Dr. Melka returns to Healthful Woman to discuss C-sections. In this episode, she covers the reasons why an obstetrician may recommend a planned C-section, choosing an induction date, and what patients can expect during the labor and delivery.
“What to Expect When You’re Expecting a C-Section” – with Dr. Stephanie Melka
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Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics and women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OB/GYN and maternal fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy and wellness. Melka?
Dr. Fox: Welcome back to the podcast.
Dr. Fox: We’re getting a lot of Melka time in. Love it.
Melka: It’s super exciting.
Dr. Fox: Super-duper.
Melka: There’s no place I’d rather be than here in the podcast studio with you. I can’t even say that with a straight face. I’m sorry.
Dr. Fox: Well, that makes two of us and I do say it with a straight face. And I’m slightly offended that you laugh when you say that, because this is really joyous.
Melka: You love me. Who are you kidding?
Dr. Fox: Well, yeah, but apparently, I’m not getting in return. I’m not getting any love. Beautiful, no it’s all good. Since, you know, we only cover topics where I taught you how to do them. So it’s perfect because I know how you’re gonna respond. As we often tell people, we share a brain. And so it’s all good. And I think that C-sections is really one of those times.
Dr. Fox: Yeah, where I mean, if, you know, people do C-sections, in sort of different ways. I mean, the steps are basically the same but there’s different techniques and different just maneuvers in different ways, different instruments, and this and that. And so sometimes when you operate with someone, because it’s a two-person job, you know, you’re trying to figure out with them like, “Am I gonna do this stitch? Or are you gonna do it?” You know, which direction…
Melka: Which method are you using? Who’s gonna call for the instruments? Which sutures are we using? No, not with us. It’s just 1, 2, 3.
Dr. Fox: Yeah, 1, 2, 3. And I think that it’s funny, because a lot of people have that when they operate together all the time. But that’s actually not the case because we don’t operate together all the time, it’s actually pretty unusual. It’s just that we really just trained the exact same way and so it’s just second nature the way we call for an instrument, so it’s pretty cool. So we’re gonna talk about that today, we’re gonna be talking about C-sections, it’s focused on the scheduled C-section, meaning someone knows in advance they’re having a C-section, and they’re walking into the hospital, sort of knowing, “I’m here for a C-section.” A lot of these things do apply for someone who has a C-section from labor, which is a different topic and slightly different in terms of, you know, what to do and what to expect.
So this is more unique to the person who’s, you know, coming in, they have a date on the calendar, you know, “Tuesday, the 14th is my C-section at 10 a.m. with Melka and Fox,” whatever it is, obviously, or anywhere else, and we’re gonna talk about that. So I guess the first question a lot of people might ask is, “Why would someone have a scheduled C-section? Why would there be a date on the calendar that says, “I’m having a C-section,” specifically?
Melka: Usually, it’s some reason that it’s safer for the mom or for the baby to be delivered by C-section.
Dr. Fox: Yeah, there’s a misconception that those scheduled cases are just, “Hey, someone says I wanna C-section and not a vaginal delivery.” That does occur but it’s pretty rare. It’s definitely rare in our practice, it happens from time-to-time, and that’s fine. But almost always, it’s because of a decision that was made by us and the patient that it is a better choice either for her health, or for the baby’s health, or some combination of both to have a C-section versus trying to have a vaginal delivery. And so what would be those reasons? Like if we had to start going through them and people are curious, like, “Well, why would that be?” What would be sort of the more common ones?
Melka: So in terms of the baby, it would be a baby that’s breech, so we wanna deliver a breech baby vaginally, a baby that’s very big when we think a vaginal delivery might not be safest.
Dr. Fox: Right, we’re gonna do a separate podcast on that. How do we make that decision? It’s complicated. So making that assessment is not easy…
Dr. Fox: …because there’s a lot of unknowns. How big is the baby actually is unknown, because we just estimate and what would happen if she tried to deliver vaginally is also unknown. So you have like, unknown times an unknown. It’s very…
Dr. Fox: Okay, so that’s another one.
