” Even the best-planned labors may not go according to plan, especially for first-time mothers. You may become exhausted or your baby may become distressed and need to be delivered quickly. Thinking about the possibility of a Caesarean or forceps delivery in advance will help you to know what to expect should the situation arise“.
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A Breech Baby is one that is born buttocks first. Most babies are in the breech position until about the 32nd week of pregnancy when they turn head down (cephalic position). Four out of every hundred babies, however, stay put. If your baby is one of these, do not be concerned, most breech labors are smooth, though you will have to have the baby in the hospital. Doctors used to try to turn breech babies by applying gentle external pressure on the abdomen. This procedure is rarely performed now.
Doctors do not generally recommend a home birth if the baby is in the breech position. However, if you are at home, try to adopt a supported upright position with your legs wide apart and your knees bent to give the baby’s head more space.
After the birth, your genital region might be slightly swollen but the swelling will subside within 48 hours. Because many breech births are helped by forceps, babies may have bruises on the face and head, but they will fade fast. You are more likely to have an episiotomy with a breech birth because the head has less time to be compressed during delivery, making it more likely to get stuck.
Attitudes towards breech births differ some doctors feel that a breech baby should always be delivered by Caesarean section, others are less rigid. However, about 50% of breech babies are delivered by Caesarean section in the UK.
Inevitably there are slight risks associated with the Caesarean section, as it is a major operation. There is the risk attached to having a general anesthetic and the risk of bleeding or clot formation which is always possible with major surgery, there is also the disadvantage of being left with a scar on the uterus that may weaken it.
The rate of Caesarean sections is still rising so there is some concern that the operation is undertaken without enough thought. You may know weeks or only days in advance that you are to have your baby by Caesarean section. This is known as a planned or ‘‘elective” Caesarean. You will be admitted to hospital on a certain day, but if you go into labor spontaneously beforehand, you will still be given a Caesarean. Some Caesarean is performed as emergencies when it’s essential that the baby is delivered quickly. Caesareans can be done under an epidural or spinal anesthetic, which is safer for you and the baby and means you can be conscious throughout. However, if an epidural isn’t already in place at the time, an emergency Caesarean would have to be done under general anaesthetic.
Some women find a Caesarean section a great disappointment after looking forward to a vaginal delivery, especially if the hospital unit is not one that allows mothers and fathers to participate actively in the Caesarean labor and birth, and have immediate and intimate contact with the baby at birth and afterward. Some women feel guilty that they have let their partner down and that he couldn’t be there with them at the time of birth. Many mothers are angered and disappointed if they are not able to have their baby with them after the operation and have to be separated just at the time when mother and baby need each other for mutual support. But these psychological effects can be minimized if you prepare yourself for having a Caesarean section and look on it as a positive experience.
Ask to see your obstetrician so that you and your partner can have a relaxed discussion about what the operation entails, what the procedures will be in the operating theatre, whether you can have epidural anesthesia and be awake and alert during the operation and whether your partner can be with you.
Ask your hospital clinic if there is a video available that shows what happens during a Caesarean. You can also prepare yourself by talking to other women who have had Caesarean sections. This is one of the best ways of preventing you from having negative feelings about it. Not only will you get moral support but you will also get useful information about what it feels like, how long it takes to be completely fit again after the operation and tips on caring for your baby while your wound is healing. By talking to mothers who have had subsequent pregnancies after a Caesarean section, you can allay your fears about the future. A self-help group will be able to put you in touch with midwives and obstetricians who have a flexible and realistic attitude to pregnancy after Caesarean section.
Your pubic hair will be shaved, the epidural anaesthesia will be set up, you will have an intravenous drip inserted into your arm so that fluids can be fed directly into your bloodstream, and a catheter will be inserted into your bladder to drain away urine. A screen will probably be placed in front of your face and your partner might prefer to stand behind it at your partner might prefer to stand behind it at your head if he doesn’t want to see the surgical procedure. A Caesarean section usually takes about 45 minutes but the baby is delivered within the first 5-10 minutes. The remaining time is for stitching the uterine wall and the abdomen. A small horizontal incision is made and the amniotic fluid is then drained off by suction. You will hear this quite clearly. The baby is then gently lifted out either by hand or with forceps. You will be given an injection of ergometrine to make the uterus contract and to prevent bleeding. You and your partner can hold the baby while the third stage is completed. If everything is all right you can start nursing him as soon as possible. Depending on the reasons for the operation, your baby may be taken away to special care for an observation period. The catheter and the drip will remain in for some hours and the stitches or clamps will be removed five days later.
The so-called ”bikini line” incision is common for obvious cosmetic reasons and because the low transverse cut heals more effectively.
After the operation, you will return to the postnatal ward with your baby. Because you need plenty of rest after abdominal surgery, you can concentrate on feeding the baby and getting to know him. You will be expected to get up and move around the next day and you can start gentle exercises, after two days. Most mothers feel normal from one week onwards after the operation. You will lose blood from the vagina just as you would after a vaginal delivery. You must take care when lifting and avoid strenuous activity for at least six weeks. The scar will fade, usually in 3-6 months.
When breastfeeding after a Caesarean section, your abdominal wound will be tender so prop the baby up to the level of your breast with pillows. Hold him with his feet under your arm.
Stand up perfectly straight when you get out of bed. Don’t crouch over your stomach. When you a cough or laugh, hold your hands over your wound to give yourself confidence. Keep moving around to aid your recovery.
Place the baby on some pillows and then lower yourself down beside him to feed. You can support yourself on your elbow.
Some of the conditions that warrant abdominal delivery of the baby may not be apparent until labor has begun and this will then result in an emergency Caesarean section. Unless you already had an epidural in place and depending on the reasons for the emergency Caesarean, you will be given a general anesthetic, although a good alternative is a spinal anesthetic (which is like an epidural but cannot be topped up).
One of the arguments put forward by the advocates of natural childbirth is that forceps are being commonly required because mothers are routinely given drugs and anesthetics that interfere with their own efforts to deliver the baby. In other words, a certain proportion of forceps deliveries are probably doctor induced. For centuries obstetric forceps offered the only method of delivery that was not a natural one. As Caesarean section has become safer, the use of forceps has declined, so that they are no longer used for any hazardous type of delivery. Nowadays, forceps are applied only when the first stage is complete, the cervix is fully dilated and the baby’s head has descended well into the mother’s pelvis but has failed to descend any further, or there are signs of either fetal or maternal distress.
A forceps delivery is normally done with the mother in the lithotomy position. Your legs will be put into stirrups and a local anesthetic will be injected into the perineum. The forceps, which are shaped rather like serving tongs, is inserted into your vagina one side at a time. The doctor will have already determined where the baby’s head lies and with gentle pulling on the forceps for 30-40 seconds at a time, and in time with your contractions, the baby’s head gradually descends to the perineum.
There should be little pain. An episiotomy is then performed. When the head is delivered, the forceps are removed and the delivery can be completed normally.
If longer forceps are needed to pull the baby out, you may be given a pudendal nerve block, which is a local anesthetic that is injected into the vaginal wall.