Tough decision - Elective C or not ?

The docs words ere something like - Its a large baby so we won't let u go
over term. No mention of doing nothing...

"We won't let you?"

Uhh... Paul.... I would highly recommend that you and your wife start looking
for a new doctor right now. Any doctor who would treat a patient (especially
an educated patient -- you did say your wife is a nurse, correct?) with such
insulting condescension is not one I would want treating ME!

What is he going to do? Show up at your home at 40 weeks and drag your wife to
the hospital and section her against her will? SHE is the mother. It is her
choice what she does or does not do. Not the doctor's choice. And yes, doing
nothing is ALWAYS a choice. (And if your doctor wants to claim that it is going
to put your baby at unreasonable risk to do nothing, to the point where he
would be able to force your wife to have interventions against her will, he'd
better be able to prove it -- something he is not going to be able to do.)




Naomi
CAPPA Certified Lactation Educator

(either remove spamblock or change address to to e-mail
reply.)

In article ,
says...

This doesn't make any sense at all -- and I saw you repeated this
several times about 'contracting muscle'. A c-section on a
contracting uterus is NOT a problem at all!! It is not medically
worse to have a c-section once labor had started (an exhausted Mom who
has to also recover from major abdominal surgery has it a little worse
than the women who slept right before, sure


This came from my wife about 'contracting muscle' (from her experiences as a
recovery nurse). Maybe shes got it wrong?

Recovery from standard ops? When my ankle was operated on (flat wasn't a
medically recognised shape for the leg around that point) then flexing
the muscles during and post-op would have been downright dangerous. A
contracting muscle would have caused untold injury and damage. However,
it is considered a *good thing* to keep the contractions going as long
as possible during heart surgery and only switch in the pumps and
oxygenators when needing to get a grip on the heart itself or to open
the big arteries.

The C-cut shouldn't hit *too* much muscle (most of it has gone off to
either side anyway), you're dealing with stretched strands. Overall
there's usually enough to push out the baby the right direction when you
take everything into account as the C is an up-down cut usually, it is
along the lines of the muscle (going with the grain as it were). The
strands that are cut amount to a torn muscle effect for the mother and
will be as painful as the sports injury eventually. The contractions
will head off to either side of the cut and leave the womb available for
entry you can pretty much ignore those contracting muscles now since
they'll be squeezing the baby out through the front once they've been
re-routed. Being careful with the knife when opening the womb is now
fairly important since there will be a pulsating problem with the womb.

I'll let you look up the rest of the section procedure yourself.

Warwick

Liz S. Reynolds wrote:


I guess I'm thinking of it more as a way to psyche yourself into it - if
you start out saying "I'm going to do this for 8 hours because it's good
for the baby, then I can quit and have the section" maybe when you get
there you'll find you can go through with it and have the vaginal birth
after all. If you don't know of a good reason to even try, maybe you'll be
more likely to skip out altogether and take the elective section if it's
offered. This is for random values of "you"


You're absolutely right--it is often a very effective
strategy to say, "I'll try until..." Often, you can keep
"trying until" you actually succeed at the thing you never
thought you could manage because you find it's not as bad
as you imagined it would be. I think this is something
that often gets lost in childbirth planning. Unless there
is some good reason that it's actually *unsafe* to try,
you can *always* wait and see. If you need an epidural
or a c-section or whatever, you'll get it! You don't have
to make a decision that you definitely won't have those
things. You can reevaluate your decisions every single
minute if you like and ask if you need pain meds NOW, or
if you need a c-section NOW. You never have to make
a decision about some point in the future. You only need
to decide about now.

Best wishes,
Ericka

"Warwick" wrote in message
...
In article ,
says...

This doesn't make any sense at all -- and I saw you repeated this
several times about 'contracting muscle'. A c-section on a
contracting uterus is NOT a problem at all!! It is not medically
worse to have a c-section once labor had started (an exhausted Mom who
has to also recover from major abdominal surgery has it a little worse
than the women who slept right before, sure


This came from my wife about 'contracting muscle' (from her experiences
as a
recovery nurse). Maybe shes got it wrong?

