Did i really need an emergency c/section?

[[M]umma[M]ia]

Im not happy with the way my daughter was brought into this world, but i feel like the way to get over it is to try and get some of my questions answered.

Long story short - I went in for app 9 days before my EDD. Blood pressure 170/120 (pre eclampsia). Labour induced, 3 lots of gels and my waters broke on their own. No drip needed as went from 0-7 cm in 3 hours. Mias heartrate kept dropped... down to 80 then up tp 180, dropping at every contraction. Emergency c/sec was done. I was told that she was trying to come out ear first. (i believe this aided in her bad head tilt which has only just corrected itself).

Questions being -

why did they induce? isnt there something to help bring blood pressure down?
Why didnt they do more investigating before they rushed me off? couldnt they have tried to turn her or use a vacuum or something?

[rayray]

PE is not something to messaround with, sometimes they dont even induce, they go directly to c/s.
if my baby's HR was erratic like that I know Id want her/him out asap with no messing around. Sorry I've just had 2 friends with in labour losses because the right decision wasnt made in time

[feeb]

They induced you because PE is very dangerous your bloods and urine must have been out of whack. There are medications that can bring down BP and stablise it but it takes time. If BP keeps climbing people can FIT which causes you to be deprived of O2 and also baby.
They may have been giving you medications through a drip to bring BP down.

They can only do a vacum if you are full dilated, and also if baby is low enought in birth canal.

Babies heart rates dropping and rising so dramiticlly does happen at differing times in labour (eg pushing and when head compression).
If she was malpositioned as she must have been if ear first she was not going to get to right position in a hurry and her heart rate is a sign that she is distressed.

Distress with PE can also be a sign that placenta is slowing down on bloof flow and function.

hope this helps

[STARRYSKY]

oh hollye- big hugs hun, i know the feeling.......
I remember reading in our belly buddies group when you went off to hossy due to the pe and all the problems u were having....i felt so badly for you, and disappointed for you too when you ended up being induced only to have to have a c section.
I was so happy that mia was here safe and healthy, i was worried that u might have some negativity but you surprised me with how well i "thought" you took it all.
why did they induce? probably because of the high bp, mine was all over the place and was the "medical reason given for my induction. if i recall correctly an epidural can lower bp.
i am guessing here but i think that cos of mias heart rate dropping they would have wanted to get her out asap.
there are alot of positives to think of too, your water broke on its own, you did actually dialate to 7cm (well done! i only got to 4!) and the best bit Mia herself.
when i was having a really hard time with m experience i posted on here, one of the fantastic ladies suggested focusing on the positives of the experience, which is what i have done, and it has helped, but
i keep asking myself, will i know better next time? would i, could i , should i have done things differently??? and i will never know...
hugs again sweet, if u need to talk let me know.

[ausgirl]

My friend very nearly died from pe - she was gravely ill in intensive care for several days - so I think in your case, the c section was a wise decision.

[Kate07]

A c-section may have been the right thing for you and the little one. I was a birth partner at a birth that sounded similar to yours at the begining.

Unfortunately, the Ob wouldn't listen to the midwife who was calling and took his time getting back. When a c-section was ordered, the anesthetist was then unavailable. Eventually, ventouse was tried thrice and finally forceps. The bub had been in distress way too long and had to be resuscitated. She spent the next week on life support. A Christening was performed at the hospital and life support was turned off, but thankfully, the bub had other ideas and decided to stick around. She is now a gorgeous 2 and a half year old, not walking yet due to the brain injury at birth, but she is an intelligent, determined little girl and will get there.

Many times there is unnecessary intervention in birth, but sometimes it is necessary. And sometimes, appropriate intervention is not done and it could have prevented a whole lot of other heartache.

