Tips to have a safer c-section......

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Registered: 03-19-2003
Tips to have a safer c-section......
Thu, 03-23-2006 - 10:20am

WHEN HAVING A CESAREAN SECTION, what are some tips for having a safer cesarean delivery?

Discuss these options with your caregiver even if you plan vaginal birth. If an unexpected problem arises at the end of pregnancy or during labor, it may be much more difficult or impossible to obtain them.

* Schedule a planned cesarean after the 38th week of pregnancy if there is no urgent reason to deliver the baby sooner: Babies born before the 39th week of pregnancy are more likely to have breathing problems.
* Use epidural or spinal anesthesia: Regional anesthesia (you are numbed from your ribs down) is safer for you and your baby than general anesthesia (being "put to sleep").
* Request antibiotics at the time of the cesarean: Antibiotics reduce the chance of infection. You do not need them afterwards unless you develop an infection.
* Ask for your uterus to be closed with two layers of stitching (double-layer uterine suturing): In recent years, many doctors have begun closing the uterus with one layer of stitches instead of two. Some studies suggest that this may lead to the scar giving way more often during a future labor. Research that established that there was a very low likelihood of the scar opening during labor was done when double-layer stitching was the norm. Until this controversy is resolved, it may be wise to request the older technique.
* Request care after surgery to reduce the chance of blood clots: Depending on how likely you are to have this problem, preventive care may include getting you up and walking soon after the operation, having you wear elastic support stockings, or prescribing medication.

What are some tips for having a satisfying cesarean birth experience?
Having a birth experience that is as much like a satisfying vaginal birth as possible and good pain control after the surgery are keys to having a satisfying cesarean birth experience. Discuss these options beforehand even if you plan vaginal birth. If an unexpected problem arises at the end of pregnancy or during labor, it may be much more difficult or impossible to obtain them.

Some of these options may be readily available; others may require some effort on your part. Still others may not be available at all. In that case, you will have to decide whether they are important enough to you to seek care elsewhere. You may wish to choose a doctor and/or hospital based on your preferences.

* Participate fully in decisions about the birth: The difficulty or ease of the birth and whether the baby was born vaginally or by cesarean have little to do with how women feel about the birth. Women are most likely to feel satisfied with their births when they feel a sense of accomplishment and personal control and when they have a good relationship with caregivers. A good relationship includes such elements as being treated with kindness and respect, getting good information, and having the opportunity to participate in decisions about care.
* Have an epidural or spinal anesthesia (regional anesthesia): Epidural or spinal anesthesia allows you to be awake and aware to greet your baby and to hold and breastfeed your baby in the recovery area.
* Have the bladder catheter inserted after the epidural or spinal is administered: Then you will be numb for this somewhat uncomfortable procedure.
* Keep your partner and any labor companions with you throughout: You can benefit from the support of your partner and any other labor companions during what may be an anxious and stressful time. This is particularly true during the preparation for surgery and administration of the epidural or spinal anesthesia, which many women find more stressful than the surgery itself. Your partner and support team will also have the opportunity to share in moment of birth and to greet the baby.
* Keep your baby with you after the birth, in skin-to-skin contact: Unless your baby has problems at the birth that require care in the nursery - and few babies do - there is no reason not to keep your baby with you so that you and your partner can enjoy and begin to get to know your baby, and you and your baby can get breastfeeding off to a good start. Skin-to-skin contact can contribute to breastfeeding success and your early relationship.
* Work with your caregivers to carry out your preferences: For example, you may wish to:
o videotape, or at least videotape after the baby is delivered
o play the music of your choice
o not have your arms strapped down
o have the drape that screens your view of the surgery placed low enough that the baby can be laid on your chest; if your arms are free, you can hold and touch your baby
o have a doctor or nurse explain what is happening throughout
o have the drape lowered or have a mirror at the time of the delivery (your belly will be covered so you will basically see your baby lifted out of an opening in the sheet)
o announce or have your partner announce the sex of the baby or be the first to speak to the baby
o take the placenta home (some people bury the placenta and plant a tree or bush over the site; if of interest, bring a sealable container to contain the blood and relieve staff concerns about contamination in this time of HIV/AIDS)
* Have a narcotic (opioid) medication injected into the epidural tubing catheter at the end of the operation: This provides sufficient pain relief that you will feel comfortable enough to hold and breastfeed your baby in the first hours after the surgery.
* Have your baby and your labor companions with you in the recovery area: Holding and breastfeeding your baby soon after delivery helps both you and your baby get started on the right foot and may avoid problems with breastfeeding.
* Have your partner able to be with your baby in the nursery: This includes the newborn intensive care nursery. If your baby must be separated from you because of concerns about the baby's health, it will be comforting to know that your partner can provide a reassuring presence and can bring you word of your baby's condition.
* Control your pain medication: A new alternative is patient-controlled analgesia (PCA). With this technique, you can give yourself a small dose of medication through the intravenous (IV) line when you need it by pushing a button. A lockout mechanism keeps you from going beyond a preset dose. Since narcotics can make you feel sleepy and nauseous, you may wish to combine narcotic with non-narcotic pain medications. This can reduce or even eliminate your need for narcotics.
* Begin drinking and eating again when you feel ready: Access to food and drink when you feel ready will help you feel more normal and can avoid hunger and thirst.
* Get help with breastfeeding: Breastfeeding can be more difficult right after surgery and with a healing incision. A knowledgeable person can help you find ways to make yourself more comfortable during breastfeeding sessions. Your partner or others can help with switching sides, burping, and diaper changing.
* Get plenty of help at home: You will be recovering from major surgery with all that entails in terms of how you may feel, as well as restrictions on lifting and driving. At the same time, unlike the usual experience of recovering surgical patients, you will have the demands of caring for a newborn and possibly other children.

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