C-Sections: Planned v Emergency. How was it for you?

[Mazzletov]

It's taken over a year but next week I'm having a meeting with the Clinical Director of Women & Child Health and the Head of Nursing for Women & Child Health at my local hospital, to discuss a letter I wrote to them following the emergency Caeasarean birth of my undiagnosed breech baby. I am hoping to get them to think about ways to make the surgery less traumatic, and I would really like your help with this!

Having planned a home birth, I had anticpiated:

• seeing the baby immediately
• being the first to hold her
• mine being the first voice she heard
• seeing her all covered in goo
• generally being more of a participant at the point when she and I separated.

None of these things happened. Given the fact that I have a beautiful, healthy daughter it may seem churlish to complain about:

• People describing her to me while I remained unable to see her

• hearing her voice amongst others in the room (and the blare of the radio) but not being able to see her
• Her being cleaned, wrapped in an unfamiliar blanket and having a hat put on before my husband could hold her near enough for me to see her face while they sewed me up

...but these are the things that overwhelmed me with sadness at the time, and still do. I am aware that I'm not alone in this. On mumsnet and in magazines I have read about mums:

• leaving crusty bits of blood on their baby's eyelashes for days, as "evidence" that the baby had indeed come from inside them.
• feeling outraged about the HAT being put on before they'd met the baby.
• finding it very frustrating being able to hear the baby but not see them.

I think that if there is a general consensus about what makes emergency C-sections disappointing, this could form a case for urging hospitals to take note. Similarly if there's a consensus about what HELPS, they could make sure these things happen.

(From Mumsnet I learned about the terrible experience of women who have C-sections under GA, and how helpful it is/would be to have photos "proving" the baby they are holding the next day is the one that was indeed inside them before they were put to sleep. A midwife reading the thread said that henceforth she would try to take pictures in such a situation. This just seems so blindingly obvious to me that I can't believe it isn't general practice. I'll mention this in my meeting too.)

In my letter I wrote, "I understand that planned C-sections are significantly less traumatic than emergency ones, because such arrangements are made." I also wrote, "I understand most women's negative experiences of c-sections are very similar, yet it seems this information is commonly and routinely ignored with regard to new cases".

Am I right?

I don't have the time or energy to do proper research. I would just ask Mumsnetters to please share their experiences on this. I'LL BE CHECKING FOR LATE ADDITIONS TO THE THREAD SO PLEASE SPREAD THE WORD AND ASK PEOPLE TO JOIN IN by answering the following:*If you had an emergency C, what did you hate about it, and what might have made it better?

*If you had a planned C, what aspects of it DID you plan, and how did this help?

*If you've had experience of both, what was the difference?

*If, unlike me, you've done more reading around this subject, do you have any useful references/figures/data for me?

I just keep hearing that planned ones are so much better, and I think it CAN'T BE THAT HARD to transfer some general lessons from planned C-sections into everyday practice when they are doing emergency ones.

I'd like to go to this meeting and say, "I asked on Mumsnet, and X hundred women said they would rather you didn't clean the baby before handing it over. X hundred said they'd rather have seen the baby leave their body. And X thousand said they'd rather, instead of pestering them to have an epidural in the hour preceding the surgery, you'd been discussing these options with them."

I would like them to acknowledge an emergency section is an operation as I was told it was not considered as such ten hours after I left theatre and they tell you what you do with your wound when you need to coughafter this non surgical event.

I planned a homebirth, dd was very stuck and after 6hrs of pushing I transferred for an episiotomy, 3 failed ventouse attempts, a failed manual rotation and an eventual emergency caesarean.

I can relate so well to some of what you have written. I had envisaged holding dd straight away, bfing, skin to skin, her hearing my voice. She was taken out, whisked away and brought back in a hospital outfit and hat. I didn't see her as they whisked her away. I didn't know the moment she was born, they announced 'she's here by the way' in the middle of a conversation they were having about female drivers (surgeons/anaesthetist/some other uniformed types). I lay there with tears rolling down my face and feel sadness to this day that I didn't hold her naked body, I didn't see her cord, I saw no evidence that she came from me.

I understand the need for checking the baby over but it wasn't an 'emergency' in the sense that there was anything wrong with her or me, there were no signs of distress, her apgars were perfect.

I carry around such guilt that she was dragged from in a bright theatre by unfamiliar hands and I didn't hold her for half an hour.

