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I'm trying to help my partner understand all the choices that we need to make regarding the birth of our baby.
We really want a natural birth but realise it may be neccesary to have a c/s. We would like to know specific reasons we may be given as to why that may not be possible.
Why might we have to have a c-section?
Fetal Distress
Bleeding
Placenta previa (placenta over cervix)
Placenta abruptia (placenta coming away from uterus)
Breech (very few drs will do a vaginal breech)
Twins
Failure to progress
Deep transverse arest (baby stuck)
Prolonged labour
CPD (small pelvic outlet)
These are main reasons
Your EDD is 1 day diff to when my DS was due! but was induced early
add premature labour;
and if you are really sick
no expert, just experiance
My DDs head was just in the wrong position, and wouldn't come down. After my emergency c-section, the doc reckoned we made the right decision (she had had a bit of distress, but we could have tried to push for longer, but they said that we would probably still be in the same position in 2 hours time, and still heading for a caesarian), coz apparently she really was stuck in there, and wasn't going to come out on her own.
DS wasborn via c-section and it was because he wasn't going into labour. I am induced due to GD and we waited 6 hrs going through contractions and being on monitors and everything and he just wouldn't go into labour and chose to have a emergency c/s so that he wouldn't become distressed.
Careful of the "big baby" excuse handed by drs, it's often a total load of crud.
Yes, Lulu is right true CPD (small outlet/big baby) is incredibly, incredibly rare. And "prolonged labour" can be a dodgy one too - i know a woman who was sectioned for failure to progress because she was "stuck" at 6cm for 3 hours! Her total labour up to the section was only 5 hours!
There are some genuine emergencies or situations where nothing can be done which warrant immediate surgical intervention. Cord prolapse, placental abruption, placenta praevia (you would know about that though, praevia is visible on scans, so you'd have a planned section). The others depend on the situation.
For example i wouldn't let anyone diagnose me with CPD unlss i'd been fully dilated and pushing for 3+ hours with no progress at all (baby still high, not descending into pelvis). In True CPD babies don't fit into the pelvis at all and after many hours of pushing are taken out by c-section with a completely unmoulded head (because it didn't ft into the bones at ALL). Prolonged labour is subjective - how long is too long? 24 hours is normal for a first time mum, yet so many women i know say "oh i was in labour for SEVEN hours!" as if it was a month! Realistic expectations really help one to deal with a longer labour. Deep Transverse Arrest is when the baby becomes stuck in the pelvis but usually a little time allows the head to slowly mould and the baby will come out. If there is no marked foetal distress it is ok to give that a chance to happen if you wish - the bones of a baby's head can take a week or more to re-shape after birth, so why do obs think they should mould in an hour inside? There are some doctors who will do breech and twin deliveries vaginally, and with determination you can seek them out. You may decide to OPT for a section in that circumstance, and that is absolutely fine, but it'sbetter to opt than feel forced by circumstance.
Avoiding induction and epidural will minimise the chances of any complications brought on by interention. Unintervened-with birth usually works fine. :)
Bx
I'll second that. One of mine was considered failure to progress ("Stuck" at 5cms for 4 hours). Only they were *so* busy that they didn't even start discussion the options until 4 and a half hours later. They were in the middle of doing that when DH paged them because the head was out and the rest wasn't far behind. All I needed was time.:
I had 30-40 sec contractions every 4-5 minutes for roughly 12 hours, but didn't dilate at all, not even to 3cms (apparently, I wasn't checking for myself ;) ) . When they broke my waters there was meconium, so the decision was made to insert a drip to induce, but that included an epidural first. When they put the epi in, DS went into foetal distress, his heartrate just dropped with each contraction. They waited through about 4 contractions to see if his heartrate would stabilise, but it didn't, which worst 15 minutes of the whole experience cos it was so awful hearing the heartrate drop on the machine. So I was whisked in for an e- c/s.
I haven't any scientific knowledge to base this next bit on, but I blame my "failure" to dilate on the fact that they gave me pethidine to help me sleep, because it meant that for a few hours I gave up on the whole active birth concept (too spaced out on drugs, just wanted to sleep), and then I blame the epidural for his foetal distress. This could be completely wrong, it's just how I've rationalised it for myself to make me feel a bit better about it all.