Even though the intervention may have been the right thing to happen, You still have full rights to be upset that it wasn't the birth you were hoping for.

take care,

k

[Trillian]

In your case, I think it was unavoidable. You probably didn't have much choice about the induction due to the PE because women with PE can get very sick very quickly and if that happens it can be disastrous for the baby and often there isn't time to allow medication to work etc. But that is the catch 22 - you needed the induction but then that alone also started you on the cascade of intervention path. I think that you just didn't have enough time in labour to allow her to get into the best position she could, especially an induced one where your uterus is contracting harder than it would have in a 'normal' labour. Sometimes induced births can be harder physically on a baby, and that's why her HB was dropping, so it's not necessarily that she is in distress, but that the contractions are hard on her kwim? Not only that, her head wasn't in the right position and no amount of instruments were going to get her head in the right position without a huge amount of discomfort and distress to you, not to mention the possible physical injury to her by trying to do so, so it would have been the best outcome for her to go to a c/s to get her out, especially if you think that she did have some residual issues from the way her head was.

[Emmy83]

You would have being induced because of your BP and to prevent it getting worse and you getting sick and the baby so I would say delivery was a must. Yes they can give you medication to bring the BP down but sometimes its not enough and if your liver function is already affected it is not going to improve from bringing your BP down. You can not perform a vacuume without being fully dilated unless they cervix is able to be stretched back past the baby's head. This can usually onlt be done when you are almost fully dilated. Like 9.5cm and the cervix needs to be stretchy which is usally isn't until you have had a vaginal birth before. With bubs heart rate going down you need to know if its recovering quickly and going back to a normal rate and only going down occassionally. Usually its a sign of distress and delivery needs to occur quickly. Sometimes they can do a PH on the baby (by taking a blood sample from its scalp) if its high or low they need to delivery it quickly as its a sign they are burning to much oxygen. Sometimes they do go down and back up down again etc but there PH is fine and then they are happy to continue with labour and not resort to a c/s. As for her coming ear first unless she is very very tiny you can not deliver a baby coming ear first. The area of the scull that would be trying to come through the pelvis is to large for you to birth that way. Your labour would become obstucted and even with a forceps or vacuume they could not deliver her whilst she was coming that way. To my knowledge you can't turn them either at that stage of labour. I'd say she was firmly stuck which could have lead to her being distressed as she is trying to come through an area she was never going to fit.

It sounds like you have a terrible birth. If she was in a better position you might not have needed the C/S as her position and the fact she was distressed was obviously the final decision for the C/S not your BP. You are less likely to have high BP in future pregnancy's although you are at an increased risk theyn the general population seeing as its happened before. I know this doesn't help now but if/when you have more children you will probably have a much easier time and be able to have a VBAC if thats what you wish.

[Julie Doula]

Hi Hollye,

As a doula, I have seen situations in which I thought the c/s was unnecessary, other things could have been tried, coercion was used etc. I have personally witnessed such situations, in which I thought the only reason the woman ended up with a c/s was because of the obstetric model of care, and I honestly thought, if only she'd been at home with a midwife, or with skilled midwives in a birth centre, the c/s could well have been avoided. You know, the usual 'cascade of intervention' type scenarios.

But in your case, my gut response is, it was the right call. It seems to me from what you've described, that you would fall into the 10-15% of caesareans recommended by the WHO.

Even though it's highly likely that your c/s was the best thing for you and your baby, I know it is a big shock, and there is still a certain grief associated with processing all that happened. Whenever we face unexpected events while ttc, or during pregnancy, or during birth, there is shock and loss to comes to grips with, perhaps even trauma, and certainly a need to process all that happened.

It might help you feel a little better to know that by consenting to a c/s, you made a wise choice for you and your baby. However, it's only natural that you'd still feel a need to talk through what happened. That de-briefing can really be helpful when birth does not go to plan.

In time, finding out more about PE may also help you feel more confident that you made the right choice the first time, and help you feel confident if you should ever find yourself pregnant again. PE is more common with first timers and less common with subsequent births. Also, diet and life-style can make a positive difference. Finding out about your options for VBAC might help you should you ever have another child.

Here is a summary of info about Pregnancy Induced Hypertension and PE, based on info I found at the Gentle Birth Midwife Archives.

Preventing & Managing High Blood Pressure in Pregnancy
Are you in the position of being told that you have to be medically induced because your blood pressure is rising? High blood pressure can be a sign of a serious condition called Pre Eclampsia. It’s possible to reduce the high blood pressure, and even avoid the need to be induced, by making some changes in your diet and lifestyle.

