Politely, undemandingly enquired about "natural" caesareans. Received response seemingly tailored to a naive and delusional lentil-weaving control freak

[DorotheaPlenticlew]

So, second pregnancy and I'm booked in for an elcs at month end (will be 39+1). If I start labour sooner, though, I'll probably try for a VBAC. This has been discussed w/consultant (weeks ago) and various factors taken into account, incl previous emcs-after-long-labour experience; everyone seems happy with the plan as far as it goes.

Today I had a quick follow-up appt with the consultant I saw before. Clinic v busy, ended up waiting over an hour beyond appt time, then had to see another doc as mine was busy doing something else.

He was perfectly OK until ... well, as thread title, basically. I had read about "natural" CS on a thread here. Also read articles in Guardian and Times about it. Thought it sounded appealing. Asked consultant whether it was something I ought to discuss with my midwife, or could he maybe advise about whether it was likely to be something I could try for at our local hospital?

He hadn't heard of it, so he had a skeptical reaction & then went onto Google and looked at the Times article, skimming bits of it v quickly while at the same time telling me various reasons why it wasn't a good idea. I tried to make it clear that I wasn't trying to push for anything unrealistic, just kind of sounding out whether this approach was a familiar one amongst the team of people likely to be doing my surgery. Asked if it was possible the other consultant (the one I had seen before) might have heard of it. He said he would ask her, but still felt need to tell me that "birth isn't romantic". I said politely that I wasn't getting swept up in romantic ideas, and wasn't really fussed about aspects like lighting or music, but liked the sound of some things like the slower delivery, or the immediate skin-to-skin instead of taking the baby away first.

So off he went, came back with the other consultant. I somehow got the feeling right away that he'd quietly implied I was Being Awkward. She said she did know all about "natural" CS but that it was really not realistic, and not actually "natural" at all (I know that, it's obviously journalistic shorthand, it's surgery ffs, I'm not an idiot) and that if I was expecting the baby to crawl up my body to the breast on its own, it wouldn't happen (I had never mentioned or thought of such a thing). Also impressed upon me that the people who write these articles aren't doctors (again, I realize that, but there is an actual doctor (Nick Fisk at Queen Charlotte's) involved here and he's been doing these procedures for a few years now, so obviously not everyone thinks it is just silliness).

There followed a stressful conversation in which my specific wishes & reasons for them were picked apart in more detail than I'd prepared for at this meeting; many supposed misconceptions on my part were patronisingly overturned; and I was basically spoken to with the kind of weary patience that normally indicates the person is barely managing not to roll their eyes extravagantly at your outrageous, silly ideas. I was also asked if I really wanted my naked breasts exposed to the entire theatre team throughout the procedure, as they'd need to be if I want immediate skin-to-skin. Said that would be OK if necessary. Was told "It's quite a lot of people, you know, quite a different atmosphere to a small labour room" (yes ffs, I KNOW! I had a cs last time!).

Upshot: it sounds like I will be able to have skin-to-skin with DD immediately as long as she is breathing OK and stuff; so that is a small victory, I guess. But I also get the distinct feeling that simply for raising the issue, I've been branded a "difficult" patient (notes were made), which seems really unfair given that I didn't remotely go in with fixed ideas or demands -- I am not like that, not at all. I mean, last time around I didn't even make an effing birth plan.

Sorry so long, just needed to rant a bit as I had been feeling very positive and confident about the prospective elcs, but am now associating it with feelings of difficulty and potential awkwardness/struggle and being judged by the very people who may actually be performing the surgery. It's making me feel kind of sad.

So sorry to hear this. I asked my consultant about skin to skin after my elective, due in 9 weeks. I also felt I was being looked at as an ignoramus. I explained I had felt very detached after DD's emergency forceps birth and didn't see her until she was completely wrapped up in towels and hat. Didn't know what gender I had had. I understood she had needed checked over but I missed out so many parts of what I hoped for in the birth I was hoping an elcs would allow for a little more 'sight' of the new arrival.

I know people on the boards here have spoken on how they had skin to skin straight away. I have been told its not possible. DC will need to be checked, wrapped to keep warm and then I can hold him in recovery once all stitched etc. Last time I was an hour and a half being stitched after forceps so again I am sad I will again not be able to hold my baby for ages.

Not much help, but I just wanted you to know you are not alone and I am also going to bring it up again gently when I next see the consultant. Doubt anything will be changed though.

I have had 2 electives and was lucky enough to have a great consultant. I too had read about Nick Fisk and wrote a c-section birth plan listing specific things I wanted. My consultant went through the specifics and said i could have all of it, except asking for dimmed lights at the point of birth. I thought it would be nice for baby to be gently brought into the world but consultant said that the baby needs the shock of birth to kick start breathing which made sense.

