Maternity Experience

c-section

Caesarean sections

On Monday, to begin #ExpOfCare week, we had an insightful blog from Dr Sarah Winfield reflecting on her experience of taking part in the ‘Lithotomy Challenge’. And today, to end #ExpOfCare week, another #FabObs, Dr Florence Wilcock – the originator of the #LithotomyChallenge and co-founder of #MatExp – tells us all about Caesarean sections and what really happens…

Dr Florence Wilcock

As we come to the end of #ExpOfCare week, I would like to share a blog about Caesarean sections, to demystify the birth that mothers and partners may unexpectedly experience. I originally wrote this blog at the request of Milli Hill & the positive birth movement in October 2016 , subsequently this has been included as a contribution to Milli’s book ‘The Positive Birth Book’ published 16th March 2016.

Why do we need to talk about Caesarean sections?

Unfortunately, sometimes people can be prone to making value judgements about different types of birth. One of the most common examples is vaginal birth = good and Caesarean section = bad. The truth is that in the UK current statistics show 25% of women will give birth by Caesarean section, 10% planned so called ‘elective’ and 15% unplanned ‘emergency’. We can argue these rates back and forth; we can aspire to improve care and change these facts, but for the moment given that 1in 4 women will meet their baby in the operating theatre it is vital that we talk openly about this experience and how it can be a positive, emotional & fulfilling birth for each new family.

Even in an unexpected ‘emergency’ there are still choices to be made. Nice guidance on Caesarean section CG132 section 1.4.3.4 recommends 4 categories of urgency; only category 1, the most urgent suggests delivery within 30mins. Far more common is the ‘emergency’ caesarean category 2, delivery within 75mins of decision making. This gives a woman time to express contingency birth preferences and ensure that even if she did not plan a caesarean birth it remains a calm and positive start for her and her baby. Skin to skin in theatre, optimal cord clamping, birth partner announcing the sex of the baby, choice of music are all possible. I would love to say these are all standard in every hospital but unfortunately that wouldn’t yet be true, however the more women know and ask, the more these will become universally accepted. As I often say ‘Wrong is wrong even if everybody is doing it and right is right even if nobody is doing it’. I wish you all an interesting and positive month discussing Caesarean birth and would like thank Milli for inviting me to contribute & become part of it. If you want to know more about how I am working to try and improve maternity services do check out matexp.org.uk

Caesarean Section a theatre experience & Who is who in the operating theatre? 

The majority of caesarean sections in the UK will be done under a spinal anaesthetic, that is numb from the nipples downwards. It’s a peculiar feeling as one can feel touch but not pain. It means that women will be awake and aware of people milling around them which can be daunting but it also means they are awake and ready to meet their new baby. Lying on the operating table we tilt women slightly to their left to keep the bump of the baby off the major blood vessels, this prevents dizziness from low blood pressure. If you lie on the operating table in the maternity theatres at my Trust you will look up and find butterflies & cherry blossom on the ceiling, something nice to focus on while you wait for your baby to arrive. I know this is unusual & we are lucky but there is nothing to stop you tucking your favourite picture or photo in your birthing bag so that you have something familiar and relaxing to look at.

It might seem odd that at the start everyone in the theatre will introduce themselves to one another. It isn’t that we have never met but its start of the World Health Organisation (WHO) safety checklist. There is a special checklist just for maternity theatres and it is routine to start by checking simple information such as the woman’s name and date of birth and move onto clinical issues and equipment and it is all aimed at making the experience as safe as possible. So, who are all these people around you and what are their roles, why are there so many people there?

Anaesthetist: At least one sometime two; these are doctors who will administer the anaesthetic ad monitor you closely during the surgery. They will be standing just by your head and often chat to you and reassure you as the operation progresses. 

Operating Department Practitioner (ODP): at least one; their role is to assist the anaesthetist, getting & checking the required drugs, drips or equipment, the anaesthetist cannot work without one being present.

Obstetricians: at least two; one will be performing the Caesarean section (the surgeon) the other will be assisting (the assistant) e.g. cutting stiches, holding instruments.

Midwife: At least one; to support the woman and help her with her newborn baby when it arrives

Scrub nurse or midwife: At least one; To check, count all needles, stiches and instruments and to hand them to the surgeon when needed.

