Caesareans and Pain Relief (Open thread)

[nonyanomemory]

Just about to post then read AlisonC's and thats pretty much what I would have put. It is difficult I think to get one birth story generally thats the same, so what one finds ok another may not! hms/eds aside.
With regard to local's and my stitching. etc.. they did not work and I was deemed an hysteric, this was many years ago now and I really think there is much better info out there on this aspect of EDS. So do take the info Alison suggests along. Second time around I was much more willing to take pain relief earlier and was more demanding generally !! I chose to tear naturally second time around and heal naturally although was lucky as all went well with that rather than awful experience I had with local not working first time round. I know the recovery time is longer but I think if I had have had a third I may just have decided to go ahead with a caesarian (sp) probably not very politically correct I know. good luck with whatever decision you come to at least you have time to mull things over.

nonya

[Tiz]

I'm 32 1/2 weeks pregnant now and madam is still the wrong way up. I've been offered a caesarean anyway rather than try to manage the labour with limited mobility, I had been planning to try a natural birth if she turned but now I'm having second thoughts anyway. I'm having so much trouble with my back and hips I'm a bit worried about my ability to maintain any kind of position for long enough to give birth and that I might end up with permenant damage to my already very dodgy hips. No worries about anaesthetic, given my history of locals failing (and my all consuming terror of needles) they've agreed I can have an GA for it so no problems there.

Just 2 things I'm rather worried about, the first is trying to cope looking after a baby in hospital from a wheelchair, from what I've heard there really isn't a lot of help available and I'll be stuck there for a few days after the op, if I had a natural birth I could come straight home and Dan could look after me.

The other thing is whether or not having a caesarean will affect my ability to carry another baby safely, I don't think I'd be considering a VBAC for fear of scars rupturing, from what I understand it's a big risk for normal mums let alone us bendy folk. I definitely want another one as my sister's very important to me and I want my little girl to have a sibling growing up like I did, I don't want to ruin my chances of a second baby by having a caesarean with the first.

If anyone's got any experience in either issue I'd be very grateful for some information.

[Rosie]

Hi Tiz

About the help in hospital, start asking questions now about how much help will be available to you. Make sure it is written very clearly in your notes that you will need help with care of baby and yourself due to limited mobility. If special arrangements have to be made for you then they can start arranginf this now. It will make it more difficult for anyone to ignore your needs if you raise it now. Also, keep asking, whenever you see your midwife, obsteotrician (sp?) etc, keep asking, make sure they know this is a big concern for you.
If you do find yourself in a situation where you don't have the help you need, ask to see whoever is in charge of the ward, and show her (usually a her) your notes. Be polite but firm and hopefully the message will get through.
I know that the amount of help on offer can vary tremendously. I had a relative who had a ceasarian delivery of twins, and she was left alone all night (the first night) and then told off for not waking the babies up to feed them! She could barely get out of bed and was still affected by the GA. The second night she got stuck on the bed with a baby in each arm feeding them but as she couldn't move to put them down, she was there for 4 hours before the tea lady found her (she was in a single room). In the other maternity ward there was another lady who has a ceasarian, and the staff couldn't do enough for her. It really depends on the attitude of the peson on charge.
I can't say much about the scarring and second pregnancy, but I am sure someone will be along soon who knows more.

Rosie

[hollilyric]

hello - that person would be me!!!

I have 2 wonderful boys who are 23 and 4 months old and had both by elective section due to my EDS. I was definitely the right decision as they found during my first section that my uterus had no muscle tone whatsoever and explained why I never experienced any braxton hicks or contractions throughout either pregnancy. we were told we couldn't have anymore children after my eldest son and so we hadn't planned to get pregnant 11 months later and I was concerned about how my scar would hold up. I was delivered at 38 weeks with my second as i had started to get a bit of scar pain but that was just to be ultra cautious.

with regards to help - my hospital let partners stay from 10am-10pm and so your hubby could be there helping all of the time as you don't have any other kids. i was in for 8 days with my first and 4 days with the second in order to monitor my bleeding post op and wound healing as they are the biggest issues with EDS III/HMS.

