View Full Version : Another Question: re labour
After my earlier question, I have decided to ask all you mums out there another question that has been bugging me for the last couple of weeks...(this is not related to my earlier topic- haemoroids either..he,he)
I was wondering/concerned if I am in labour say for 20 hours....am I able to ask for a C-Section? My only reason for asking this is that I have been told of many occassions, whereby mothers have been in labour for 20+ hours to then be told that they are required to have a C-Section. Can anyone also please tell me if a spinal needle is better than an epidural..as I understand that the epidural stays in, whereby the spinal needle (not a spinal tap I dont think) is just administered then removed straight away. Also if I have opted to go Public..can I request Private Doctor if I need a C-Section?
I know many questions in one here, but any help will be appreciated.
Bec and Peanut
I had an emergency c/s with Jack who is 5 months old, I had the epidural not that I was given a choice as they had me on a drip for 2 hours as I had only reached 9cm and wasn't going any further (turned out Jacks head was tilted back preventing him from coming out) even though the needle stayed in I felt no discomfort (they were able to top it up just before surgery) the only problem I had after was I did end up with a bruise that was a bit sore but otherwise it was fine. I went public and wasn't given a chioce about what Dr I wanted I was in too much shook about having have to have a c/s that I didn't even ask so don't know about that one.
Nice to hear that you and baby are well after the C-section....this is the thing I am dreading the most...and the thought of a needle in my spine..but what will be will be I suppose!
Yes you most certainly can ask for a c-section! I was in labour for about 12 or 15 hours with no dilation and my ob gave me a choice of either going on the drip (still no guarantee of dilation), waiting it out (which could take days), or c-section. As it was about 10pm I opted to wait through the night and see how I felt in the morning. Still no dilation by the morning, I was tired and cranky, so I opted for a caesarean. Eloise was born by 11.35. There was no fetal stress, no stress from me, I just wanted it over with.
I had a spinal block which was great - lasted just long enough to have the op and then the feeling came back not long after that. And I was in a public hospital and my own OB assisted with the caesarean, along with a midwife and about 5 other doctors and mediacl staff.
Don't stress - no question is a stupid question in pregnancy!! Good luck! :)
Ok - there is a spinal, and epidural, and a combined spinal/epidural. Spinals are used for c-sections only, as they cut off all feeling and movemnet for a few hours. Epidurals can be used in labour or for c-sections. The needle doesn't stay in your back - a small needle is used to inject local anaesthetic, followed by a larger needle to get to the epidural space. Once the space is found, a flexible plastic catheter is threaded in, and that's what stays in your back, not a sharp needle. The spinal is a one-off injection that will only last a couple of hours, whereas the epidural is usually hooked up to a pump and runs overnight. The advantage of a combined spinal/epidural is that the spinal injection works pretty much instantly, whereas an epidural can take up to 30min to come into effect.
If you get admittd as a public patient, you can't ask for a private doctor to perform your caesar. Depending on the time of day, you will get the obstetrician on call and the resident or registrar to assist.
Just another thing - a spinal tap is another procedure all together - it is taking a sample of spinal fluid to check for infection, so you won't get one of these in labour ;)
After all that information, one of the problems you may encounter is that in an emergency, you will get no say as to what sort of anaesthetic you will get, and some anaethatists are set in their ways and will only do one sort of anaesthetic.
Well! As you can probably gather, I'm a nurse, and I work in theatre, so if you have an other questions, please feels free to ask.
I had twelve hours of regular contractions (and 0 dilation) before established labour even began. Paracetamol was enough to deal with this pain which was like bad period pains. My labour was theoretically 31.5 hours but it wasn't serious for that much of it. People like to talk-up their labour times when it was extreme but I bet much of it isn't full on established labour.
The reason for the length of my labour, like so many others, was that DD was posterior so contractions were pushing uselessly on her feet and then into the open space at the front of my uterus rather than down her spine. This is something that midwives can easily see (by the shape of your belly) if you allow them that privillage, and believe it or not they can enourage the baby to turn into an anterior (ideal) position. So those types of long labours don't have to be *that* long. I blame myself a bit for not letting my midwife be hands-on to be honest.