Midwifery assistant or runner: This person double checks the swab and instrument count with the scrub midwife or nurse and ‘runs’ to get any additional equipment required as they are not ‘scrubbed up’ so can go in & out of theatre to fetch things.

Paediatrician: asked to attend any ‘emergency’ situation or if there are known concerns about the baby.

So, you see in theatre there is a minimum of seven people caring for any woman all with specific tasks to perform, any complication may result in us calling in extra members of the team.

So back to the woman, she will be on the operating table with her birth partner by her side and the anaesthetist and ODP close at hand. She can often choose the music she would like her baby to be born to. The anaesthetist needs to monitor her heart with sticky labels but these can be put on her back and her gown left loose leaving her chest free and ready for skin to skin with her baby. A sterile drape will be placed over her bump and this is usually used to make a ‘screen’ so that the woman doesn’t see and surgery she doesn’t wish to see however usually we drop this when the baby is ready to be born.

Many hospitals are starting to explore options of optimal cord clamping (waiting to clamp the cord) and passing the baby straight to the mother if the baby is in good condition. These can be done but need to be thought through so as not to contaminate the sterile surgical area, and the surgeon needs to be confident no harm such as excessive bleeding from the womb is happening whilst these things occur. Surgical lights need to be on so the surgeon can see clearly and operate safely but I know one anaesthetist who works in a hospital where the rest of the theatre lights can be dimmed. The mum and new baby can be enjoying skin to skin whilst the rest of the operation proceeds. Weighing and checking babies can be also done at this time but also can be done later on.

Traditionally if we operate with women under a general anaesthetic (asleep) her birth partner has not been in in theatre as their role is to support the woman. Recently on several occasions I have challenged this so that a baby is welcomed to the world with at least one of its family present and awake rather than by a group of strangers caring for the unconscious mother. There are safety considerations to be talked through for this to be successful but it is possible. However, kind and caring staff are, they are no replacement for a birth partner whom the mother has chosen to support her in the intimacy of birth.  

I hope I have given you a brief glimpse in to life in a maternity theatre. As an obstetrician, I am privileged to help bring many women and babies together for those special first moments. The emotions are always different for me: sometimes it is a couple I know very well and have bonded with over months or years, sometimes a woman I have only just met who has had to put her absolute trust in me immediately. The theatre atmosphere can range from almost party like jollity to quiet intimacy. Every birth is different; each birth is extremely special just as much as the births that happen in a less clinical environment and each birth will stay with that woman forever. 

Useful CS references

Ref NICE CG132 https://www.nice.org.uk/guidance/cg132/chapter/1-Guidance#procedural-aspects-of-cs https://www.nice.org.uk/guidance/cg132/ifp/chapter/About-this-information

RCOG Consent advice No 7

https://www.rcog.org.uk/globalassets/documents/guidelines/consent-advice/ca7-15072010.pdf

 

 

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Ways in which my c-sections make me amazing

I’ve had 4 c-sections (2 emergency, 1 elective and 1 planned due to medical reasons) and time and again I find myself making excuses, or defending myself when the topic of birth comes up. I’ve also spoken to many women who feel they failed, or did not give birth because they had a c-section. I’ve come to the point now where I want to celebrate the way that my babies came into the world, and show other women that they did NOT take the easy way out. A c-section is not the easy option and there is no need to feel ashamed either.

If you’ve had a c-section, I hope you know that you are amazing.

I’ve had four c-sections. And until now, I have always been- if not ashamed- a little defensive over them.

But baby was in distress, so the section saved my life.

My son WOULD have died without a section.

It was the easiest decision for me after two traumatic failed labours and emergency sections.

The doctors said it was the safest and only way my baby could be delivered alive.

Ways in which my c-sections make me amazing~ Ghostwritermummy.co.uk

I’ve always been a little anxious when meeting new mums and the conversation turns to the birth. I’ve always assumed that there was something wrong with my body. Something wrong with me. I failed. I didn’t do what I was supposed to do.

But I’m tired of defending myself. I’m tired of feeling like I never really gave birth. So what if my baby came out on the operating table? I might not have given birth in the conventional way, but I gave life just the same. Who cares how the babies arrived?

