DS1 - 7/2011, DD 12/2012, DS2 - 4/2014, MMC - 12/2015
May 2014 Moms
Xath
member
DS1 - 7/2011, DD 12/2012, DS2 - 4/2014, MMC - 12/2015
Anecdotal Cesarean Advice
Xath
member
I had my 3rd cesarean section last Saturday, and wanted to share my experiences. I know some of you are planning cesareans, or know they're a possibility; some of you are not planning on them, but may end up with one anyway. So I figured I'd write out what I've learned from the last 3 surgeries in case anyone is curious (or other previous cesarean folks want to chime in).
Disclaimer: I am not a medical professional. All of this is anecdotal from my experiences, and everyone is different in how they process surgery and recover.
What kind of cesarean are you having?
Many people I've talked to are familiar with the vertical incision vs. bikini line cesarean. At this point, the vertical incision is almost never used except in the absolutely rarest of circumstances. However, there has been a new version of the bikini cesarean developed during the last 7 years that many people are not aware of. Not all OBs practice it, but it makes a HUGE difference in recovery time. The difference comes from whether the abdominal muscles are cut (the old method) or spread (the new method). Everyone I know who's had their abdominal muscles cut has had an absolutely abysmal recovery time. When my mom had her cesarean, we rented a hospital bed for the house because she couldn't sit up on her own for weeks. I know people who've had a cut cesarean as recently as 6 years ago, and my OB tells me that it's still common practice in many areas.
I've had 3 cesareans with the abdominal muscles spread each time. I've been able to sit/stand/walk on my own within hours of each surgery. This is not to say that the spread method has no recovery time or that you bounce back right away, but there is a significantly different recovery curve. Regardless of whether you're planning a cesarean or not, I'd ask your OB which method they practice so you can make appropriate recovery preparations.
Anesthesia
Spinal - With each of my cesareans, we went for a spinal block as the anesthesia of choice. The first time it didn't take, the second it took amazingly, and the third time it took well enough. Even with the issues I've had, it's my prefferred method of anesthesia for the cesarean. I got to witness the births, talk with my husband, and see my babies immediately. Even in the most recent surgery (where the spinal just didn't go terribly high on the abdomen) the most I experienced was physical discomfort from all of the pushing/prodding/scooping, and I'd take that discomfort for the immediate moments of seeing my baby every time.
General - Not going to lie; my first spinal was kind of a cluster. The spinal failed, and the anesthesiologist gave me a drug from a family of drugs I was allergic to (even after the OB told her not to). [This goes into another bit. If you have ANY drug allergies, make sure you educate yourself on what "families" of drugs that allergen is related to. You might not be allergic to the rest of the family, but why take the chance if there are other options? ] Fortunately, my OB is cool under fire, and as soon as I started reacting to the drug, he leaned over the sheet and told me that we were just going to take a nap and when I woke up I'd have a baby. And I did. And he was safe.
The thing to know about GA cesareans is that the actual opening/birth process tends to have to happen a lot faster, as the OBs are racing against the clock to get the baby out before too much of the drug gets into their system. If it's your first cesarean, it's not a huge deal. But if you've already had one, your doctors are going to have to deal with your existing scar tissue, and that causes opening to take longer. What this means for you is that you might get a sleepier baby with lower immediate APGAR scores. But it's OK. Whatever happens on the table, the thing to remember is the priority is to keep you and your baby safe. My GA cesarean was my first, and because my OB is apparently the Waco Kid of obstetric surgery, the whole thing only took 15 minutes open to close, and DS1 was out within 1 minute of me going under GA. Following his birth, I had a lot of anxiety that I wouldn't be able to bond with him as well because I hadn't witnessed his birth or the first 30 minutes of his life. This seemed like a completely rational fear for past me, but present me can tell you that such a fear was not only unwarranted, but also ridiculous. DS1 was fine, immediately nursed like a champ, and is a completely amazing kid.
Epidural - This has been presented to me as an option instead of the spinal, but I've never experienced it, so I can't comment. From what my OB explained to me, epidurals are usually used in cesareans that occur from a complication or lack of progression in a vaginal delivery. If the epidural is already in place, they'll just use that as the cesarean anesthesia.
During the Surgery
Getting "Cleaned Out" - After the baby is born, the OB will clear out the placenta and tissue from the uterus. How thorough they are is variable. Getting "cleaned out" is not a terribly comfortable process, especially when the spinal doesn't take fully, BUT it is totally worth it. The more thorough and aggressive they've been during the surgical stage, the less post-partum bleeding and cramping I've experienced. My OB was SUPER thorough this time. During the surgery it was a few seconds of gagging nausea, as it felt like I was being punched in the stomach from the inside (and sort of was). But the PP bleeding and cramping has been the least I've ever experienced, and I've been able to use regular maxi-pads since day 3 post-surgery. (All OBs should do a certain amount of tissue clearing to reduce the risk of hemorrhaging; it's just the amount of tissue they leave behind tends to vary).
