C-Sections: Should we all do 2 birth plans, just in case?

[Mazzletov]

I've just posted a thread asking for your views on what factors make an emergency c-section traumatic, and what factors make a planned c-section less so.

I've had another thought which I'd like to assess general opinion on.

Having found out, too late, that there are apparently certain "options" available during a c-section that women can request (but like me, don't necessarily know about in an emergency situation), I wonder if they should get us to do two birth plans: one for the straightforward birth (at home in water, in my case) we're anticipating and one for the appalling surgical delivery which we're not?

I was so confident of avoiding hospital that I didn't even pack a bag, and so would probably have laughed in the face of any midwife asking what my preferences would be in the event of an emergency C-section. (I might have asked, "what could cause that then?" and she might have answered, "nobody realising your baby's upside down til your waters finally break 15 hours into labour," and I might have said, "golly, if that could happen, how's about a 38 week scan just to be on the safe side?" ...) But it might have alerted me to the fact that REALLY AND TRULY, you sometimes don't know what might happen, and at least you can feel a teeny bit in control and "own" the experience if the worst should happen.

I wonder if our local Trust should insist on it since they've got such shockingly high c-sect rates. But would such a practice just be pandering to this awful state of affairs? Would a routine gathering of info on women's c-sect preferences almost justify their continued over-use of the procedure?

I'd rather they hadn't cut me open. But failing that, I'd rather they'd given me the opportunity to express my preference to have their pop music turned off, for example...

My birth plan said absolutey nothing. I had implicit trust in my midwife. I understood that all the community midwives routinely let the cord stop pulsating so I didn't even need to specify that. All it said was that I wanted a very clear explanation of anything that might be untoward. I think that once you're in the ambulance, and they know you'd been a candidate for a home water birth, the birth plan goes in the bin anyway. It might be a good idea to have a back-up. What do you think?

DD is 14 months old. I don't really feel let down by her personally - 2 other midwives and a near-graduation student also failed to diagnose the breech position. But I do think that somebody somewhere along the line should have flagged up that sometimes they get it wrong! I had no reason to believe I would have anything but a nice, easy home birth, and I feel she was just trying to be encouraging and supportive, but it did leave me unprepared.

She knew that a surgical delivery was the last thing I wanted, but I think it woud have been productive to say, "OK, it's the last thing you want - so if it SHOULD happen, let's talk about how to make it easier for you". Or, the people in hospital who spent ages popping in and out nagging about various things ("please put this gown on in case you end up in theatre". "Will you have an epidural in case you end up in theatre?") should have taken time to go through a few options I might like to consider. Like "Would you like us to turn the radio off?"!

My other post is trying to gather suggestions from others about what they'd have asked for in their CSs. Because it seems the things that people like/would have liked, are fairly universal and if they can't be made standard practice, then I feel that at least a short discussion about them should be.

It does sound like you need to go through this thoroughly with someone to lay your ghosts. Also that a big part of the problem is that you feel let down by the midwife.

It seems from this and other threads that the people who have come best out of crash sections are the people who had time to come to terms with it beforehand. Mummyfor3 and I, who spent many weeks in hospital talking to other mums, would naturally have come to the conclusion that sections were things that did happen to people, so they might well happen to us. (I was next to a woman who had already lost two babies and lay sobbing at night at the thought of having to go through yet another labour with a stillborn baby- so I think I was mentally prepared for pretty well anything.)

Maybe this is something that ante-natal courses should stress more. But then they are probably afraid of being accused of not promoting natural birth. To some very vocal natural-birthers, it's like waving a red rag to hint that 'actually, we don't know for sure what your birth might be like, any one of you might end up with a section'. But by the sounds of it, that is the approach that would have helped you.

I did find the booklet given out by the antenatal clinic helped as they had quite a good piece on that, explaining exactly what might happen.

I think the ante-natal class covered sections too- but I missed that because I was in hospital. I know they did a visit to the SCBU unit, to prepare mums for the experience of a prem baby. That sort of thing should be promoted more.

Also, from the posts on this and all other threads it seems like the attitude of the operating team makes a huge difference. I would have felt perfectly comfortable to ask my lot to turn the radio off without any sort of birth plan, but then they were a really nice bunch. In fact, I don't think they had the radio on- they were talking to me. Maybe better training for people like anaesthethists on their role in women's experience.