where are you based? i was sent to the Birmingham Women's Hospital as a 'discussion case' as they have a clinic with a Prof. of rheumatology and Consultant in fetal medicine who work together to deal with pregnant bendy women! they advised my obstetrician to definitely deliver by section and to use interupted sutures rather than one long continuous stitch. i also had my stitches in for much longer and had alternate ones removed after 7 days and the rest on day 8. they also advised a week of anti biotics post section to help wound healing. they didn't give me the anti biotics the second time as my consultant went on holiday immediately after delivering me and i did get a post op infection. PM me if you want the names of the birmingham consultants - i'm not sure i'm allowed to post names on here.

i am very glad that i had sections, my sister is now being investigated for HMS as after 2 natural delveries she had the worst prolapse they have seen in a 31 year old. i recovered well after both but the second time it was a bit more painful as i had a toddler to carry and lift but also because i was sterilised during the section. we knew that we didn't want anymore children and my consultant agreed that the risk of a third pregnancy would be much higher. my hubby would have been snipped but he has to take warfarin as he has a carbon fibre heart valve so they can't do any non urgent surgery.

please let me know if you have other questions - i've been through it fairly recently!

ps locals anaesthetics don't work for me but i had spinals both times and they worked without any problems

xxx

[Finarda]

Local anaesthetics don't work for me either, and neither does the epidural or spinal during labour. But during the actual c-section they can give much higher doses and control it better so I didn't feel anything during my youngest's birth. BUT... if you really do want an epidural, then get a consult with the anaesthetist before hand, bringing in a copy of the paper about local anaesthetic and EDS (and probably one about HEDS= HMS in case he quibbles about that).

On the positive side, it was the anaesthetist that spotted that I had EDS!

Fiona

[Tiz]

Thanks for the replies everyone. I'm not worried about the anaesthetic at all since they've agreed to knock me out I've been doing a bit of reading and it seems that she should definitely be head down by now, which she's not, and given that I'm not going to let them try to turn her in case she's inherited my bendiness and could get damaged from being manipulated, it seems like the decision's out of my hands, I certainly won't be attempting a natural birth with a breach baby. I had been trying a bit of lying in funny positions to try to get her to turn by herself but really struggled staying in any position for any length of time which rather suggests to me that I would struggle with labour anyway.

I've said every time I've seen a midwife that I'm worried about coping in hospital but they've always brushed it aside, one just said "everyone struggles after a caesarean" and completely missed the point that it would be even harder in a wheelchair. At my last appointment I did seem to get through a bit, I've got the name of the ward manager and I'm going to ask for a meeting with her when I see the consultant next week. It's occured to me I need to make sure there's a sit down shower, I think I'll start writing a list of questions. And no they won't let OH stay to help, doesn't matter how bad I am. I'm not allowed a private room after a caesarean because I have to be on the main ward so that they can keep an eye on me. On the plus side I do have a friend who works in the maternity department, she's not a nurse but she does bed baths and stuff and she has ended up holding peoples hands during labour. She's got a week off the week before I'm due but has offered to come in specially if I end up having the baby then, I think I'll take her up on it.

[hollilyric]

why would you need to stay on the ward??? i was put in a side room next to the nurses station so that they could keep an eye on me and had my own ensuite. don't worry - they have chairs in the showers so that you can sit down and for the first 36 hours you just stay in bed post section. the day after they help you to shower and so you won't just be left alone to manage.
ask the ward manager about beds. my hospital has electronic beds in maternity so that you can sit yourself up and get more comfortable. also, do you have any issues with pain relief? morphine doesn't really work with me (as with many EDS-ers) and so i had a morphine infusion (drip) the first time and a 'block' the second time where they injecting local anaesthetic into the muscle layers in my abdomen post section. they have to use an ultrasound to do it and it's done in theatre. my anaesthetist was the only one in my hospital who could do it and it did help. it might be worth asking whether they have a pain management specialist to see beforehand?

