C is for Caesarean (General Medical Happenings)
added by geena on March 31, 2003 at 2:09 PM
I saw my first C-Section on 3/29. I've been in OR's before, but this was quite different - the very first and most important aspect of difference-ness being that I was watching my very good friend on the table and not some "random" patient.
I was thankful to even be there; usually the father is the only person allowed into the room. The new mom and dad wanted me to be there so that I could stay with New Mom while New Dad went with New Baby to the Nursery.
Everyone we asked - nurses, the midwife, the OB, the resident - all said "Well, it's up to the anesthesiologist. He gets to decide if anyone else will be allowed in, but it's not our usual policy to let others in as space is quite tight already." I understood all of this, especially because I am intimately familiar with being on the other side of the nurse's station. But hearing this like 5 or 6 times was getting old.... And I kept thinking "Where's Mr. Anesthesiologist, anyway? Why not get him in here and ask?!"
Finally, he did come in and said, "So you both want to be in there, eh?," to which we nodded yes. He then replied, "Okay." Just like that. Geez. You would have thought we'd need to present a paper outlining the reasons we were requesting this by the reactions of the rest of the staff :-)
It was amazing to be there in the OR! Finally, a time I can sit in there and not have to be all nursey! I was really surprised at how long it took them to get the baby out (healthy baby girl, btw!) and also that it took at least another hour to stitch Mom back up again. Maybe I shouldn't have been surprised, but time moves verrrry slowly on the other side of the drape.
Seeing my friend's blood in the canister was disconcerting, as was glancing down to see that the OB was standing in a pool of it herself. I was really grateful for the chance to sit with her - the CSection was a surprise (but not an emergency) and I hope that I was able to provide her with some comfort as to what was going on and how much longer I thought it would be.
The anesthesiologist was completely awesome - very friendly, comforting, informative, helpful - as was everyone else. It was great to be on the receiving end of such great medical care and compassion.
Because of my previous experience with fainting, I was trying to pay close attention to how I was feeling during the case. I was sitting on a stool and didn't think there would be a problem, but about 10 minutes into it, I started feeling very hot and lightheaded, much to my absolute horror. It was quickly remedied with deep breaths and insane leg muscle tensing/releasing (so much so that my legs were a bit sore the next day!), much to my relief. I would have rather died than have to stand up and walk out - I can't even bring myself to think about it :)
The biggest irony of CSections are, of course, that the mother is the last to see the baby! They had to take the baby to clean her up and do Apgar scores. Dad got to see her coming out (as did I to a lesser degree... I'm a bit shorter!) and was obviously thrilled and excited. It was at least a good 7 minutes or so before Mom got to see her - and even then couldn't touch or hold her or anything. I was really sad about that. They have since made up for that initial lack of bonding though!
All in all, it was an amazing experience - I had many many misconceptions are labor and delivery. I figured labor came on fast, like in the movies, and you have to hurry - it really isn't like that at all sometimes. My friend's labor was agonizingly slow.
I hope you enjoyed reading about this experience - I realize that it's much more interesting to me than to you, but I've really enjoyed sharing it.
Progress Notes
You've summed it up nicely. People think that L&D is all about pushing and grimacing. They forget about the agonizing wait. The blood. And, the joy of the baby....except during a C-Section. My daughter was a C-Section baby and it killed me not to be able to hold her right away. But, it was all for the best.
I've acted as scrub nurse for sections and I've done my share of observations. It never ceases to amaze me how long it takes for the stitching. (Did this doc take the whole uterus out to stitch? That's a trip!)
added by Da Goddess on April 7, 2003 12:01 AM
Glad to ehar everything went alright with the section. :)
Yeah, there certianly is a large ammount of blood. Was always amazed that THAT much could come out of someone...STILL am amazed actually. It's funny how in T.V and movies they don't show the big mess afterwards, and how much birthing can be a messy experience.
Hope Mom, Dad and Baby are doing alright though.
added by Kaylin on April 11, 2003 11:28 AM
I too had an unexpected C-section and was also the last to see my first born. If there are any L&D nurses or OBs reading, please explain to me the importance of "cleaning" a baby with Apgar scores of 8 and 9 before allowing him to be held by his mother. He had apparently been "dirty" for a full 40 weeks, what was another 10 minutes?
added by Nurse Roxy on October 16, 2004 3:19 PM
Re: Nurse Roxy's queries: I'm a nursery nurse who often attends deliveries and cares for the newborn immediately after birth. I am also a mom of 3, so I understand how much a new mom usually wants to hold her new baby immediately. At more than half the deliveries I attend, the baby can be immediately placed on the mother's abdomen for the mother to hold right away. I listen to the baby's heart and lungs right there, use the bulb syringe to suction out the baby's mouth, assign the 1-minute apgar score, dry and stimulate the baby, and keep the baby covered with warm blankets. After about 5 minutes, though, I usually move the baby over to a bedside radiant warmer to take a good overall look at the baby, weigh, measure, make sure the baby is really warm and dry, give erythromicin ointment, and give vit. K. We do not give the sponge bath right away, but it is necessary to get the baby nice and dry, since evaporative cooling can chill a baby and cold stress can be very harmful, especially if the baby already has any kind of compromises.
In many deliveries, though, the baby is not immediately pink, crying, wriggling, and vigorous. In these cases is it important to take the baby right over to the warmer. We do not announce to the mom, "uh, oh, your baby is floppy, blue, and staring up blindly like a corpse. I hope I don't have to give compressions today." No. We calmly start freeflow oxygen to the baby, flick the baby's feet, and dry the baby well. It may be necessary to use deep suction to clear the baby's airway. Usually at this point the baby starts breathing well and pinking up and crying. However, if the baby doesn't come around quickly, we start giving the baby breaths with the ambu-bag and may proceed to give chest compressions or even epinephrine. According to the Neonatal Resuscitation Program, the official way nurses and doctors are trained, fully 1% of all babies need this advanced level of care. All the foot-flicking and drying in the world will not bring them around, because they are in secondary apnea. However, after the resuscitation, they are usually fine. It is possible for a baby to have been resuscitated with oxygen or even a few breaths with an ambu-bag and still receive relatively good apgar scores. A lot can happen in 1 minute before the first apgar score is assigned. If the first apgar score is an 8, that usually means the baby is still blue from head to toe after a whole minute,even though everyone,including the parents, can hear that the baby is crying well. That is one baby I would not be handing over to breastfeed right that very second. There is absolutely not that choice. I would be making sure that the baby kept breathing, and I would have to keep 5 liters of oxygen flowing to the baby until the baby pinked up. That is the standard of care, and I am sure that is exactly what was done for your baby. We don't usually announce the use of oxygen to the parents or make a big deal out of it. It is a happy time, their baby is fine, and just needed a little help.
When it comes to c-sections, there are many reasons why the baby is routinely taken right to the warmer, rather than presented to the parents. With a cesaerean birth, the lungs are still much more full of fluid than with a vaginal birth. The baby didn't get that squeezing. More suctioning of the baby's oropharynx is necessary, and this is best done right away. This applies even for a routine c-section. Certainly in any urgent or emergency c-section there is also a very real risk that the baby may need advanced resuscitation or even intensive care.
I know this is a long answer, but I think it is a good question you asked.
added by GIna on April 7, 2005 3:03 PM
Thanks for that explanation, Gina. It's odd to find out later that all kinds of stuff was going on while I was staring at the ceiling half wondering what was going on below the drape (besides a lot of tugging) and half just floating on a fluffy fluffy narcotic cloud.
added by C on June 17, 2005 8:31 PM
So, what brought you to the hospital today?