My team asked me if I had a preference of music (during an emergency cs), I said no so they just bunged the radio on - but then immediately after DS was delivered they all burst out laughing when I said the following:

me - 'what is it?'
them 'it's a boy'
me - 'is that fecking Toni Braxton I can hear?'

I´m getting the impression that some women are almost confrontational in their interactions with hcps. Yes, mistakes happen and sometimes things could have been done differently, with the benefit of hindsight, but why should the mother´s views be better than the opinion of hcps who have had YEARS training in the field and are potentially using their experiences of thousands of women who have birthed with them previously? At my last delivery I had an episiotomy and did not suffer in the least for it , though would not have chosen it given the choice (I was not consulted about the procedure) Imo this should not be done routinely, but in the opinion of the soon to retire obstetrician the outcome is better than with no episiotomy. I don´t know, I don´t have 30 years experience of birth, and accept that other doctors may believe the contrary. You can only put trust in the staff to do what they think is right.

I don´t understand this need to ?own? the experience and to exercise control over it. The whole point is you are NOT really in control, your BODY takes over. The worst that can happen is not having a cs, this is not any kind of failure but could lead to a healthy baby being born. We all know how many women die in or shortly after labour in the developing world. A ?medicalised? birth can prevent this and we should be more grateful for it! I think we ARE getting too precious about birth. Why not think in terms of delivering a healthy baby, however that may be, and bearing in mind that the vast majority of women recover in a reasonable timeframe. Mazzletov, why do you think a surgical delivery will be appalling? A lot is in your reaction and perception of circumstances. I would never have presumed it would be appalling ? a pity, and inconvenient, but not appalling. Why on earth is having a cs the worst thing that can happen? A still born baby and dead mother are the worst things that can happen and hcps are much more awate of this than we are.

Is birth experience now a competition? Why do some women feel they´ve lost out or failed because of a cs? However the baby gets into your arms, you should celebrate the birth!

Starlight, I am not particularly ignorant about labour, tell me, why shouldn´t a woman stay at home until 4 hours before the birth, presuming she is a low risk case? And fully informed about the stages of labour ). Of course, anyone in the higher risk category might be told to come in earlier, even weeks before, like a poster here. I did ask when a woman is expected in the maternity suite (anyone? ? I had my babies abroad so not familiar with NHS procedures). I didn´t want a home birth, but was confident to stay home until what turned out to be 7 and 8 cms dilated. And went to the hospital in the car with dh (why go by ambulance, btw, presuming you have a car.) I think there is a happy medium between the home birth and hospital birth, and this is it.

I´m so sorry for those of you that have had a nasty birth experience. It really shouldn´t be that way. I don´t doubt that there are incompetent hcps or that someone can have a bad day and make a bad judgement. And people should always be treated with respect. But you have to believe that the hcps basically have your best interests at heart.

I don't know if anyone is still watching this thread, but for what it's worth...

Sachertorte:
'You can only put trust in the staff to do what they think is right.'
The CS rate at my local hospital is...wait for it...70%. The majority of women who go in to have a baby come out having had a cs.

The World Health Organisation says that in a country like the UK, with the standard of living and healthcare being what it is, the CS rate should be less than 5%. The UK overall has a rate that is deplorable by European standards, at 20-25%. Wth all due respect to those highly experienced professionals, I don't believe for a moment that all the surgical deliveries performed in my town are necessary.

There are many reasons why hcps favour cs over natural delivery. They get to draw down more funding for them. The team is hanging around anyway so may as well be used; otherwise their figures suggest inefficiency. A labouring woman is an unknown quanitity. They don't know how long she'll be pushing, what problems might arise, etc. etc. Their view is often, may as well whip it out and have done. They prefer surgical births because the procedure puts them in complete control.

The world of medicine is full of practices which are designed to give the doctor authority, power and control. Doctors like women to give birth on their backs, although it is known that it makes birth HARDER, because it restricts the space available to the baby (the tailbone flexes backwards to allow more space), because it gives them the best view. I put my trust in hcps to do what they think is right...for THEM, given their timescales, targets, budgets and the dozens of other considerations they have that are not even related to health outcomes.