It's preventing me even considering having another. I have flashbacks and nightmares. I was in such a state of shock and fatigue after 3 days of no sleep that I didn't ask to see her as soon as she was born, I didn't insist that they leave the vernix on her. I lie awake at night and tell myself off for not being more assertive.

I wish they'd talked to me instead of chatting amongst themselves.

I wish they'd told me what they were doing and when she was coming out.

I wish I'd seen her little naked body.

I wish I'd been offered skin to skin.

Hi I've had both, an emergency with my 1st DC and a planned with my 2nd DC.

In my planned C i knew what was coming as i had it all explained to me, also it was calmer and not as rushed. We (DH and I) planned to have DH in the room with me, also i wanted to be told what was happening as it was happening, also that i wanted to see my DC as soon as she was born unless of course she needed medical attention. other than that we didnt realy plan.

In the emergency C it all happened so fast and i wasnt realy sure why it happened! As it was my 1st DC i was quite scared about the birth anyway, but then to be whisked into surgery without knowing why made it quite scary. I was litteraly signing the consent form as i was being wheeled into the operating theatre. I was then put to sleep because the epidural hadn't kicked in and i was very aware of what they were doing IFKWIM. The next thing i know i have woken up in a different room with a nurse and my DH and DC no where to be seen! I didnt get to do skin to skin until an hour after birth instead of straight away.

I think the difference between the two is that with a planned C its alot calmer and everything is explained to you beforehand.

I think they could improve emergency C's by explaining whats going on. Also my DH felt quite left out of my emergency C as no one realy told him anything either.

I must say though that both my DC were happy and healthy and i am very glad that the hospital delivered my DC's safely, thats the main thing.

Hi, Mazzletov, I am sorry that you had a bad experience with your emergency section, even if you had a good outcome.

I had an emergency section for placenta praevia and antenatal bleeding which did not stop after 12 hrs at 31 weeks. I have no complaints about how things were handled, maybe helped by the fact that I knew from when the problem was diagnosed, that DS3 would always be delivered by ECS. My overwhelming memory now, 5 years later, is the rummaging around in my abdomen, DS3 being lifted out, all quiet and limp, he was held over the partition thingy for me to see, and left a bloody/gungy footprint on my glasses. He was then whisked away for rescusitation and away to SCBU whilst I was being stitched up.
I have nothing but gratitude to all those involved in my care, but feel v strongly that it helped me greatly to NOT have any particular expectations as to how I wished my ideal delivery to be. BTW, DS1 was delivered after induction, epidural, syntho etc etc, and with DS3 I had brilliant "natural" labour. IMO, the most difficult bit is having to reliquish that control that we would all like to have.

Sorry, I'll shut up now, realise I did not at all answer what you were asking for, so I'll try again:
hospitals should invest/improve communication with women, listen to them, but also explain to them why what happens.

I hope your meeting goes well and you feel afterwards that you have achieved what you are setting out to do.

Sorry to hear you had a bad experience. Here are my answers.

If you had an emergency C, what did you hate about it, and what might have made it better?

I didn't actually hate it. I was relieved that things were happening quickly once they realised there was a problem, I didn't have very strong feelings about which way I gave birth anyway (it was my second), quite nice that the labour pains stopped, and the operating team where very friendly and jolly: we were joking and laughing as they got ready to cut me up. They really did speak directly to me, explaining exactly what was going on, it was a very warm atmosphere. Ds was put straight onto my chest after delivery, so I got to see him in all his blood-soaked glory.

The only bit I didn't like so much was that dh (who was present in the operating theatre) wasn't allowed into the room where I was recovering- but I gathered that was to do with some sort of emergency concerning the other woman who was in with me at the time, so possibly beyond their control. It was only for a short while anyway.

*If you had a planned C, what aspects of it DID you plan, and how did this help?

no experience

*If you've had experience of both, what was the difference?

n/a

*If, unlike me, you've done more reading around this subject, do you have any useful references/figures/data for me?

not really

I've had both EM CS with DS then planned CS with DD.

What I hated about my em cs wasn't the operation itself but the lack of care during recovery. I genuinely didn't mind that he was checked over before I held him, I was just releived he was ok. However there wasn't enough support on the post natal ward, really just lack of staff. I was crying a lot and my mum had a word with the lovely head midwife who came to see me. She said she also did not think post cs women had enough care and it wasn't right to expect them to do so much so soon.