Ok, so I care. I do. I really care. I care about the fact that my very first experience of childbirth was terrifying. I was ignored and laughed at. I was dismissed. I was given drugs and injections and Ways in which my c-sections make me amazing~ Ghostwritermummy.co.ukexaminations that did not help me. My baby was taken from my body not just once, but for a second time too. I was left in pain. I was taken to the brink of death and my baby almost died. I was sent to sleep while surgical hands reached inside to find my blue baby and bring him out into the world. I was not there. And I care about that. I care so much.

And because I care, I want to make it clear that those first two birth experiences make me amazing. I laboured for hours each time. Alone. Without the support of a midwife to hold my hand. Without the knowledge that I was a strong, capable woman. Without power. I laboured despite myself, for hours, with no pain relief. And just when I thought I could take no more, I was taken for major surgery. The mask over my face and the knife to skin just moments later.

And if you know what it is like to labour so intensely, with the sole purpose of bringing your baby into the world, only to realise that you will need to see that happen in an operating theatre… then you will know that I am amazing.

And if you know what it is like to labour so intensely a second time, with the desperate need to bring your baby into the world otherwise he might die, only for the world to go black and to wake up with a baby by your side… then you will know that I am amazing.

Ways in which my c-sections make me amazing~ Ghostwritermummy.co.uk

And if you know what it’s like to move your battered body a few inches across the bed, to gingerly ‘swing’ your legs around so that your feet brush the floor, to step lightly onto the ground for the first time since ‘it’ happened… then you will know that I am amazing.

To stand in the hospital shower weeping in pain each time the water jets strike the cannula in your battered hand; cursing that cannula because you didn’t want to be there, in that shower, in pain, not again. To wince in pain with each step you take. To choose to spend the night sitting up in a chair rather than to lie down in a bed because it is slightly less painful to do so. To need a cushion so that you can laugh. To still hold on to the belief that your body might make it next time.

If you know what that is like, you will know that I am amazing.

 

 

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Don’t call me high risk! #MyPositivePregnancy

This post was written during my 4th pregnancy, my journey towards a VBA3C. Throughout this pregnancy I was fit and healthy yet classed as high risk due to having had three previous c-sections. 

Don’t call me high risk.

Don’t take heed of the warnings that spew out into the papers at an alarming rate. A VBAC is not a disease, or a dirty word. A woman who has had a c section is not ‘risky business’. I am a woman who wants to give birth to her baby. To feel her baby. To be awake to see her baby take the first breath, open their eyes onto this world and feel their skin against mine. I am a woman who wants to be one of the first people to hold her baby. I am a woman who wants to sit up and hold her baby. To feed her baby with arms that feel the life within. I am a woman who wants to tell the world her baby’s name; not discover it for herself when she wakes.

Don’t call me high risk. Don’t greet my intentions with raised eyebrows and furrowed smiles. Don’t assume that my intentions will not be ‘allowed’. Don’t deny me the chance to be normal for once.

Don'r call me high risk_ my positive pregnancy~ Ghostwritermummy.co.uk

This weekend I came across this article by Milli Hill (@millihill) and I found myself nodding along to almost every word.

When my body screamed out to me that my son was on his way, the ‘High Risk’ label echoed the cry and we called the hospital straight away, as we’d been told. We went straight in, as we were told. We never questioned a thing and we never assumed that we were anything but high risk. The fact that I was labelled as High Risk left me in no doubt- what I was doing was scary. I wanted no part of it. But in actual fact, lots of women have a VBAC, and the fact that we didn’t should not be held against me.

This time, I am a woman striving for a VBA3C. And supposedly higher risk than ever before. And yet I feel more positive this time than I ever have. Whether it is age, experience, or having come to a point of peace with what has gone before, I do not know. But I do not feel scared. I do not feel High Risk. I feel like a woman who passes a mirror and catches sight of her swollen body and smiles, stops to capture the moment; when once I would have collapsed inside.

I feel like a woman with a life growing inside. I feel special. I feel on the edge of something wonderful. I feel strong. Strong enough to question decisions that are made for me. Strong enough to face the fear that I know will come as the weeks pass by. Strong enough to cast aside my label and just be a woman giving birth. For once.

That is my positive pregnancy. It’s taken four attempts to get here and I’m going to hold on to it.

To find out more about #MyPositivePregnancy, #TeamMama and Mama Academy,please click here. You can also read about the Made to Measure campaign here  and if you have a moment, please sign the petition urging all UK trusts to help save 1000 babies by adopting The Perinatal Institute’s GAP programme.

 

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