life threatening emergency thinks "oh what can I do which will save the nhs money and/or time".

I would really not underestimate the trauma that you've been through with your first birth which now seems to have been understandably compounded by your second.

Can you seek out some specialist therapy from someone experienced with birth trauma? The Birth Trauma Association should be able to point you in the right direction.

I have got help but does not really change the life changing injuries I have sustained to my spine by my body being crushed with this procedure.

Anyway thank you for those who posted helpful and nice replies much appreciated.