Speaker 1: Who baby, my baby, belof I need you, Oh how
Speaker 1: I need you? What to expect? As a production of
Speaker 1: I Heart Radio, I'm your host Heidi Murkoff and I'm
Speaker 1: a mom on a mission, a mission to help you
Speaker 1: know what to expect every step of the way. It's
Speaker 1: definitely the happiest surgery you could ever dream of having,
Speaker 1: but it's still surgery, whether it's scheduled or last minute,
Speaker 1: a first or repeat. Let's face it, a C section
Speaker 1: is in a box on a birthland you were likely
Speaker 1: hoping to check. But let's face this too. Accessarian delivery
Speaker 1: is something you and every expecting parents should be prepared for.
Speaker 1: That's because c sections are pretty common in the US,
Speaker 1: was close to one in three moms ending up with one.
Speaker 1: The upside to a C section, it's very very safe,
Speaker 1: and in some cases, it's the safest way to deliver
Speaker 1: a baby. The potential downside. If you're a mom to
Speaker 1: be with your heart set on a vaginal birth, the
Speaker 1: news that your baby needs or may need to be
Speaker 1: delivered by C section can definitely be disappointing. Scheduled for
Speaker 1: a C section, hoping to avoid one, hoping to avoid
Speaker 1: a repeat, just plain stress about the possibility you might
Speaker 1: need one, just trying to do your labor and delivery homework.
Speaker 1: No matter what, We've got your back and your belly.
Speaker 1: Today we're delivering everything you need to know about C sections.
Speaker 1: I'm here with my good friend, maternal fetal medicine specialist,
Speaker 1: Dr Sarah Obachon, who is medical director of Mother to
Speaker 1: Baby Florida and Assistant professor at the University of South Florida. Hey, Sarah, Hello,
Speaker 1: thanks for having me. Oh, it's great to have you back.
Speaker 1: We always need you for advice. It's clear how much
Speaker 1: you care about the moms you hair for, and your
Speaker 1: empathy and your reassurance. And you're easy to talk to um,
Speaker 1: which is so important when a mom is stressed out
Speaker 1: about something like having a C section. So let's talk
Speaker 1: about c sections as if I were your patient. Close
Speaker 1: to one in three moms in the US end up
Speaker 1: having a C section. Now, the w h O believes
Speaker 1: that rage should be under percent if c sections were
Speaker 1: only done for medically necessary reasons. Why do you think
Speaker 1: rates are so high in the US. That's a great question.
Speaker 1: There's so much struggle with this that we're working on
Speaker 1: over so many years. I do think they should probably
Speaker 1: be lower. I don't know if it's possible to be
Speaker 1: less than in the country, but they certainly seem like
Speaker 1: they should be lower than they are. And it's always
Speaker 1: a really tough emotional discussion with the with the patients
Speaker 1: because some patients do really need one and it's really
Speaker 1: the safest for them, and they're maybe if you have
Speaker 1: a placenta creta, if you have a placenta previous, so
Speaker 1: it's covering the birth canal, maybe really shouldn't come out
Speaker 1: vaginally under any circumstance. But there are sometimes that it
Speaker 1: was casually that maybe really need to have a cesarean,
Speaker 1: And that's a question that's being worked on nationally, uh
Speaker 1: kind of really higher level of work looking at data
Speaker 1: how to decrease that first cesarean in women. And the
Speaker 1: reason for that reason that sometimes it's harder to get
Speaker 1: a b back to have a vaginal delivery after a
Speaker 1: C section because some hospitals won't do it. Some hospitals
Speaker 1: are scared the medical legal aspect of it, or their
Speaker 1: doctors won't perform it, or I don't for multiple reasons.
Speaker 1: But if we can decrease the chances that a woman
Speaker 1: the first time around is going to have a C section.
Speaker 1: This is where we would be probably winning the most. Yeah,
Speaker 1: because if you avoid the first c section, then you're
Speaker 1: going to automatically reduce the rates. That's right, and we're
Speaker 1: gonna have a much better chance of having the second one.
Speaker 1: That generally, do you think they're getting your care from
Speaker 1: a midwife? Assuming that you are low risk makes it
Speaker 1: less likely that you'll end up with a C section
Speaker 1: if all other things are relatively equal. I think that depends.
Speaker 1: Just like any time you think about doctors, good doctors,
Speaker 1: you know somebody don't really click with the same with midwives.