My planned cs was very calm, had skin to skin after DD's checks and I felt physically better as I had slept the night before and not had the stress of labour. I also stood my ground in the post natal ward and managed to get a private room. When I buzzed to ask for DD's nappy to be changed after the op the midwife said "can't you do it?!" When I said I'd just had a cs she said there was no reason why I couldn't change her, I stood my ground and asked her to do it. I also insisted they left the catheter in until DP arrived the next morning as I knew they wouldn't help me get to the loo. I bet they thought I was a right cow, but I had to make sure I was able to rest and recover so I could look after DD better.

I was miserable after my em cs (although I did realise there was a genuine reason for it), but I think I coped with the planned cs so well as I decided to speak up and not take any nonsense from anyone.

I had to beg to have my catheter out as the bag was full to bursting point.

I was made to clean up my own blood from the floor when I leaked.

I was discharged after 12 hours when dd hadn't even latched on.

Yes, postnatal care was woefully inadequate.

They wouldn't even let us have the music we had chosen on when i had my emergency cs! I don't remember most of it, I think I've blocked it out. I ended up with a psychotic illness that is still undiagnosed and I reckon its because of the traumatic birth.

I found there was a vast difference in care between my vaginal delivery and emergency section.

After section I was waited on hand and foot, had cups of tea brought me etc. All because the damage had been inflicted by men in green coats.

After vaginal delivery I was in far worse physical shape: heavy blood loss, bad tear and episiotomy scar, in agony- but got told off when I rang for a nurse rather than shuffle all the way down the corridor to the desk. So the next time I did shuffle and nearly fainted at the desk. But hey, I'd had a natural birth; of course I couldn't expect people to do things for me.

In my emergency CS (which was not a crash section):

I did get to see DS immediately (he was lifted above and around the screen).
DP got to go to across the room with him, cut the cord and take pictures while he was cleaned and dressed. (That should be standard if there is a partner there.)
I did find it odd he was dressed (why?, although they did use our clothes. But I don't much care that he was cleaned: I saw him and he was very slimy (further off the due date than the doctors thought, but I kept telling them that). I got to hold him as soon as was practical though (I was still in theatre but had been stitched back up) and the MWs did try to help me with breastfeeding.

Staff also talked to me during the operation. Probably helped - they were very nice.

TBH I saw as little of DD (ventouse) as she was whisked away from me just in case. So DS wasn't really a different case.

Hi there, I have just read all these messages and then promptly burst into tears.
I had no idea how others were feeling after their em c's, I simply thought I was over reacting to my very traumatic experience.
I had pre eclampsia and baby and me are more than lucky to be here, every day I am beyond thankful for all life has given me..... BUT why do I not feel like a proper Mum ??? I had a GA and did not get to see my babe for about 8 hours, My husband feels this pain also as she was 5 weeks prem and she had to be delivered very quickly.
Absolutely nothing was mentioned to me about what was happening and I was so scared (I really thought we were both going to die)
I was being undressed as I was rushed to theatre, along with doctors yelling "move aside, life & death situation"
Like I said, after 10 years of trying she is my everything and more but why do I feel so robbed ?? (still crying)x
I just wish it had at least been acknowledged. Very soon after I left hospital I asked if someone could help me find out what went wrong so I could try to understand, only to be told "you are both so very lucky to be here".
Eighteen months later it is still with me everyday, I have stopped going to baby groups as I get upset when other Mums talk about their birth experience (jealous almost!)
Aftercare and emotional support would be fantastic and I would absolutely loved to have had a picture of baby being lifted out.
After carrying her all that time and dreaming of looking into her eyes, months of imagining how she would look and reassurance that she is ok, I think this is the first part of becoming a Mother.
"When a baby is born, so is a Mum"

mumamandy, it sounds as if you may be suffering from PN PTSD. IMO it is much more common after a traumatic birth than people think or than the medical profession would like for us to believe. I had it terribly after my emergency section with ds1 who was an undiagnosed breech like Mazzletov's. I was so angry at going through 36 hours of labor before anyone figured out something was wrong - and it took me hysterically demanding a second opinion for them to get it.

There have been some wonderful birth trauma support threads on MN and the birth trauma association can give you more information.

I would not have ds2 if I had not gone through CBT for a year.

I had an emergency for my first and a planned for my second.

The first was bad as I had no idea what was going on!! All happened to quick really. Looking back though I think it was a blessing that it was an emergency. I don't remember much either as I was so out of it with the gas and air and the pethidine. I would like to have seen my baby straight away but didnt.