* Water – drink more plain water

* Protein – this is a major factor in avoiding many pregnancy complications including PIH and Pre Eclampsia. Nuts, Seeds, Wheatgerm, Beans, Cheese, Milk, Yoghurt, Soy, Eggs, Chicken, Fish and Meat are all good sources of protein.

* Increase Calcium
Raw beetroot is the fastest and most effective way to naturally increase available calcium to the body. It also balances the sodium/potassium ratio of your blood. You can juice beetroot & carrot together, or make a raw salad of equal parts of one freshly grated raw apple and one grated raw beet. Other good sources of calcium are low-fat dairy products (milk, cheese, yogurt); dark green vegetables (silverbeet, broccoli); dried figs, dates, apricots & prunes; nuts and seeds; lentils and beans.

* Increase Magnesium

• Magnesium deficiency leads to Pre-Eclampsia. Junk food has hardly any magnesium. Whole grains, raw fruit and vegetables lots of magnesium. These foods have the most: Spinach, Silverbeet, Nuts, Pumpkin Seeds, Sunflower Seeds, Avocado, Beans – kidney, navy, pinto, lima, soya; Brocolli, Tofu, Wheatgerm,

• Have a bath in Epsom Salts, which contains Magnesium.

* Increase Potassium
Bananas and ripe yellow cucumbers are good sources of potassium.

* Vitamins C, E and A
Raw fruit and vegetables, especially green leafy vegetables, are good sources of these vitamins and also of calcium.

* Evening Primrose Oil

* Fish Oil

* Exercise
Regular physical activity reduces the risk of developing Pre Eclampsia. It helps by:
- reducing stress and promoting general well-being
- helping the placenta grow healthy and helping the blood flow to the placenta.

* Avoid stress and practice relaxation. Prayer, affirmations and visualization helps too.

* Sex
Semen can help prevent Pre Eclampsia. Women with one long-term partner are less at risk than women with new or multiple partners.


* Swimming
Full body immersion (in a pool, not a bath) for 30 minutes a day will help bring the blood pressure down. You need to get into the pool up to your neck and swim and float around for 30 minutes a day.

* Healthy Gums
Gum disease can cause Pre Eclampsia. Brush, floss and use mouth wash daily. You could use an Echinacea mouthwash or use tea tree oil on your gumline after brushing.

* Herbs & Homeopathics
• Garlic
• Parsley
• Lemon or lime juice with a tsp of Cream of Tartar, once a day for three days. Cream of Tartar is a source of picnoginol.
• Passionflower
• Skullcap (Scutellaria lateriflora)
• Hawthorn berry
• Dandelion
• Raspberry Leaf Tea
• Nettle tea
• Grape Seed Extract

Sometimes women can get ‘White Coat Hypertension’ when their blood pressure goes up while in the hospital or doctor’s office, but goes back to normal when no one is fussing over them anymore and they are able to relax again.

If you only have high blood pressure, but no other symptoms, this is less to worry about. Sometimes there will be a natural sudden rise in blood pressure two or three weeks before the baby is born, with no other clinical problems. If you’re not stressed and drinking plenty of water, this should not be a problem. It could actually be a healthy compensatory mechanism to increased circulatory volume and other metabolic demands of late pregnancy.

A slow steady rise of blood pressure over the weeks is more of a concern.

The other symptoms to watch out for are:
• swelling (all over, not just feet. E.g., you’ve had to remove your rings.)
• sudden weight gain
• protein in the urine (usually after 26 weeks)

Diet, drinking water, using salt normally and exercise is the best way to avoid this.

References:
Ronnie Falcao’s Midwife Archives
http://www.gentlebirth.org/archives/pih.html)

Heart & Hands – A Midwife’s Guide to Pregnancy & Birth by Elizabeth Davis

Regarding de-briefing, I have a PDF booklet published by South Australia Homebirth Association, entitled "Healing after a traumatic birth". If you would like a copy, feel free to email me at autumnrainoz@bigpond.com, and I can email you a copy.