Melka: And then mainly the rest of them are for mom. People that have had a certain number of C-sections before. So people that have had three C-sections, people that have had one C-section and don’t wanna have a VBAC. Certain surgeries on the uterus preclude labor, placenta previa, the placenta’s blocking the cervix, that’s probably it.
Dr. Fox: Those are the majority of it.
Melka: Those are the most of it.
Dr. Fox: Yeah, occasionally is other things that come up certain like infections where she shouldn’t deliver vaginally. These are pretty rare. By far, the most common reason is someone had a C-section, or two C-sections, or whatever previously, and you and I are the ones that did the podcast on VBACs and sort of if someone had one prior C-section, there is a decision to be made about whether you know, it’s better for her to have a C-section or try a vaginal delivery and there’s, you know, a lot of the patient’s sort of like own thoughts about this go into that decision frequently.
So if she had one C-section and either she or we determined it was best to have another C-section that would be a very common reason. And again, in that situation, I would say, people have a more concern potentially for the baby than the mother, I would guess. I mean, again, it’s not particularly risky for anybody in these circumstances. But all right. But once someone’s had, you know, two prior, or three prior, or four prior, it’s both I mean, obviously, she went to labor could be an issue for the baby, but we’re really concerned about the mother. So that’s the most common reason, I would say that people have this. And for them, they have some idea of what a C-section is, like, because they’ve done it before, they’ve had one before.
And I think for people who have had, you know, three, or four, C-sections, and they’re coming in, they really know what to expect. But I think for that first time, where they have it on the calendar, right? So their first pregnancy, they labored and had a C-section for whatever reason, and, you know, that was a whole thing. And then the next time around, a decision was made again, either by us by them, whatever it was to do a C-section. It’s such a different experience. So like, “Wait, I’m picking my baby’s birthday, and I know, who’s gonna operate on me, and I’m picking the time and I’m scheduling it.”
Melka: It’s like, I’m scheduling like, dinner, or a hair appointment, like I’m choosing a day, a person. Like this is very surreal.
Dr. Fox: I mean, some people love it, obviously, because there is some, you know, convenience factor. And, you know, they have a child at home, right? And they got things going on. And there’s certainly, it’s nice to be able to arrange some of that. And obviously, you can go into labor before your scheduled C-section, we’ll talk about that. But most of the time they make it and so they sort of like that certainty aspect of it. But yeah, a lot of people feel a little weird with that as well, that it’s just unnatural, so to speak. And yeah, that is true, it is a little bit unnatural to pick your date. So if someone’s in this circumstance, and we’re gonna be scheduling a C-section, how do we decide when to do it? Do we do it after the due date, on the due date? People think it’s gonna be on the due date. It rarely is on the due date. So how do we decide when to do it?
Melka: We look at why they’re being delivered, you know, is it a big risk of going into labor? Do you want them delivered around 37 weeks? Or is it more they just don’t want to labor or maybe shouldn’t labor, but it’s not the worst thing if they did. So you’d look around 39, 40 weeks.
Dr. Fox: The concept is that, you know, you don’t wanna deliver a baby too early. Because there could be issues with that the earlier you go, the higher the risk of issues of prematurity. Once you get to about 39 weeks, so a week before the due date, as far as we know, there’s really no advantage to the baby to staying inside any longer meaning outcomes for newborns born at 39 weeks, or 40 weeks, or 41 weeks, they actually do best at 39 weeks around, they don’t do better at 40 weeks. So we’re not inclined to keep someone pregnant much past 39 weeks, if they’re scheduled for a C-section. Now, it may end up being 39 weeks and two days or three days based on you know, they want it on a Monday, they want it with Melka, like whatever it might be, and that’s okay. So there’s some leeway with this. But we’re not gonna say, “Oh, let’s wait till after your due date,” because it really isn’t an advantage.