The second was planned due to Major Placenta Praevia. I had a General Anesthetic. I have to say that it was worse than the emergency. I had too much time to read and think. Also the GA was worse as when I came round the pain was absolutely unbelieveable!!!!!! I didnt see my son for around 7 hours either.

In my opinion stay awake if you can and if your anything like me try not to read up about things too much!!!
xx

In my emcs

The staff talked to me all the way through, explaining what was happening and generally being very nice (they all laughed at the name dh wanted to call dd)

Although it was (I found out later) reasonably urgent that they got dd out quickly, they were all very calm and I never felt panicked.

They held dd up for me to see her as soon as she was born before whisking her off to do the checks (her Apgar score was 5 at birth, so I'm glad the checks were done so quickly).

Dh was with me throughout the operation and all the time in the recovery room etc, which was great. He got to cut the cord etc and was holding my hand throughout the cs.

They did wrap her up in something, a hospital swaddling thing, she was cleaned up a bit I think but still had vernix on her.

As soon as they could, she was placed lying next to me on the trolley/bed and the mw got me to have a go at feeding her pretty soon - within an hour certainly.

Despite it being pretty speedy (20 mins from them saying I needed a cs to her being born) it was fine and maybe the things I have listed above helped to make it an experience I have no bad feelings about. Also, I never particularly wanted a vb, I know some people who had really bad tears and the thought of that scared me more than the thought of a cs!

I hope your planned cs goes better. I think they are probably also less traumatic because the woman hasn't been through labour first so less tired and is also psychologically prepared for cs.

Oh and thought I would just add that because of the trauma of both births I was admitted to a mother and baby unit because I began to suffer with severe panic attacks. The first question that came out of my mouth with my second baby was 'is there anyway that he could've been swopped' and 'are you sure this is definately my baby'... How awful to feel like that!! I have nightmares too and can't seem to get the experiences out of my mind...
I can honestly say that both my birth experiences were traumatic.

I had an emergency CS. My DS was 36 weeks so I had not really got my head around birth and a birth plan but I knew I wanted a VB

In the event, I was rushed off to emergency CS. I was lucky that staff and team were fab. I was given one go at epidural which worked, I had been warned a GA otherwise, so am thankful I was around

DH was with me and the atmosphere was calm, quiet, no chatting but anaesthetist and consultant talking to me. It was only after DS was out and atmosphere lightened considerably that I realised they had been tense...

Scary things -
(1) DH signing consent and being told there was no time to explain all risks, simply we had to trust them to go and they would talk later

(2) watching consultant straighten up from exmainig me and saying "now, I need you to stay very calm"

(3) watching consultant back out of room and then run for help

(4) watching blood drain from midwife's face

but I don't mind as such because I know the medical team saved my DS's life and possibly mine

However, I saw DS as he was lifted up and heard him yell and saw him all pink and squiggly. The Dr held him up on his palm facing me so I saw him properly...

But I would have liked to see and hold him naked, to have him lie on me, to bf at birth, to cut the cord (even to see the cord) to have him in our clothes (not that we had any ) not just a hospital swaddling thing and actually to have a sense of peace and fulfilment from having birthed my baby

I never even had a single contraction and I don't feel I have given birth - I feel my baby was taken from my body - which is different but inevitable

I think for me the team tried to be as calm and helpful and peaceful as possible I just wish they hadn't had to be....

and the aftercare was wonderful we were in a private room and DH and DS stayed with me from that moment on.... I know that helped immeasureably

I agree I think the standard of aftercare can affect things hugely. I was in a private room with own bathroom (standard after a cs where I live) and it was very peaceful and private, dd slept loads for the first few days and I got to rest and recover.

I've just come back to this thread and it strikes me that 2 things stand out in affecting how woman feel about their experience after their deliveries:

1. Knowing what was going on and why
2. Aftercare, incl some kind of debrief after a traumatic experience.

I am uncomfortable with this dichotomy between CS and vag delivery as clearly either mode of delivery can be seen as a positive or traumatic experience depending on the circumstances.

mamamandy, DO make contact with the hospital/midwife/consultant who looked after you (or not, by the sounds of it ) and ask for a post-natal consultation. Of course your experience cannot be undone, however hopefully you might get the answers and explanationa you need to not let the way your DD arrived in this world spoil the rest of your relationship with her. These post-natal meetings are often done, you would not be the first and you would not be seen as a "difficult patient" . Who knows, you might want to go through a delivery again, some time??