Speaker 1: I have worked with midwife, some wonderful midwife in my
Speaker 1: career here at USF and also at George Washington University,
Speaker 1: and sometimes the criteria to be their patient is rather
Speaker 1: strict because they know if you're a waking during pregnancy
Speaker 1: is not very high. If you are otherwise healthy person,
Speaker 1: if you are a nutritionally doing well, then your chances
Speaker 1: of having a badge of delivery a higher. So it
Speaker 1: depends if you have a midwife who is able to
Speaker 1: guide you in that process and do that with you,
Speaker 1: then that is wonderful. But also it like of the
Speaker 1: way some people from seeing a midwife if they feel
Speaker 1: a little bit marginalized, like they couldn't keep the weight
Speaker 1: down for some reason. So it kind of works a
Speaker 1: little bit both ways. But finding the right fit for you,
Speaker 1: I think it's been most beneficial for each patient, and
Speaker 1: that right person could come in the form of maternal
Speaker 1: fetal medicine specialists, or it could come in the form
Speaker 1: of a midwife that's right, or a combination, which is
Speaker 1: always possible. What are some of the most common reasons
Speaker 1: for medically necessary c section? You mentioned plus center preview,
Speaker 1: and of course placentas can do a lot of moving
Speaker 1: during pregnancy, so you shouldn't assume too early on that
Speaker 1: you're destined to have a C section if you're placenta
Speaker 1: is low lying right, well, what are some other reasons
Speaker 1: why you might have a planned C section? So for
Speaker 1: planned c section, the most common reasons are things like
Speaker 1: fetal mouth presentation, In other words, the baby has just
Speaker 1: turned the wrong way, it is transverse, or its reach.
Speaker 1: That is one of the bigger indications for a planned one.
Speaker 1: Some times twins uh will be more likely to be planned.
Speaker 1: Sometimes when the baby is very large. Is whether or
Speaker 1: not it's a good indication for a C section in
Speaker 1: a different discussion, but oftentimes that will be one of
Speaker 1: the reasons that's quoted for the cesarean. And what about
Speaker 1: reasons that come up during labor for a C section?
Speaker 1: The two most common ones tend to be later for dystocia,
Speaker 1: in other words, you've been trying to have a vagine delivery,
Speaker 1: You've dilated a certain amount and you're not dilating anymore,
Speaker 1: You're not dilating quickly, or the other reason is that
Speaker 1: the baby may or may not be tolerating the labor.
Speaker 1: So there's uh what was previously called non reassuring fetal
Speaker 1: heart tracing, so abnormal tracing on the monitor. So in
Speaker 1: other words, if the baby is not doing well, then
Speaker 1: it's time to move straight to a safer birth through
Speaker 1: C section. Yes, one of the things we're looking at
Speaker 1: in terms of how we define whether or not there's
Speaker 1: an abnormal all tracing. And this is the part that
Speaker 1: I think helps a lot on an institutional basis, um
Speaker 1: a large number basis, meaning that I can teach a
Speaker 1: lot of physicians or nurses how to appropriately interpret some
Speaker 1: of this feutal heart rate tracing so that everybody using
Speaker 1: the same language. And really what is considered to be
Speaker 1: a risk is risk versus not having the same kind
Speaker 1: of communication and maybe misinterpreting some of the fetal heart
Speaker 1: rate tracing. And is it sometimes just a matter of
Speaker 1: changing mom's position. Yes, there's a few things that we
Speaker 1: can do in labor that can help the fetal heart
Speaker 1: rate tracing. We can change the mom's position. We can
Speaker 1: actually sometimes infuse fluid if the mom is already ruptured,
Speaker 1: we can put a little bit of an amnio infusion,
Speaker 1: meaning to put a little bit of fluid into the
Speaker 1: uterus in order to buffer a little bit of that
Speaker 1: fetal cord so that there has less of these decelerations
Speaker 1: on the fetal monitor. So the refuse tricks that we
Speaker 1: can do one and for all. Let's clear this up
Speaker 1: to epidurals make a C section more likely. No, epidrows
Speaker 1: are rather safe. It's one of thost commonly performed procedures.