Closing the Uterus - One of the big dangers from repeated cesareans is the thinning of the uteran wall around the scar tissue. This can lead to rare, but scary things like a scar-line uteran rupture or tear during subsequent pregnancies. One thing that will minimize this is a healthy separation between deliveries. While my OBs recommend a minimum of 16 months between deliveries following all cesareans, they also believe that 24 months between deliveries results in a much healthier and recovered uterus. If you're planning (or thinking of planning) on a shorter separation than 16 months, make sure to talk to your OB. One of the things they may be able to do is double-sutcher the scar line, for a thicker hold. Full disclosure: After 4 weeks of pre-term contractions with my DD, my uterus did rupture along the scar line. Fortunately, I was already on the operating table when it happened. When the OB closed following delivery, she folded the uteran wall over itself in a double layer and sutchered twice. This time, the uterus held together, but the wall was too thin to fold the tissue over. So instead, she pulled uteran tissue from behind the bladder, and used that to reinforce the closure line. This time we're planning on putting more space between pregnancies, but thanks to those techniques, my OBs believe that I should be able to have many more children if I so desire.
Closure Techniques
This is the part that seems to vary the most depending on your OB's preference. I've had 2 different OBs perform my cesareans; they both favor dissolving sutchers with tagiderm (a clear plastic tape) on top. I have no other closures to personally compare it to, but I think it's a great option. The tagiderm keeps everything contained and dry until the 2 week follow-up, and I've been able to shower without issues.
I've also seen people have success with staples. The only closure my OB advises against (currently) is dissolving staples. They're relatively new, and he says that the dissolve time varies and he's seen more incisions complications when they dissolve too soon. He hasn't seen serious complications; usually just uglier scarring.
Pain Management
The most important thing I've learned through the 3 surgeries is that it's very important to MANAGE the pain, but not ELIMINATE it. I've done both, and have had a far easier time with the overall recovery when I manage the pain appropriately. At my hospital, they ask you to rate your pain on a scale of 1-10. The goal for a post-cesarean is to keep the pain at a 3 or below. This most recent time, I found that was possible to do using just Motrin, so I did. After my previous cesareans I used Motrin (all three times), Percocet (the first 2 times), and Morphine (the first time). Here's why I prefer the just Motrin approach:
- It doesn't fully eliminate the pain, so you don't risk overdoing it. With my first two cesareans, between all of the painkillers, I found that my pain was at a 0 almost all the time. Since I had no gauge to tell when I was overtaxing myself, I did it frequently. I believe my overall recovery took much longer than it could have as a result. With the motrin, I can do what I need to do, but I know very easily when I need to take a break.
- No constipation! Percocet will constipate you to a ridiculous degree, and after major abdominal surgery, you DO NOT want to have to strain to poop. If you do take percocet, make sure to ask for a stool softener, preferably with a laxative. If you don't use percocet, the stool softener is still a kindness to yourself, but make sure you take the kind without the laxative. That's a recipe for diahrea, and you do not want to have to try to run to the bathroom in the hours and days following your surgery.
- I feel like my recovery has been overall faster (so far) this time. I'm on day 6 post c-section, and I've actually felt so good that I've forgotten to take my motrin a few times over the last few days. I realize pain tolerance and recovery is different for everyone, but this has been my easiest recovery so far. I don't know if the Motrin has made the recovery easier, or if the recovery has been easier so I've been able to get away with just the motrin.
Other Stuff
Abdominal Binder - Get one! Day 1 after the surgery it wasn't a big deal. I was so full of fluids that my stomach still jutted out as though I was 7 months pregnant. But after I started to deflate, I started getting a lot of pain and irritation from my flab folding over on my incision. I talked to my OB about an abdominal binder and she put an order for one in the system. I had one within the hour, and it's made a huge difference. My stomach is supported and it feels great. It's not as fancy or durable as a belly bandit; mine is 4 strips of elastic with a crap-ton of velcro. But it still works very well and I'm grateful for it. I've even been sleeping in it. I took it off for a few hours last night to sleep and felt so much worse after.
Simethecone - Take it! Take it liberally and often. The operation will put gas in your body where you've never had gas before. After my 2nd cesarean, I thought I was having a heart attack because I had terrible chest, shoulder and arm pain. Simethicone (aka Gas-X) is an OTC gas aid, and it makes worlds of difference for me in terms of cramping and overall discomfort. Plus it's chewable in either mint or cherry flavor.
Stool Softeners - A stool softener is helpful no matter what other medications you're taking. After abdominal surgery, you do not want to have to strain to poop. So regardless of anything, I'm pro stool-softener post surgery. The question becomes whether you take the stool softener with or without a built-in laxative. At my hospital, it's the difference between them giving you Colace (no laxative) and Senna-S (laxative). Take the Colace regardless. Only take the laxative if you're taking a constipator (like percocet).
