Category: csections commentary

YES!

On a daily basis I have emails from women with questions and worries. Many of which originate in stories and myths they have been told by friends, health practitioners or read in the media.

A classic one:

‘Will my arms be strapped down?’

The simple answer: NO

However, many women have heard that this is a possibility and some link it to the truth that the table will be on a slight tilt giving it seemingly more credibility. The table is on a tilt but the tilt so slight it is not necessary to restrain you in any.

The list of  myths is huge and the fear they generate considerable. Is it any wonder that some women are terribly afraid of this mode of birth and fight the thought of it even when it might be the safest means of delivery in their specific circumstances?

It is essential to cover caesarean related questions in a balanced, respectful manner and all women should have access to such an approach from those responsible for their antenatal care.

Other examples of typical myths I have been repeatedly contacted about are:

• I will have to wait till I am back on the ward before I can see my baby (IT DEPENDS – Your baby can be delivered straight onto your chest for skin to skin contact if there are no medical complications. Where there are complications your baby may indeed be elsewhere, but then she is in the best place given her physical condition and you can be wheeled to her immediately if you too are well enough)
• I will be able to see my insides (UNLIKELY – You will have to look very hard to see anything at all in the blur of the lights above you and there is a large screen between you and your abdomen in any case. Women who want to see their baby lifted from them need to ask to have the screen lowered in order to view anywhere close to the surgical area)
• I’ll be cut right down the middle (UNLIKELY – Most caesarean scars are horizontal and in your bikini line, it is only in very specific circumstances where this might be necessary and you will be told in advance)
• I won’t be able to breastfeed my baby (MYTH – Breastfeeding can be tricky however you give birth but a caesarean delivery does not make this more so unless you have needed a General anaesthetic in which case you may be drowsy for up to 24 hours after delivery)
• I won’t be able to pick her up for days (MYTH – She is NOT too heavy for you to pick up it is more an issue of how quickly you can move in the first 24 hours. You may benefit from having her passed to you initially but you can now request basinets which attach to the side of your bed so even this is becoming a problem of the past)

Then there are more detailed questions:

• Will I be awake?
• What is the difference between a spinal and an epidural?
• Can my partner be with me?
• Will I have a vertical scar?

I am often asked such things by women who have already been told they need a caesarean and therefore should also have been told the answers in their case. I find it staggering that women are having to ask such things AFTER their appointments.

Educators should not wait to be asked, the information should be presented fairly and accurately. It is not respectful to assume that women do not want to know (many do) nor should it ever be assumed that women know what questions they should be asking in the first place.

There is no clinical evidence which concludes that recovery is longer or more difficult after a second caesarean. That said, anedotally you will always find women who say this was the case for them. For some it may be the surgery itself causing physical difficulties second time round but in many cases it is actually the circumstances around the birth that create the difficulties. By this I mean not only the circumstances at home but also whether or not the second caesarean had been planned.

Please do not underestimate the disappointment and emotional trauma that can follow a failed VBAC attempt (Vaginal Birth After Caesarean). Some women view a vaginal birth not only as their preferred mode of birth but also as a way to expunge the memories of a previous emergency caesarean. So when a second vaginal birth attempt ends in caesarean some women can be left with a lot to deal with emotionally.

However having a young child already at home plays a very particular role too. The extent to which it is possible for you to ‘take it easy’ after  this caesarean can vary significantly depending on the age of siblings, how much help you have etc. A young child needs your time and attention and will be making physical demands, not just to be carried or lifted but they will naturally want to play with you and half the time that will mean on the floor. Getting up and down, trying to visit playgroups, do the nursery / school run as well as look after your new baby and run a home means that the circumstances in which you are trying to recover from this caesarean are really very different from the last.

So listen to your body – even quite small twinges should be viewed as your body’s way of telling you you’re doing too much. At the very least they may be telling you to change the way you are doing something or to do it more slowly. The way in which you approach this recovery is very important. You will need to plan even more than last time.

Something as simple as getting everything on one level e.g. the changing mats on your dining table for the first few weeks (then daily bring everything you and your baby need for the day downstairs) so you limit the number of times you go upstairs, manage your toddlers expectations before the birth – start them climbing onto your lap rather than you picking them up etc.  I talk about this in lots more detail in my book Caesarean Birth: A positive approach to preparation and recovery.

Speaking personally, I found recovery second time round to be no more difficult than after my first, if anything it was easier:

• I knew what to expect and so did my immediate family
• I didn’t fret about getting off the pain medication as fast as possible
• I knew how to get out of bed and off the sofa without hurting myself
• I had my ‘baby station’ set up downstairs
• My toddler loved ‘helping’ (though I didn’t sell it to her as helping – she thought she was playing games seeing how many things she could fit in her trolley (the muslin, the remote, the telephone, the baby wipes) when all I actually might need was the baby wipes)

Put simply: Be prepared both physically and emotionally.

A study in Israel has found that there is an increased likelihood of babies delivered via caesarean failing their initial hearing test.

Traditionally this test is carried out on babies within the first 24 hours of delivery, but the study reveals that around 20% of babies delivered by caesarean are likely to fail this test, as compared to only 7% of those delivered vaginally. (Though it is worth noting that the failure rate is higher in general for all babies tested within the first 24 hours).

However, and it is a BIG however, the study showed that on re-testing the results normalised over subsequent days and most of these same babies then went on to pass the hearing test. Within the group (10/483) that continued to fail, 5 were caesarean deliveries and 5 were vaginal deliveries and with further testing the majority of these tested subsequently passed too.

What this study shows is that “There is nothing worrisome here for parents” so says Dr Woo, a paediatrician at the University of California, Los Angeles, Medical Centre in Santa Monica. The problem is often transient, and if the first test were done three or four days after birth instead, the results would likely be very different.

At the very least parents should be aware of this ‘effect’ and ideally defer the first hearing test until after the first 48 hours to avoid the worry that may be caused by early testing.