Elcs birth plan - do they take notice of it?

[LittlePickleHead]

I'm due for an elcs in three weeks and I've just been writing my birth plan on the advice of my consultant.

Has anyone else done this and what kind of things did you include? I had a traumatic first birth with DD where my birth plan was completely ignored, and I guess I'm a little worried the same will happen again.

I have so far got that I'd like a commentary of what is going on, the screen lowered at the moment of birth (or is this a bad idea and will I faint when I see my tummy cut open?!) and immediate skin to skin with myself or DH. I've also added that's would like bf-ing support and if possible a cosleeper crib on the postnatal ward.

Is there anything else I should be thinking about? I don't really know what to expect and it's daunting!

If you draw their attention to it then I guess they would pay attention.

Not sure about the complete screen lowering thing - usually they just lift baby above it to show you when it's completely out. It's part of the sterile field & you'll be lying down so depending what you call the moment of birth (head out?) might not really see much with the lowering that can be done - the incision is quite low.

If it's a clear Apgar 10/10 then could go to parents for skin to skin but there would be an intermediary of onto sterile blanket/cot then handed to you/picked up by DH because again, the person holding it needs to stay sterile. Otherwise there may well be a Paediatrician there - some C-section babies are a bit stunned & need resuscitation to get things going which may take priority.

I suppose ElCS are more defined than writing a generic birth plans - so can't think of many specific things I'd put in one! Spinal v. epidural analgesia perhaps, DH to be present & think I'd be interested in commentary too (apart from needing to hear if I need a 'fat stitch' layer or not - haha!).

One thing to remember is that unlike when you were in labour and rather distracted, you will be with it and able to speak throughout an ELCS, so you can talk to the team before you get started. Ask them if they have read the birth plan, about lowering the screen, skin to skin etc and they can explain what will happen.

One thing you need to think about that you haven't mentioned is whether you want baby to have the vitamin k injection.

Does your postnatal ward have co-sleeper cots?
With the bfing support, once you are out of surgery, I don't think anyone will look at your plan. Bfing will probably be first attempted in recovery, in which case you can ask the duty midwife for help (there has to be one with you full time until you are recovered enough to go on the ward). Once on the ward, ring the buzzer whenever you need to give baby a feed - as you won't be able to get out of bed until the catheter is removed. You can ask for support then.

Yes I thought the same thing Morgan about how fixed the process is which is why I've struggled to know what to put (I lifted those points off an nct guide sheet). My consultant was very keen for me to do one though!

Really I just want them to do what they need to do and for it to be a lovely calm experience

Sorry x-post noble, that's all really helpful thank you. Hadn't thought about the vitamin k so I'll read up about that.

Not sure if the post-natal ward has the cots, I was going to go through the plan at my next me appt and hopefully she can let me know.

I mean MW appt

I didn't write a Birth Plan for my ELCS but DH and I were kept well informed during the op, were asked who should have DS first, whether DH wanted to cut the cord, DH watched all of the op, it was a really good experience. i had told Dh i wanted skin to skin immdiately (when DD was born i had a GA and didnt get to hold her until she was 3 hours old and really didnt wamt that repeated) but I found I shaked a.lot during the operation so didnt want to hold DS until I had been propped up a bit and had stopped shaking, but as soon as I wanted him, he was given to me, and I took the lead about everything in recovery (drugs, bf'ing, food, drink, move to ward etc). So I guess have an idea of what you might like, but be prepared to go with the flow too. Good luck!

Consider delayed cord clamping....? Still very possible after a c section as long as baby sent to shocked and needs to be attended to away from the table.

Do you really want a running commentary? Like "I am now cutting into your skin, I am now cutting through the fat..." Even as someone who does Caesareans every day I'm not sure I'd want to know that much detail if it was me!

Lady - do you low if that is compatible with cord blood donation?

Zamboni - I'd heard that from others about the shaking so I've told DH he needs o be ready to whip his shirt off for skin to skin!

I don't know if I want that much detail (def not in fact). Hmm I do clearly need to think about this more.

As I said, I'm kind of clueless what to expect! I'd like to have a general idea of what is going on

I didn't write a birth plan for my ECLS (which was four weeks ago tomorrow!) but found it very controlled and easy to make my wishes known throughout.

I had a traumatic first labour which I won't go into here as it would take too long. The c section operation was very calm and a good experience.

The anaethetist spoke to me first and explained how he would put in my cannula and epidural. I explained I had terrible pain with my previous epidural and he explained how he would avoid that for me. He did this very patiently, listening to me.

The operating doctor also spoke to me and went through several checklists and made sure I'd like Vitamin K. She asked me if I had any questions.

The surgeons kept up a commentary all the way through telling me what was happening.

They asked if I would like to see the baby come out. DH piped up "yes" and so we did! I couldn't see my insides luckily but DH did - he said it was very interesting and nowhere near as gross as what he saw first time round.

When the baby came out, he was pretty annoyed and peed all over me and screamed. He was then taken to the station where he was checked over and they asked if I would like to hold him. (I wanted to.)

I then asked the anaethetist if he would help wiggle down my gown so I could do some skin to skin. It was awkward but possible and I'm glad I achieved it. The baby was screaming and rooting but I couldn't feed him as I was lying down on my back.

I was shaking a lot but the anaethetist put a sort of inflatable plastic thing around me and pumped hot air into it. He also stroked my hair and face to keep me calm.

So during the section, everyone listened to me and took notice of my wishes. So all the things on your birth plan sound realistic.

As for the recovery....well, when I came out of theatre, there was nowhere for me to go. So I was put in cupboard - yes, a big cupboard - next to the theatre with a nurse until a bed was free on the ward.