Walking - Get up and do it. I don't wish a NICU stay on anyone, but with my 2 in the NICU, I had to get up a lot sooner and walk a lot farther than I did with my firstborn, and I believe my recovery benefited greatly from it. Each time I get up it gets easier. Even with my first, I'd put him in his rolling hospital bassinet and push him around the L&D ward. I am not, nor have I in the recent years been in any sort of shape (unless amorphous is a shape). I'm not talking about walking miles; just up and down the hallway. It helped me keep my muscles from seizing up, and helped move things through the digestive tract as well.
No matter what type of birth you end up having, I wish you all the best.
DS1 - 7/2011, DD 12/2012, DS2 - 4/2014, MMC - 12/2015
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Re: Anecdotal Cesarean Advice
I'm hoping my incision gets closed the same as last time. Dissolvable internal stitches and on the outside was glue and surgical tape.
I had a great experience last time and I'm really hoping it goes well again. I'm going to ask if she cuts or spreads the muscles.
Happy Endings
DS: 11/8/11 | 9 lb 7 oz, 22 in
DD: 5/22/14 | 9 lb 9 oz, 21.5 in
And on the stool softeners: take the highest recommended dose. My nurses only gave me one Senokot-S a day and I didn't think to ask for more. I seriously regretted not speaking up. I went into the hospital Monday night and didn't poop till Saturday. It was nightmarish. This time I'm taking my own bottle of Colace just in case they're stingy again.
I'll have to ask my OB whether she cut my muscles or spread them. Hmm....
DS: 11/8/11 | 9 lb 7 oz, 22 in
DD: 5/22/14 | 9 lb 9 oz, 21.5 in
I'm a FTM and they have to do a C/s because she's breech and I have cholestasis so she has to come next week.
1st BFP-8/17/12! Missed Miscarriage discovered @ 8 week US. D&C.
2nd BFP-2/13/13! Blighted Ovum discovered @ 8 week US. Natural miscarriage.
3rd BFP-5/22/13! By early June, progesterone plummeting. Another loss.
August 2013 - started Donor Egg process, but surprise BFP with my own eggs.
Dear Son born 5/28/14
A spinal is a single injection of anesthesia to the mid-lower spine. When I've had mine, they numb the area with a local injection first, and then do the spinal. I sat on the operating table, rounded my back and shoulders, and koala-hugged the nurse anesthetist while the anesthesiologist did her thing.
I believe with an epidural, they insert some sort of tube into the same area of the spine, and it allows them to pump in additional medication if needed.
DS1 - 7/2011, DD 12/2012, DS2 - 4/2014, MMC - 12/2015
BFP # 1 - 12/19/09 EDD 08/27/10 - D&C 1/26/10 @ 9w5d
BFP # 2 - 06/05/10 EDD 02/17/11, DS1 born on 2/14/11
BFP # 3 - 04/10/13 EDD 12/21/13 - D&C 05/15/13 @ 8w4d
BFP # 4 - 07/27/13 EDD 04/08/14 - CP 07/29/13
BFP # 5 - 09/14/13 EDD 05/28/14, DS2 born on 5/22/14
Though to be honest I prefer the idea of the epidural. The thought of a spinal wearing off during surgery scares me. O_O
DS: 11/8/11 | 9 lb 7 oz, 22 in
DD: 5/22/14 | 9 lb 9 oz, 21.5 in
The spinal can make you sick too. If you have a scheduled c/s definitely don't eat beforehand just in case. I was tempted to (never had any issues with regular anesthesia) but luckily I didn't because I'm too much of a scaredy cat to break the rules. If you start feeling off don't try to be tough, tell them. My anesthesiologist was amazing. His assistant got me laid down and used a cool cloth to try to help. Eventually they resorted to alcohol pads waved under my nose to curb the nausea/dry heaving.
Post partum- my best advice is move, move, move. The nurses kept thinking I was a vaginal delivery because I was doing so well but they also commented that most section moms aren't as eager to get up and move as I was. Once we went home my mom took me out as much as I could stand to do. I was 100% on my own (DH travels) at 1 week pp.
If you haven't toured your hospital yet then make sure you do. And make sure you actually pay attention if/when they show you the c/s OR. I didn't because I was going to have a vaginal med free birth (or so I thought) so the day of it was very overwhelming when I walked in there.
I would also add that my skin gets really itchy after the spinal wears off for awhile. I was told some people have that reaction andtand they gave me some meds to help. If any of you are feeling that speak up and ask if they can give you something. It's no fun to snuggle your new baby and want to scratch your arms and face because they itch so much.
DS1 - 7/2011, DD 12/2012, DS2 - 4/2014, MMC - 12/2015