Cat 3 EMCS - experiences and questions to ask

[Meier]

Hello,

I was due to have an ELCS (due to traumatic first birth, decision made following many discussions with various consultants).

Popped into triage today for something that turned out to be fine, but baby didn’t pass the first monitoring check (not active enough, but they said they weren’t too worried) so they’ve changed me to a Cat 3 C section, likely tomorrow if they can fit me in. Being back on this ward is more triggering than expected, so popped on here to ask:

1. any questions I should ask during pre op conversations ? im going to ask for delayed cord clamping and skin to skin if possible… but anything else I need to think about? My minds gone a bit blank with the shock of it all.

2. any positive c section stories to help with the anxiety would be much appreciated 💕

Best of luck for tomorrow, so sorry you’re finding being on the ward triggering and hope you’re first on the list in the morning and cuddling your baby very soon!

I had a really beautiful elective section experience a couple of years ago. I also asked for skin to skin and delayed cord clamping and baby was passed straight to my chest and the drapes lowered so I could see her being born, so worth discussing if you’d like that too. I also was offered to choose music so if there’s a particular playlist that will help you I’d really recommend asking.

Make sure your birth partner brings their phone or camera in to take photos if you’d like those. Afterwards id really advise keeping on top of the pain relief, they can be quite stingy in hospital and when you’re discharged home, but I asked to take home oramorph and also got some diclofenac prescribed privately from an online pharmacy and they really helped me remain mobile during my recovery which really helped my mental health too.

Can’t think of anything else except to say you’ve got this and best of luck and enjoy all the newborn snuggles ❤️

Thank you so much ! thats super helpful!

Completely agree on the pain relief. I asked for, and was given, Oramorph both the days I was in hospital. I was also sent home with a week’s supply of dihydrocodeine, which I took all of on top of ibuprofen and paracetamol. I carried on with ibuprofen and paracetamol for a few weeks after. As the PP said, that was really helpful with mobilising and I had very good recoveries.
laxatives - do make sure you take them. I am naturally prone to constipation anyway, so I asked for and was prescribed senna tablets on top of the usual Lactulose. That was really helpful and made life very easy.

Do pack a pillow if you can, it’s so helpful for putting it between the scar and the seatbelt on the way back home.

Use plain water only on the scar and keep it as dry as possible. I used to use a clean maternity pad to dry it throughly after showering, and I would lie down on the bed for a few minutes to air it. I wore dresses and mesh pants as much as possible to let it air.

Very best of luck. I had a very difficult vaginal birth followed by two elective c sections and the sections, including the recoveries were so so much better. I really wish I hadn’t been so nervous before the first section and enjoyed the moment more. I was completely calm before the second.

Obs anaesthetist. Cat3s are pretty much the same as electives.

Everyone gets delayed cord clamping as routine (unless baby is very unhappy which is rare, and super super rare in cat3/4), everyone gets skin on skin (again less baby is unwell or you don't feel up to it, then your partner can do it instead). Bring your own music most labour ward theatres have Bluetooth speakers now

But generally all very cheesy and cute, try not to worry xx

I wouldn't count on the baby direct to chest, I've seen it allowred once in 8 years of obs. And noone goes home with oromorph (International pain consensus guidelines

Oh another tip, I got some disposable pants ( they were Tena Pro skin super night pants off Amazon) and wore them for the first week or so, SO comfortable. Also before you go home from the hospital, get a couple of extra pairs of the anti-embolic stockings so you can wash them.

Another thing I found comfortable was putting a sanitary towel inside your pants sitting against your wound (with the sticky side sticking to the pants) I found it just made me feel a bit more cushioned once the dressing was off!

When dc2 was born (meant to be an elective but I went into labour first), she was passed to the midwife who then gave her to me so I had her in about 3 minutes (we also had delayed cord clamping). They did her measurements/vit k about 3 hours after her arrival in recovery. Watching her come out was amazing. Do you want to see your placenta? They're fascinating although I drew the line at taking mine home but that was an option.

I found her birth to be healing after what happened in my first. It helped me understand a lot of what had happened before and this time I was listened to which made a huge difference. I originally wanted a general anesthetic and jumped through all the hoops to get it signed off but the Doctor who actually delivered her asked me to trust her. It was an absolutely amazing experience. Everyone but the Consultant cried (but she did hug me and ask for a baby cuddle in recovery), there were lots of hugs and actually I can't imagine any way in which it could have been more perfect.

As for recovery I think it really varies. Mine literally didn't hurt beyond a mild ache without pain relief (dc1 was in NICU and no one told me to go back to the ward for medication and with my 2nd, I just didn't take anything). With my first, this caused a bit of a problem and I was prodded far too much by an anesthetist in an attempt to find an issue.

One of the NICU doctors recommended scar massage once everything was healed as numbness around the scar can be an issue. It worked for me. I don't have any numbness at all now.

Wishing you an amazing experience and lots of lovely squishy baby hugs tomorrow.

It used to be routine practice in our trust to be prescribed oramorph to take home after a section when going home after 24 hours. Unfortunately it’s no longer routine here, but when I asked my team for it, they were understanding and supportive. I definitely was able to mobilise better with it for the first couple of days. The diclofenac also really helped and I am grateful that my recovery was very straightforward.

It’s wild that women are typically expected to have major surgery and go home the day after with a newborn to look after and just take some paracetamol and ibuprofen! Pain management is such an important part of postoperative and postnatal care.