But to answer your question, on why I thought a surgical delivery would be appalling: I just don't like hospitals! I'd never had an operation. I'd never been in an operating theatre. I wanted to be comfortable, at home, with my things around me, to welcome my daughter with as little intrusion and interference as possible. The bright lights, smells, uniforms and alien practices of hospitals freak me out. I become passive, compliant, submissive...and leave feeling ashamed for letting uncomfortable and unecessary things happen to me. This is why I THOUGHT it would be appalling. More to the point I was horrified at the thought of having a newborn babe to look after immediately following major surgery. (And I was right on that point. Our house has a lot of stairs. Our bedroom is very small. It was frickin torture.)

In reality, what really made it appalling was: not knowing who was in the room and why. Not being aware of the moment DD left my body. Knowing others were handling her while I waited. Hearing her make noises but being unable to see her. Getting a running commentary from a stranger while other strangers passed her around. Wishing I'd been more of a participant in the whole process, somehow. Spending the next 3 months feeling like I'd left the gas on...with a sense of having just suddenly upped and left the room in the middle of a job half finished. Because every cell in me was IN LABOUR, gearing up for the big push when DD and I would separate, and it didn't happen.

I then got a terrible rash, accompanied by a rather dismissive explanation ("it's the drugs"), and after 8 months of having a painfully sensitive abdomen (I couldn't wear jeans for 7 of them, and for the first 3 often didn't go out because I literally couldn't bear having clothes on), learned this was due to nerve damage. It was pretty appalling, TBH.

I'm glad we're both here but I think some astonishingly simple procedures could have made all this much less heartbreaking. They spent the hours before my surgery pestering me about medications instead of asking whether I'd like the screen lowered so I could see her immediately. And if they can't be trusted to have that simple conversation, I wonder if it should be brought into the planning process long beforehand.

That's all.

I don't know if anyone is still watching this thread, but for what it's worth...

Sachertorte:
'You can only put trust in the staff to do what they think is right.'
The CS rate at my local hospital is...wait for it...70%. The majority of women who go in to have a baby come out having had a cs.

The World Health Organisation says that in a country like the UK, with the standard of living and healthcare being what it is, the CS rate should be less than 5%. The UK overall has a rate that is deplorable by European standards, at 20-25%. Wth all due respect to those highly experienced professionals, I don't believe for a moment that all the surgical deliveries performed in my town are necessary.

There are many reasons why hcps favour cs over natural delivery. They get to draw down more funding for them. The team is hanging around anyway so may as well be used; otherwise their figures suggest inefficiency. A labouring woman is an unknown quanitity. They don't know how long she'll be pushing, what problems might arise, etc. etc. Their view is often, may as well whip it out and have done. They prefer surgical births because the procedure puts them in complete control.

The world of medicine is full of practices which are designed to give the doctor authority, power and control. Doctors like women to give birth on their backs, although it is known that it makes birth HARDER, because it restricts the space available to the baby (the tailbone flexes backwards to allow more space), because it gives them the best view. I put my trust in hcps to do what they think is right...for THEM, given their timescales, targets, budgets and the dozens of other considerations they have that are not even related to health outcomes.

But to answer your question, on why I thought a surgical delivery would be appalling: I just don't like hospitals! I'd never had an operation. I'd never been in an operating theatre. I wanted to be comfortable, at home, with my things around me, to welcome my daughter with as little intrusion and interference as possible. The bright lights, smells, uniforms and alien practices of hospitals freak me out. I become passive, compliant, submissive...and leave feeling ashamed for letting uncomfortable and unecessary things happen to me. This is why I THOUGHT it would be appalling. More to the point I was horrified at the thought of having a newborn babe to look after immediately following major surgery. (And I was right on that point. Our house has a lot of stairs. Our bedroom is very small. It was frickin torture.)

In reality, what really made it appalling was: not knowing who was in the room and why. Not being aware of the moment DD left my body. Knowing others were handling her while I waited. Hearing her make noises but being unable to see her. Getting a running commentary from a stranger while other strangers passed her around. Wishing I'd been more of a participant in the whole process, somehow. Spending the next 3 months feeling like I'd left the gas on...with a sense of having just suddenly upped and left the room in the middle of a job half finished. Because every cell in me was IN LABOUR, gearing up for the big push when DD and I would separate, and it didn't happen.

