During pregnancy you will be having conversations with your caregiver about delivery options which may include elective c-section. I’ve had friends tell me they were asked outright if they wanted to set a date for cesarean delivery on their first meeting with their caregiver.

When any form of medical procedure  including medication, a test, or a form of treatment is offered to you, you are entitled to "informed consent". This is a legal right which means your caregiver has a responsibility to explain; reason this type of care is being offered; exactly what it will involve; all the risks and associated benefits of this type of care;  potential alternatives  and  their risks and benefits. You are also entitled to request a copy of your medical records  and to ask for a second opinion.

It is also your legal right to accept or not accept the care that is offered. Should you choose to not except this is called an ‘informed refusal’. It is a good idea to go over your options in this way with your caregiver during your pregnancy. Equally your caregiver has rights too, for example if you requested a c-section without any medical need for it your caregiver has the right to refuse to carry out your wish.

Most of us  are conditioned to see those in the medical profession as authority figures and to

simply accept what it is that they tell us. It is a good idea then to make a list of questions before you meet with them and to make notes of their responses. When you are with them it is important to feel okay to ask further questions, ask for clarification, and explanations,  to ask for  sources of information, and the sources for research that support their recommendation.

It’s also important that you don’t feel pressured into making a decision before you’re ready and it’s perfectly acceptable to have more time, and to even get a second opinion if you feel uncomfortable with what is being recommended. The bottom line is if you have questions ask them I keep asking until you get the answers you need.

Some questions to consider asking are your caregivers feelings and past history with a) epidurals b) inducing labor c) episiotomies (surgical cut to enlarge the vaginal opening) d) slow or stalled labor e)continuous electronic fetal monitoring CEFM f) labor support from partner, doula etc.

These are all issues to be familiar with yourself and to consider what you ideally would like to happen. We can’t control how the birth will go, but we can create the circumstances that will give us the best opportunity for what we want to be what happens.

Technorati Tags: C-Section, C-section delivery, Cesarean delivery, Child-birth, Elective C-Section, Planned C-Section, Pre Natal, Pregnancy

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1. Reasons for a C-Section

In my last post I mentioned binding as an alternative to heavy pain killers after c-section delivery. I first saw binding used during my time in the peace corps in Africa. It is one example of how centuries old healing wisdom has been supplanted by dependence on pharmaceuticals. So what is it and how does it work?

Binding is an ancient healing tool for both pain control and affective healing. Bandages are an example of medical binding. When used for a wound, surgical or not, the binding creates compression at the site of the wound. Compression presses the body fibers together, reduces swelling and tearing and at the same time offers some protection for the incision.

Soft abdominal binders can also help support the body changing with pregnancy, as well as for both post vaginal delivery & cesarean section recovery. Unfortunately the ancient healing art of binding is less well known today as I discovered after my own emergency c section.

Cesarean Section birth requires special recovery care because surgery is stressful, painful and now a new baby requires your loving attention. Binding will reduce both your pain and scar. Abdominal binding or wearing a belly belt, also makes it easier to get out of bed because compression helps to

reduce swelling, stabilizes the skin,muscles and internal organs to shrink back in size. Basically compression from binding presses tissue of the incision back together because it makes the space in between the fibers smaller through pressure. Compression is most effective done with binding, though massage or holding of the area are two other means. Ideally a combination of the three will be used for maximum benefit.

Binding can protect and support your incision from day 1. Many women, myself included say they feel like their insides are going to fall out the first time they rolled over to get out of bed. Compression supports your abdomen so you feel comfortable and confident to move. It will also help reduce scar tissue density. Many women do not realize that the doctor cut into 6 layers through the abdomen, and then stretched open the muscles. With binding you can have the feeling of being supported and stable, rather than vulnerable to gravity and afraid to move.

Binding also supports organs to go back to their original size and location. Bladder, intestinal and reproductive complications can arise from a c-section or other abdominal surgeries. The support of binding means less tearing, which means less scar tissue, inside and out. Less scar tissue means more comfort and fewer secondary complications and a better looking scar. With belly binding you can avoid the tearing and complications that lead to possible abdominal adhesions, painful periods, and a lumpy scar.