If you had an emergency C, what did you hate about it, and what might have made it better?

My answers.

I had an emergency c section at 35 weeks. Mine was a complicated twin pregnancy - placenta praevia, increasinly, recurrant bleeds and bed rest in hospital from 30 weeks. I had a section scheduled at 36 weeks as the bleeds were increasing in volume and frequency and my consultant was worried that I was going to have a catastrophic bleed (rare, but potentially fatal bleeding for babies/me). At 35 weeks I woke up in a pool of blood - pumping out of me - and after a long night on the labour ward whilst they paged my consultant and dithered over what to do with me I finally had a section the next morning.

They had problems siting the cannulas and the epidural failed as they punctured my dural membrane. No idea why as I (apparently) had the top consultant in the hospital doing it, but I guess one of those things. They then gave me a different epidural (spinal block?) which didn't take so I felt the first incision. AFter that, they knocked me out with a GA which was very traumatic - machines bleeping, force-feeding me some vile liquid, pressing on my throat. I went under to the sound of Karen Carpenter on the radio, the awful bleeping of machines and the feeling that someone was trying to violently suffocate me.

I didn't see my babies being born. My husband didn't either - he was booted out into the corridor as he was told my being tubed was very traumatic and "a bit like dying" so best the husband didn't watch. He waited for over half an hour outside hearing no sounds, pacing around and eventually accepting that the babies had died. He was given Twin 2 wrapped up in towels fast asleep. Twin 1 was still being resuscitated. I was pushed out after another 20 minutes, still unconcious and with Twin 1 resting between my legs.

When I came round I felt very ill. Possibly from the anaesthetic and morphine. The latter makes me sick so I spent the afternoon retching, which after abdominal surgery is no fun. The pain was incredible - I'm not wimp but I remember begging my husband to get them to knock me out again as I couldn't bear the tearing sensation every time I tried to puke. A consultant came to warn me about the possibility of a " bad headache" from the botched epidural but refused to go into further detail. Just said "we'll cross that bridge when it happens" which was rather worrying. The consultant who did my epidural apologised to my husband in the corridor but didn't come to see me to explain why it had happened.

Both babies felt like strangers. I wasn't a witness to their birth and although I signed the consent forms before the operation I had no concept that things might go wrong and I might have to have a GA. Foolishly, when I'd been in hospital for the weeks beforehand (going out of my mind with loneliness and panic and fear about the bleeding) I'd consoled myself with the thought that one day it would be over. That in amongst all the worry and crap and panic I'd see my babies being born. I'd have that "oh, it's YOU" moment. I'd witness their arrival.

Sometimes things go wrong and epidurals don't work and I accept that I was just one of the unlucky ones. It feels very unfair given that I had a difficult time beforehand but I realise that life is sometimes like this. That's just my lot; that was just my day. What I DO find hard to accept is that no one (consultants, midwives) made any attempt to explain what had happened during the caesarean or the reasons why things went on. We were just left to get on with it, told we were lucky - that "you've got two healthy babies to be grateful for". Of course. We understood that but it felt as if what I/we had gone through that day was somehow insignificant and to be brushed under the carpet. It wasn't.

I had a debriefing a year after my daughters' birth, when I'd struggled with cracking PTSD/PND and that helped. An anaethetist, consultant and the head of midwifery went through my notes with me as I sobbed and sobbed my way through the meeting like a madwoman. The main gist was that I didn't see my babies being born, I had no idea how they came out and, importantly for me, what happened to them whilst I was out of it. I wasn't there to 'protect them' at birth and the thought that they may have been distressed or ill (they were both resuscitated at birth) was awful for me. They went through my notes in the meeting and explained what happened to me and why and it helped hugely.

It should have happened straight after the birth and I made this point to them. My daughters' birth is a mystery to me. Some people might say that doesn't matter - that a healthy baby eclipses any trauma that may have occured in the delivery - but rightly or wrongly it did matter to me. Not seeing their birth was and is a huge sadness and trauma to me for many reasons. A debriefing of my notes the day of/the day after their birth would have helped fill those gaps. It can never give me the moment of their birth as that was witnessed by strangers in a room with no love for my daughters (another sadness of mine) but it can give me a picture. It's just about enough. NOt really, but I can make and have made an uneasy peace with that.