So at 39 weeks is sort of the standard for people.
Melka: Some women might choose after their due date. Like if it’s a VBAC, where she might say, “I wanna go into labor, but I don’t wanna be induced, I wanna give myself as much time as possible,” where we sometimes even let people go two weeks past their due date and she’ll have a C-section scheduled then.
Dr. Fox: Yeah, no, that’s a good point. So it’s sometimes a scheduled is your second plan. Like if I go into labor, I’ll labor, but if I don’t go into labor, I’ll do a C-section, then you pick your date. But for those who are definitely gonna choose a C-section, we usually do it around 39-ish weeks. And those are the people who it’s sort of like, “All right, we’re choosing a C-section,” but if she were to go into labor beforehand, it’s not dangerous to her or the baby. So a classic example like breech, right? So it’s not that she can’t go into labor with the baby breech. It’s we’re concerned about the actual delivery.
So as long as she can get to the hospital and have a C-section before she’s fully dilated, and pushing the baby out, which is almost always the case, then it should be fine. Same thing with people who had one prior C-section, and we don’t think it’s really dangerous to labor. But, you know, a decision was made, and usually by her that it’s not what she wants to do, like, “Okay, we’ll schedule at 39 weeks. And if you happen to go into labor earlier, we’ll do the C-section earlier.” And those are common ones or same thing like a very big baby, it’s not that she can’t labor, we’re just worried about the actual delivery.
Then there’s like the next one where we just don’t want her to labor because that itself, just the labor process could be dangerous. And in that situation, since the risk is higher to the mother or the baby potentially, we’re gonna deliver a little bit earlier and take on a little bit of additional risk. Not really prematurity because we usually do it around 37-ish weeks and that’s technically full-term but just, you know, there’s slightly higher chance to go to the NICU and slightly higher chance of some complications.
And those are the conditions, like for example, a placenta previa we actually do at 36 or 37 weeks because then if they go into labor they can be hemorrhaging. So that’s a really big deal. Or if let’s say, they didn’t have a prior C-section, but a prior rupture of the uterus where a C-section scar opened, that can be really dangerous to labor. And so if we’re recommending it in the sort of 36, 37-week range, that’s a situation where not only do we think you need a C-section, but we think you shouldn’t labor.
And that’s an important distinction to be made. Because we wouldn’t do it for someone at 37 weeks, if really, it was fine for them to labor. You know, there are situations where people disagree. You know, like, if someone had three, or four, prior C-sections, is it dangerous for them to labor or is it not dangerous for them to labor? And there is disagreement over this. We tend to do it around 37 weeks in that situation. Other people do it at 38 weeks, other people do it at 39, there isn’t exactly a right answer. Now, there are some circumstances where we do it even earlier than 36 or 37 weeks. And what might those situations be?
Melka: Vasa previa, so if you have a baby’s blood vessel sort of crossing the cervix, certain twins or triplets, if there’s growth restriction, even a singleton with significant growth restriction.
Dr. Fox: Right. So those are really reasons more related to the baby. But the vasa previa that you mentioned, is really important, because that is such a high-risk to the baby for going into labor. It’s like literally life and death. And so we don’t mess around with that. So typically, we’re gonna deliver them as early as 34, 35 weeks where the bar gets pushed, or for mother’s health, something like a placenta accreta, we usually do around 34, 30, for the same reason. It’s just so dangerous if she went into labor, that we’re willing to push the bar and that’s sort of how these decisions are made. And they’re definitely individualized based on the reason but that’s sort of how we decide on the scheduling. And it is a discussion with each person what is the right time for you? There isn’t an exact right time for everybody you have to sort of figure it out for each individual person.
