# What does coming down with a bad flu have to do with needing a c-section?



## Mama_2_Boy (Jun 18, 2007)

So can someone enlighten me here? I think I was in shock when I met with my secondary MW last week. Next week I go see my primary and will speak more with her. Anyways she told me that if I wasn't planning on getting the H1N1 vax, that if I did fall ill and go into labor that could mean a possible c-section (I'm planning my second HB).
Eh?
Can someone please enlighten me as to why this would be necessary?


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## mntnmom (Sep 21, 2006)

I suppose if you're sick enough they think you might die, they would want to take the baby.... but I can't imagine what you going into labor would have to do with anything?
I'm almost 6mths. So I'm curious if anyone has a good answer.


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## lunita1 (May 12, 2008)

Quote:


Originally Posted by *Mama_2_Boy* 
So can someone enlighten me here? I think I was in shock when I met with my secondary MW last week. Next week I go see my primary and will speak more with her. Anyways she told me that if I wasn't planning on getting the H1N1 vax, that if I did fall ill and go into labor that could mean a possible c-section (I'm planning my second HB).
Eh?
Can someone please enlighten me as to why this would be necessary?

I don't know for sure but here's an article that is probably relevant if you could get access to the rest of it http://www.springerlink.com/content/k6286h7026531n05/

I think what is at issue is that influenza can make you very weak and unable to breathe properly, so you might not have the energy or physical strength to labor and push a baby out. I can't imagine how miserable it would be to have the flu when you're very pregnant and already have reduced lung capacity (because of the space the baby takes up).


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## Mama_2_Boy (Jun 18, 2007)

Quote:


Originally Posted by *lunita1* 
I don't know for sure but here's an article that is probably relevant if you could get access to the rest of it http://www.springerlink.com/content/k6286h7026531n05/

I think what is at issue is that influenza can make you very weak and unable to breathe properly, so you might not have the energy or physical strength to labor and push a baby out. I can't imagine how miserable it would be to have the flu when you're very pregnant and already have reduced lung capacity (because of the space the baby takes up).

It's interesting that this is coming up now in my pregnancy, at 35 weeks. Because many weeks ago, I posted a question on the boards asking women "if you get the flu, will it change your HB plans" and everyone said the same thing - "NO". Women were still pretty adament that they would have their birth at home. I have to check into this some more. I'm wondering if I even have a choice in the matter?


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## Courtney&Ry (Feb 3, 2009)

Uh, yeah...I don't understand either...it would seem to me if you were that ill, that major surgery (including c-section) would be contraindicated (as in DON'T do it) due to additional risks involved with a weakened immune system and inability to fight infections and such....hmm....anyone got an answer??


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## Courtney&Ry (Feb 3, 2009)

Quote:


Originally Posted by *lunita1* 
I don't know for sure but here's an article that is probably relevant if you could get access to the rest of it http://www.springerlink.com/content/k6286h7026531n05/

I think what is at issue is that influenza can make you very weak and unable to breathe properly, so you might not have the energy or physical strength to labor and push a baby out. I can't imagine how miserable it would be to have the flu when you're very pregnant and already have reduced lung capacity (because of the space the baby takes up).

Well, this kinda makes sense...I guess...But considering women in comas can and do give birth - the body will figure out a way to get that baby out, since it can't hold onto the baby forever...I guess it comes down to risks and condition of mom and baby....


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## Mama_2_Boy (Jun 18, 2007)

Well my other concern here is, what are my rights? I'm in Canada. I would want to know if I could refuse the c-section.


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## riverscout (Dec 22, 2006)

I had what appeared the swine flu recently, and I remember very clearly what it was like to give birth, so I can totally understand why having the flu might increase the chance for needing a c-section.

I was beyond exhausted, had a raging fever, my chest and head were congested which made breathing difficult, and I felt like I was coughing up a lung. The thought of trying to give birth in that condition is a bit frightening.

I'm not saying it couldn't be done, and if I found myself in that situation, I think I would certainly try to give birth naturally if at all possible, but I can see where it might get complicated to say the least.


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## dachshundqueen (Dec 17, 2004)

Pregnancy (late term with reduced lung capacity) with swine flu + secondary infection (let's say pneumonia) can = death.