Recovery from standard ops? When my ankle was operated on (flat wasn't a
medically recognised shape for the leg around that point) then flexing
the muscles during and post-op would have been downright dangerous. A
contracting muscle would have caused untold injury and damage. However,
it is considered a *good thing* to keep the contractions going as long
as possible during heart surgery and only switch in the pumps and
oxygenators when needing to get a grip on the heart itself or to open
the big arteries.

The C-cut shouldn't hit *too* much muscle (most of it has gone off to
either side anyway), you're dealing with stretched strands. Overall
there's usually enough to push out the baby the right direction when you
take everything into account as the C is an up-down cut usually, it is
along the lines of the muscle (going with the grain as it were).

No no *no*, this is not the way the procedure is done anymore, except in
very premature births performed to safe the life of the mother or baby (when
the lower uterine segment has not thinned yet), or in occasional dire
emergencies. This cut is called the 'classical' cut and is *far* more likely
to rupture in subsequent pregnancies or labors (and is the way it used to be
done, thus 'once a c-section, always a c-section'). The modern standard
'bikini' cut goes across muscle strands, each one of which heals
individually. This is why it's stronger than cutting *between* strands.

--angela

"Ericka Kammerer" wrote in message
...
Liz S. Reynolds wrote:


I guess I'm thinking of it more as a way to psyche yourself into it - if
you start out saying "I'm going to do this for 8 hours because it's good
for the baby, then I can quit and have the section" maybe when you get
there you'll find you can go through with it and have the vaginal birth
after all. If you don't know of a good reason to even try, maybe you'll
be
more likely to skip out altogether and take the elective section if it's
offered. This is for random values of "you"


You're absolutely right--it is often a very effective
strategy to say, "I'll try until..." Often, you can keep
"trying until" you actually succeed at the thing you never
thought you could manage because you find it's not as bad
as you imagined it would be. I think this is something
that often gets lost in childbirth planning. Unless there
is some good reason that it's actually *unsafe* to try,
you can *always* wait and see. If you need an epidural
or a c-section or whatever, you'll get it! You don't have
to make a decision that you definitely won't have those
things. You can reevaluate your decisions every single
minute if you like and ask if you need pain meds NOW, or
if you need a c-section NOW. You never have to make
a decision about some point in the future. You only need
to decide about now.


Sounds like good advice and, to honest, this is now the way we're leaning
towards...

Only worry is that these things like epidural and C won't be available NOW
in the heat of the moment so to speak...

"Chotii" wrote in message
...

"Paul W" wrote in message
...
"Taniwha grrrl" wrote in message
...
Circe wrote:

BTW. My wifes a registered nurse (and a theatre recovery
nurse at
that!) so knows a bit about things.

She knows what recovery from surgery is like; what she
doesn't
realize, I suspect, is how much *harder* recovery from
surgery
generally is than recovery from a normal vaginal birth.

Not to mention taking care of a newborn baby while
recovering from surgery, I don't think she'll have
experience in that. You can't pick up your baby to comfort
him when he cries, you can't put him to the breast, you
can't even pull the bassinette close by to gaze at him
without using that buzzer to get the staff to come in and do
it for you. Your totally dependant on other people to help
you care for *your* baby in those first day's after surgery,
it can be very depressing. It was torture to me, as I'm very
independent, to have to ask someone to pass me my baby when
she cried so I could put her to the breast.


Yep. Agreed. This is something, obviously, neither us have any
experience
in...

But many of us have. Some of us have had this experience repeatedly.

When my 4th baby was born vaginally after 2 cesareans (1 singleton, 1 set
of
twins), I kept asking the nurses if I could do things. Like have the baby
in
the bed with me at night, and pick her up by myself, and have her in the
room when nobody was there with me. The answer was always "Yes, of course"
as if I was asking silly questions. But I wasn't. I was going by my
previous
experiences, when I was *not* allowed to have the babies in bed with me,
or
pick them up by myself (ha, I could hardly walk), or have the baby in the
room with me when I was alone. I wasn't out of pain with my first
cesarean
for something like 6 weeks - I mean, I was still taking pain medications.
I
was still taking them 2 weeks after the second cesarean...and having to
take
care of my firstborn also. And I was lucky - I didn't get an infection in
my
incision either time. Many women are not so fortunate.