[hollilyric]

PS i actually found that i coped far better with a section than the non EDS people on the ward because i am used to being in pain. i have to say that having a section was NOTHING compared to knee surgery x

[janey]

The risk of uterine rupture for a vaginal birth after caesarean is 0.5% so not huge. As a midwife I would always recommend a vaginal birth wherever possible as it is what we are designed for. Having said that, breech babies are nowadays better delivered by caesarean due to the lost skills of breech vaginal birth. I have seen many breech babies born vaginally so it can happen and if you are really keen to have a vaginal birth then ask who is the most experienced practitioner at your unit and meet with them to discuss your options.
If your baby does turn and you decide to proceed with a vaginal birth then I would always recommend a water pool for labour as your joints are supported and it makes mobilising much easier during labour.
Re: caesareans and post natal care - many women feel that post natal care is somewhat lacking. I think you have a very good case for having your partner with you overnight or a carer/friend (to give your partner time to sleep). Try and get this arrangement sorted prior to your admission, perhaps ask if you could meet with the post natal ward manager. If you think it would help then highlight all the areas where you need assistance and make sure there is a copy in your hospital records and your handheld notes.
Hope that is a little bit helpful, good luck with it all and I hope that madam does turn as that should help you be slightly more comfortable in the last weeks of your pregnancy.

[hollilyric]

RE: water birth

i was told that having EDS automatically ruled out a water birth as they will only allow them for people without any risks whatsoever and because with EDS they have to monitor blood loss. is that the case janey or does it depends on hospitals and staffing?

[elliejay]

My daughter was told she couldn't have a water birth because of her HMS. They said it was in case she did any damage and couldn't get out of the water.
She had lots of trouble with epidurals took about three times the dose to work even slightly.
Although she had discussed all her problems in advance and it was all carefully written in her notes neither the midwife, the anaesthetist or the consultant on duty had ever heard of it so she ended up doing damage to her pelvis, she wasn't supposed to have her feet in stirrups.
I am going with her next time(if she can face a next time !)
Ellie

[hollilyric]

i guess that is one good thing about an elective section - i got to meet the anaesthetist in advance and plan everything knowing exactly what team would be delivering me

[janey]

Re: waterbirth and HMS/EDS - a woman to be told she cannot have a waterbirth because of an existing health condition is absolutely shocking. It is completely non invasive (unlike epidurals) and just shows a lack of basic midwifery knowledge. If an emergency arises when a woman is in a pool then it is dealt with by adding more water into the pool thereby lifting her gently out. However, if a baby needs to be continually monitored during labour then that is not possible in water, likewise if a woman chooses to have opiates during labour then it is safer for her to labour on dry land.
I have assisted countless women in labour in water and have never, ever had to get anyone out for an emergency. Re: blood loss - an experienced waterbirth midwife will know if there is excessive bleeding and will take the necessary actions - the first line measures for this are the same whether in water or on land.
Rather than saying no to women these hospitals would be better to provide women with additional needs the most experienced midwife they have.

[Finarda]

I spent most of my labours in water and it was wonderful. I'm also shocked that they have such a nurse-centric view that they put you in the main ward to after a c-section so that it's easier for them, rather than put you in a private room (which is what happened in the hospital I delivered in) which makes it easier for you to recover (less noise - trust me newborns cry a lot at night!)

From my first birth, I was told that she had until 36-38 weeks to turn, and in actual fact what she was doing was continuing to roll around in there and didn't stay pointing down until 40 weeks. I always wondered if it was because I had an extra stretchy uterus. Even though my uterus did start to rupture after a subsequent labour, the odds really are low for uterine rupture and I'd always want to try a vaginal birth if possible.

Good luck!

Fiona

[Tiz]

I had my consultants appointment this morning, found out that madam has turned after all, I thought she'd been a bit quieter the last few days. Anyway, after much thought I've decided to have the caesarean anyway, I simply don't feel up to coping with labour and I'm really frightened of the damage it might do to my hips. I'd have to be on my back as there's no way I can support my weight on my legs long enough to deliver a baby and my physiotherapist has said it would be disastrous for me to end up in stirrups, also the SPD is getting to be a real problem. I'm feeling a bit more reassured about the post op care now, OH won't be allowed to stay overnight but should be there a lot during the day and they've promised the midwives on the ward will be able to help too. They have sessions every week where you can go and look round the maternity ward and ask questions so we're going to do that. I'm allowed to take my memory foam topper and pillow in with me too, I've explained I don't travel light!