Speaker 1: Because c sections are our most common like performed procedures
Speaker 1: that we don't think it decreases the chance of having
Speaker 1: a vaginal birth um sometimes and this is sometimes that
Speaker 1: I dotal too. It's like, well, sometimes it helps just
Speaker 1: to relax all your muscles to be able to have
Speaker 1: avaginal delivery. Honestly, that is a choice every woman can
Speaker 1: answer for herself whether or not she's interested in something
Speaker 1: like this, and a good discussion with her doctor and
Speaker 1: also with her anesthesia. But it doesn't matter at what
Speaker 1: point in the process you have your epidural. There are
Speaker 1: no rules, but you can't have it too early. No, No,
Speaker 1: this is something that every woman should be a part
Speaker 1: of that conversation. Now, does inducing labor lead to a
Speaker 1: greater risk of C section? This is something we were
Speaker 1: taught even when I was a resident, And there is
Speaker 1: now really great evidence that an induction doesn't increase the
Speaker 1: risk of your of your C section And this study
Speaker 1: was done relatively recently. Um, but when is the best
Speaker 1: time to deliver? And an induction itself isn't the culprit
Speaker 1: for the cesarean. I don't think we should really be
Speaker 1: afraid of inductions as we used to be. And what
Speaker 1: about being admitted to the hospital too early in labor?
Speaker 1: Does that increase risk? That's a great question. I think
Speaker 1: that one's harder to answer because sometimes you know, when
Speaker 1: you're looking at so many things, like you're looking at
Speaker 1: if you don't heart retracing, and if you're acting on
Speaker 1: it too quickly, then maybe there would be an increased
Speaker 1: risk for that. But you never want to tell the patient, oh,
Speaker 1: stay at home for as long as you can, because
Speaker 1: you then you really don't know how she is or
Speaker 1: how that baby is doing. There have been some hospitals
Speaker 1: who have been putting restrictions on when a mom can
Speaker 1: come in that you know, I've heard, for instance, ince
Speaker 1: some military hospitals you have to be six centimeters, which
Speaker 1: seems like a lot to me. It seems like a lot, yes,
Speaker 1: because you can go very quickly from six to ten.
Speaker 1: And also you're right, I mean women progress very differently
Speaker 1: if you've had a baby before, and just women themselves.
Speaker 1: I have patients who, even if it's their fourth baby,
Speaker 1: it takes them a long time to have a basin
Speaker 1: of delivery, but they do. And then there's moms who
Speaker 1: you know, there are two centimeters to senates, two senators,
Speaker 1: and then then they're called because I'm running to catch
Speaker 1: the baby. But it's hard, right, It's hard to to
Speaker 1: make a cut off for every single patient. For sure. Now,
Speaker 1: if an opie pushes first C section and Mom's kind
Speaker 1: of like, I wish there's some way out of this.
Speaker 1: What are the right questions for her to ask? That's
Speaker 1: great question. I think one is really important to have
Speaker 1: a good communication with your doctor, right, make sure that
Speaker 1: you obviously trust their judgment, and then you know them
Speaker 1: and they know you. While you're having that discussion, you
Speaker 1: know some things even if you don't maybe understand if
Speaker 1: you trust their judgment, Like my goodness, it's easy to
Speaker 1: say yes because if it's the right thing to do,
Speaker 1: it's the right thing to do. But thanks to ask like, Okay,
Speaker 1: is this really necessary? What do you think the risks
Speaker 1: are to me and my baby? Um? You know, could
Speaker 1: I try a little bit longer? And you can read
Speaker 1: the person too if they're like, look, I'm really worried
Speaker 1: about this for this reason, and they give you really
Speaker 1: good reasons. I mean, you really need to trust the
Speaker 1: doctor that's helping to take care of you, too, especially
Speaker 1: if you've chosen that person you feel most comfortable with.
Speaker 1: That's a great place to start. Yes, what are some
Speaker 1: ways of reducing the chances that you'll have a C section?
Speaker 1: Things that you can do during your pregnancy or even
Speaker 1: before so being an optimal health is really important. That
Speaker 1: is just for good pregnancy outcomes in general. Taking care
Speaker 1: of yourself, making sure that you are managing your diabetes
Speaker 1: or your high blood pressure, to make sure that you're
Speaker 1: managing your eight It's important that you have an appropriate
Speaker 1: weaking and talk to your doctor what that appropriate weight
Speaker 1: gain is. We know gaining too much weight during the
Speaker 1: pregnancy may increase the rest for our ces areanum. Being
Speaker 1: obese may increase the risk for cesarian So those are
Speaker 1: the things that we may have some power to help
Speaker 1: ourselves in our pregnancy outcomes. Douels research has shown that
Speaker 1: having a duel at your birth may reduce the risk
Speaker 1: of a C section. Why do you think that is?