Things to consider seriously... even if a C/S is considered elective after a long labour YOU are still four times more likely to die after a C/S than a vaginal delivery. Your baby is five times more likely to end up in special care, and 2% of C/S born babies suffer scalpel injuries. C/S are rarely the safest option. What's more... the further you get into labour before having a C/S the less likely you are to be successful at a subsequent VBAC. So if you request a C/S at the eleventh hour then you chances of have a succesful vaginal birth in the future are greatly diminished compared to those have to have electives because of pre-existing medical conditions/breech etc. Labours do generally get shorter with each baby as the uterine muscles and cervix has dilated previously. I gather that a five-year gap reduces this chance as your body has recovered so much by then. The point is that requesting a C/S and dealing with the increased risks associated because of a long labour will reduce your chances in the future (statistically) though your body will probably never have to labour for anything like that period again.
C/S are not a rosy option!
I had an epidural by the way. All you feel with an epidural is the local anaesthetic needle, you certainly don't feel the catheter being inserted (that's why you have the anaesthetic). Epidurals are more flexible than spinals since they can top it up as required and their intensity can also be controlled to some degree. All depends on the skills of the anaethetist. I don't believe for a moment that a private practitioner is any more skilled than a public either.
I was a little concerned about your statistical information. From what Ive read your statistics seem a bit alarmist.
AT times a csection is the safest option for mum and bub. The longer the bub is in labour the the more likely it is to suffer fetal distress.
A csection is not the ideal delivery method but can often be the best and safest option in the end.
Though there is some discussion about why the stats are so bad (ie some of the women who died after having a c/s had other risk factors) in the article below (which is a report submitted to the UK parliament) you can read that maternal deaths were 5x after c/s rather than vaginal birth.
I was unable to find equivalant results for Australia.... but I'm sure that the research is out there if any one else feels like a bit of a google.
(the relevant info is in a box on the last page with 'health implications for the mother' as its title)
¨ Risk of mother dying after caesarean is 4 in 10 000-; 4 times overall vaginal birth (Enkin M, Keirse M, Neilson J, Crowther C, Duley L, Hodnett E, Hofweyr J. Effective Care in Pregnancy and Childbirth, 3rd Edition. Oxford University Press, Oxford 2000.)
¨ Risk of mother dying after elective (ie non-emergency) caesarean is 2 in 10 000- 4 times normal vaginal birth. (Enkin M, Keirse M, Neilson J, Crowther C, Duley L, Hodnett E, Hofweyr J. Effective Care in Pregnancy and Childbirth, 3rd Edition. Oxford University Press, Oxford 2000.)
¨ 1 in 5 women have fever post-operatively- infections of uterus, wound, urine are most common. (Enkin 2000)
¨ “Serious infections such as pelvic abcess, septic shock and pelvic thromboembolism [blood clot] are not rare” (Enkin 2000)
¨ Australian study showed 6 times increased risk of postnatal depression, 3 months after an emergency caesarean. (Boyce P, Todd A. Increased risk of postnatal depression after emergency caesaraen section. Med J Australia 1992;157:172-4)
¨ After a ceasarean, women are less satisfied with their birth experience; less confident with their babies; more fatigued (up to 4 years after) and less likely to breastfeed. (DiMatteo MR, Morton S, Lepper HS et al. Cesarean Childbirth and Psychosocial Outcomes: A Meta-Analysis. Health Psychology 1996;15(4):303-14)
RISKS TO THE ‘NON EMERGENCY’ BABY
¨ 5 times increased risk of needing intensive care treatment after birth. (Annibale D, et al. Comparative Neonatal Morbidity of Abdominal and Vaginal Deliveries After Uncomplicated Pregnancies. Arch Ped Adol Med 1995;149:862—867)
¨ 1.6% of babies require a machine for severe breathing difficulties compared to 0.3% vaginal births. (Annibale 1995)
¨ Persistent Pulmonary Hypertension, of which 40-60% of affected babies die, affects 3-4 per 1000 elective caesarean babies, cf 0.8/1000 vaginal births. (Levine E et al. Mode of Delivery and Risk of Respiratory Diseases in Newborns. Obstet Gynaecol 2001;97:439-42.)