Melka: Yeah, the accretas get even more complicated from a surgical aspect, because you’re looking at GYN oncology. Sometimes if you think there’s bladder involvement, a urologist available and having that entire team, which we can have them come in at the middle of the night, but it’s much much tougher, you know, and the surgery itself is tougher in somebody that’s bleeding or in labor compared to scheduled.
Dr. Fox: Yeah, I would say that sort of, you know, just by the numbers, the vast majority are getting scheduled, or at least the majority are getting scheduled at 39 weeks, and then the next biggest group is at 36 or 37. And only a handful are gonna be that 34, 35 just a few. Those are obviously more exceptions in the situation. So okay, so someone has their C-section, they sort of have a timeframe that it’s gonna be done, what should they expect is gonna happen, right, other than picking a date? So let’s say they know that, you know, we usually do about two months in advance, we can schedule them that’s related to the hospital not related to us. And so they know that it’s coming up. So what’s gonna happen in the weeks and days before the scheduled C-section.
Melka: So they’ve got their day and time, they get all the instructions from us from the hospital, there are certain blood tests that we do in advance. One is a blood count, just checking your hematocrit platelet count beforehand, having what’s called a type and screen on file with the blood bank, which is basically in the rare case that a blood transfusion is needed, that allows us to be transfusing cross-matched blood that’s typed specifically and tested for the patient. And instructions on not eating or drinking a certain amount of time beforehand, potentially meeting with the anesthesiologist in advance if there are any other surgical consultants available. You know, we have somebody with like prior bowel surgery, we might want their GI surgeon in the room or at least available on that day. So a lot of that coordination.
Dr. Fox: Yeah, and a lot of those either the blood tests or we do them in advance more from a convenience standpoint, they could be done the day of but then you’d have to wait many hours potentially until your C-section is done. And so if you do them in advance, that sort of makes the day of a little bit less likely to get delayed, and we’ll talk about all C-sections might get delayed, but it just sort of improves the chances of running on time. You know, we’re gonna be the ones who are gonna let someone know, “Hey, I need you to meet with an anesthesiologist before your C-section,” because most people don’t but some do. And you know, we do want you to meet with another surgeon.
Again, that’s an exception. Most people don’t, but some do and that’s something that we’ll be guiding. We didn’t on this podcast put the specifics of what you can and can’t eat or drink before surgery because, number one, you know, our listeners are in many different hospitals, many different states, or countries, and it’s different probably in every system and so we don’t wanna like say something, have someone you know think that’s gonna apply to them and even in our own practice or in hospital these recommendations sometimes change.
And so part of the pre-surgical instructions that someone’s given is, all right, these are the rules, right, you can’t eat food up to x time and you can’t drink water, you know, or you can drink water up to x time. And sort of those are really important rules to follow. Because if you don’t follow them by accident or even on purpose, and you come to the hospital, and you tell the anesthesiologist, you know, “I had a coffee and a bagel two hours ago,” you will not have a C-section that day, they will cancel it because they’re just saying, “Listen, you’re scheduled, you’re not in labor, we have to wait because it’s not safe potentially, to do it on a full stomach rather than an empty stomach.” And so those are important instructions to look at. And you know, for your own hospital, what are the instructions. And if you don’t know what we’re talking about, ask, say, “Hey, is there something I need to know about eating and drinking beforehand, because I didn’t find out?”
Melka: And follow those specific instructions, because it makes it really awkward. If you’re coming in and you’re like, you’re not gonna win a fight with the anesthesiologist, if you say like, “But at this other hospital, they let people eat up to four hours before but you’re telling me eight, like I’m following the four-hour rule.” It’s like, “No, that’s not…” they are the doctors like…
Dr. Fox: Right, or, “During my last C-section it was this,” because these things can sometimes change. So that’s something to be really mindful of. And again, if you’re scheduled for a C-section, and you don’t know what these instructions are, you should ask because they’re definitely out there. There are definitely instructions to be read somewhere, if you don’t have them. And then what about things like, who’s gonna be operating on them? Is that something that people typically will know in advance or won’t know in advance?