Speaker 1: It's so interesting. I think it's wonderful to have a
Speaker 1: continuous labor support right, somebody who's really in your corner,
Speaker 1: who had some training, is really there to be your
Speaker 1: helping your voice through the process. And just like with anything,
Speaker 1: you know, good doctors, bad doctors, good miitherwise bad. You know,
Speaker 1: it's not good or bad. It's just that you have
Speaker 1: to click with somebody well right, And if you do
Speaker 1: and you have the right support person, I think that's wonderful.
Speaker 1: To be a part of that that labor process, and
Speaker 1: I think that well, clear the doctors and nurses aren't
Speaker 1: there with you, but just having someone there by your
Speaker 1: side the entire time can reduce your stress level and
Speaker 1: hopefully that makes a difference. But also, you know, just
Speaker 1: positive affirmations getting you into a position that's perhaps going
Speaker 1: to help the baby move down. Massage doesn't hurt right, right, right,
Speaker 1: Absolutely positive affirmations, you know, even imagery and position they
Speaker 1: like you said, massage, all those things are really positive.
Speaker 1: Do you think that it's important to have childbirth education class?
Speaker 1: Take a class even if you know you're having a
Speaker 1: scheduled C section? Yes, I think that is a good idea,
Speaker 1: especially if they cover c sections right. C sections can
Speaker 1: be scary. I think some of the some of the
Speaker 1: concern my patients have is that obviously they haven't had one,
Speaker 1: and they don't know a lot about people that have.
Speaker 1: Maybe they don't have positive stories about people having c
Speaker 1: sections and there really are mean someone men tell me
Speaker 1: when they have done both that they prefer the season. Actually,
Speaker 1: I mean, who would have known, right, But just understanding
Speaker 1: and knowing what to expect really does kind of change
Speaker 1: your outlook. On what's to come. Definitely, knowledge is power.
Speaker 1: Have you ever had a patient use hypno birthing? Yes,
Speaker 1: I've been part of that too. Um. I think anything
Speaker 1: that helps a patient in in terms of relaxation is important.
Speaker 1: I don't know that hypno birthing will take care of
Speaker 1: all that pain. It's kind of really hard. I think
Speaker 1: the best thing that works is an ever dural if
Speaker 1: pain and pain management is your main concern. But something
Speaker 1: for anything that positively affects you. Imagery, meditation, massage I
Speaker 1: think are all helpful during labor. Yeah, we definitely don't
Speaker 1: want to rely on hypno birthing to deliver during a
Speaker 1: C section, right, correct, You don't want me to do that? No, no, no, Um,
Speaker 1: let's talk about v back a little more. Tell us
Speaker 1: who might be a good candidate for v back and
Speaker 1: who might not. B three candidates for a feedback are
Speaker 1: those women who have had a vaginal deliberate or we've
Speaker 1: had a C section and then had a second vaginal birth.
Speaker 1: Um that makes things a lot easier, b am. I
Speaker 1: um comes into that equation, our age comes into that equation.
Speaker 1: So there's a few parameters that are really important, and
Speaker 1: these things can be calculated by their healthcare provider. And
Speaker 1: you had mentioned that some hospitals are not big fans
Speaker 1: of feedbacks or perhaps won't allow one. So this is
Speaker 1: the conversation you need to have with your doctor well
Speaker 1: ahead of time. Absolutely, this is a conversation early in
Speaker 1: your pregnancy that you should discuss. Do you, guys offer
Speaker 1: a vaginal birth? Actors is are and how is that done?
Speaker 1: Do you have anesthesia at your hospital? Two seven? Am
Speaker 1: I good candidate? How can you help me understand that?
Speaker 1: And if that's not the right pctory, then trying to
Speaker 1: find somebody in your community that would be able to
Speaker 1: do that safely and an option if your baby is
Speaker 1: your mentioned transverse, which is side to side or in
Speaker 1: a breach position that wouldn't be favorable for a vaginal birth,
Speaker 1: having using procedure like external cephalic version, which is turning
Speaker 1: the baby, or possibly other spinning baby techniques. I don't
Speaker 1: know how you feel about those, but the idea that
Speaker 1: maybe you can get the baby to move into position
Speaker 1: so that a v back or just a vaginal birth
Speaker 1: in general is more likely. Yes, agree, I think that
Speaker 1: all those things are an option. Um, definitely speaking to
Speaker 1: your doctor about doing an ECB and explaining to you
Speaker 1: what it is, what are the risks and benefits of that,
Speaker 1: how that is done in their institution, and do you
Speaker 1: feel safe about that being done in the hospital setting?
