Cesarean Sections

Whether you are considering an elective cesarean or are just aware that an emergency section may be necessary there are several issues surrounding c-sections that are of particular interest to ME/CFS sufferers.

Elective Cesarean's

When considering an elective c-section it is worth remembering that it is a major operation and has risks of serious complications. You are given a lot of pain killing drugs during and after the operation which some ME/CFS sufferers may react to. It takes a long time to recover from, (4-6 weeks is average though it may take longer) during which time you are advised not to drive a car or do any lifting. While you are recovering you will need additional assistance with housework and getting around. For some people the physical stress of a c-section may be similar to that of a natural birth.

Elective c-sections are not always available on the NHS unless they are for a special case, so you may need to fight for your case to the consultant, this really depends on how well informed your consultant is on ME/CFS.

If you do chose to have an elective c-section do not feel that you have in some way failed, being as healthy as you are able to is much more important for you and your baby than having a vaginal delivery. Also choosing a c-section certainly isn't an easy way out of birth.

Other reasons a C-Section might be needed

There are other reasons apart from having ME/CFS that a section might be planned. These include:

placenta previa (where the placenta partially or completely covers the cervix),
fetal malpresentation (transverse lie, breech (breech can sometimes be managed by External Version, exercises or a vaginal breech birth), or asynclitic position),
cephalopelvic disproportion (CPD, meaning that the head is too large to fit through the pelvis.This can also be over diagnosed, it can be caused by maternal positioning either from restraint to bed, lack of mobility or anaesthetics.),
maternal medical conditions (active herpes lesion, severe hypertension, diabetes, etc. (please note that these conditions do not ALWAYS mean a cesarean.) )
repeat cesarean (where there have been previous c-sections, although vaginal birth is possible after c-sections)

Situations where an emergency c-section becomes necessary are:

prolapsed cord (where the cord comes down before the baby),
placenta abruptio (where the placenta separates before the birth),
fetal distress (This is a hot topic with the recent studies indicating that continuous electronic fetal monitoring increases the cesarean rate and does not show a relative increase in better outcomes. Discuss with your care provider how they define fetal distress and what steps are used to remedy the situation before a cesarean.), maternal exhaustion (where the second stage (pushing) does not progress)

Risks of a Cesarean Section

If you are trying to decide whether or not to have a c-section knowing the risks involved is important.

Risks to the mother include infection, increased blood loss (blood loss on the average is about twice as much with cesarean birth as with vaginal birth.) decreased bowel function (The bowel sometimes slows down for several days after surgery, resulting in distention, bloating and discomfort.), respiratory complications (general anaesthesia can sometimes lead to pneumonia), longer hospital stay and recovery time (three to five days in the hospital is the common length of stay, whereas it is less than one to three days for a vaginal birth), reactions to anaesthesia or other medications during the surgery. Risk of additional surgeries. For example, hysterectomy, bladder repair, etc.

Risks to the baby include the following: premature birth (if the due date was not accurately calculated), breathing problems (babies born by cesarean are more likely to develop breathing problems such as transient tachypnea (abnormally fast breathing during the first few days after birth)), low Apgar scores, fetal injury. Although rare, the surgeon can accidentally nick the baby while making the uterine incision.

What happens during the Cesarean Section?

After you have received your anaesthetic a screen will be raised so that you can't see what's happening. Your husband/partner will be dressed in operating room clothes and will probably stay by your head, though he is usually welcome to look at the surgery, particularly at the time of the birth.

Once the anaesthetic has taken affect the surgeon will make an incision along the bikini line (you will have been shaved prior to the surgery) through the skin. A second incision will go through your uterus. Your baby will then be eased out of your uterus and born. At this point you can ask for the screen to be lowered slightly so you can see the birth. Your baby will be checked over and given any help needed (if labour hasn't already started baby's tend to be a bit sleepy and may need help to start breathing) then will be handed over to you or your husband/partner while the placenta is removed and the surgeon starts stitching you up again. Although the initial birth may be very quick it can take a lot longer to stitch up all the layers of skin and muscle.

Once the surgeon has finished stitching you up you are moved onto a bed and taken to the recovery room.

