How do I have the best c-section possible?
July 23, 2013 9:14 PM   Subscribe

I'm currently pregnant with twins and scheduled to deliver them via c-section this October. Is there anything I can do help with preparation or recovery?

I had an emergency c-section after 36 hours of labor with my first child, four years ago. I ended up at a different hospital than planned with a doctor I didn't know or like, I was exhausted and near-delirious, I couldn't stop throwing up as they were performing the c-section, my husband was so scared for me that he refused to leave my side once they got our son out, I had to get a blood transfusion because I lost too much blood on the operating table, . It was pretty much a completely horrible and traumatic experience.

I had every intention of at least attempting to deliver the next baby naturally...and then I found out I was having twins. After talking with my doctor, I think I've decided on a scheduled c-section this time around, but I'm really hoping it's at least slightly less traumatic.

Is there anything I can do in advance to prepare for this? Anything special we should pack in the hospital bag? Any tips for easing recovery? Anything specifically related to twins?
posted by logic vs love to Health & Fitness (10 answers total) 1 user marked this as a favorite
I had an unmedicated birth-turned-C-section and was grateful for the presence of a midwife-in-training and my doula. The midwife-in-training took all the photos, and sat with me just chatting and keeping me calm and distracted while the baby was delivered and while they closed me up. The doula, who wasn't allowed in surgery, was able to run to the car to fetch things, and then sat with me in the recovery room while my husband and the midwives were with the baby. The whole thing was very calm and peaceful -- lighthearted, even.

I wished I had brought 3 days' worth of snacks, because I'd always be busy when the hospital food came and then it was gross and congealing when I was ready to eat.
posted by xo at 9:31 PM on July 23, 2013

I can't help you with the twins aspect (congratulations, though!!) but I do have some thoughts on c-section. I think a planned c is an entirely different beast than an unexpected one. Best advice would be similar to a regular delivery: eat well, sleep when you can, get some good, gentle excercise in the days and weeks leading up. I highly recommend pre-natal yoga and swimming. Get a pregnancy massage if you can.

Then see if you can fill the pantry with lots of easy to prep, high-protein snacks. Stock the freezer, etc.. And please discuss your fears with your doctor. I would hope they could allay your fears and tell you why this C will likely be different.

Best of luck to you!
posted by amanda at 9:34 PM on July 23, 2013 [2 favorites]

I have no twins expertise, but my advice after 3 C-sections is to take enough (appropriate-for-breastfeeding-mothers) pain medication post-surgery to ensure that you're comfortable and, as soon as possible, mobile. The less energy you spend on pain, the more energy you'll have for your babies. The more you move, the more quickly you recover - also better for the babies.
Congratulations and best wishes!
posted by Slugette at 10:33 PM on July 23, 2013

Though my experience wasn't as traumatic as yours, I too a similar experience with my first child - emergency c-sect after a 36 hour stalled labor, threw up during the surgery, they actually ended up putting me under. So I was pretty discouraged when we made the decision to have a c-sect with my 2nd child. was a totally different experience scheduled vs. emergency after labor. Even though I didn't sleep great the night before, getting any rest made such a difference, and while I was still anxious during surgery and threw up again, the whole thing was much more pleasant.
I really feel like I was able to savor the birth of my 2nd child in a way I didn't get to the first time around, I experienced things I have no memory of with my eldest, even though my husband tells me they happened. My recovery was way, way faster, I was out of the hospital in about 48 hours.

Try to get as much help as you can so you can get your rest. Get on your feet as soon as possible, 2nd-ing don't be shy about the pain meds, I was more vocal about asking for them this time around, and found that I got off of them sooner once I got home.

As far as preparing, I don't have any twin specific advice, but a friend of mine who had twins swore by her water aerobics class. I did one as well and it was wonderful for my back, etc. Best of luck with everything!
posted by snowymorninblues at 10:41 PM on July 23, 2013 [1 favorite]