¨ 2% risk laceration by knife during operation (Smith JF et al. Fetal laceration injury at cesarean delivery. Obstst Gynecol 1997:90;344-46)
¨ Maternal request is a very uncommon reason for caesareans. Brisbane survey found 93.5% of women preferred a vaginal birth, and only 1 woman out of 310 requested caesarean without a medical reason. (Gamble J, Creedy D. Women’s Preference for Cesarean Section: Incidence and Associated factors. Birth 2001;28:101-10)
¨ Over-use of obstetricians. “Having a highly trained obstetrician surgeon attend a normal birth is analagous to having a paediatric surgeon babysit a healthy 2 year old” (Marsden Wagner, ex-WHO perinatologist, 2000)
¨ Countries with high numbers of obstetricians caring for healthy women have high caesarean rates, but no better outcomes.(Australia, Canada, US, Greece- Wagner, Marsden Pursuing the Birth Machine. ACE Graphics, Sydney 1993. )
¨ Low technology models of care (midwifery, birth centre, home birth) are at least as safe and with less interventions and caesarean rates typically below 10% (eg Rooks J et al. Outcomes of care in birth centres- the National birth Centre Study. N Engl J Med 1989;321:1804-11, Parratt 1999)
I could go on forever. This info all comes from a Brisbane-based Dr by-the-way
Incidentally, the use of the term "foetal distress" is a bit of an issue in Australia too. It's amazing what you can get away with when you start telling a mother her baby is in distress...
Hi again Angel
Thank you for supplying all of that information and with references. I hope you dont think I was attacking what you were saying. I worry that too many women are made to feel guilty about having a csection, emergent or elective.
The risks are of course higher than that of a natural birth but when you look at those statistics alone, without comparing them to a natural birth, they are not extremely high.
Im sure there are OBs out there who schedule elective csections to suit their time lines, but the two I know are wonderful and have been happy to leave the decision to me. We need to avoid lumping everyone together.
Thanks again for your research
Thank you to all for you advice and statistics....a little daunting to read the stats to be honest...I think that I am just getting a little concerned...probably too early for that...and I want to be as informed as possible.
Starting antenatal classes tonight..so that will interesting!
Just a quick question for our on hand nurse....at what stages o the pregnancy am I required to get my Anti D injections?? I have forgotten!
Also did any of you not fast when you went for your 27 week GTT (for diabetes)?I have been told to only not eat b'fast and that my blood will be taken, then I will drink the glucose drink then wait an hour and get another blood test (apparently this is a short GTT and is performed by my GP)?
Bec and Peanut
Don't allow yourself to get too concerned about statistics, but I agree that you should be as informed as possible. Women and their babies have never had better resources to assist them during the labour process and at the end of the day a healthy baby and mummy are the only thing that matters. I had an epidural with both my pregnancies and in my first one I think it made my labour go faster. I knew (from all my reading :p ) that I should be relaxing with each contraction and imagining my baby coming down and out into the world, but I couldn't - I would tense up with each contraction which is exactly the wrong thing to do. Anyway, I decided that this was inefficient (I'm an engineer :rolleyes: ) and opted for the epidural. Dilation was pretty fast after that. It was an amazing experience, being able to feel the pressure of the contraction, but without pain. I'm still amazed when I think about it now!
In specific answers to your latest (only from my experience, I'm not a health professional). I had two diabetes screening tests for each pregnancy. For the first one (1 hour GTT)no fasting was required, I just went down to the pathology centre in my lunch hour, drank the drink and had a blood sample taken. When I "failed" that screening test (in BOTH my pregnancies!), there was the 3 hour GTT. This one requires fasting overnight, drink a different drink, and have blood samples taken initially, then at each hour (I think). With my first pregnancy (2001) I had to give a urine sample as well (not for the second though in 2004). BTW the second test showed I did NOT have diabetes (in both cases). :)
Here's a site to give you some info on anti-D injections;
Hope it helps!
I have to reply to this thread. I too am alarmed by the stats and I believe that we should be informed as much as possible but there is a fine line between being informed and down right scaring people. I had a c/s with Harry and I'm proud to say Angle that it was the safest option for me and my baby. Harry was breech and had the cord wrapped around his neck. So here was my choice continue my labour and have a dead child at the end or have a c/s and have a beautiful healthy baby boy. You know which one I choose.
Rebecca, you should look at all your options and discuss them with your birthing partner so they are informed also of your wishes. You can ask for a c/s or drugs and if you know which you prefer even better. Harry was deliveried by a Registar and she was fantastic, explained everything to me and Dh and made us feel as comfortable as possible with the decision that had to be made. As for the needle in the back. It took my Dr 5 attempts to get it in and yes it was a little painful but the relief was worth it. I did have a little bruise the next day but I didn't feel it as my beautiful baby boy had arrived and nothing else mattered.
Inform yourself as much as you feel comfortable and good luck with the rest of your pregnancy. Ask your midwife at Ante-natal classes if you have any concerns or questions. They are the best people to ask.
Bye for now
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