I then got a terrible rash, accompanied by a rather dismissive explanation ("it's the drugs"), and after 8 months of having a painfully sensitive abdomen (I couldn't wear jeans for 7 of them, and for the first 3 often didn't go out because I literally couldn't bear having clothes on), learned this was due to nerve damage. It was pretty appalling, TBH.

I'm glad we're both here but I think some astonishingly simple procedures could have made all this much less heartbreaking. They spent the hours before my surgery pestering me about medications instead of asking whether I'd like the screen lowered so I could see her immediately. And if they can't be trusted to have that simple conversation, I wonder if it should be brought into the planning process long beforehand.

That's all.

Gosh, yes, I am still watching this thread, am totally fascinated by it.

I am NOT particularly interested in the science bit of current accepted wisdom in managing labour and childbirth, but am very interested in how experiences have affect people.

Mazzletov, I agree, CS and, to some extent, insturmental delivery rates in this and most western European countries are appalling. And at rates of 70% that you are quoting. I thought our local one of 22% was bad enough!

IME, here and abroad, the decision to not "allow" a labouring woman to carry on is often coloured by the fear of litigation. My own experience of obstetric care has been mainly with my own pregnancies and deliveries, and I count myself lucky that I feel I do not have cause for complaint. As part of my training I spent 3 months in an obstetric hospital and really, really did not enjoy it, mainly because the midwives were so fiercly protective of "their" labouring woman that they (quite rightly) did not want some silly junior doctor messing things up. You are doing these (mostly) woman, and medical staff a significant disservice by suggesting they proceed to operative or instrumental delivery, or in fact, other interventions because it suits them! I accept your point about funding, and about control: believe you me, it is scary to watch a labour not progressing to plan for whatever reason, and to let it continue it you know a CS would at least in the shortterm give a more certain outcome.

Like I said before, I think you are doing an important thing, going in for your meeting, obviously v well prepared and informed. I am hoping that you will be pleasantly surprised about how much people WILL be prepared to discuss things with you, and explain; here's hoping. You may have a more satisfactory discussion if you do not go in with all guns blazing; it makes us HCP defensive , please don't. Most of the time we are trying our best.

I think the bigger issue, is political; hospital policy, guidelines, protocols and a general atmhosphere of fear. All this is a whole other story, and I certainly know is a development in the NHS I very much dislike, and I think longterm will work against patient's interest.

Right, I am off my soap box now.

Mazzletov, Thank you for your message, I´m so sorry if I´ve brought it all back to you again and upset you again. That was not my intention at all!

I wish you had said in your OP that the CS rate was at 70%! This puts an entirely different perspective on your situation, I really am finding it difficult to believe that this is possible in anything other than some kind of crisis unit for the highest risk pregnancies! Maybe Mummyfor3 could explain how this happens?

As I said, I am not familiar with the NHS and hope this kind of service is very far from common. I think it´s great that you´re striving towards putting procedures in place in hospitals to make a cs as comfortable as it can be.

Mazzletov, I do believe you can only put trust in hcps UNLESS it is obvious that they are incompetent or not doing their best for their patients, for whatever reason. It´s shocking that you midwife had not run you through the possibility that you would be transferred to hospital and what that might entail.

Starlight, you have quoted me out of context. It just so happened that I didn´t spend more that 4 hours in labour in hospital, and that worked for me. What I advocated was waiting until as far into the labour as is comfortable, judging as far as possible when it is prudent to have medical assistance, giving your knowledge about labour. I´m not saying ?go into hospital when you only have 4 hours to go?!

I don´t presume that all births are the same and like mine. I specifically said you can not plan out every eventuality and I don´t doubt for a second that some women have truly horrendous labours.