Speaker 1: And if it was an emergency, what would be done next?
Speaker 1: All those are a good questions to ask for the
Speaker 1: external symphalic version, which are usually done before term, like
Speaker 1: thirty six thirty seven weeks. Great. I feel like every
Speaker 1: mom should be prepared for the possibility of a C section.
Speaker 1: Even if all systems seem to be a go for
Speaker 1: vaginal birth, you never know how labor is going to
Speaker 1: progress or not progress, And even if you're being scheduled
Speaker 1: to deliver at a birthing center by a midwife, it's
Speaker 1: always a possibility. So knowledge is power. We're going to
Speaker 1: get empowered about c sections. First of all, what kind
Speaker 1: of anesthesia well you probably have if you have a
Speaker 1: C section, If you're come to have a C section,
Speaker 1: there's a few ways to do this to make sure
Speaker 1: you have appropriate pain control. The usual is something we
Speaker 1: call spinal anesthesia or an epidural anesthesia. UM. Spinal is
Speaker 1: just something that happens go at one time, needle goes
Speaker 1: the medicine goes in and it's good for a couple
Speaker 1: of hours, which should be sufficient time for a cesarean.
Speaker 1: An epidural will give you a little bit more of
Speaker 1: pain control afterwards, uh with maybe like a pump that
Speaker 1: you can do yourself, so you have a little bit
Speaker 1: more control there. And then in some cases, depending on
Speaker 1: the high risk cases of the pregnancy, that may have
Speaker 1: to do general honest esure where the woman has to
Speaker 1: go to sleep, but those are less common. Will you
Speaker 1: be allowed to have your partner with you during a
Speaker 1: land sea section? In our institution, we are allowing a
Speaker 1: partner to be there during the time of delivery, either
Speaker 1: a vagin deility or cesarian, to have that support for
Speaker 1: us present. And you should always check with your specific
Speaker 1: hospital and your specific guian group to discuss who is available,
Speaker 1: who's able to come to your delivery. How many hospitals
Speaker 1: are making cesareans more mom breastfeeding friendly. Some hospitals call
Speaker 1: them gentle cesareans, so you have immediate skin to skin
Speaker 1: and breastfeeding if it's possible. Yeah, that's a really good,
Speaker 1: big trend that's happening, and I think it's a positive one.
Speaker 1: The idea of just even though this is surgery and
Speaker 1: you know it's very technical and we're all trained to
Speaker 1: do this, to make this more of this loving environment
Speaker 1: of this is actually the birth of a child. And
Speaker 1: in our institution we do things like a clear drape
Speaker 1: where the there's a clear drape that is put up
Speaker 1: and the blue one comes down when your baby is
Speaker 1: being born, so you are able to see part of
Speaker 1: that process. Your see your baby immediately as I am
Speaker 1: cleaning up the baby for you and the baby is
Speaker 1: being necessitated, the baby is there with you. And then
Speaker 1: as soon as the baby is given off to be
Speaker 1: checked quickly, but it's put on your your chest and
Speaker 1: we encourage breastfeeding early. Um. There are a lot of
Speaker 1: these different mechanisms that are happening in different hospitals that
Speaker 1: are helping moms feeling more connected more quickly with their scaria.
Speaker 1: I think that's so great. I've even seen a drape
Speaker 1: with a portal in it that a couple of nurses invented.
Speaker 1: Have you ever seen that? I have not actually seen them,
Speaker 1: so curious. That would be so wonderful. I think it'd
Speaker 1: be an interesting um thing too, just to watch. I
Speaker 1: would be fascinating. But I have not seen that yet
Speaker 1: in our hospital. What happens during necessarian your baby is born.
Speaker 1: Hopefully you're not going to feel anything in terms of pain,
Speaker 1: but what will you feel and here and possibly see? Yes.
Speaker 1: So one of the things I try to explain to
Speaker 1: patients is that, look, you're gonna be on this table.