Debrief people. Make sure the realities and risks of caesareans are fully known beforehand. Make them an educated part of antenatal classes, not just the responsibility of a junior surgeon in scrubs running through the consent form with two minutes to spare. Talk about caesareans afterwards. Counsel those who've had caesareans under GA and offer them photographs of the birth. Fill them in on what happened. Give them the moment of birth, even if it's secondhand. If that's all you've got then it's very precious.

Sorry for the epic. This is a hearfelt topic for me, as you can probably see. The only real trauma and heartache of my life and one that I can't ever solve. And there's the rub.....

*If you had a planned C, what aspects of it DID you plan, and how did this help?

*If you've had experience of both, what was the difference?

*If, unlike me, you've done more reading around this subject, do you have any useful references/figures/data for me?

If you had an emergency C, what did you hate about it, and what might have made it better?

I hated the fact that it was out of my control and that I didn't know what was going on. Everyone in the operating theatre was very calm despite it being an emergency which did help but I would have liked to have known for example roughly how much longer until DS came out, how much longer until I was all stitched up again etc. Being a first timer you have no idea how long things take so I was lying there convinced either me or DS weren't going to make it but with no idea when it would all be over and I could at least know the operation was going to be finished.

Apparantly DS was held up for us to see him when he came out but I don't remember (three days of labour and no sleep will do that to you) and DH went over to take pics while they did all the checks.

In an ideal world I would have liked DS to be passed over to me immediately without being cleaned but I guess in an emergency this isn't going to happen.

The absolutely worst part of the whole experience was spending only 30 seconds with DS before he was whisked off to SCBU. But again, it was an emergency so there's nothing I could have done about it.

I too was left with undiagnosed PTSD and PND - it was only when I went for CBT for chronic imsomnia (which I'd had since he was born) well over a year later that it all made sense. I have to say the CBT was absolutely amazing and put alot of ghosts to rest and I wouldn't be pregnant again now if I hadn't have had all the counselling. After mmy experience I was convinced DS was going to be an only child.

I agree with Kitstwins - a debrief after an emergency section should be offered to all new mums. It could potentially save the NHS thousands in follow up GP vists/CBT/therapy for PTSD and PND.

I had a very positive experience with my planned section, for dd who was diagnosed breech.

The only thing I planned was that I insisted the surgeon describe what he was doing whilst performing the surgery. When he came to see me immediately prior, to scan in order to confirm that she was still breech, he actually made a joke of it and said, 'I believe you want a running commentary'. He was absolutely fantastic, as were the entire team in surgery, they made me feel very comfortable and at ease. I particularly remember the anaesthetists assistant, who held my hands whilst the spinal was administered, and then along with the surgeon, who was Spanish and very funny, they told me exactly what was going on, and really made me feel like an active part. I was very clear that I did not want to feel like a piece of meat on a slab.

It was a wonderful experience. I am currently ttc #2, and it remains to be seen whether I will opt for another section, but the experience that I had certainly hasn't put me off.

HTH

If you had an emergency C, what did you hate about it, and what might have made it better?

My emergency c-sec was 4 years ago - To be fair, they did go out of their way to ensure certain things despite dd being IUGR so teeny and having to come out early. They made sure she stayed with me as much as poss and was handed to me as soon as possible wrapped in a blanket. However, the one thing that stayed with me was that no one actually told me what sex she was or showed me until the anaesthetist asked me a) if he could go and have a look whilst she was being checked out and b) whether I knew what sex she was and he came and told me (ok so DH was also at fault over this but he was caught up in stress/excitement of situation).

*If you had a planned C, what aspects of it DID you plan, and how did this help?

I had a semi-planned c-sec a week ago. I was planning a VBAC but waters went and i didn't go into labour so I had to go in for a c-sec. Given that I was fairly disappointed these were the things that were different -

I asked for the screen to be lowered when the baby was coming out and for us to see immediately what sex she was. This was great - made a 'moment' of it.
DH was prompted to take photos so we have some great ones of dd2 having just come out.
They arranged skin to skin as soon as possible (in recovery) and made sure I was holding dd2 as much as I could before this (blood pressure kept dropping so I kept feeling faint so I kept having to pass her back to DH)
We chose the music unlike with dd1 when we had crap middle of the night radio on.

Hope that helps. Will add if I can think of anything else.

dont' know if this related to emergency vs. planned but with the emergency DH wasn't allowed in theatre whilst I was having the spinal administered. With the elective he was and was able to hold my hand - a small thing but important nonetheless !