The most important thing was immediate skin to skin. The babies were brought to me immediately. The cords were cut because I had short cords both times. My chest was bare because I had the gown on back to front and as soon as the baby was coming out the mw opened it for me. The baby was not covered in a towel, so could only feel my skin. The AGPAR score can be calculated whilst you hold the baby. Obviously if the baby wasn't breathing etc it would have gone straight onto the table but no mum would contest that. After about 10 minutes the mw took them for a quick look over. I could see them at all times and breast feeding was established whilst in recovery.

Is there anything specific that you want from the c-section that they are not allowing? What hospital are you at - just in case it happens to be the same one and could have another consultant - I was at Mayday in South London.

You weren't being awkward - you were trying to work out the best way of delivering your baby. I'm sorry they were so unsympathetic.

I'd be inclined to send them this saying you thought they might be interested in reading a little more about the technique. They might respond more favourably to something in a medical journal than something in The Times and if not, they might learn something from reading it! But then I don't mind being thought of as awkward!!

Thanks Lovethesea. I wish you luck bringing it up again.

And if they won't budge, well, hopefully this time at least your stitching will be a lot quicker -- I don't recall the timing of my emcs very well but I don't think stitching took anything like 1.5 hours.

It seems obvious that there are a lot of variations in approach between hospitals and individual surgeons, so I wish they could get their own heads round the fact that a woman who asks about something outside their own habits isn't necessarily just talking out of her arse!

Oh hey, more posts, thank you so much for wading through my lengthy OP.

Good idea about having gown on back to front! I did think there must surely be a way to avoid being simply totally naked the entire time (although would still do it if had to). It sounded like she was actually trying to make it sound embarrassing, tbh. I am at the Edinburgh Royal Infirmary; and the thing they baulked at most that I'd hoped to try was the notion of a slow, partial delivery without cutting the cord straight away -- thereby allowing the baby to look around a bit and "autoresuscitate" and just get used to what was going on instead of being whisked out all in a rush. But apparently this is not feasible for various reasons ...

Thanks for link, Haliborange, haven't clicked yet but much appreciated.

Glad I posted, can feel my confidence coming back already

I hadn't spotted the bit about naked breasts. I actually find it quite funny that they said that (quite apart from the fact that a gown put on the right way can simply be pulled down to allow skin-to-skin). It's not as if you keep your bits hidden in a cs- they have to catheterise you FGS. And then if you BF you spend the next few months showing your breasts to all and sundry - as if a few medics seeing them would make a jot of difference!

Haliborange - thanks for the article. I will print it out and discuss it with my consultant at my next meeting. I don't care if it all needs to be abandoned for the baby's health, but I would like to feel part of the birth as much as I can.

It's a really useful article. I wish I'd had a printout of it with me -- a lot of the problem, I think, stemmed from the fact they seemed to think I'd just read some made-up idealistic guff in the papers, and was so dumb that I didn't realize it wasn't by Real Doctors.

I mean, actually telling me in a kind voice that journalists aren't in fact doctors -- the more I think about it the more depressingly patronising that seems. Hey ho, I guess it was just a throwaway remark with an unspoken "as we both know" attached. I will generously give her the benefit of the doubt on that one

What an excellent article. I think you need to highlight the parapgraph starting, "Perhaps, the biggest obstacle to implementation is reluctance of staff to change roles and give up rituals", before sending it!

Check out the Royal College of Midwives homepage, they published a fab supportive article yesterday.

I'm a bit torn now though. Do I raise my hopes and expectations of what this birth could be like .... and then get crushed again as I was when DD's birth went so awful. Or do I have almost no hopes for anything nice from it and so leave myself less likely to be disappointed?

Hopefully there will be a middle ground of compromise with the consultant.

With DS1 I was devastated as ex-DH was told to take him from the room and by the time I got into recovery he was fully clean and dressed I had no skin to skin, I had morphine, I didnt manage to breastfeed very well and had a horrible recovery and postnatal period.

With DS2 (attempted vbac, emcs) I had in my birth plan that DS2 wasnt to be wrapped in anything but a towel, that as soon as I was in recovery (theatre ideally, but I was being sick and wouldnt open my eyes so didnt happen) he was placed skin to skin on me - he also wasnt to leave the room until I did. They were very accomodating of all of this - I managed to breastfeed as soon as I was in recovery (and for 10m instead of a few weeks with DS1) and had a lovely hour of skin to skin and getting him dressed.

I had a great midwife who sat with me and did my birth plan. Even when things went really wrong she stuck to as much of it as she could, and I am really thankful for her. Is there a way of doing something similar, with the midwife in the room with you when you are getting prepped for surgery? IME the midwives are there for the mothers and babies, where as the consultants/surgeons just think of the operation.

Malteser, thank you so much for pointing out that article on the RCM page.

I think I will maybe email the consultants (or at least one of them; it looks she has an email address available online). Probably they will still be about me but tbh I can't really afford to worry about that, too much else going on in life just now.