Speaker 1: There's gonna be a lot of people on you, uh,
Speaker 1: And I trying to empower them. And I was saying,
Speaker 1: look even at your instigia team right next to you,
Speaker 1: and I am literally a blue drape away like it's
Speaker 1: so thin, and you and I can actually talk during
Speaker 1: it if everything is going safely, and I can have
Speaker 1: a conversation and as I talk to your baby, and
Speaker 1: when your baby is ready to come out, I'll let
Speaker 1: you know. And so they don't have pain, for say,
Speaker 1: but they may still experience some pressure because I still
Speaker 1: need to push on their belly a little bit to
Speaker 1: get that baby to come out of that decision and
Speaker 1: show the mom obviously, but um, there might feel some
Speaker 1: pressure that kind of feels odd because there are paints.
Speaker 1: Sensation is very different with that type of anesthesia. Um.
Speaker 1: I tell them about the stark lights sometimes that people
Speaker 1: are like wow, just so bright. And here it is
Speaker 1: because we're doing surgery, so it's a little bit tough.
Speaker 1: But we try if they make things a little bit
Speaker 1: more calm by picking the music that they like to hear,
Speaker 1: what they want their babies to be born too. So
Speaker 1: we have these little tricks that are being implemented, but
Speaker 1: I try to warn them of all the things are
Speaker 1: going to be experiencing. Well, I'm sure you are so reassuring.
Speaker 1: That makes a huge difference. Oh, I hope. So I
Speaker 1: think any birth is really a positive one. Getting a
Speaker 1: healthy amount and healthy babies really what we can all
Speaker 1: hope for. About how long does the C section take
Speaker 1: from start to finish? That's the great question. So if
Speaker 1: we're doing it for the first time, in other words,
Speaker 1: we've never had abdominal surgery, that means we are not
Speaker 1: really going to anticipate having scarring during necessary And the
Speaker 1: c sections are relatively easy to do. I mean, even
Speaker 1: though it's a lot of training goes into that, it's
Speaker 1: not a very difficult surgery if we've been trained well,
Speaker 1: and so it can take only like thirty minutes to
Speaker 1: forty five minutes um. And a woman who has not
Speaker 1: done that before and women have had priority sections. There
Speaker 1: might be a lot of scoring and which basically be
Speaker 1: very damtic about how we do things and make sure
Speaker 1: we put back things the way exactly what we were
Speaker 1: um and delivering the baby safely. But in that case
Speaker 1: it might take longer an hour and a half two hours,
Speaker 1: depending on how much trouble we may liked. He could
Speaker 1: be there for a while. Yes, what is your partner
Speaker 1: going to see if he looks during the procedure. There
Speaker 1: is a lot of blood flow in the interus during
Speaker 1: the time of pregnancy, so in a lot of water,
Speaker 1: and when water is mixed with even a little bit
Speaker 1: of blood, it's gonna look very bloody, even though it's
Speaker 1: actually lots of fluid from the baby. Right, So if
Speaker 1: somebody is squeamish, they ain't feel like busy when they
Speaker 1: see it, So we try not to have them look
Speaker 1: during the time, I heard all this fluid is coming out.
Speaker 1: What depends you know, some people are physicians or nurses
Speaker 1: and they feel comfortable you can king or something like this,
Speaker 1: So I think that's fine. How will you be closed
Speaker 1: up after the surgery? So as soon as the baby
Speaker 1: comes out, we take care to close the uterine incision. First,
Speaker 1: it is that muscle that's closed. Usually the incision is
Speaker 1: what we call like a very low transversion decision, so
Speaker 1: it goes down almost where your bladder is that is
Speaker 1: closed up. It's contracts nicely. The uns become smaller, so
Speaker 1: we have decreased bleeding. After that, depending on the surgeon,
Speaker 1: they may crowse some smaller layers, but everybody closes the fashion,
Speaker 1: which is that big, tough, kind of very thin layer
Speaker 1: that is holding all our organs inside or abdomen um
Speaker 1: that is always closed up. Sometimes some of the fat
Speaker 1: is closed up, so we decrease the chance of having
Speaker 1: what we call like a currona, which is basically a
Speaker 1: little inflammation and infection of the fact tissue. And then
Speaker 1: we close the skin and we usually do that now
Speaker 1: more with suture. What are some surprises about recovery? Swelling
Speaker 1: is one that I hear a lot, a lot out
Speaker 1: of swelling as well as vaginal bleeding. Moms don't expect
Speaker 1: because they didn't deliver vaginally that they would have vaginal bleeding,
Speaker 1: which they do just as if you had a vaginal birth.
Speaker 1: Gas pain referred pain, hard time peeing, Yes, all of that,
Speaker 1: So you're right just because we delivered it a different way.