Personally, I would NEVER put some kind of value judgement on women who had a difficult labour and perhaps you assume wrongly that I had an easy first birth. I laboured all night on my own, no pain relief , in hospital had an obstetrician stamp on my stomach (baby stuck), instrumental birth, episiotomy, couldn´t sit down for 6 weeks after the birth. So lots of things women might complain about. The difference is perception, not that I ?had an easy time?. I was happy the baby was born healthy. Staying home in itself gives control over your situation and I think improves your perception of pain. The hcps did what they thought appropriate to get the baby out when they became worried about it (and here I can perhaps be grateful that I wasn´t in UK, otherwise they may well have performed cs)

I suspect you have completely unrealistic expectations of hcps. You think they should KNOW you and your QUIRKS? Er, no, I don´t think so. Provide a big cheering party if necessary? No. Your birth partner, yes. Make you as comfortable as you can be, of course, but their input to me is basically medical. And if you treat them in any way like I have the impression you do, I´m sure you didn´t get the best out of them. In any situation, does somebody respond better to a 7 page report or to being spoken to directly, whether the mother or birth partner convey the message. I think Mummyfor3 answered confirmed this earlier.

?Hindsight IS a wonderful thing and most people use it to control and ensure their second births are nothing like their first? ? the point of hindsight is that it is easy to know what went wrong AFTER the event, that does not mean that people did the wrong thing, but what they thought best at the time. You presume that ?most people? are not happy with first birth, I don´t know if that is the case. And each birth is different, and not surprisingly different to the one before it.

CS rates in UK seem appalling. Absolutely shocking. This is the one thing that I have taken out of this thread and I hope things improve. Any mums to be, reading this thread will be much more aware of this and can prepare for it. I hope they take away the (VALID MESSAGE) that labour is not always terrible, it can be the most wonderful experience with caring hcps who do have your interests at heart..

i wanted a home birth with dd3 but thats wasnt to be i was already everything planned and saw a stand in midwife she sent me off to hospital for scan turned out baby was breech so much for nice relaxing homebirth stuck in hospital emergancy c section stuck there for three days

Interesting thread, thanks for the time invested in it! I´m so shocked by some of what you have said, still can not believe a normal maternity ward can have a 70% cs rate..

Different countries in Europe, would rather not say tbh... I have to say, the biggest difference imo is the length of sta in hospital after birth.. 5- 6 days normal following a "normal" birth, longer after cs. As in UK, staff can be overstretched but my overwhelming impression is that it´s 10 times better over here.

Mazzletov, do you have anymore information how a CS rate of 70% comes about?
I have been thinking about it today (anything to keep the mind busy whilst smiling and nodding politely to MIL drivvel conversation ) and even accepting your hospital may be tertiary referral centre or some other centre of excellence for high risk pregnancies/deliveries, I just cannot get my head around a CS rate as high as that. And are they elective or emergency CSs that drive the rate up?
The mind boggles.

Apologise for poor grammar... Particularly last sentence is baaaaaad!

Hi, sorry to have left you hanging so long, Mummyfor3!

This is one of the questions I might raise tomorrow but tbh I don't want to get them all huffy and on the back foot so it might be best not to push them on it. There are hundreds of things I'd like to get them to change so I'd better pick my battles (but delicately, like daisies, thanks for your advice on that point ). All I can say is that during the NHS antenatal classes (which are called "parentcraft" as they give no more than passing attention to actual childbirth, it's more about washing, dressing and avoiding SIDS), the phrase, "unless you have a Caesarean" seemed to be tagged on to so much of what the MW said that someone picked her up on it and asked what the rate was. Her answer shocked us all. It's not a high-risk referral unit at all, just a normal hospital (well ostensibly normal: "CENTRE OF EXCELLENCE"?? - snort and guffaw!!!). I tried to look at official stats and couldn't find anything to confirm this, though. I don't know where she got it from, but she did say it with absolute confidence, and repeatedly. One person I spoke to has suggested she MUST have meant the VB rate was 70%, to a CS rate of 30% (I'd still have been appalled). She did say that a very great proportion of them were elective. I'm not really sure how they class this, though. I do know women who were administered an "elective" cs after a good deal of nagging from the HCPs in attendance.