Some hospitals provide post surgery binders (and many more don’t), but they are generally stiff and not very soft. When I had my emergency c section the hospital gave me… a bandage! Can you imagine, with an incision like the one above what it would feel like to attempt to wrap a bandage around your tummy over and over to create  the effect of a cesarean binding belt?

The uniquely designed C Section Recovery Belt of Maui Healing kits does not contain elastic, making it perfect for immediate use after c section birth or other abdominal surgery. It is designed it to be as adjustable as possible to allow you to find the perfect binding pressure and adjust it as you heal. It also comes with the detachable Bikini Belt, which does contain elastic, for another level of fully adjustable support, font or back. I have to say when I first saw it I said to myself, now why didn’t I think of that.

The same company produces the Hem It In Belt which is great for post vaginal delivery, laparoscopic abdominal surgery, and from about 2 weeks after the cesarean, when you want stronger compression and support. The cotton covered elastic provides firm support when you are getting back to your daily routine, or just going to the car with baby. Because the incision is through 6 layers, and our muscles were then stretched open to get the baby out,  holding them closed is a good thing and gives you an immediate freedom and mobility that would otherwise be weeks away.

Both the C Section Bikini Belt and the Hem It In Belt are available individually. They also offer a C Section Recovery Kit which includes the AbdoMend Recovery Belt & Bikini Belt, a dry skin brush and C-Section Recovery Massage Therapy Guide with detailed instruction and over 100 pictures. There is also a Deluxe kit which also includes a Hem It In Belt. The binding belts designed for maximum adjustability and are available in 5 sizes.

What is really inspiring about this company is that it was born from it’s founders own emergency c-section experience and the belts are designed for women by women. 

image used with permission of Maui Healing Kits llc

Technorati Tags: C Section Binding, C Section Pain, C-section delivery, C-Section recovery, Cesarean delivery

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1. Post C Section Pain Control

It’s quite possible that your doctor won’t use the word pain when talking to you about c-section delivery, and in my opinion that is not only dishonest it is a disservice. You will hear me say this a lot, there is pain, it’s a big factor in your post cesarean recovery.

If you had an epidural or spinal for your c-section, you possibly had morphine added, which can give great postpartum pain relief for up to 24 hours without the grogginess that you get from full anesthesia. Know though that once your local analgesia stops providing adequate pain relief, you’ll be given systemic pain medication, usually pills containing a narcotic and possibly acetaminophen. It may help to take ibuprofen, too. You’ll also be given a stool softener to counteract the constipating effect of the narcotic.

If you had general anesthesia for your surgery or you don’t get morphine through your spinal or epidural after the birth, you’ll be given systemic narcotics for immediate postpartum pain relief. You’ll either get a shot of pain medication every three to four hours or you’ll use a system called

"patient-controlled analgesia": You push a button when you’re feeling pain that delivers medication through your IV. A machine controls the doses so you don’t get more than what’s safe.

If the medication that’s been ordered for you isn’t covering your pain, let your nurse know. If the nurse can’t help you, ask to see an obstetrician or anesthesiologist. The more comfortable you are, the easier it’ll be to breastfeed your baby and to get moving again. It’s important to know though that systemic medication can cause a variety of unpleasant side effects, like drowsiness, dizziness, and disorientation. Because of this, you’ll have to stay in bed. Some of these drugs may also cause nausea and itchiness. Obviously using pain killers like this can interfere with your first precious days with your new baby because of these side effects.

Well that’s the modern approach. The traditional care to aid recovery from a surgery like cesarean section is binding. Binding not only greatly reduces the pain from c section (or other abdominal surgery), it also aids in a faster recovery and reduces the likelihood of complications. If you use binding straight away you can greatly reduce, even possibly eliminate the need for pain killers and be available for bonding with your baby.  I will write about binding in detail soon, and I recommend taking a look at this c-section recovery binder in particular, it is unique and the best one I have seen so far for immediate use after delivery.

