Advice needed on choices for unplanned/emergancy c-section in birth plan

[allyfe]

I'm nearly 35 weeks pregnant with DC2 and was thinking it might be worth my re-visiting my birth plan from DC1. This pregnancy I've been diagnosed with gestational diabetes, and one of the possible risks can be the need for an unplanned/emergancy c-section. I am adamant that I am going to have as much chance for this to be a vaginal birth, but JUST IN CASE, I wondered if anyone has any advice/thoughts on any choices I might have on what happens? They didn't cover that during the NCT classes the first time round .
Thanks! Ally

I would imagine you will have every chance of having a vaginal birth, but if a need for a cs comes up, unless it's an immediate emergency, it will be discussed with you so you know why it's being suggested.

Is this what you mean?

Speak to your midwife. If necessary ask for an appointment with the hospital to talk about your concerns. I had an em c/s with dc1 and was terrified right the way through my second pregnancy. I spoke with people at the hospital and they were pro vaginal delivery and very anti c/s unless life or death, as with my first baby. Trust me, when you are told your baby may die if you wait to deliver naturally you really don't have any choice. They will discuss it with you and you have to sign a consent form before they operate so make sure your partner knows your wishes in advance in case you are off your head on gas & air!

Best of luck with it all!

By the way, I delivered naturally second time around

I had a emergency cs with ds, and I agree with fiftyfifty, to be honest you really have no choices by that stage. I was almost given a general anaesthetic for mine which I really didn't want but when the alternative is to feel the pain of them cutting you open again there's no real choice. They also weren't reading the birth plan! Which is exactly as it should be when potentially your child is at risk.

I would instead focus on your own mental preparation for it and maybe 'give yourself permission' for an em cs if you need one - I felt terrible after mine, revisiting the whole thing and thinking 'if only I'd made this choice at that stage maybe it wouldn't have happened...'. I also felt completely unprepared for the cs by both the NCT and the NHS classes. Sometimes there are no choices.

Why so negative about it? It really is a choice about mum/baby may die - what's the confusion? Nobody gets a medal to pin to their vulva you know.

They didn't cover c-sections in NCT classes? I know this is now besides the point, but I'd be tempted to complain. They are meant to. The teacher might put a more or less negative slant on it as she talks to the class about what might happen, but they are certainly meant to cover this possibility - especially given the c-section rate in the UK.

I'd find out about it from your GP or MW (or talk to a friend who's had one) and write an 'in-case' section of your birth plan. Clearly you don't want a c-section rather than the vaginal birth you say you'd prefer, but there are still a lot of things you can still have. Like skin-to-skin with the baby as soon as it's born, like breastfeeding at once, or like your DP holding the baby and giving it skin-to-skin if you had to have a GA. Put your preferences in your plan and if it goes towards a c-section, make sure everyone in the room KNOWS.

(Oh, and if you plan to breastfeed and are worried that GD may mean they'll want to push formula, find out about this from a local breastfeeding counsellor (check the NCT website for a local one) or pro-BF midwife, and maybe consider expressing some colostrum in the run-up to the birth, in sterile syringes that you can freeze. I was fretting about this the other week, and my MW said if I did end up with GD, I could express and freeze, and she or DH would pump the baby full of colostrum in between my feedsd, every time the baby opened its eyes. Granted, she's an Independent MW and is going the extra mile, but I think it's sound advice if breastfeeding is something you feel strongly about. Feel free to ignore me if I'm making assumptions, though. )

ReshapeWhileDamp and fiftyfifty the 'in-case' bit of the birth plan was exactly what I was thinking about :) I'll be pleased if I manage to make the gas and air work, last time it felt like air and no gas so I opted for the epidural!

I wasn't sure what my options were likely to be and so I was wondering if anyone had any advice since I'm not sure when I'll get to see the midwife next (I keep seeing the consultant instead!).

I'm not expecting them to be reading the birth plan either (although the idea made me laugh), but rather for my OH and me to know we want. Although, nesomja you may be right, it may well be a situation where there are no options.

Alpinepony I think you missed the point slightly. Evidently, if an unplanned/emergency c-section is necessary then I will have one. Nevertheless, some hospitals are quicker to offer them than others and I want to be aware in advance what my options are (if I have any and it isn't an emergency). My DD will be only 20 months and will find it really hard to understand if I can't pick her up but can the new baby. So I'm not looking for a badge of honour, csections are an important in many situations for the health of the mother and child. However, I do want to best understand what my options (if any) might be.

Just because it's an EMCS, doesn't mean it's necessarily a case of get-the-baby-out-in-5-minutes-or-someone-dies. So you may want it in your birth plan that you want what is happening to be explained unless it's a case of there not being time to save your life or the baby's.

Also, they will still try for a spinal or epidural over a GA because it is safer unless it really is a case of every second matters. So you can still have options like your OH staying with you (or not), having skin-to-skin when the baby is born (or baby being cleaned first or OH taking baby).

