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Sunday, October 21, 2007

Things I Wish I Had Known about Cesarians

Now that I am in my third trimester, I find myself reflecting on my last birth, the one that ended in a surprise and terrifying Cesarean Section. Because of the last one, I'm required to have a "repeat c-section" with this birth. At least I have the good fortune of being able to prepare for this surgery. So, partly as a reminder to myself and partly as advice to others, I offer these things I wish I'd known last time but will be careful to remember this time.

If you are expecting, and you are certain that this post will never apply to you, I beg you to read it anyway. Humor me. I was also certain I'd never need a c-section. I wish I had learned more about them.

1. Any delivery can involve surprise emergencies. No mother is exempt.
In my case, I was certain that a c-section was out of the question because I'd successfully delivered four children already, two of them large. I have what one obstetrician once called "very good birthing hips." And I figured with my history, I could even be fairly sure that my children would be in the normal size range. It never occurred to me that the words "uh oh" muttered by a nurse during a labor exam would change everything. It never occurred to me that I'd have a ten and a half pound breech baby. Be at least a little prepared, even if you think it isn't a possibility.

2. Many doctors routinely feed a medicine called "Duramorph" into the epidural or spinal for c-sections. It is a form of Morphine, and will make you feel strange. If you start feeling sleepy or surreal on the table, don't panic; it's just the medicine.

3. The Spinal or Epidural medicine may surprise you.
Even if you've had an epidural before, for a non-surgical delivery, the epidural or spinal you receive for a c-section does not feel the same, because it is dosed much more strongly. It can actually make you feel numb all the way up to your lungs, so that you can't feel yourself breathing. It does not mean you are not breathing. Again, do not panic. If you are really worried, just tell the nurses, and they will watch you closely during recovery.

4. After delivery, your first pain may be a sharp pain in the shoulder. This is not a pulled muscle, but a gas bubble pressing against an abdominal nerve. The best remedy is to walk. That helps you work out the gas.

5. Ask for what you need in the hospital.
The nurses may not think to give you a stepstool to help you into bed, or a shower chair for in case you get dizzy while showering. Just because they don't think of it does not mean your needs are unimportant. You will have needs after a c-section that you would not necessarily have after a natural delivery.

6. Do not go home sooner than you need to.
I can't stress this one strongly enough. I thought I was ready, and felt a little silly staying in the hospital being "waited on." So I went home before they made me. One of the first things I discovered was that my bed was not patient-friendly, and that the need for a mechanical bed that automatically raises and lowers can be extreme. The first night home, I was not even able to get into my bed, resulting in serious leg swelling the next day from not being reclined during the night. I also discovered I could not get in and out of my chair very well to pick up the baby to nurse. The assistance available at the hospital may not be available at home, and don't underestimate its importance.

7. Medicine maintenance is a much bigger issue after surgery.
Don't be afraid to use pain management medicine, especially if you are nursing. Pain can seriously impede your ability to nurse. But also be careful not to use more than you need, particularly narcotic medicine. If you find that it becomes difficult to fall asleep without it, you may be working into a dependency, and it may be time to reduce your dosage or stop using it.

8. It can take a couple of days longer for your milk to come in if you are nursing after a c-section.
I'm not sure if this is because of pain, or shock, or because your body hasn't been through the whole birthing process. But extra patience is necessary. The more often you nurse, the more milk you will get, so keep at it! Also, prepare for nursing after a cesarean by reading a good article or two on the subject.

9. Have fiber.
Prepare ahead of time, and make sure you have a fiber supplement in the house before you have the baby, whether you expect a c-section or not. I cannot begin to tell you the pain you can save yourself by using a good fiber supplement daily while recovering from any birth but especially from a surgical delivery. Your muscles will not have the strength to push, and you will have natural (and possibly wise) fears about stressing your stitches. But a case of constipation can leave you very, very sore even after it is gone. So take the fiber preventively, before you need it.

10. If you catch a cold, hold your belly.
Specifically, if you need to cough or sneeze hold your abdominal muscles in place. This will make your cough or sneeze far less painful and less dangerous.