Best answer: I completely understand why you are fearful, and especially the nausea/vomiting aspect is of course very distressing. I give a lot of anaesthetics on the labour ward and would like to assure you that in my fairly extensive experience in the British NHS elective C-sections in situations like yours are generally quite calm and peaceful affairs.
Have you had an opportunity to discuss your worries with one of the obstetric anaesthetists? If not, make an appointment to do so - this allows the doctor to flag up your particular concerns and proposed solutions/strategies, and should ensure that whoever ends up anaesthetising you will be fully informed of the plan that is in place.
As your anaesthetic is most likely going to be a spinal or epidural block rather than a GA, it is worth emphasising that a drop in blood pressure is a very common side effect of this, and in turn probably the commonest cause of nausea during the operation (since the BP in your brain also drops); therefore tight control of your BP with BP-supporting drugs (vasopressors) is the first line of defense against nausea. Supplemental oxygen (best administered by a nasal cannula rather than a face mask) can also help. Should you still experience nausea despite the above, then additional measures may be called for. Although most anaesthetists might hesitate giving pharmaceutical antiemetics (drugs against nausea) unless absolutely necessary, studies have shown that stimulating the P6 acupuncture points at the underside of your wrists - either by wearing SeaBand(TM) on both arms or by having an intradermal injection of water - is just as effective as any one antiemetic drug, and will not have any effect on the baby.
After the operation, good pain relief is obviously important, and here it is helpful if a long-acting morphine-related analgesic (we use diamorphine) is added to the local anaesthetic in the spinal or epidural injection. But be aware that this almost always causes the patient to itch later! You should also start taking simple painkillers (Paracetamol/Acetaminophen and nonsteroidal anti-inflammatories unless contraindicated) in adequate doses right from the time of your operation, at fixed intervals rather than only if you are in pain. The idea is that it ultimately requires less drug(s) if you combat pain before it becomes noticeable compared with when it has become severe.
Assuming your baby is strong and healthy, and you breast feed, the traces of these drugs that will be present in your milk will be harmless to your baby.
The other important point is of course having a positive mental attitude - psychologically humans are predisposed to experience what they expect, so while I understand why you are fearful going into this, it is very important not to let your fears determine your expectations. This is why extensive communication with the labour ward team (midwives, obstetricians and anaesthetists) will help you to appreciate that everyone there is working hard to give you the best possible experience and outcome, which in turn will reassure you, your partner and your family and thereby reduce overall stress levels for everyone. And a Doula/experienced friend is an excellent idea. Good luck!
posted by kairab at 1:57 AM on July 24, 2013 [2 favorites]

I'm not a mother, but I'm everyone's fairy Godmother.

As you know, this is major surgery, so you are going to need a LOT more help once you get home. Call in the reserves. Mothers, mothers-in-law, Doulas, friends, etc. Give people specific assignments, someone can cook freezable meals, someone else can take your older child on playdates, a third party can look after the babies while you get some sleep.

As sleep deprived as you are with a singleton, it's worse with twins. If breast feeding turns into a problem, bail early rather than late. Or, start augmenting breast milk with formula, only so people other than you can feed the little rascals.

Take every opportunity to sleep.

As for the surgery, it will be SO much easier as a planned event, than an emergency one. Firstly, your doctor will be performing the procedure, so right there, you've got an edge. Secondly, you KNOW this is going to happen, as opposed to being in labor for hours and having it foist upon you. Thirdly, you can discuss anesthetic and pain management up front, so you won't have the bad reaction you had the first time.

You may want to discuss some hypnobirthing options with a doula or with a hypnobirthing practitioner. It can help with stress reduction, which will help with any pain and anxiety.

You, and your family are going to be fine, but don't underestimate how much help you're going to need.
posted by Ruthless Bunny at 5:28 AM on July 24, 2013

Make sure the anesthesiologist has experience with twin births. Find out the hospital's infection rate, especially with c-sections. I had a surgical delivery after hours of labor, then had a post-surgical infection after I went home, which was majorly not enjoyable. Talk to your doctor, or a surgical nurse about having a catheter, which can cause some side effects. Ask if you will be able to hold your babies right away, for that early bonding. My ex- and I had discussed the possibility of surgical delivery, and as planned, he went to the nursery and held our son (with his shirt off for skin-to-skin contact, the the hilarity of the maternity staff) while I got stitched up. Because I'd had a long labor, then surgery, I was out for hours after. You may very well be awake and able to hold your babies.

Make sure you have extra help for when you get home, and a good selection of pillows so you can hold the babies without discomfort. I wore maternity panties, then got granny panties (waist-high briefs) until the incision healed. Twins and a 4 year old and surgical recovery will be tiring, so take as much help as anyone can offer.
posted by theora55 at 7:01 AM on July 24, 2013

Congratulations! I had a scheduled c/s (well, it was scheduled the day before) with my triplets, and it really wasn't too bad. I guess with multiples it's important to remember that you might not have them rooming in with you (they might be in the NICU) and that's not the worst thing in the world. My boys came home after 11 (1) and 13 (2) days, and by the time they came home, I was pretty much recovered. I honestly can't comprehend taking care of more than one baby while recovering from a c/s. So I guess just be prepared mentally that (even if born close to full-term), they might not come home with you. With triplets, I didn't even really consider the possibility of taking them home with me, but I know a lot of twin moms are surprised by the NICU time.

Good luck, I truly hope you don't have to deal with the NICU, but it's just something to think about.
posted by pyjammy at 9:11 AM on July 24, 2013

If you are planning on a c-section and breastfeeding I found that a three sided crib was essential with all three of my children (c-sections emergency and planned). Here are the two things I found essential:

1) Co-sleeper bassinet -- three sided bassinet that attached securely to the bed. It made it much easier not to have to get up out of bed to do feedings or changings;

2) bedside bottle warmer -- this was handy if I was having dad do the duties or if I needed to have a bottle waiting. Test it out first so you can guage how long it takes to heat a frozen bottle vs. a cold bottle.

If you have pets, train them not to jump on you while in bed. I thought my cat was out to get me after the first surgery. Love of god, just be good to yourself. Set up your nest of recuperation and have a plan to exercise.
posted by jadepearl at 9:35 AM on July 24, 2013 [1 favorite]

nthing that the 2nd scheduled C was nothing as bad as the first C at the end of 36 hours labor.
posted by RoadScholar at 12:23 PM on July 24, 2013

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