I haven't seen an answer yet in this thread to a couple of questions:

1. What is it about a "large baby" that frightens you and your wife so
badly? If you can express your fears, perhaps they can be addressed with
further cites from peer-reviewed medical journals.

Possible difficulty in V Birth. For my wife - epesiotomy. Baby injury.


2. On what do you base your aversion to the use of venteuse or forceps?
I
will assume that it is not because of pain for the woman, since you say
your
wife intends to have an epidural (and I can tell you that if the epidural
works, pain is not an issue with the venteuse).

Injury to baby.


3. Do you consider the risks (immediate and long-term) from surgery to be
preferable for mother and/or child than the risks from venteuse or
forceps?
If so, why? (Yes, I do know that venteuse and forceps can cause birth
injuries.)


Consider risks from C section to be less than a 'bad' labour with possible
forceps and/or emergency C.


3. What coping methods for labor have you researched and practiced using
in
the event that an epidural doesn't work, doesn't work completely, or
cannot
be administered for some reason? (They don't always work. I have even met
one woman whose cesarean was performed with an epidural that failed, and
this is not as rare as you may think.)

Was'nt aware that epidurals sometimes don't work?


I agree with your assessment that birth is an "inexact science". Actually,
no, I don't agree. It isn't a science. It's a natural function of the
female
body. Like other natural functions, it may sometimes need help, but that
doesn't make it less *natural*. I'm concerned when people approach it as
a
science, because often when nature doesn't fit into science's "box",
science
*makes* it fit. And since I've been there twice, and didn't like the
experience either time, I hope others may avoid going through what I went
through.


Yep. Maybe its because of my background in computers where things are a
little more scientific :-)

"Linz" wrote in message
...

"Paul W" wrote in message
...

I would note, however, that when I started this post (which was
shortly after our last visit to the hospital), I was'nt even aware
that the option of no C, no intervention was even viable.

The docs words ere something like - Its a large baby so we won't let
u go over term. No mention of doing nothing...

I love it when the doctors say things like this. Yes, there may well be
very good reasons why your wife shouldn't go too far overdue, or
shouldn't have a vaginal delivery - and I'd say check them out so you
both have fully informed consent. But I always laugh when I hear "We
won't let you go over term". What is the doctor going to do? Come round
to your house and drag you in to hospital?

If your wife and you do your research and feel you would rather go into
labour normally and then have a section; or do the research and opt for
induction; or do the research and go straight to theatre, the important
thing is to do the research /yourselves/ - don't let the doctor bully
you (they may think they're gods, but your wife should know you from
experience that they aren't!). Goodluck with your decision, whatever you
decide.



Thanks. Trying to make an informed decision is exactly what we're trying to
do...

On Tue, 30 Sep 2003 22:08:55 +1200, "Kereru"
wrote:

Mind if I ask why you say that? I ask because I am having a large baby
(looking to be 10-11lb by 40 weeks) and the midwife isn't keen to let me go
too far past term so induction may come into the picture.

So do you mean that induction is worse then c-section in general or do you
just mean that in the case of this woman who's scared of a vaginal birth?

I REALLY want another vaginal birth, I'm pretty much terrified of having
surgery.

You should be ok since it's your second baby. I was induced with my
second child and because the midwife knew that it wasn't a first child
she started out with AROM, then moved onto a syntocin drip. It was
started at the very lowest level and she listened to me about how my
contractions felt so we never actually ended up having the syntocin
drip very high. I think it started out at 15 units per hour, then was
doubled to 30 units per hour, then at my request was only increased to
45 units per hour. When I asked she said that some first time mothers
require 120 units per hour to even get contractions started so I was
on a pretty low dose. The labour went smoothly and quickly, no
trouble at all. Induction does not have to be a terrible experience
if you have a good care provider and your body is pretty much ready
but just needs a kick start. Being the second baby helps even more.


--
Cheryl
Mum to DS#1 (11 Mar 99), DS#2 (4 Oct 00)
and DD (30 Jul 02)

Paul W wibbled

Only worry is that these things like epidural and C won't be
available NOW in the heat of the moment so to speak...