Planning a C-Section

Even though the cesarean itself is a surgical procedure over which you have no control, you can still plan aspects of the birth and write up a birth plan. You can usually have someone in the operating theatre with you (except in emergencies) and can still have your husband/partner cut the cord. Your baby can be brought straight to you for you to cuddle and breast feed unless you are having a general anaesthetic.

Pain Relief for the surgery

If your c-section isn't an emergency one you are likely to have a choice about the pain relief used for the operation. Generally only a local anaesthetic is used for planned c-sections (such as a spinal anaesthetic or epidural) but you could opt for a general anaesthetic (where you are completely unconscious) too. Obviously very few people would chose to be unconscious for the birth of their baby, and usually a general anaesthetic is only used in emergencies. General anaesthetics are also more likely to cause relapses in ME/CFS sufferers.

If an epidural is already in place (for example if you had an epidural during labour and the need arose for a c-section) then that is used for the surgery (more on epidural's in the pain relief for labour article). But generally spinal anaesthesia is the most chosen pain relief for planed cesareans. This is because it can be administered quickly, and has less risk of uneven coverage than the epidural.

A combined spinal/epidural may be available to you, this gives the fast acting effect of the spinal with the flexibility of the epidural. It is worth considering this as the epidural catheter allows pain relief to be provided direct to the spine after the operation instead of having injections into the blood stream or tablets (which has more risk of sensitivities for ME/CFS sufferers).

Pain Relief after the surgery

If you had a general anaesthetic pain relief is usually given intravenously, where you can control the amount that you receive.Alternativly you may be give an injection into the muscle. If you are sensitive to drugs you may find that you can not tolerate as high a dose as you need to give complete pain relief. Usually a narcotic is used for this and side effects may include drowsiness, , vomiting and itching.

If you had a spinal then the numbness may last a few hours after the operation, after that the pain relief may still last some time depending upon the drug used. Duramorph may be placed into the spinal right before it is removed and generally gives good pain relief for 16-24 hrs after the delivery. The duramorph will come through into the breast milk in less quantity than orally or intravenously administered drugs, and is less likely to affect you as well. After the duramorph has stopped working you will have to have intravenous, oral or injected drugs as after a general anaesthesia.

The epidural (or spinal/epidural) gives the most flexibility postoperatively. The epidural catheter can be left in for longer and allows lower doses of the narcotics, while providing excellent pain relief. Either the drug can be repeated as necessary or a constant drip can be attached to supply constant relief. Having a constant drip does limit your mobility though.

Hospital stay after surgery

After the surgery you will be taken to a recovery area where you will be under constant observation. This area may have other women who have had c-sections or vaginal births, so is likely to be noisy and brightly lit. After this observation period you will probably be able to have your own room, which will be quieter and you should be able to rest a lot easier here.

Normally you are expected to get out of bed and take a walk 24 hrs after the surgery. You will also have a physiotherapist visit you and give you exercises to do. Don't feel forced to do more than you are capable of, you know your limitations with ME far better than the physio does. Try to do at least a minimum of exercises to keep your blood circulation going as blood clots are more likely if you stay immobile in your bed.

The surgery will have slowed your digestive tract down, so constipation is quite likely. Try either taking some over the counter remedies (ask your chemist), or take a bag of dried fruit such as apricots to snack on.

The average stay after a c-section is 5 days. I you feel able to cope at home before this time and feel you will be able to rest better do so, or if you feel you will get more complete rest at the hospital ask to stay longer. They won't turn you out unless they feel you are able to cope.

Recovery at home

Once you get home you will still need a lot of assistance from your partner/husband with lifting and carrying things. Focus on just looking after your baby and yourself, let your partner/husband take care of everything else. Remember not to expect to recover quickly, your abdomen will take a long time to heal completely so take it as slowly as you need to.

Staying in your nightclothes for a while will help remind visitors that you are recovering from a major operation, so they will be less likely to expect anything from you, and perhaps more likely to offer help.

Having your baby in a moses basket on a stand, or similar will mean you don't' have to stoop over to reach him when he awakens. Similarly having changing stations that are on higher surfaces will avoid leaning over, just make sure your baby can't roll off.

 

For more info on cesareans see this link: babyworld