Seeing my midwife on Monday, so will ask her about this too, and bring a draft birth plan to see what she thinks. I have a feeling I'd have been better off not asking the docs at all (or not yet), but instead speaking to her in the first instance. She's sympathetic, seems quite open-minded and knows me well because she was my MW during last pregnancy too.

Lovethesea ... it's so crap that you have to even ask yourself that question, but I can certainly see why you're doing so. Wish I had a good answer for you. Will be thinking of you though. 9 weeks till your due date = still time to think and plan your approach and keep drawing on any RL support you can find. Have you got a good midwife you can discuss this stuff with?

After my planned cs I had skin to skin with DD within 2 minutes of her being whipped out. IIRC they showed her to me then gave her a quick check and on the table then passed her back. I certainly didn't have to wait for very long or until she was dressed or anything. She was with me all the time and stayed in the little plastic cot when P left the room to get changed into his clothes. The surgeon showed me the placenta too and talked me through it as I'd forgotten to ask when I had an em cs first time round.

The consultant said it was normal procedure to do skin to skin after a cs. It was just a bog standard large hospital / maternity unit and a typical consultant (who was probably off to golf after the op). I am suprised its not standard in all maternity units.

I have to say it was jolly awkward holding her with one arm and I was only too happy to pass her back to P after a few minutes as I thought I would drop her . It was easier to hold her in recovery when I was propped up. Pics on my profile actually, she is a little squashed.

QTPie, x-post, but actually I completely agree with you; I'd rather a surgeon was comfortable and working in the way he/she preferred, so I wouldn't insist on anything out of the comfort zone (excuse cliche). And actually, as I said to both docs yesterday, the emcs I had was really a good experience in general; no complaints about that surgeon at all or how it was done, I just wanted to explore other possibilities this time as it's not an emergency situation.

I think what bothers me more, really, is the feeling of having had my basic intelligence seriously underestimated simply because I brought the topic up; that, and the fact that they felt the need to pin me down on stuff I hadn't expected or prepared to discuss in-depth yesterday, and then spend ages telling me how wrong I was about everything.

In fact (a) all I'd wanted was a general response about their feelings towards the whole notion of the so-called "natural" caesarean; and (b) as articles linked here show, it is clearly not the complete pile of toss they appeared to be "kindly" trying not to say it was.

Honestly, if you can transfer from the ERI to St. Johns I would recommend it. Heard very good things about St. Johns.

Simpsons is a baby factory full of arsey career doctors who treat you like a moron unless you are a good little patient and do as you're told, then they'll treat you like an obedient moron. I was not an obedient moron , and I certainly wont be having DC2 there!

Your welcome, if your midwife is a member of the RCM she will have received her copy of the journal through the door this week. For once it was a copy with some interesting reading! The unit I work in always offers skin to skin in theatre and will drop the drapes so the mums to watch the baby being born if they wish. I don't think you are asking for much....I think the problem stems from the term 'natural cs', it needs a rebrand to make it acceptable to obstetricians!

Agree with that, "natural" cesarean is not the best term, and that it probably does not help.

I can understand consultants being a bit nervous of changing their procedures, especially with something like elcs where the procedures are actually quite established. Walking out the baby for example sounds quite groundbreaking. But there ought to be some middle ground - I think lowering the drapes, making it possible for the mother to be amongst the first few people to hold the baby and perhaps not taking the baby out of the sight of the parents could be a good starting point and surely not all that contraversial.

I did hear a while ago about a woman who had a lotus birth with her elcs, which just goes to show what some surgeons will accomodate.

dorothea I had my elcs 10 days ago. Overall it was a positive experience. I didn't get skin to skin in theatre but did in recovery, around half an hour later and was able to bf straight away.
If I was you I wouldn't really give a shit if you are worried they think you are being difficult. But to avoid disappointment, I would pick a couple of issues that you are not willing to be budged on, for the whole birth situation and tell your dh/dp whoever is going with you and don't let them talk you out of it.
My ds2 had borderline low blood sugar levels and the midwives in recovery were very pushy to give him a bottle and I refused. Got a narky comment in my notes and then she sent for a paediatrician (sp?) to come and bully me into it.
I firmly said that I understood what I was being told, but I didn't want to jump straight to formula without trying to bf more first.
It is hard to stick to your guns, but you must choose your battles and fight them. I told dh from the start, no formula or if I was in a coma or similar, no bottles only feed from a cup. He was supportive and happy to go along with my decision and backed me up which really helped.
Apologies for mammoth post, but hope you get the gist, pick a couple of issues and stick to your guns. But be realistic and obviously be aware that your health and you baby's is what counts!
good luck!

Ooh, can anyone link me to the RCM's article you're talking about please? I've had a look, and I can't find it (grrr). Ta

Think this is it.

Good luck with the birth. You never know you might end up witha vbac anyway mine took me by surprise and was wonderful

Ah, thanks - just seems to be a rewrite/summary of the Smith 2008 article, but worth noting!