In retrospect though, I wish I'd known a bit more about the whole c/s thing, I was so convinced that I'd manage a natural birth that I glossed over anything that mentioned c/s, so I was a little unprepared for some parts. So I think it's a wise idea to at least consider the possibility.
Having said all of that, I've tried not to dwell on it too much, because at the end of the day I got a healthy baby & a healthy me, which I was grateful for, as was my DF. And for me, the C/S wasn't a difficult thing to recover from, and it got me out of quite a lot of housework for a good 6 weeks :lol:
:D Thanks heaps, I can always count on you lovely ladies to give me a good, comprehensive answer.
My DP doesn't have much faith in the doctors to do the right thing by us, so he wants to know all the stuff they might say and what is true and whats not. I just dont know how to answer him. I reckon I'd have to be a doctor myself to be able to give him the answer he wants. lol
Anything else they might say to or do to hurry us along? In our birth plan we mentioned we dont want any un-necessary augmentation or drugs.
What are the chances of them reading our birth plan then and completely disregarding some or all of it? If they do what can we do about it?
...
ARGH so many questions :wall: Doesn't matter how much research I do or how many questions I ask there always seems to be a million more.
No housework hey??? That's it!! Book me in!! :lol: jk:
IMHO, I think birth plans are ultimately for you, not the middies or Drs, they may read it and listen but the MAY have their own agenda. Whilst it would be nice to rock up and say " I'll have an intervention free birth with a side of gas please", things can chance once you are there and if a medical professional speaks sternly to you (for eg.) about needing a cs, epidural or "failure to progress" (watch out for that too!) it can be very, very off putting.
Its GREAT your DH is so determined to be informed - it really is. There may come a point where you don't want to communicate with anyone, so DH can do that for you. Get him on here too if you like and keep informing yourselves of the mechanics of birth etc. Get a copy of The Business of Being Born, go to private birth education classes run by those with similar thoughts about birth as you and decide between yourselves what you will do in the event of x, y and z.
and best of all - GET A DOULA!!! They can help interpret things for you and DH and support you BOTH to get the outcome you desire.
I'd never have another bubba without one!
xoxoxo
I know the birht plan is more preferences, I'm trying to prepare myself and DP for the chance that things may not go the way we want. Hence the original question. We wanted to know when we should speak up about what the doc says, whats true and whats just them trying to hurry things along so they can go home for dinner.
I would love to do all of that stuff but we are so broke right now. Not a cent to spare as it is. I dont really know where to start with any of it either.
It is great that DP wants to know everything about everything but he wants me to do all the research for him and tell him because he doesnt like reading. I'm useless at explaining things as it is, let alone with this stupid preggo brain. lol So I've compromised (I am at home all day as it is, while he's studying) I'll look up the info and he has to read it. but he wont read it on the comp, so I have to print it. Then I print it and hes too tired from tafe to read it and retain the info. grr. I feel like I have to do everything when its him that wants all the answers!
*ahem* /end vent
Well I want answers too but I browse around online most of the day and get them. I cant print EVERY page I read. There'd be no paper left for anyone else in QLD. lol
What about a trainee doula, they do it for free dont they, because they're studying? Is it too late for me to get one? Where do I even start with that? Is that a good option for me being a first timer or would I need someone more experienced?
How do I convince DP that a doula is a good idea?
I had high blood pressure and pre-eclampsia...
:rofl: Perfect, I think I will be using that!:
--- High BP is another one thats in the 50/50 category. My mum had High BP all 7 times - and had trouble free SVB all 7 times.
And yeah - Failure to progress can a lot of the time just mean "failed to dilate before my shift was due to end" - I *swear* they hate handing people over to the next shift and would prefer to send them to theatre instead. Makes no sense. I have gone through many shift changes - and could always tell when it was about to change because all the intervention options start being spouted.
High BP can be very serious. I agree there is slightly elevated which is often called high, and then there is high, HIGH. But not something to be taken lightly if it is true high BP. (As well as it being an indicator that other things may be going wrong.) ;):
High BP is another one thats in the 50/50 category. My mum had High BP all 7 times - and had trouble free SVB all 7 times.
I had placenta praevia where the placenta was not over the cervix, but very close, and required a c/s. An u/s will show a low lying placenta/placenta praevia from midway through your pg. Most of the time this is resolved by delivery, although rarely if it's actually over the cervix itself.