Technorati Tags: About C-Section, C Section Binding, C Section Pain, C-Section, C-section delivery, Cesarean delivery

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1. Binding in C-Section Recovery
2. C-Section – Potential Risks
3. What Is a C-Section?

Today the number of cesarean sections births around the world is on the rise, in part because a c-section is a very safe procedure. It’s a fact that the instances of serious complications is very low. This doesn’t mean there aren’t risks, in fact certain risks are higher after C-section than after vaginal delivery. If you are considering an elective c-section it is important to know about these risks and not pretend to yourself about what is involved. Your doctor won’t necessarily tell you about all of these risks, or indeed any of them but they need to be part of how you make your  final decision

If like me you don’t plan a cesarean delivery, but it ends up being necessary, it is important to know about the risks because some of them are things that can happen after the delivery. In the event of having an emergency c-section if you know about these potential risks involved you are more likely to notice any signs of them and take the necessary steps for your  recovery.

So the main potential risks of cesarean birth are

•      Infection of the bladder, uterus or kidneys
•      Injury to the urinary tract
•      Injury to the baby  caused by use of forceps or vacuum and in very rare instances, the surgeon may        accidentally nick the baby with the scalpel.
•      Increased blood loss. Blood loss on the average is about twice as much with cesarean birth as with vaginal birth. However, blood transfusions are rarely needed during a cesarean.
•      Breathing problems – Babies who are delivered through cesarean birth are more likely to develop breathing problems like transient tachypnea meaning abnormal fast breathing during the first few days of birth.
•      Lower Apgar scores – Babies delivered through cesarean birth have lower Apgar scores. The low score may be an effect of the anesthesia. It can also be that the baby may have been in distress to begin with or maybe the baby was not stimulated as he would have been in normal vaginal delivery. (The Apgar score is a number arrived at by scoring the heart rate, respiratory effort, muscle tone, skin color, and response to a catheter in the nostril. Each of these objective signs can receive 0, 1, or 2 points, with 10 being a perfect score.)

•     Premature birth – If your due date was not correctly calculated, your baby may be delivered too early.

A c-section can also be the cause of problems in later pregnancies. This includes a higher risk for:

•     Placenta previa (Placenta attaches in abnormal location).
•     Placenta grows into the muscle of the uterus and has trouble separating after the baby is born (placenta accreta)
•     Uterine rupture

    
Any kind of surgery has risks. Those due to anesthesia can include:

•     Reactions to medications. The mother’s health could be endangered by unexpected responses (such as blood pressure that drops quickly) to anesthesia or other medications during the surgery.
•     Problems breathing. General anesthesia can sometimes lead to pneumonia.

The likelihood of you actually experiencing one or even any of these potential cesarean delivery risks is pretty small, but I think it’s much better to have the information, I hope it’s helpful. If you did experience any of the above do leave the value of your experience as a comment below.

Technorati Tags: About C-Section, C-section delivery, Cesarean delivery, Elective C-Section

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1. Reasons for a C-Section
2. Post C Section Pain Control
3. What Is a C-Section?

There are essentially two varieties of C-section delivery, planned and emergency. Here I will write about reasons why either might take place.

First planned or as it is also know elective cesarean. There are many reasons for a planned or elective c-section, below are five of the most common.

• The baby is in a breech or transverse position, this is when the head is upwards, instead of downward near the cervix. When a baby is breech at around 38 weeks, and time for the baby has run out, the doctor will schedule the c-section, usually somewhere around 39-40 weeks. 


• Multiple babies. Twins can prove difficult to deliver vaginally and in such cases a c-section is chosen. Any more than twins from Triplets onwards will almost always be delivered by cesarean. 


• If you have delivered before by c-section (particularly a classical c-section) many doctors won’t allow you to deliver vaginally because the scar on the uterus from your earlier c-section may tear. This is called uterine rupture. 


• Placenta prevail. This is when the placenta is at the bottom of the womb and covers all or part of the cervix, making a vaginal delivery dangerous. 


• The mother or the baby has a health condition that may make the stress of the vaginal birth a risky option.