This just shows how much practice varies between trusts, where I am at the moment we have window drapes and it is standard practice to pass baby straight through to mum at electives.

What are the international pain consensus guidelines? I’ve had a quick google but not been able to find anything. I’ve definitely sent people home with oramorph (both after a section and following other surgeries) if there was a reason they couldn’t have dihydrocodeine. Didn’t have any pushback from pharmacy so I don’t think it can be that uncommon.

https://associationofanaesthetists-publications.onlinelibrary.wiley.com/doi/10.1111/anae.15262

Yeah they did when I very first started too. Now most, but not all trusts give dihydrocodeine (30mg = 3mg oromorph) with paracetamol ibuprofen

Yes @Destiny123 different trusts must be different as straight to chest is not unusual for us and oramorph for home is also not unheard of!

Thanks!

https://fpm.ac.uk/sites/fpm/files/documents/2021-03/surgery-and-opioids-2021_4.pdf

This is the longer version @SomethingDifferentBloomed

Yeah definitely will be huge variation I moved to a trust and was like "youll likely be home tomorrow" and the midwife was like "no she wont" lol opps!

I've done obs in 7 trusts now and direct to chest only happens for trials. Makes sense tho..same as eating post section, some trusts can eat immediately within reason, others make the lady wait 6 hours post op

6 hours! Yikes! I’m so grateful that my hospital didn’t do that. I was so hungry I could have chewed my own hand post section.

Also, this time they let patients drink sips of water right up until going to theatre for categories 3 and 4. It’s a new protocol since my last section, and it was a huge improvement.

As others said, a category 3 is basically the same as a normal elective. It just means it wasn’t planned for that day, but it’s still not an emergency.

I have had two c sections, one of which was a category 3. Both times they lowered the drapes as DC were being born (though it was very hard to have a good view when I was lying down), passed him to me right away for skin to skin and delayed cord clamping too.

It’s one of those things that you may need to stress several times. A friend of mine had a c section at the same trust and they took her son away to be weighed, etc before she even saw him. So because of that, I told everyone I could that’s what I want so it happened.

I was in for 3 days with my first but was due to separate issues. Went home the day after with my second. And definitely ask for pain relief and ask for it before you even need it. If you wait for the midwives to bring it to you, it might be too late and your previous dose may be wearing off, so just stay on top of it and take it regularly. And definitely get more than ibuprofen and paracetamol - I had dihydrocodrine for one and co-codomol for another.

Dihydrocodeine is the default, when we don't know breast feeding choices as normal codeine can't be taken when breast feeding (a large proportion of the population don't metabolise it properly either so get no benefit from it, hence I don't prescribe it unless patients are on it at home preop and not breast feeding

I’m not a medic so conscious I may sound thick there…

So does that mean co-codomol shouldn’t have been prescribed if they knew I was planning to breastfeed? I’m still breastfeeding at 18 months but also now have extremely painful periods that OTC painkillers don’t even touch so still take the co-codomol I have left from my c section when the pain is really bad.

The risk with codeine is that a small proportion of women metabolise it differently to the rest and if those women breastfeed them the baby is at higher risk of side effects including respiratory depression (one of the breakdown products of codeine is morphine and genetic variations mean that some people can make more morphine out of codeine than others do). For most people codeine would be fine but prompted by a well documented case of a catastrophic neonatal outcome, and the fact that there’s another option (dihydrocodeine) that is safer and possibly works better for some women, it’s been advised in the uk at least that codeine should not routinely be used for women who are planning to breast feed. Probs best to speak to a real life HCP so they can help weigh up the pros and cons.

Thank you so much everyone for your replies - they’re really reassuring ! Waiting to hear from the doctors where I am on the list 🤞

Yes, but guidelines only changed recently, so if you're child is relatively old then it was common practice historically

(some people very quickly metabolise codeine into lots of morphine, others don't metabolise it at all... and we can't tell who is who) hence we now give dihydrocodeine to everyone as its metabolism is predictable, so we know that if mum is feeling more drowsy then baby will likely to be a bit more drowsy and needs a closer eye

Hello again ! So I’ve been nil by mouth since midnight, so haven’t eaten or had more than small sips of water for almost 18h now.

I was told the emergency and elective c sections are separate lists, and I keep getting bumped due to higher priority emergency sections.

I totally understand being bumped for people higher risk, and if all the sections going ahead while I wait were medical emergencies I wouldn’t complain at all… but it feels so unfair that electives are going ahead when ive not had anything to eat or drink for so long?!

i was on the elective list originally (though they still hadn’t given me a date), and was always told I might get delayed if there’s an emergency section…. And although I know it would be super disappointing for them at least they could eat and go home and come back the next day ?!

it just feels like by being changed to cat 3 im in this awful in between place where I never get to the top of the list! I’m worried about how going into the op so dehydrated and energy deprived will affect my recovery.

the midwife is going to ask if she can put me on a drip, but has anyone been in this situation?! is there anything I can do to?!

You should have been able to carry on drinking. i’d ask if it’s likely to be in the next couple of hours and if not have a large glass of squash/water if not.

electives and emergencies are supposed to be kept separate - elective doesn’t just mean the maternal request sections - they could be really high risk. Cat 3 can be a difficult place to be.

I kept asking about drinking and every time they said keep taking small sips.

i understand what you’re saying about elective c sections with medical reasons, thanks.

is there a limit to how long they can leave someone who is 39w pregnant without food ?!

That’s so frustrating I’m so sorry! Worth asking if they can at least give you some fluids through your cannula to help keep you hydrated?