Melka: Almost always people know about it in advance. There are some patients that will say like, “I want my C-section on this day, and I want this doctor,” and we do what we can to make it happen. We have some patients that are like, “I love everyone, I don’t care who delivers me,” but like they’ll still find out in advance who’s scheduled to be there that day. We’re always assisted by somebody, typically a resident, or a PA, that’s somebody that they would meet the day off. That it’s much, much harder to know in advance.
Dr. Fox: Yeah, it’s definitely harder.
Melka: Sometimes an hour before things change.
Dr. Fox: Yeah, I mean, in our practice, again, most of the time, people know which doctors from our team are gonna be there for the C-section. Again, occasionally that changes, there’s some last second emergency. But that’s pretty unusual, because the scheduled cases are almost always done by the person who’s scheduled to be there that day, they definitely would not know which resident and again, we don’t know which residents gonna be there. And that’s because they’re all over the place and that’s, that’s good. Like, that’s how it’s supposed to be. And occasionally, you know, we’ll schedule it for one of us, with the second person sort of like a wildcard, unknown who it’s gonna be. Sometimes we’ll have two of us scheduled for the operation, why might we schedule two of us there instead of just one plus someone from the hospital?
Melka: So if we think it’s gonna be a technically difficult surgery, it’s sometimes nice to have a second attending around. Because there’s some days that there just are not residents available then we would want a second person. Usually, it’s more if we’re anticipating a difficult surgery.
Dr. Fox: Typically, it’s not that necessarily, it’s better to operate with, you know, two of us versus one of us and a resident, it might be a little quicker, potentially. What I tell people is if I’m scheduled to do a C-section that I think, you know, sort of typical C-section, let’s say is, you know, 30 to 40 minutes, something like that, I can do that while I have people in labor. It’s not so hard to do, because I sort of know if someone’s gonna deliver within 30 to 40 minutes. And if they are, I’m gonna wait, to do that delivery, then do the C-section. If they’re not, I’ll do the C-section and come back. But if the C-section might potentially take two hours, then I don’t wanna be stuck doing a C-section with someone delivering so we wanna have two of us there because one of us could always run out and do that other delivery.
So a lot of it is sort of those types of logistics. And it’s one of the other reasons, it’s not always great to have this done in the middle of the night, like showing up in labor, because you’ll have your doctor on call there. But what if you have two people in labor, it could make either your C-section delayed, or potentially someone has to run out during your C-section, then there isn’t the other person or so it definitely makes it more challenging. So we try to decide in advance which C-sections might take more time just logistically. And those cases, we’ll have two people there.
And then yes, sometimes we think it’s gonna be really hard, we’ll have two people just in case we think it’s gonna make it easier. But you know, it’s one of these things where sometimes we have two people scheduled to do it. And then again, one of them’s is someone in labor, and then all right, the other one of us will do it with one the residents, and that works out fine as well. And that’s not something to be concerned about is that happens, because we’re very comfortable operating with pretty much anybody.
And then I guess there definitely are people who prefer a certain let’s say day of the week. Why might someone care if it’s like a Monday, versus Wednesday, versus a Friday, other than who’s which doctors there, and they wanna a certain doctor potentially?
Melka: So I have some people that say they want the Monday, Tuesday, so that way their kids who are at home are in school and can be in school while they’re in the hospital. Some people want the weekend because the weekend is easier for their parents to come up and take care of their kids. Most of the time I see it, it’s logistics.
Dr. Fox: Right. It tends to be that sometimes people are concerned like on a certain day of the week, there’s like less staffing or it’s a holiday, it doesn’t really make a difference that they wouldn’t schedule a C-sections if there’s not enough staffing. So it’s basically it really doesn’t make a difference in that regard, what day it is. And, you know, sometimes people like to, you know, strategize and what’s the best day to get a private room or this or that, but it’s so random.