They didn't have any co-sleeper cots on the ward - just the standard plastic ones. And the staff weren't very helpful about getting him in or out so I could feed him. So that was all a bit rubbish.

So the section birth plan sounds pretty realistic to me, but it might fall down a bit in recovery if it's anything like my hospital.

Oh the commentary was just a bit like: "Ok, you can't feel this, can you? Great, we are just starting."

"Alright we are soon going to be getting the baby out now...."

"Everything is looking great here, so don't worry..."

"Alright, we're just sewing things up. It's all looking very good and everything has gone normally..."

So not too much detail, just reassurance and a bit of a clue about how long it might all take.

Ah, I do that anyway Ruby - wouldn't think of it as a commentary but glad some people like it anyway!

Yes it wasn't commentary like "now here we go chopping through the stomach muscle", Vinegar. I might have found that a bit too much information......

It's nice not to have complete silence from your surgeons though as otherwise you start to worry that things are wrong/taking too long etc. So I just meant that kind of thing.

You could ask them to provide a commentary if appropriate. I was out of it having been given a hefty dose of tranquilizer and so I don't remember much. But dd was born fast asleep (from the drugs) which caught them unawares and her agpar was terrible.

But I didn't know any of this at the time - I think it would have been awful if they'd said "your baby's being born now" only to get complete silence and then have everyone rushing around and the pediatrician erupting into the room.

As it was, by the time I asked if she was out yet, she had picked up a bit.

Oh and oh wandered round for look as I was being stitched and announced my insides looked just like a cow's. Bloody farmers

How about stuff like:
I would like to have skin to skin contact. If that is not possible due to my treatment then I would like DH to have skin to skin contact instead.

If baby needs to be taken out of the theatre for additional care, I would like DH to go with her.

Is the baby's sex going to be a surprise? Do you want them to tell you, or find out for yourselves?

I agree about the vitamin K choice - most of these things are fairly minor in the grand scheme of things, but by expressing your choices in your plan and feeling that your choices have been followed, you may feel more in control of the situation, rather than just being led by others.

Oh - and can you choose music in the theatre, if your provide a CD?

My ElCS was a fab experience but I didn't do a birth plan. We just chatted to the staff as we went along- they were so nice - a lot of the chat was nothing to do with birth or babies. i think they are sort of trying to take your mind off it until the key time!

I am not sure they would have allowed me to see the baby coming out - it may cause you to feel faint/sick and at that point you want to be focussed on your baby.

Unfortunately all the bf support, co-sleeping crib etc depends on what the staff and resource availability is like afterwards. I must say second time round though, I was much more demanding of what I wanted (in a polite but assertive way). With my first DC I had an EMCS which was hideous and the next morning they never brought me breakfast - I was too scared to ask and therefore rang DH to get over asap with something to eat - was well F&&cked off he had slept in til after 9.

Thanks so much for the responses - Ruby your message is great as its given me a really good idea of what will happen! I think the level of your 'commentary' sounds just about right for me, I really don't want to know any more gory details than that.

We know the sex and I had thought about music but decided against it, so I think the points I have made are probably about right, I will add in about DH going with him if he needs special care though.

I am realistic that the postnatal requests might not happen, but I thought if I don't at least ask then I won't get. Unfortunately the post natal ward at this hospital hasn't got great feedback, but then my experience at my previous hospital was pretty shoddy. It seems to be standard unfortunately

If they give you the option of a morphine suppository, say yes, bloody marvellous stuff and you won't feel them put it in.

Also, just in case you didn't know: while the c-section will be pain free, it will not be sensation free. You will be able to feel them moving your insides around and some tugging. It's a really weird feeling and possibly a bit uncomfortable, but it is never painful.

In my experience, will make you get up and have a shower within 24 hours. You will also have the bandage removed so that the wound is open to the air. I was asked to try to do this myself when in the shower. This is very scary but your insides will not fall out. The stitches mean that the wound holds together and it just looks like a red line, it doesn't gape open or anything.

You then don't have any bandage on it at all, so it will be against your clothes. Buy big cotton granny pants that will be soft against it, normal low waisted pants will rub against it. Also buy leggings and track suit bottoms and don't plan on wearing jeans for a good few weeks as this will hurt.

Thanks for the suppository tip noble! I had been given advice to wear a mat pad with tea tree oil on it stuck to the inside of my granny pants against the wound - do you think that's a good idea? Akers me wince thinking of fabric right next to the wound (even though I have no idea what is actually going to feel like)

Makes not Akers!

Good points Noble.

Although you can hardly see my scar already after four weeks, it hurts when anything rubs on it. I normally wear skinny black trousers every day but these are way too sore so I am wearing Dorothy Perkins boy fit jeans in a size up from normal, which are baggy at the waist so don't rub. For two weeks, I wore only Gap Body stuff with soft, soft fabric. It took a while for my stomach to go down too, so these were the only things that fitted.

Also, although I was up and showered the next morning and then discharged after 24 hours, I was truly shocked how bad I felt for the first week. I had to get more pain relief - they discharged me with paracetamol, which didn't cut it. It took a week before I could turn on my left side in bed! The scar stung the whole time and I got a UTI from the catheter. I found it much harder to recover from the section initially than my vaginal birth.

But after 10 days, my recovery was great and the only things I am not doing now is driving, wearing a sling and picking up my heavy two year old. I think I could do all these things, but leaving it as long as possible to recover as well as I can. I haven't taken any pain relief for the last two weeks now I'm over the initial recovery period.

Good luck!!!