So this one would not be a 'surprise' when it came to labour and delivery time.
I hear you - I had a trainee doula for DD2.
There were screenings for BOBB, does anyone know if there is any more due?
what does BOBB mean?
Business of being born.
I had a homebirth and my last daycare (in hospital) monitoring BP was 139/111, that high enough for you!? Of course that was the first (white coat, meaning i was scared of the whole situation) reading, the last came down to 130/99 so i was "allowed" to go home.
There is a BIG difference between high BP and PE. Pre-eclampsia is supposed to be diagnosed with blood tests if the mum is showing 2 or more of the 3 main symptoms, high BP, swelling (edema) and protien in the urine. A blood test will show a struggling liver and yes, with PE the baby and mum are in danger and a c/s is the best course of action.
They tried to diagnose me with PE because i had high BP. I'd had high BP all pregnancy long. I had an undiagnosed thyroid condition which could have been spotted with a simple blood test but they woould rather have dx PE, put me on BP drugs or given me a just-in-case c-section than do that blood test. I had 4 PE assays done in the last 9 days of my pregnancy because i refused to take drugs or treatment until they proved i needed it (probably helped bring my BP down in fact, having blood taken all the time!). I wish i'd known about the thyroid conditon then, it would have saved me a lot of stress and heartache.
High blood pressure CAN be very dangerous, but it isn't in every case. I had no symptoms from my high BP, and no complications. If women could all have dedicated one-to-one care during pregnancy then less women would be diagnosed and treated for things they didn't have. The only midwife i saw regularly, Sandra, actally came into my daycare with me to argue with he Ob because she'd done dozens of BP readings out at my house and knew i was about 12 diastolic points terrified. No one wanted to listen to her.
Heva i would look for a student doula if i were you. I would also, if at any point in your labour you are advised to have some new kind of treatment, ask that everyone except you DP and the doula leave the room so you can talk calmly without tem pressuring you or making you feel watched.
The first thing to ask whenever a new course of action other than just letting you labour is introduced is "will this benefit the baby? will it compromise the baby?" If you need to have continuous monitoring with whatever it is (epidural, augmentation) then yes, it will potentially compromise the baby. If the baby is already showing distress during contractions they may wish to try something to benefit the baby. It is ALWAYS ok to ask "why?" when offered anything. If it is an emergency you will be told so.
In general the less intervention you have the less likely you are to be faced with such decisions (SOME babies need help however you labour, but if that happens you know it was meant to be, rather than caused by the intervention). Try to stay at home as long as possible, avoid pharmaceutical pain relief (gas and air is fine and causes no issues if used correctly), and use heatpacks, water, massage, tens, whatever else you like instead. Visualise strong effective action during contractions, think "down baby" and "i'm opening up" an try to "go deep" into the sensations rather than fighting them (helps relax everything). Believe in yourself hun. Your baby and your butt know what they're doing! :)
Bx
In a week my BP went from 120/80 to 176/126. I didn't have any other PE symptoms at the time, (well, except my fundal height hadn't changed for a week, indicating bub was not growing.) I was admitted for BP monitoring. My BP stayed that way for 5 days. Urine and blood tests were borderline, but fine. I really didn't want to be induced and i REALLY didn't want a c/s. I resisted being induced but finally agreed.
After 5 days in bed and no change in BP, i was induced. DD was born that day. 2.6kg She looked like a little skun rabbit! My placenta had big black holes in it where it had infarcted, DD was not getting enough nutrients from the placenta so my body increased my BP to try and force more nutrients to the baby from the placenta.
Until i saw my DD and the placenta, i didn't realise the severity of my situation. I thought i only had high BP and it was all a fuss over nothing. Turns out it was more serious than i thought. I am glad my cervix was favourable for an induction, otherwise i would have been sent to theatre for a c/s.
Totally agree. I'm glad my OB was ontop of things.:
High blood pressure CAN be very dangerous, but it isn't in every case. I had no symptoms from my high BP, and no complications. If women could all have dedicated one-to-one care during pregnancy then less women would be diagnosed and treated for things they didn't have.
Like you say high BP is often nothing, but also not something to take lightly. ;)