Blinded by the screen (please)

Oh my. As my mind is made up that I want a caesarean section, and my overactive imagination/madness/heart rate monitoring has baby distinctively not head down - whatever the midwife says - I pondered as to how they get a baby out in a section if it's not head down. As I am now at the watch-all-birth-programmes-incessantly stage of pregnancy, I've seen footage of a fair few c-sections, which go as follows:

Cut through outer mother then inner uterus etc and tear membrane. Allow waters to gush out. Grab baby's head and tug until entire baby comes out. Stand by with sucker to clear airways. Snip cord, make sure baby is breathing and something a lot closer to pink than blue.

So, if head isn't first, which I actually have no reason whatsoever to presume (other than it would be useful for argument's sake if baby wasn't cephalic on Friday), what happens?

I did a silly thing to find out. I asked the Internet and found icky YouTube footage of caesarean delivery of transverse lying babies.

Yuk.

Most of the procedure is as above, except the bit where they ease the head out. If there isn't a head there, the surgeon appears to plunge his hand in, rummage around until he finds some part of baby, then tugs on that. Often the head will then be last out, and the baby is invariably more blue when this happens. It does not look nice, thank heavens for the screen that stops visibility to the mother - and father who is forbidden and unwilling to be at the action end.

I console myself that a) obstetricians tend to know what they're doing, b) both twins were breech so were probably head last, there was two sets of limbs etc to be tugged upon, and they were fine and c) there is no reason to think that baby isn't head first.

People do always say that c-sections feel like someone washing dishes inside you, so I guess there's always an element of rummaging. I so don't want to see it happening to me, it does not ever look reassuring. The commentary from the anaesthetist is far nicer.

Incidentally, the babies that come our the conventional route don't look any healthier or less blue and the mum looks considerably less healthy. I have not been put off.

I was asked today if I was hoping baby'd come early and naturally and I said no. But if she did, and it was quick, and therefore successful, then yes I do. What I don't want is an unsuccessful labour.

Baby's a go go this evening!! Whatever position she was in she sure isn't in it any more!

To be consulted

Or am I doing the consulting? Dunno

I shall be having a consultation with my obstetric consultant on Friday, re: the birthing of baby.

Also included is this fortnight's ante natal check, so unless I suddenly start being muchly unwell and/or I swell up, I'll leave worrying about my BP till then.

And so to prepare for the consultant.

I would like my baby to be delivered by elective c-section for the following reasons:

The rate of successful VBAC is somewhere between 34% and 50% - depending what you read - which means at least 50% end in an emergency c-section. At nearly 37 years old, having never been in labour before (I only got as far as stage one of induction with the twins, and nothing began at all) my own chances of a successful VBAC would be less than this.

An emergency section carries the greatest risk to baby and me, as well as having the longest recovery time. The only sure method to avoid an emergency section is to have a planned one.

My pelvis limits labour options, but not as much as my previous c-section. I cannot be induced or helped along hormonally, nor should I have any form of assisted delivery as both of these increase the chance of uterine rupture or general distress on the part of mother or child. Additionally there are time restraints in a VBAC. The trial is abandoned and a section performed in a number of scenarios of an attempted VBAC. So, the chance of an emergency section is pretty damned high.

Reasons I won't be sharing with the consultant:

Supposedly female obstetricians and GPs have a much higher rate of repeat elective sections than the general population. They have the facts and that is the decision they take.

An entirely vacuous and not vote swinging reason, but I am happy with having a definite date to make arrangements around, and not being left to overcook.

With regards to a trial of labour, that involves, well, waiting, trying and a probable emergency section, having put my body through an unsuccessful labour. If I could know it would work, then yes, I would go for it, but statistically, I'd like to minimise the risk. Baby's health is far more important to me than my experience of being a complete woman etc etc. I do not fear pain or worry about saggy bits (although avoiding them would be nice, I am aware of the udder effect/recovery period from a section). I am not too posh to push, I am too prudent to persevere.

Doesn't quite have the same ring/dismissive tone to it though. Huh.