Melka: It doesn’t matter.
Dr. Fox: Yeah, it’s so random.
Melka: Sometimes it’s things that people are like afraid to tell us because they feel it’s really superficial. Like I had one patient who was like, “But like I was told I need this day, but that was my wedding anniversary with my ex-husband, and I don’t want my delivery that day.” And I’m like, “That’s fine.” And she was like afraid to tell us that for some reason. Like, there’s people who say like, “I want this day, because it’s my mom’s birthday, and I wanna have a baby on the same day as my mom’s birthday.” Others don’t want that day. So like, any reason you can think of people choose that day.
Dr. Fox: Right, as long as you’re picking the day, you may as well choose any reason you want. Again, we wouldn’t sort of change the recommendation for the timing of delivery. But the timing is usually like there’s like a week. Right, like when we say 39 weeks, we mean 39 weeks and zero days, 39 weeks and six days. So we’re comfortable with any day in that seven-day window. And so whichever day works for you is fine with us. We wouldn’t say, “All right, will do it at 38 weeks, because that’s when you’re mother’s birthday is,” generally we would not do that. Okay, so that’s coming up to the day of C-section. What are the things that might happen the day of the C-section, so like, take us through what it would be like for someone walking into the hospital the day of their C-section?
Melka: So you get to the hospital, you check in at the front desk, and they bring you in. Typically you get admitted in the recovery room. So you put on the hospital gown, they put the baby monitor on. You meet the nurses, they put in an IV…
Dr. Fox: How far in advance of your C-section are you coming? Like what time is this?
Melka: This is usually two hours beforehand.
Dr. Fox: Yeah. So if you’re the first case of the day, let’s say 8 a.m. you’re coming in at 6:00.
Dr. Fox: Right, that’s something to know if you’re…
Melka: Yeah, please come at 6 a.m. if you’re supposed to come in early.
Dr. Fox; Yeah, if you’re a late riser, do not pick the 8 a.m. C-section because you will be missed. You know, it’s like a flight, we wanna take off on time. Okay.
Melka: Yes. So you get checked in, you get a bed, IV, blood pressure, heart rate monitoring, you meet the nurses, you meet the anesthesiologists, and then whoever from our team is doing the surgery, one of us and then whatever resident is working with us that day.
Dr. Fox: Right. And it’s generally pretty calm, because, again, the blood work’s already done. If you had to meet an anesthesiologist, like in advance to go over a specific problem, you already did. So the day of it’s really just to say, “Hello, here’s who we are,” you know, if they haven’t met us is a very quick, you know, telling them about your medical history. And they ask you to open wide and look in your mouth just to see, you know, if they had to intubate you, what does your airway look like? You know, they talk to you about the plan, which is usually a spinal or epidural, what that’s gonna be like, can we see you? But we already know you, you know, we know what’s going on. We’ve already talked about this. So it’s usually very social, like, “How are you doing? How are you feeling? You know, who’s coming to the operating with you?” Those types of things.
And then one of the really interesting parts about it is you walk into the operating room, right? It’s not like, you know, when you were in labor, and you get rolled in with an epidural with you know, like, after being in labor, you literally you walk in like you’re on your own two feet, but we do have you walk in alone, right, whoever is gonna join you for the C-section. And usually it’s one person who can come in with you.
Melka: The new rule is now only one person.
Dr. Fox: Only one person?
Dr. Fox: Okay.
Melka: That’s what I was told last week.
Dr. Fox: I thought that was the old rule also.
Melka: It was and then it maybe wasn’t, and they’re back to it.
Dr. Fox: They’ve reaffirmed the old rule?
Dr. Fox: All right, so one person and that person, whoever it might be…
Dr. Fox: Right, is not gonna come in with you. And why is that? Why do we bring you in alone? We tell secrets.
Melka: So the anesthesiologist are doing the spinal at that time. They need to kind of work without an extra person watching and I think it’s sometimes tough for a partner to watch somebody go through that.