If you cannot get enough oxygen, you will suffocate. The baby will die or have severe brain injury from oxygen deprivation. Same risk for a severe asthmatic having a severe asthma attack late in pregnancy. If you are that sick whilst pregnant that you are hospitalized due to a secondary infection, their job is to ensure your ability to breathe and while it would be risky, getting baby out would be a viable option as failure to treat mother could result in death of both. You're going to be intubated either way and at least that way there is hope to get baby into a NICU and you hopefully extubated in the near future.

I had a VERY frank discussion with my pulmonologist whilst pregnant with my first. I had had a very bad pulmonary response to chemical cleaning agents and the resulting asthma attack nearly killed me when I was engaged. I was significantly concerned about taking my asthma medications, but his response was, "They're safe. A dead mama cannot care for a newborn."

Liz

"Why? It's not entirely clear, but there are two likely mechanisms:
* As pregnancy evolves, a woman's diaphragm is pushed upward and she has decreased lung capacity. This makes respiratory disease more dangerous.
* During pregnancy, a woman's immune system shifts away from the kinds of immune responses most effective in battling viral infections. This makes her more susceptible to some viral diseases such as flu."
Healthy Pregnant Women at Risk of H1N1 Swine Flu Death, Hospitalization
By Daniel J. DeNoon
WebMD Health News


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## 4Blessings (Feb 27, 2008)

For those who have not had a c-section I can assure you that coughing after a c-section is the worst pain I have ever experienced.
I cannot imagine having a c-section while sick with a cold or flu. It would be absolutely horrid.

I'm also worried about the effects of anesthesia when lung function is compromised.

Very interesting topic.


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## dachshundqueen (Dec 17, 2004)

Quote:


Originally Posted by *Proud2BeAnAmerican* 
For those who have not had a c-section I can assure you that coughing after a c-section is the worst pain I have ever experienced.
I cannot imagine having a c-section while sick with a cold or flu. It would be absolutely horrid.

I'm also worried about the effects of anesthesia when lung function is compromised.

Very interesting topic.

I would imagine that this would not be standard protocol for someone presenting late term pregnant with flu-like symptoms, rather someone presenting with decidedly low pulse/ox scores, having crunchy lungs, fever and perhaps showing a partially collapsed lung (as is common with pneumonia).

ETA: I am also thinking that this is not going to be standard protocol for all presenting patients rather L&D patients presenting for treatment specifically of the flu/secondary infection which would generally be then referred out/bedded in the ICU.

Liz


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## Bokonon (Aug 29, 2009)

Quote:


Originally Posted by *Proud2BeAnAmerican* 
For those who have not had a c-section I can assure you that coughing after a c-section is the worst pain I have ever experienced.
I cannot imagine having a c-section while sick with a cold or flu. It would be absolutely horrid.

I'm also worried about the effects of anesthesia when lung function is compromised.

Very interesting topic.

I had just gotten over a bad cold when I had my last c-section. The coughing was wretched!


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## LiLStar (Jul 7, 2006)

I wonder if your body will even allow natural labor to begin when you're that sick? I like to think that in most circumstances, our bodies will wait at least until the worst of the illness has passed before deciding its time to labor.


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## Mama_2_Boy (Jun 18, 2007)

Well this is very interesting indeed!
I would imagine that if I was near death to begin with, that natural pregnancy would be a definite challenge. However, my MW did not go into any details. In fact, thinking back I don't know that she is in agreeance with me not getting the vax? I know for certain my primary MW is 150% behind me, but my secondary...meh.


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## lunita1 (May 12, 2008)

Quote:


Originally Posted by *LiLStar* 
I wonder if your body will even allow natural labor to begin when you're that sick? I like to think that in most circumstances, our bodies will wait at least until the worst of the illness has passed before deciding its time to labor.

From the portion of the article/case study I linked to that I can read, it was describing a mom who was on a ventilator, and I think they took into consideration the deaths of other pregnant women who had been put on ventilators and performed a very early c-section (at 31 weeks or so?)


