Elective caesar- Can I hold my baby immediately?

In two weeks time i will be having my second child by caesar (due to interspinous measurement of 8.7cm). My first son was born by emergency caesar after a long labour and there were complications in theatre which meant i couldn't see him until almost 5 hours later.( Tearing in my cervix and vagina).

This time , my caesar is elective and everything should go smoothly. My baby, another boy will be 39 weeks gest., and a good size, around 8 pounds. I have been given a birth plan (which i assume is a token gesture only) because everytime i ask for something i am told no. This includes holding my baby in theatre. I have been told that this is never done, and no exception will be made for me. Yet every Australian caesar birth video i see, and book, show this happening. What is the standard procedure?

(i am a public patient in NSW).

I am also interested in discussing, at least, the epidural drug that will be used, as i have heard Thomas Hale (US expert on obstetric drugs, and breastmilk) talk about the different drugs and which ones are better.

I would also like to have confirmed my pain relief after the event, because i know some women get pethidine, as I did last time, and i don't want this or any other drug that will get in my breastmilk and affect my baby.

As yet the doctors at the hospital will not intellegently discuss the drug thing with me.

Thanks, Amanda (27 years)

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Dr David

Moderator posted 22 December 2000 11:51 AM         

Amanda

I have worked in many hospitals and it has always been routine for mothers to cuddle their newborn in theatre during an elective caesar under a regional block. In fact, this close early contact is one of the main advantages that regional (awake) anaesthesia has over a general (asleep) anaesthetic.

I have phoned one NSW hospital birthing suite (John Hunter Hospital, Newcastle) and the nurse unit manager said that early cuddling is routine in their hospital, and indeed many mothers put the baby to the breast while still in theatre.

I'm not aware of the evidence regarding different regional anaesthetic drugs effects on breastfeeding. Most caesars are done under a spinal anaesthetic where a small amount (about 3ml) of long-acting (about 2 hours) local anaesthetic is placed in the sub-arachnoid space. Addition of a small amount of narcotic can lengthen the duration of analgesic effect for up to a day. An anaesthetist would know much more about this than me.

Post-op pain relief protocols are many and varied, and your hospital would have a protocol, or at least a usual practice. You could ask the charge nurse of the post-natal ward, or perhaps the Director of Anaesthesia.

The usual medications used fall into 3 groups

• Simple analgesics like paracetamol. Given regularly (say every 4 hours) orally or rectally. Usually not enough by themselves in the first 24 hours.
• Non-steroidals - aspirin, Voltaren, Indocid. Very little (nil?) Voltaren crosses in breast and this can be given 12 hourly as a suppository to augment the effect of paracetamol.
• Narcotics like pethidine, morphine.

I am familiar with an oral regime that uses paracetamol, aspirin and oral morphine mixture. (Ref:Monagle J et al Aust N Z J Obstet Gynaecol 1998 May;38(2):169-71) In my own practice, I find that regular oral morphine is only needed for about 24 hours, and the aspirin is stopped by 48 hours, prior to when a significant volume of breast milk is being taken by the infant.

Dr. David. 

DISCLAIMER:
This advice is of a general nature to help in decision-making. It does not constitute recommended treatment for an individual. You must consult your health care provider for individual advice.