Dr. Fox: Yeah, there’s definitely the capacity for someone to pass out. And that’s much more likely to be the partner than the patient during the procedure. That’s actually true with you know, epidurals and labor and that’s usually they do let them stay in the room, but they always make them sit in the big lounge chair. They do not have them stand. It’s not a great idea. It can be freaky to watch.
Melka: Yes. And they have them sit in a way that they’re not watching where you can’t do that in the operating room. Like you just don’t physically have that space.
Dr. Fox: Right. The anesthesiologists are working on your back. So in the labor room, they’ll have the partner sort of by the patient’s front, facing them so they can’t see what’s going on. In the operating room, it’s again not possible. And the other thing is, you know, after the spinal is placed, it’s kind of freaky to see a loved one on an operating table. It’s just not…it’s scary, right? Even though it’s you know, everyone’s awake, you know, the spinal, you know, she’s awake and we’re talking and you’re just lying there looking straight up at the ceiling for many parts of the prep, you know, she’s unclothed, you know, certainly, you know, like, from the belly down.
And you know, we’re putting in a catheter, it’s impersonal, it’s not something that people would necessarily want others to be watching happen. And so what typically is after that’s done, and we come in, and we’re about to start this, you know, we get everything prepped and put on all the drapes, everything is all ready to go. We’re like literally standing there ready to start. And before we start, it’s like the grand entrance of the partner. They come in, they sit down, everyone’s here, now we start.
And it’s the same thing on the way out of the C-section, we generally escort the partner out, before we remove all the drapes and start cleaning her up. Because again, it’s just one of these things you don’t wanna see. And it’s the same reason why if someone needed general anesthesia where they’re put to sleep, you know, tube in the throat, the whole thing, they don’t have partners come in the room for that. Because even though they may wanna see the baby being born, clearly, it’s not gonna be supportive to the person who’s asleep, because they won’t know the difference. But it is very freaky, to watch. And that’s not something you wanna see your loved one in that position. It’s really not a good situation. And so that’s not a time for someone to come in. So…
Melka: And it’s a rule that they don’t break. People try to talk us into it all the time, you know, the partners.
Dr. Fox: Yeah, I’m a doctor.
Melka: “I’m a doctor, I don’t pass out, I’ve never passed out. Oh, I’m good with blood.” It’s like, “Please just let us do what we do.” Like, there’s reasons for all of this.
Dr. Fox: Yeah, no, absolutely. And then, you know, generally the C-section, like I said, most of the time from when we start, certainly if it’s you and me, to when we finish, it’s, I don’t know, 30 minutes, maybe 40 minutes, you know, it could be longer. Sometimes we know in advance, it might be longer, and then it may be you know, an hour plus or something like that. When we’re all done, almost always, you know, you and the baby go out together. This time, you can’t walk because you’ve had the spinal. So we wheel you out back to the recovery room from where you started, stay for a couple hours. And then once everything is cleared, and you seem okay, and the spinal is wearing off, and you know, everything is fine and you’re not bleeding too heavily because of the spine, we send you upstairs and usually you go home, I don’t know, somewhere between, you know, two to three days later, you know, sometimes four if there’s been, you know, just things going on, but usually two or three days afterwards.
Now, what are some maybe suggestions that you have for people who are coming into a scheduled C-section like you know, sort of your tips, your tricks of the trade, like, “Oh, don’t forget to bring this or don’t forget to do this.” Do you have anything that you tell people beforehand?
Melka: I tell them to sleep the night before. Have a nice dinner. There’s a lot of myths out there that they have to have clear liquids the night before or can only eat something bland. I’m like, “Maybe don’t get like a five-course steak dinner. But like just eat normal, like, live a normal life.” When people are checking in, I tell them, “You look like a pro if you only come in with like one bag. Like, don’t bring all this stuff. Wait till you’re upstairs in the postpartum room to get like the car seat and the breastfeeding pillow and all that.” Because you come in, you’re in the recovery room, then your stuff goes into a locker, you might have to get put somewhere else for a bit and then upstairs and there’s just all the schlepping back and fourth. So the less you bring in at first, the better.