Birth plan

When I was having my twins, up until the 36 week scan (twin pregnancies necessitate 4 weekly scans, which is lovely) both of them were breech, we were on for a caesarean. As such I didn't pay all that much attention to antenatal classes and what not. Not for me, thought I.

36 weeks and R was head down, they said. So induction it was to be, as they don't like you to go overdue with twins in case you pop or something like that. Refocus mind to natural birth and think, hmm, I've not done this before I think I might just trust the experts.

My birth plan was a lot like this:

I do want the babies to have the vitamin k injection.

My husband doesn't want to cut the cords.

I'd prefer to avoid general anaesthetic.

Other than that I leave it to the medics to make the best decisions for me and my babies.

Nobody read it in the end.

As R was breech on the day (at 38 weeks and 6 days) the twins were delivered by caesarean anyway, after much it's a head/no it's a bottom/no it's a head/let's just go for a section.

Anyway. This is my proposed birth plan for this time:

Have planned caesarean section.

This doesn't apply if she comes early. Supposedly if I am in advanced labour I will be keen (keen? Really?) and indeed expected to carry on with a natural delivery, but as I fully expect to be at the hospital approximately 24 seconds after any water breakage or contractions, this is unlikely.

As I got to nearly 39 weeks with "they always come early" twins after not a hint of imminent labour, I guess I'm not an early dropper. Not to mention the fact that she's so far been fast forwarded 2 weeks already and they're planning a 39 + 2 delivery date so early is really unlikely.

The VBAC option has been dismissed. Way too risky for me and baby. In case you wondered.

VBAC??

I had a chat today with a friend who delivered her second child naturally, following the caesarean birth of her first some years previously. I was of the impression she had a rotten time of it and would be loathe to recommend a VBAC.

On the contrary, she said she'd do it again happily, it was far better. She had it as a trial of labour, which is where they let you go into labour, but will intervene and section if there are any complications.

Which sounds ok. They won't induce you, or they shouldn't, or to put it another way, if it is me they will not be inducing me. I don't know what Forth Park do, but a lot of hospitals constantly monitor the foetus for any signs of distress. The "experts" say that they shouldn't because the likelihood of any complications are lessened the more active a birth can be. "They" also don't recommend epidurals for the same reason, which loses me a bit.

Reasons to intervene and perform a c section include:

Foetal distress
Failure to progress in a sensible time frame
Mother changes her mind about a natural birth

When I hear tales of people who have their children easily, quickly (for a labour) and relatively painfree-ally then I think, well, do I really want unnecessary surgery for no reason? Diabolical it may be, but it is all over once it's over. No big recovery (apart from the ripped bits, ugh). And supposedly you feel dead proud and all that. But supposedly you also feel close to suicide if you cannot breastfeed and I sure don't sign up to that school of thought. I didn't feel bad about any of it last time and I failed all my NCT badges of honour.

Basically, my aim is a healthy baby. It is my considered opinion that I don't want the risks of a failed natural delivery, and so an elective section would remove those risks. But maybe - maybe - a trial of labour would see if the normal/sensible/conventional/nonsurgical method could work, with consultants and what not on hand to operate if required would be a good way to proceed. Maybe.

We'll see what they say at the scan. If the baby's a sensible size, in a sensible position and all looks shiny, I could be persuaded to try on the strict understanding it's a trial not a no-matter-what, and that in the event of going overdue they perform a section rather than leaving me to overcook or any hint of induction.

Possibly. I have a meeting with the consultant at 34 weeks to discuss the birth.

Baby is currently at least two or three centimetres higher than should be. Not mad, confirmed by heartbeat. This can be indicative of a breech position, or placenta praevia - where the placenta covers the cervix, both of which are situations where a section would be essential. So as I say, we'll see what they say at the scan. (We'll not think about the bad things that can be indicated with a large for dates uterus). Most likely it's due to having a stretched and battered uterus having had twins last time.

Or there's a twin in there this time and it was hiding at the scan...