Speaker 1: You still may have some swelling. Swelling of the labia
Speaker 1: might be their lower extremity, meaning your your feet might
Speaker 1: be still more swollen. That's all expected as the fluid
Speaker 1: that's in your body is now going back into your vessels.
Speaker 1: That takes time, and then it's getting processed by their
Speaker 1: kidneys and then essentially you are urinating that out, so
Speaker 1: that all takes a little bit of time to settle.
Speaker 1: In the same for bleeding, that uterus was still had
Speaker 1: a baby, and it's still it's contracting, and the natural
Speaker 1: kind of system of things is that it's going to
Speaker 1: go down in size, and as it's doing that, it's
Speaker 1: letting go of some of that blood. Still may have
Speaker 1: some vaginal bleeding for even a few weeks, slight. It
Speaker 1: shouldn't be a lot, and if you do have a
Speaker 1: lot of bleeding, we actually want to know about it.
Speaker 1: But slight bleeding for the next few days, even a
Speaker 1: few weeks is normal finding so wearing a pat is important.
Speaker 1: Sometimes women have this funny sensation where they have an
Speaker 1: incision for the C section and their skin feels numb,
Speaker 1: and that is often the time where we have a
Speaker 1: c section. Some of those nerve endings are cut because
Speaker 1: you don't see them, so it's impossible to not do that,
Speaker 1: and you may have some dumbness there for a while,
Speaker 1: and that takes a few few weeks to come back
Speaker 1: even months. Sometimes. Also a pretty normal finding maybe inflamation
Speaker 1: that should be checked out or infection. Making sure that
Speaker 1: it's always nice, clean and dry, but if it looks
Speaker 1: inflamed or angry, it's always a good reason to visit
Speaker 1: your doctor. I wanted to mention a few suggestions that
Speaker 1: mom's had on my Facebook page after c section, because
Speaker 1: nobody knows what to expect better than mom moves out
Speaker 1: a c section, And they said for packing for the hospital,
Speaker 1: even if you don't know if you're going to have
Speaker 1: a c section, high wasted, very loose underwear as well
Speaker 1: as high wasted, very loose lounge pants so that there's
Speaker 1: no pressure on the incision. A belly band and a
Speaker 1: pillow to hold against your incision. Definitely for the ride home.
Speaker 1: A lot of moms find it helpful to clutch when
Speaker 1: they're getting out of bed, but also in the car
Speaker 1: and for nursing to avoid putting pressure on the incision.
Speaker 1: One mom actually suggested mcg ivering a Maxi pad to
Speaker 1: cushion the incision, which I thought was ingenious. Right, Yeah,
Speaker 1: we do that a lot of curvacients. I think anything
Speaker 1: like that can give a little bit of a buffer
Speaker 1: between your clothes that might be chugging on it, it
Speaker 1: would be helpful. I think the belly band idea is
Speaker 1: really nice idea because it gives you a sense like
Speaker 1: something is helping to hold you in, you know, and
Speaker 1: it gives you a little bit more support when you're
Speaker 1: taking your first few steps that are getting out of
Speaker 1: a chair into a vent and so forth. The first
Speaker 1: day after sea section usually isn't so bad. It's the
Speaker 1: first thing the third or fourth day that it's a
Speaker 1: little bit tougher, and that's kind of your like you
Speaker 1: hit your bottom, you know, and then you get better
Speaker 1: and better with time, and it takes couple of weeks
Speaker 1: to really feel yourself again, maybe even a little bit longer,
Speaker 1: but every day does get better. So how much pain
Speaker 1: would you expect to have? Do you think moms have
Speaker 1: more than they expect to have? More less? And how
Speaker 1: do you feel about medications? Would you suggest they try
Speaker 1: um alternatives to prescription pain meds or should they go
Speaker 1: for the prescription ones. I think pain is very very
Speaker 1: individualized and we have to be really open to having
Speaker 1: that one on the discussion with patients. I do think
Speaker 1: you shouldn't be getting opis to every single person, but
Speaker 1: it is still a surgery and it might be needed
Speaker 1: in the first few days. It doesn't mean you have
Speaker 1: to do this and you shouldn't be doing taking opio
Speaker 1: it's for a long long time, but you maybe you
Speaker 1: would consider that in the first few days to really
Speaker 1: get you through that. I think the combination of an
Speaker 1: anti inflammatory and as an opioid and thailan all are
Speaker 1: all helpful. Right, So a combination of this that works
Speaker 1: from different angles helped to manage that pain. Sometimes even
Speaker 1: light a king patches that we put on the skin
Speaker 1: just above the incisions are helpful to the patients. So
Speaker 1: there's there's different modalities to do it. And again, like
Speaker 1: the combination might be the best. Is breastfeeding different with
Speaker 1: a C section. I know that a lot of moms
Speaker 1: find that their breast melt takes a longer time to
Speaker 1: come in. What's your experience, Yeah, it probably is true,
Speaker 1: but I think really understanding that and really having a
Speaker 1: good support team with you, where the baby is going
Speaker 1: to be put on the breast early on, maybe even
Speaker 1: in the operating room while we're closing up or soon
Speaker 1: after when you get to your recovery um or if
Speaker 1: the baby is being tended by the nick you team,
Speaker 1: let's say, then really putting on on the breast club
Speaker 1: and initiating that simulation early, all those things are really helpful.