And as you feel an EMCS is a definite risk, you may want to have info in your birth plan about wanting to keep having clear/pale fluids even if solid food is out.

yy, to not eating too much in case of an em cs. You really don't want to pig out on chip-shop chips at the start of labour then get an em cs and end up with God-awful constipation due to carb overload, not that I know anyone daft enough to do that .

I ate much less in the run up to my planned cs and my stomach, wound and bowels were much better for it.

You can have skin to skin in theatre too, it's a bit tricky IME but very sweet for a few minutes. However I always wanted the nurses to check my DC over before I held them as I do tend to worry a bit.

IME the staff are brilliant with an em cs, all hands on deck and they don't muck about but should explain what is happening as they go along. I was told I needed an em cs at 09:50, form thrust in front of me to sign (I'd like to see my beautiful handwriting on that form!), nail polish whipped off (badly

I had an EMCS under GA after a long labour. I would be asking questions about what they can do ensure Mum baby bonding and establishing BF afterwards. I had no great issue with the birth, twas an emergency after all, and dd and I survived.

But afterwards we got stuck in a room to get on with it. No help, no assistance apart from the lovely lady who took dd off for a change and feed. Bottle feed though, - noone at all was on hand to help me learn to BF. My dSis, who BF all 3 of hers gave it her best shot but.....I would not want that for others.

I would agree with all Portofino says. Make sure they do their damndest to ensure you and baby have the best chance you can to bond and breastfeed.
Mine was an em c-section after 19 hours of labour and six, count em, six bottles of gas and air so frankly I was away with the fairies but I dearly wish my shellshocked hubby had insisted on some skin to skin and breast feeding as soon as possible. I ended up in high dependency after a bleed following the section, who knows if I'd breastfed I might not have had the bleed, and by the time I was mentally able to bfeed we only just managed it. The midwife had to blow in my son's ear as he latched on as he kept falling asleep as soon as he did. The falling asleep is the final stage of them conserving energy because they're so hungry
:( Also make sure they dress them for you. My hubby was sent home and DS spent the night in just a blanket! :(

You can ask (but may not get, esp if it is a very urgent section):

• to have the monitor pads put under your arms so you can have the baby on your chest right away

• to have immediate skin to skin and the baby checked on your chest

• to have the baby not taken out of your/your /DPDH's sight (obv unless there's a big emergency)

• To find out the sex of the baby yourself.

• to have them lower the screen so you can see the baby born (you won't see the incision over your bump)

• for someone to tell you what is happening all the time

I had some of the above in the "just in case" bit of my VBAC birthplan but typically the plan went out of the window and they knocked me out instead! FWIW, my first emcs was a very leisurely affair and I am sure they could have done some of the above had I given it any thought and not been hysterical.

Poppet - I am dead impressed with your 6 bottles of G&A!

It's been really interesting to read other people's responses here as you're all right, there definitely are options like skin-to-skin and breast-feeding afterwards. I think though that in my case getting too caught up with that kind of thing make it worse - I had an extreme response to the anaesthetic (which apparently isn't that uncommon) and was shivering violently the whole time they did it and for 45 mins afterwards, and couldn't feel anything from the neck down. I obviously wanted to see the baby straight away but he was whisked away because he was in distress and then they cleaned him up because he was covered in meconium. I spent this time worrying terribly that my baby would be harmed because I wasn't able to hold him and have skin to skin immediately, and worrying that if I did hold him I would drop him - I kept telling my dh to go and have skin to skin with the baby and telling everyone in the room that I wanted to breast feed as soon as possible - looking back I think I would have done better just to realise this was one of those times when medical intervention takes over and I would just have to trust they were doing what was necessary.

So I think for me an important part of the process was realising that the options I wanted didn't not happen because I didn't shout loud enough, which was the impression I got from the NCT classes. However, we did have skin to skin later, he did breast feed and it was all okay in the end - think it might have been easier for everyone if I'd just relaxed and let them get on with it at the point of the cs though :).

I will second what people have said re skin to skin and breast feeding. Also make sure you shout loudly if you feel sick, this is very common and they can give you something to stop it. No body has mentioned photo's. We had a wonderful midwife (or poss could have been the anaesthetist) who took our camera, and took loads of photos of the birth - some are a bit gruesome but interesting to see! most are great, DH would have been afraid to move so she got much better shots than he would have. Also take some really big knickers. Normal ones sit right on top of the wound.

Oh god yes. Buy the largest pairs of apple catchers you've ever seen.
And thank you for noting my six bottles of gas and air prowess. preens. DS was stuck sideways in a fun position called deep transverse arrest so it did get a little stingy. :)

A very belated thank you to all of your for your really helpful comments.

I've just amended my birth plan drawn up for DD1. It did make me laugh to read it because nobody looked at it. But it is useful at least for me and my OH to know what we want.

Asking for the epidural over the GA (if possible) and making sure I can breast feed ASAP are really helpful. GA makes me ill (at least it did last time I had one) so it would complicated breastfeeding terribly - even once I'd come round.

Thanks again for your advice and suggestions.