Hi,

I have a few questions that I hope to get your insight on. What precautions does your hospital take in preventing infections in post c-section patients? Do you use betadine q shift, shave the entire area thoroughly prior to surgery, use prophylactic antibiotics, etc? How common is a post c-section infection turning into sepsis? The NP in my OB's office scared the bejeebers out of me yesterday by recalling a patient who was a third time c-section that ended up dying of sepsis. Not a good thing to tell someone who was on the fence about it in the first place.

I am most likely having a c-section (second one) in a few short weeks but am very leery as my first c-section resulted in an terrible infection. I want to do all I can to prevent this from happening again. My infection occoured several hours after my hospital discharge: chills, temp 103 and had to go to the ER where they kept me for 12 hrs, being poked and prodded by residents, before giving me IV fluids and antibiotics. I should also tell you that with my preg weight gain I do sweat profusely and have a lot of drooping skin in my lower abdomen from previous preg (hard to keep meticulously clean and dry, sorry if tmi).

Any input and insight is greatly appreciated. Thanks!

Where is used to work they established a new antibiotic policy that was inclusive of the type of surgery to be given while in surgery. C/S received such and such hysterectomies such and such etc. Another thing was you first c/s a bikini cut(across the abdomen?) I have seen some OB Docs do them up and down so that they are easier to see,to keep clean and dry....You know warm moist dark places promote bacteria. Maybe with you history they will do somethings differently this time. Good luck with everything and the new baby.

After my second c/sec, I too got a serious infection that went into sepsis; luckily, I was still in the hospital when it hit me, and they got it under control before I became gravely ill, or worse. It took me almost a year before I felt right again........like you, I was terrified of going through that, so when I got pregnant again I decided to have a VBAC. You might want to check w/ your OB to see if that's an option---I hear it's no longer a frequent practice due to fears of malpractice suits, but some docs are still willing to entertain it. Natural birth is far less likely to result in infection; of course, if a cesarean is your only option, you'll want to make sure you're in as good a shape as possible---your nutrition needs to be optimal, you should be taking your vitamins faithfully, and you MUST avoid exposure to colds and flu at all costs.

You also might want to ask about whether you'll be given prophylactic antibiotics if you do have the cesarean......it would probably be worth it given your history.

Best of luck to you, and remember: no matter what kind of birth you have, a healthy baby AND a healthy mom is the ultimate goal. :)

We use prophylactic antibiotic in surgery and observe the incision for drainage or changes. We also report all post-op temps greater than 100.4 (this prompt getting a CBC and then possible further tx w/antibiotics) ----and we teach patients about observing and reporting post-op s/s of infection once they get home.

Our c/s get a dose of antibiotics intra-op then q 8 x 2. We have a protocol now for all surgeries actually..hysters and the like for preop then to dc in 24 hours. We don't have a high post op infection rate. Of course they happen on occasion, but are uncomplicated.

We use prophylactic antibiotic in surgery and observe the incision for drainage or changes. We also report all post-op temps greater than 100.4 (this prompt getting a CBC and then possible further tx w/antibiotics) ----and we teach patients about observing and reporting post-op s/s of infection once they get home.

Same here. I can't even remember when we had an infection.

steph

We do prophylactic abx during the procedure. I also had a section with my first child and then a VBAC. I can tell you that my experience was 100% positive! VERY EASY recovery. The difference is night and day. If you are able to have a vag delivery, I would definitely recommend it. Remember that no surgery is without risk. I'm curious about the indication for your c-section. If you decide to go VBAC... try waiting until you go into labor naturally and avoid induction if at all possible. That can make a huge difference in cervical readiness. Let us know how it goes! T.

Thank you all for your replies. It seems that prophylactic antibiotics are fairly common, although I don't remember getting them with my c-section.

The reason for my first c-section was I was on hospital bedrest with mag sulfate for preterm labor with twins at 29.5 weeks. At 30.5 weeks my contractions suddenly intensified, and I had dialated to 9cm. Baby B was breech and as they were so premature I didn't want to cause undue stress/harm by having the doctor try and turn the baby around for lady partsl birth, so I opted for a c-section at the last minute (in order to get them into the NICU as soon as possible).

This preg I was considering a c-section because of concerns with uterine rupture (even though my incision is horizontal), although I am not sure how likely that happens, but was also thinking about having a tubal ligation done at the same time. My doctor is very supportive of VBAC and said they would monitor me the entire time.

In your experience, how often does a VBAC go bad (dystocia, uterine rupture, etc.)? I have been up for nights worrying about all this, still undecided as to how I should deliver this baby and I'm almost 35 weeks now.

I have seen one dehiscence in a VBAC. It is indeed RARE. Please discuss the risks/benefits w/your dr asap.

I would echo previous posters about VBAC. It is most certainly a safe option, given that you're medically well supported and you yourself feel safe doing so. A couple of thoughts (like I ever have one thing to say! )

1. You are one lucky mama to have a doc that supports VBAC. It's becoming more of a rarity these days, despite the medical evidence that tells us VBACing is a safe option. Your chances of infection decrease dramatically for both you and your baby with a lady partsl birth. It's definitely worth looking into.

2. Consider going to the website of ICAN (International Cesarean Awareness Network). You'll find tons of evidence-based information and support. They may have a chapter in VBAC'ed.

3. Please consider hiring a doula if you wish to have a VBAC. Your chances of success will rise tremendously, because you'll have a woman there who is supportive, constantly at your side and familiar with the birth process. She will not leave your side the entire time of the birth, which is really helpful if you have nurses who are changing shifts. (I know a lot of nurses who just HATE leaving their laboring moms in the middle.) Studies have shown that doulas confer major advantages to laboring and postpartum mothers. And by having a doula, you can have someone to call for support instead of feeling so alone in the middle of the night.

4. Go to Henci Goer's website. http://www.hencigoer.com She is a wellspring of information about all sorts of childbirth issues. While she is definitely a natural childbirth advocate, she does so armed with a ton of science and statistics, and a true concern for women's well-being. And I like her sassy ways, quite honestly. :)

5. It sounds as if you were really shaken by your experience with infection postpartum. If you can, speak with someone who can help you resolve your feelings and create a new paradigm of positive thinking in order to help yourself heal and to help you be the best mom to your new baby. A mother who has a c/s has a much higher chance of postpartum depression, and it sounds like your world was pretty rocked, both physically and emotionally. I'm so sorry. It's a difficult way to begin new motherhood, not to mention the trauma of the NICU and newborn babes.

6. Please know that you are an incredibly brave mother for having gone through what you did, and for heading back into the labor room at all! No matter what happens, it is a profound act of bravery to give birth, and you should be proud of yourself.

Good luck to you. Feel free to contact me via e-mail or IM.

Alison :balloons: