Cesarean Question

[truelife]

I was just contacted by a client who's EDD is 01/30/07 and at her prenatal today the dr. told her that her baby who was breech and then turned is now transverse. She "just doesn't think that he is going to turn again" and wants to know what my role will be during and after the c-section.

I don't believe that it's too late to get the baby to turn or that it's impossible to have the natural birth she wants but how do I convey that? What or how do you explain your role in the event of a c-section?

TIA!

[tlcdoula]

Did you suggest things such as chiropractic care to turn the baby or anything? If so, how did she respond to that?

As far as conveying your role - I would first make sure she checks with her doctor to see if he/she will allow a doula to be present for a cesarean. Sadly not all will and you would hate for her to find out you can't come in (not that you still can't help her before and after the cesarean, but she would probably get more if you were there for the cesarean). If all is okay with the doctor I would explain what your role will be. For me, I explain that I go to the hospital with them to calm their nerves before the event, will go in with them when they get their epidural and will stay with them throughout the procedure. I am then there to either stay with the mom or go with the baby (depending on where dad wants to be) after the birth. I will take photos for them, continue to calm nerves and will assist with comfort and breastfeeding after the birth.

Sorry, I know there are other things I am forgetting, but my mind is kind of on a few things right now.

[truelife]

Thank you so much Michelle!

I have taught this client childbirth classes, she goes to my chiro (Webster trained), we got the baby to turn from breech to LOA and then at today's apt. he was transverse. I'm obviously not giving up on the baby going back LOA but she sounds like she feels very defeated.

I don't know how her dr. feels about external versions but I may suggest it to her. We'll see.

[purpleheather79]

I'd tell her that babies can, and do, flip at the last minute-even in labor. I'm sure she feels discouraged but she still has time!

As far as the c-section, often they will let you accompany her into the OR and remain with her after the baby is born so the partner can go with baby to the nursery. IME, there is more PP support for a c-section than during the actual (relatively short) surgery.

[Jilian]

Have you mentioned accupuncture? My last client had great success turning her baby with moxibustion that her accupuncturist did. Of course there is always the warm bath with a bag of frozen veggies up by the baby's head and then massage to encourage the baby to turn. spinningbabies.com has some good suggestions too.

My first client's baby turned during the end of labor, so anything is possible!

[tlcdoula]

Quote:

Originally Posted by purpleheather79 As far as the c-section, often they will let you accompany her into the OR

That isn't the norm everywhere. Is that the norm where you live? Here I would say that probably 50% of the time the doula cannot go in.

[truelife]

I'm pretty sure that she has it set in her mind that she's having a c-section. She is "open to suggestions but not trying to be a hero" so I gave her a huge list of suggestions from putting music at her pubic bone, to hot and cold to encourage baby to turn, but she just doesn't think it's going to happen.

This is so different then what I am familiar with in the HB community but it's a learning experience. I really like this couple and they are very sweet - I just have to remember that it is not my birth. I also don't want to come across as being overbearing. Where do you draw the line, ykwim?



*Off-topic question - if someone types in the right words into a search will specific threads come up from All Doulas?

[tlcdoula]

Quote:

Originally Posted by truelife *Off-topic question - if someone types in the right words into a search will specific threads come up from All Doulas?

Yes, except for the board that is for members only.

[b'earth angel]

Sorry! Sounds like mom is really discouraged. Have you had a 2 to find out if there is more to this story? I wonder why she is so discouraged, believing baby will not turn?? My doula's baby's waited to flip completely around until whe was well into labor. Best wishes to you and this mom.

[helpinghands]

Not to highjack the thread..but I have a mom inching in on 36 weeks now.. baby persistantly breech/transverse. Oy.. The baby flipped during the ultrasound...still lots of room and active baby. I hope that neither one of us have clients heading down the road to cesarean recovery. Perhaps both of them will turn last minute?

[purpleheather79]

Quote:

Originally Posted by tlcdoula That isn't the norm everywhere. Is that the norm where you live? Here I would say that probably 50% of the time the doula cannot go in.

It varies from hospital to hospital... I've lived in CA, TX, VA, MD, and GA. Every hospital has been different but I'd say at least 1/2 of the time a second support person is allowed from what I've seen. Most of the time the "rules" say only one person but the OB can make the call. Can't hurt to ask though and usually they will at least let the doula in after the dad leaves with the baby...

[tlcdoula]

Quote:

Originally Posted by purpleheather79 It varies from hospital to hospital... I've lived in CA, TX, VA, MD, and GA. Every hospital has been different but I'd say at least 1/2 of the time a second support person is allowed from what I've seen. Most of the time the "rules" say only one person but the OB can make the call. Can't hurt to ask though and usually they will at least let the doula in after the dad leaves with the baby...

Okay, so it sounds kind of like here - about 1/2 of the time a second person is let in.

[mothermedoula]

Quote:

Originally Posted by b'earth angel Sorry! Sounds like mom is really discouraged. Have you had a 2 to find out if there is more to this story? I wonder why she is so discouraged, believing baby will not turn?? My doula's baby's waited to flip completely around until whe was well into labor. Best wishes to you and this mom.

This is the trickiest part of our job. If her care provider says go for the C/S and the doula says , "You can do it!" She obviously going to believe the doctor.
Women are so vulnerable and scared to question their docs. Or scared of birth. I wish that these women would go get a second opinion (from a midwife). Isn't that what anyone going in for major surgery would do????
Maybe also print out the whole 30 page booklet from childbirthconnection.org about the risks of c/s.
And she can check out the Listening to Mothers 2, too.

[lillysweets]

Quote:

Originally Posted by truelife What or how do you explain your role in the event of a c-section? TIA!

I got this from my wonderful doula trainer a couple of years ago...
Emergency Cesarean
The sounds from the monitor are alarming and the room suddenly fills with nurses. Or a mom’s water breaks and the cord is swept into the birth canal. Emergency cesareans are done for a variety of reasons and are marked by the staff rushing to get the mother to the OR, often with only minimal explanation. What can a doula do to help?

• They will not diagnose, but translate what they hear the staff saying. They will let their clients know that it may be a true emergency and they should prepare themselves for a c-section.
• If the mother is unmedicated, they will let her know she might need general anesthesia, and help her get an answer from a nurse, or from the doctor when he/she comes in.
• They will help dad find out if he can go into the OR with mom. Most of the time this is permitted. It is highly unlikely the doula will be permitted in, but it is worth asking.
• They will help dad get changed into scrubs and make sure he has the camera.
• They will ask mom and dad if they want help calling anyone or inform family in the waiting room.
• If at all possible, they will accompany mom down the hall toward the OR so she can at least hear a reassuring voice. They let mom know that they will see her in recovery.
• They will return to the room quickly and gather up all their clients' belongings. They will not leave your belongings unattended.
• They will follow the nurse's lead with regard to caring for mom in recovery.
• They will ask mom if she wants the doula to go to the nursery to get an update from dad on the baby, or bring back a digital camera with photos of him/her.
• They will help mom breastfeed in recovery. They will be respectful in asking if mom minds if she minds the doula touching her.
• Mothers who have had general anesthesia will not remember their births. Doulas will help compile all the details from dad, the nurse, and the doctor to create a birth narrative for mom.
• They will encourage mom to be very proactive about asking for pain medication. No martyrs allowed; mom needs her pain managed so she can enjoy her baby and breastfeed him/her.
• They will help dad to arrange extra postpartum help.

Cesarean after labor
After a long induction, the mom is just not dilating and the nurse says the baby is looking a little stressed. Or the mom has pushed for hours but the baby is not coming down and the doctor says he may be asynclitic. Whatever the reason, it is often very disappointing to mom and dad to face a cesarean after labor. How can a doula support them? Many suggestions from Emergency Cesarean will apply, but here are some additional things a doula can do.

• They will help mom and dad to ask all the questions they need to ask. They will encourage them to use BRAND (Benefits, Risks, Alternatives, Nothing, Decision). They will help the parents understand the answers they get.
• Mom may feel that she has failed. The doula will reframe by using phrases like, "your baby is telling us he needs some help", if applicable.
• They will encourage the mom to ask about 2-layer sutures to enhance her possibility of VBAC in the future.
• They will acknowledge the parent’s feelings (fear, disappointment) but at the same time can express calm confidence.
• They can help mom arrange a consult with a lactation consultant. Breastfeeding after a cesarean is more challenging.

Planned Cesarean
Say the mom has placenta previa and will have a scheduled cesarean at 37 weeks. Or she had a myomectomy last year and laboring is ruled out as unsafe. Occasionally, doulas are hired to support the parents through a repeat cesarean. How can a doula help make this birth memorable and positive? (Refer to previous sections for applicable suggestions as well.)

• They will help the parents prepare a birth plan. Do they want music in the OR? Can dad announce the sex of the baby? Can the drape be dropped at the moment of birth so mom can see the baby emerge over her belly?
• They will encourage the parents to discuss their plans and hopes with their doctor well in advance.
• They will sensitively help the parents explore their feelings. Mom may be disappointed and sad, or not. Either one is fine.
• They will help the mom plan for extra help postpartum. For first time parents, doulas will give them clear expectations for recovery. "I'll be fully recovered in a couple of weeks" is not realistic.

<U>Every Cesarean

• </U>

• They will refer mothers to ICAN. They will give them the website address, tell them about message boards or e-mail lists, and give them the schedule of local meetings.
• They will listen sensitively. Processing a birth that did not go the way a woman hoped takes time and is not the same for each woman. Some women are sad. Others are angry. Some are matter-of-fact about it. Doulas will help the dad process as well, if he seems open to it.

Women who have had a cesarean have a greater risk of postpartum depression, and the doula will help her and her partner watch for that. If they see signs of postpartum depression or post-traumatic stress disorder, they will help the mom get help.

[truelife]

Lillysweets - thank you, thank you, thank you! What a great post - I really appreciate it!