They will. If your wife gets to a point where an epidural isn't
available now it'll probably be because she's so far on that the end is
in sight, as it were. Otherwise, all things being well, she will get it
as soon as possible (and that's not generally long, no matter how many
scare stories you hear. They don't keep you waiting unless there's a
*very* good reason). C-section decisions, in labour, are made swiftly
(mine was 28 minutes from decision to baby) and move so quickly that
"NOW" is a concept that passes you by, it's faster than that. ;-)

I went into mine with the knowledge that if labour didn't progress fast
enough, I would need a section for my own health. As it was it
progressed quickly to a point, then stuck. I was in no pain so we
waited longer than our original plan, but then the decision had to be
made, and less than half an hour later it was all over. Your child will
benefit from starting labour, your wife won't come to any harm, and the
decision can be made at any point. I'm glad I had the first few hours
of "proper" labour, even the pain (although it's a good job no one
asked me about it at the time, the answer would have been slightly
different!).

Jac

Paul W wrote:


Only worry is that these things like epidural and C won't be available NOW
in the heat of the moment so to speak...


That is a remote possibility. I suppose when you get
down to it, *anything* is at least a remote possibility ;-)
But it's not very likely that you'll get to the point where
you need/want one or the other and it isn't available unless
you're at a *very* small hospital (in which case there'd
be doubt that they'd be available when you wanted them
even if you planned ahead, aside from a scheduled c-section
which they could delay until it was convenient for them--
assuming she didn't go into labor on her own!).

In any hospital, it's possible that an anesthesiologist
might not be available the *instant* you wanted one. Also,
it can take a little time from the decision point to get
an epidural because she needs to be given a certain amount
of fluids to protect her against the drop in blood pressure
that is a common side effect of an epidural. However,
neither of these things should take long. If a c-section
is *truly* necessary, a hospital should be able to provide
one within 30 minutes (and the epidural to go along with
it ;-) Anything less would be medically less than best practice.
If it's optional, it might take a bit longer, but probably
not that long and you can always try alternative methods
for pain relief in the meantime. And, of course, if the
c-section isn't urgent and has to be delayed a bit because
a surgeon or operating room aren't available, this is
not a problem for a failure to progress due to large
baby scenario.

As others have pointed out, regardless of what
you plan for, you should always have a plan B. If you
plan for low intervention childbirth you should still
research assorted interventions in case they become
necessary. If you plan for lots of interventions,
you should still research lower intervention coping
strategies in case they're unavailable (e.g., resources
scarce, she goes into labor before planned intervention,
she has a contraindication for an epidural, epidural
doesn't work, etc.). This is pretty much just a fact
of life with parenting--you always need a plan B because
these little people start throwing curve balls from
the beginning sometimes! ;-)

I have to say that I know few people who
had to wait a long time for an epidural once they'd
decided they needed one (assuming they were eligible
for one--occasionally it happens that someone wants
one too early in labor, though if you squawk loud
enough and are willing to accept the possible
complications, there really isn't any "too early"
at many hospitals). And while you might have to
wait for an operating room to become available
if there's a non-urgent need for a c-section, they
should be able to make your wife comfortable during
the wait, if necessary.

I think the thing to keep in mind is that while
having a plan B is always a good idea, what you seemed
to be leaning toward previously (going for the planned
c-section or an early induction) is *defensive* planning.
That's expecting the worst and making your decisions
assuming the worst case scenario (baby can't be born
vaginally; wife can't cope with labor). This pretty
much *guarantees* the worst will become reality because
you haven't left any opening for the best case scenario
to happen! Sometimes worst case scenario is so likely
and the risks of it are so high that you have to plan
that way. But if she opts for a wait and see approach
and ends up with a fabulous, low intervention, unmedicated,
vaginal birth, wouldn't you all look back and kick yourselves
for even thinking of closing that door prematurely?! ;-)
And even if she *doesn't* have that experience and
ends up choosing an epidural or c-section, at least
she had the choice and can feel comfortable knowing
that *for her* *in that situation* she made the very
best choice she could *at the time*. It can be hard
for us control freaks to adopt this sort of wait and
see approach, but it works really well if you can
stomach it ;-)

Best wishes,
Ericka