Emergency C-section happens when a woman has had no indication of needing surgical intervention for the delivery until a risk arises very late in the pregnancy or more often during labor (this is what happened to me). Here are common reasons why a woman might need an emergency C-section.

• The baby becomes distressed during labor. For example if the baby’s heart rate drops too low, or is too fast, an emergency C-section can be done to ensure the health of the baby. 
• If labor is either very hard or stops completely, many doctors will order an emergency C-section.

• If the mother has a genital herpes outbreak while in labor, a c-section is necessary because the infection can be deadly to the baby. 
• In the event of a prolapsed cord (the umbilical cord coming out of the cervix), a C-section is performed immediately because the supply of oxygen to the baby can be cut off.
* The baby is just too big to deliver vaginally.


• Other health concerns that may warrant an emergency C-section are low amniotic fluid, placental abruption (Placenta abruption is, separation of the placenta from the site of uterine implantation, before delivery of the baby.), and meconium (faeces from the baby) in the amniotic fluid.

Technorati Tags: About C-Section, C-section delivery, Cesarean delivery, Elective C-Section, Emergency C-section, Planned C-Section

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1. What Is a C-Section?
2. C-Section – Potential Risks
3. C Section – Questioning Your Caregiver

What is Cesarean Delivery?

A caesarean section, commonly shortened to C-section, is a birth delivery whereby doctors remove the baby from of the womb surgically. There is reason to believe that ceasarean delivery was practiced as long ago as ancient Egypt, Rome, Greece, Persia and even some parts of Europe. It was in those times used to deliver babies from mothers who died during childbirth, a much more common occurrence than today. The first recorded surgery where the mother survived occurred in 1500 in Switzerland and the first in America in 1794.

With the development of modern surgery, anesthesia and antibiotics, the C-section process is now very safe. There are now two types of C-section procedures: one performed by what is called a ‘classic’ incision and the other via what is called a Munro-Kerr incision after it’s inventor.

The classic C-section involves a longer, vertical incision down the lower abdomen. After this initial incision, doctors cut through the underlying layers of tissue to access the uterus. Here another vertical incision is made, and the baby is removed. The vertical incision gave obstetricians plenty of space to deliver the baby. It became clear that the larger incision increased the mother’s risk of infection. It also meant the uterus was more at risk from rupturing in later pregnancies.

The more recent Munro-Kerr incision is smaller, horizontal and made near the bikini line. After this initial incision

the doctor cuts through the layers of body tissues to access the uterus. A final incision is then made into the womb to let the amniotic fluid drain away. This this makes more room in the uterus, obstetricians can then deliver the baby.Bbecause of the Munro-Kerr incision is smaller it is possible that forceps or a vacuum may be needed to complete the delivery.

Unfortunately, forceps and vacuum-assisted delivery can sometimes cause injuries to the baby. These can include bruising, lacerations, fractures, and in extremes, brain hemorrhaging.

To prepare for the delivery, you’ll probably have various monitors in place to keep an eye on your heart rate, breathing, and blood pressure. Your mouth and nose covered with an oxygen mask or a tube placed in your nostrils to give you oxygen. A catheter (a thin tube) will be inserted into your bladder through your urethra (which may be uncomfortable when it is placed, but should not be painful). Yu will have an IV in your arm or hand. Your belly will be washed and any hair between the bellybutton and pubic bone shaved. A privacy screen will be put around your lower body.

After delivering the baby the obstetrician removes the placenta from the uterus, closes the uterus with dissolvable stitches, and closes the abdominal incision with stitches or surgical staples that are usually removed, painlessly, a few days later. The babies vital signs will be checked and any necessary procedures like suctioning carries out.
When the baby is ok, you will be able hold and nurse your newborn in the recovery room. Because of the incision this will probably be lying on your side because holding your baby can put too much pressure on your fresh incision.

Here is a video explanation of a c-section delivery that I found. It’s an animation.

Technorati Tags: About C-Section, C-section delivery, Cesarean delivery

Related posts:

1. Reasons for a C-Section
2. C-Section – Potential Risks
3. Post C Section Pain Control