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## lunita1 (May 12, 2008)

In my own case, I would feel comfortable getting tamiflu ASAP if I began getting the flu during my third trimester. I may even take it prophylactically if someone else in my household came down with it. It's just how I come down after I weigh the risks for myself and baby of flu vs.the drug.


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## khaoskat (May 11, 2006)

I will not consent to a c/s just because I have the flu.

But, we did have a lady who was pregnant get swine flu with secondary infection and they took the baby by emergency c/s and mother died a week later.


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## gwen's mom (Aug 1, 2003)

This is completely anecdotal but a friend of mine came down with the flu in the last weeks of her pregnancy and b/c of her fever, high temp, and dehydration the baby's heart rate skyrocketed and the doctors strong armed her into a section.


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## cc_mama (May 22, 2007)

I've been doing more research about this today, since they released the first round of the H1N1 vaccine testing results - one dose if effective in pregnancy. I then decided to google about H1N1 in the third trimester - I had figured since I wasn't in the first trimester things wouldn't be as serious - wow surprised me. I'm really not sure what to do, planning a homebirth and I will be discussing this with my mw on Thursday and DH also.


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## berrymama (Jul 7, 2007)

I am an L&D nurse in a large hospital. The first severe case of swine flu in 3rd trimester that we saw was way back in April. This mom thought she was over the worse of it but ended up with the secondary pneumonia and on a vent in ICU at 32 weeks. She had nearly no lung capacity left, so it was decided to do a cs to save the baby. After the baby was delivered, she actually improved because her lungs had room to expand and she ended up with a good outcome. This probably one of the first cases and they know alot more about the disease now. We have since had several labor pts come in with H1N1 symptoms, and they have mostly delivered vaginally (unless there are other reasons for cs). However, I can see how a cs would be indicated in situations such as the one above. It definately saved that woman's life. It is cases such as hers that are strongly making me consider getting the vaccine, since I have high exposure and am nearing my 3rd trimester.


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## LaffNowCryLater (May 2, 2003)

Hmmm interesting. I had the swine flu at 31 or 32 weeks and it was very mild. My 17 month old had a worse case but even then not worth a shot IMO. My older two kids did not contract it.


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## MsBlack (Apr 10, 2007)

While I can see csec as a 'worst case scenario' as a few have described, I can't see having swine flu in 3rd trimester, or even when you go into labor, as case for automatic csec.

OP, for sure talk to your primary mw about this. It may be that the other mw overstated the case....either because she has a, hmmm, 'dramatic flair', or possibly because she is not yet clear on when csec may be indicated in the presence of swine flu.

I just try to get everyone around me to remember that really--it's just a flu. As with having any other flu, you have to consider whether your symptoms need home or hospital treatment, whether your own particular case of that flu is mild, moderate or severe. This goes for anyone, pregnant or not, though certainly pregnant physiology can impose a 'higher risk' than when you're not pregnant. Still, 'higher risk' does not mean that all pregnant or laboring women are going to need treatment according to 'worst case scenario'.


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## wombatclay (Sep 4, 2005)

Well, it also sounds like the OP wasn't told she would "have" to have a c/s but that she was at an increased risk for a c/s if she contracted the flu and then went into labor. Which, from the research and comments here, seems to be accurate.

It may also be that practice guidelines would prevent the midwives from attending a homebirth if mama had a condition like H1N1 or other complicating factor. If that is the case then the OP would be birthing in a hospital and that right there would increase her c/s risk.

As for being sick and going into labor... the body might actually kick into labor sooner in an attempt to "save" the baby or maximize resources for mama. I know a few women who have been very ill while giving birth... no fun.

OP- hope you stay healthy and have a fabulous homebirth!


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## riverscout (Dec 22, 2006)

Quote:


Originally Posted by *wombatclay* 
Well, it also sounds like the OP wasn't told she would "have" to have a c/s but that she was at an increased risk for a c/s if she contracted the flu and then went into labor. Which, from the research and comments here, seems to be accurate.

That's how I read it too. While I don't think anyone should be strong armed into getting a vaccine, I think it's good to have all the facts. If it is indeed true that a woman is at increased risk for a c-section if she has the flu, then I think a HCP would be remiss if they failed to mention that.


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