Dr. Fox: Right. I mean, especially if you know that either, you know, your partner’s gonna be going back and forth, right, like you live close enough. Or, you know, you drove in and you can leave stuff in the car or in the trunk. I mean, there’s obviously some circumstances where like, people don’t have that option. Like they’re coming and they’re staying and they’re all going home together, like, okay, fine.
But most of the time, if you’re able to do it, yeah, bring little at the moment. And then you know, try to bring everything afterwards. I give the same advice. I tell people, you know, “Try to enjoy yourself before the night before, you know, have dinner, watch a movie, you know, try to get a good night’s sleep, you know, take a nice hot shower the morning of. You know, really try to you know, pamper yourself as much as you can, pay close attention to the instructions, you know, try to get there on time.”
Melka: And be cautious with the eating and drinking in the morning. Like people really don’t realize how much of a habit it is to like, wake up and like turn on the coffee pot, before you realize like, “Wait a minute, I’m not allowed to have that,” or, like you open the refrigerator to have breakfast, like make sure you’re not eating and drinking and following the rules.
Dr. Fox: Right. Yeah. And I think that there’s always you know, different people have different strategies about you know, do they tell their other kids this is happening or not? And I’m not gonna give advice on that because there’s no good way to do this. Every kid is different. But that’s something to think about right? “Are we gonna tell our kids or when are we gonna tell our kids? Are we gonna bring our kids to the hospital to visit? Are we not?”
Melka: Find out if you’re allowed to.
Dr. Fox: Yeah, and it’s also it’s a little freaky for kids to see a parent in a hospital bed sometimes. So it’s something that is not always a wonderful thing. I know when we brought our twins to visit my wife when our third was born, it was like a disaster. It was like the worst. So going back in time, I would not have done that. But okay, and I mean, have a listen, everyone’s different. And I think that it’s also good since you know you’re having a C-section you can plan for the recovery potentially, you know, sometimes like, you know, “Where am I gonna go? Do I live in a walk-up?” You know, like these types of things, you know, since you know it’s a C-section you could plan and sometimes even get, you know, pain medicine ready in advance or whatever you might need because you know it’s gonna happen.
Melka: Yeah. It’s another thing I tell people that the recovery with a scheduled C-section is almost always better than the recovery after the long labor C-section. And that’s, I guess one of the tips, but I think it also goes into like the initial counseling, but a lot of people go and have the C-section with dread, because they know what their recovery is gonna be like. And often explaining like, “Well, no, this time, like, you’re not coming in after a long labor where you have gotten two liters of fluid and you’ve been in bed or you’ve been pushing for three hours, you know.
Dr. Fox: Right, and you haven’t eaten for a day and a half.
Melka: Right. Like it’s much, much different.
Dr. Fox: Yeah, no, I agree that it’s frequently not as “bad” as people thought it might be based on their first experience. And I think, again, the people coming in for the third and fourth, sort of the veterans, they kind of know sort of what to expect and you know they’re like, “Oh, this isn’t really my second, it’s more like my third,” and they talk about that. But that first scheduled C-section, there’s frequently a lot of anticipation about that, because either they’ve never had one and they don’t know what to expect, or they had one and it was like, “Oh my God, I don’t want that again.” And it does frequently end up being a little better than they thought it would. Excellent. Melka?
Dr. Fox: Well, we’re having a C-section. All right, I’ll see you in the operating room.
Dr. Fox: Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcasts, please visit our website at www.healthfulwoman.com. That’s healthfulwoman.com. If you have any questions about this podcast or any other topic you would like us to address please feel free to email us at firstname.lastname@example.org. Have a great day.
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