The statistic seems to bear out anecdotally, with many mums in attendance at our parent & toddler group on a given morning having had a cs. One "just wasn't dilating" (only found out her baby was posterior after the birth, in passing conversation, so didn't prepare for a long 1st stage and got so tired she accepted their offer of a CS). One was making fantastic progress(7cm dilated and managing the pain very well), until she was wheeled into a LIFT with MEMBERS OF THE PUBLIC smiling politely at her arse hanging out of the gown ("Ooh, you're about ready to pop, aren't you?!") She was mortified and labour just ceased. Another had a very large baby (if you look at mum and dad this shouldn't have been a surprise!) and at some point, she's not quite sure why, he just seemd to stop descending and then showed some distress, so in she went. And while I'm the only undiagnosed breech that I know of, I was told by a physio who works at the hospital that this happens remarkably often. Now, 3 MWs and a senior student MW all palpated me in the 2 weeks prior to delivery, and NONE of them detected the breech position. I can safely say DD hadn't performed any spectacular somersaults in those late weeks so she must've been in breech for a good while before that too. I'll let you draw your own conclusions about training and competence on that score, but I'd suggest that this has something to do with a high CS rate. I do know that they simply do not allow natural delivery for a breech here. I met a girl who moved from another area where home birth options for a breech were being happily discussed, to here, where she was told to forget it. Likewise this must push up the CS rate. In the ambulance I asked the MW attending my home water birth (maybe one day!) whether she'd ever delivered a breech, and she said brightly that she had once SEEN it done ...

(I'd love to know whether a planned CS for a breech, despite the mother's wishes to the contrary, is noted as emergency or elective. I don't really understand elective CS; I thought there needed to be a pressing medical reason for it to be agreed to but it seems not, at least not around here.)

Back to those Antenatal classes - I did ask what the crcumstances were that could see you end up with an unexpected CS, and the MW said quite definitively: "If it's a big baby". (She did, to be fair, also add that a CS would be done for a breech baby. But as I'd been told I didn't have one of those, I didn't give it much thought! ) I do wonder what they class as "big", and how many women could be supported to deliver these apparently problematically humungous children naturally, given a bit more time, patience and support.

LOL, Mazzletov, at "delicately like daisies"!! Us HCPs, our egos bruise so easily .

I think you'll find a planned CS will be noted as elective, as in date was set in advance, performed in normal hours, full team available etc etc. I agree, there should be good medical reason, however what different consultant regard as such varies enormously.

I also sometimes wonder how many women have heard the phrase "too posh to push" too many times and actually believe that a section is something to "aspire" to. I have a very good friend who before she ever conceived stated she would only consent to TTC if a consultant would garantee her a CS beforehand "because she was not v good with pain" - like the aftermath of CS is not painful! AND you then have a newborn to look after. Anyway she went on to have a "normal" hospital delivery, no epidural, a bit of gas and air - and is considering no2.

Lots and lots of misconceptions out there.

I find myself v torn depending on whether I have my professional hat on or not: I would NEVER agree to attend a home birth (am not qualified, have never actually delivered a baby - puppies, yes, babies no - and am scared of complications+potential litigation), however would certainly consider one for myself (my husband would have a stroke if he knew this) with the help of an experienced midwife. I agree with you that deskilling is a significant problem, and unfortunately anybody trying to address that will be labelled "radical/militant".

Yeah, antenatal classes, useless, aren't they? I felt they were v much aimed at young/naive/illinformed people and found them v patronising - the biggest challange of impending motherhood is NOT how to change the babiy's nappy.

Size of baby - DOES NOT MATTER, size of head and pelvis do! A 10lb baby with a small easily molded head will be delivered more easily than a 7 pounder with a huge noggin! Also premature babies with tiny heads often are difficult deliveries (if they do come vaginally) as the head does not provide adequate pressure on the inside of the cervix.

Sorry, I am going to stop lecturing now. Off to earn my keep.

You go girl, go!!

really glad I did do my 3-part birth plan as I ended up having an unplanned section. My MW had thoroughly read my plan and was able to let the hospital staff know what I did/didn't want and where they were unable to do as I had asked they did explain to me why, which I was happy with.

I'm not sure if this adds much to the debate but as I had participated earlier on I thought I would update anybody interested, my birth plan strategy certainly helped me a lot when our home birth was abandoned.

goodness what is this all about statics and etc...
i never made plan, i just put open to all options, you never know what happen to you once labour started. it not like writing essay or planning bday. sounds like plan a -zor you need crystal ball

Great news titmouse and congratulations pink or blue?

thanks starlight we had a pink one