Speaker 1: And reaching out to lactation consultants within your hospital or outside.
Speaker 1: I think it's always a really good investment of time
Speaker 1: and money, even if you have to cancel it because
Speaker 1: you're doing great, you know it. That's one of those
Speaker 1: things where we don't get a lot of training in
Speaker 1: this uh as new moms, right like, we don't get
Speaker 1: a lot of teaching in this, and to get a
Speaker 1: lot of support for that is really important. Totally taking
Speaker 1: a breastfeeding class ahead of time is a great place
Speaker 1: to start, But I feel like lactation support is critical
Speaker 1: and you won't necessarily have those problems immediately. It's more
Speaker 1: likely to happen once you get home from the hospital
Speaker 1: and your your mouth comes in and you know you're
Speaker 1: a little overwhelmed by everything going on around you, that's
Speaker 1: when you might need the support most. Right, right, how
Speaker 1: much harder is postpart and recovery for a scerian delivery
Speaker 1: as opposed to have abdual delivery once you get home?
Speaker 1: Are there more restrictions? Probably on average? Now, you have
Speaker 1: some women who have had really difficult badge and deliveries
Speaker 1: in there and pain for a long time, But an
Speaker 1: average women who have a C section do have paid
Speaker 1: for longer, and they may have incisional pain that it's
Speaker 1: just obviously because it doesn't exist in a badge and
Speaker 1: delivery is just different. So it is a longer process
Speaker 1: of recovery. You know, it does make me require more
Speaker 1: pain medication, it does require more care, it's harder to
Speaker 1: get back to driving, and probably need a little bit
Speaker 1: more time before you do operate any kind of machinery.
Speaker 1: And that's usual far your baby. That's like it's complicated,
Speaker 1: gets right, and it is called that's a complicated part. Finally,
Speaker 1: what's your message to moms who are understandably disappointed, scared
Speaker 1: that they need to have a C section, disappointed afterwards.
Speaker 1: I mean my message is always when it's all said,
Speaker 1: done and snuggled, the only part of your labor and
Speaker 1: delivery story. That really matters is the happy ending. That's
Speaker 1: the healthy mom and healthy baby. And really any way
Speaker 1: that you get there is pretty much okay. In my book,
Speaker 1: what do you say to mom's Yeah, you can't really
Speaker 1: stress that enough. I agree, I mean, really, the safest
Speaker 1: way is the best way to go. Whatever gets you
Speaker 1: home safely with your baby, that's the that's the way
Speaker 1: to do it. Sure, I agree. We should decrease our
Speaker 1: c section right safely if we can, and we should
Speaker 1: work on that not only individually amongst ourselves as physicians
Speaker 1: but as patients, but also as institutions and nationally. But
Speaker 1: in the end, until we we fight that fight, it's
Speaker 1: important that you take care of yourself and that you
Speaker 1: really feel like you've done everything you can and you have.
Speaker 1: You've delivered that baby safely, You've done all that hard
Speaker 1: work and coming home safely with your baby. That that's
Speaker 1: what that's our goal, that's everybody's goal. That's an unqualified success.
Speaker 1: I would say, yes, for sure. Well, thank you so much,
Speaker 1: Dr Obanton, and for so much more on c sections
Speaker 1: and recoveries, go to what to Expect dot com baby
Speaker 1: below my baby Belove, I need you. Oh how I
Speaker 1: need you. Thanks for listening. Remember I'm always here for you.
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