By Sharon Muza, CD(DONA), BDT(DONA), LCCE, FACCE
You may find yourself headed for a cesarean birth, even when that was not what you planned. A cesarean might have been in the cards all along for a variety of reasons; or this change in plans might occur before labor begins or during labor, when you, your partner and health care providers feel that a cesarean is now the best option.
As a long-time birth doula and Lamaze Certified Childbirth Educator, I always encourage my clients and students to plan for a potential cesarean, even though many parents feel like that outcome is unlikely. Current cesarean rates in the United States tell us that 1 in 3 women will give birth by cesarean this year. Having a simple plan with some wishes that continue to honor the birth of your baby, can go a long way toward making the experience a positive one.
Here are my top tips to make your cesarean birth as gentle and family-centered as possible. Discuss these items in advance with your health care provider to see what is possible in your situation and in your place of birth.
1. If you know you are going to have a cesarean without an opportunity to labor, discuss with your provider if there is any risk in letting the baby pick his/her birth date and you heading to the hospital when your water breaks or gentle contractions start. There are many benefits to your body, your baby and future labors if you allow your baby to initiate labor. There are certain situations that may preclude this from being an option available to you, like placenta previa, where the placenta covers the cervical opening.
2. When the decision is made to have a cesarean, and if time allows, take a moment to talk to your baby. Let him or her know what will be happening, that you have confidence in your team and your baby and that you will soon be holding him or her in your arms.
3. Walk into the operating room if possible. It is very empowering to move to the OR under your own steam, if you and the baby are stable. If you have been laboring without an epidural or the cesarean is planned, anesthesia is usually done in the OR, so you should be able to walk there on your own.
4. Ask for two support people in the operating room with you. Your partner can be one, of course, and then your doula, family or friend may also be included. Having two people in the OR means that your partner can go over to greet your baby at the warmer, and you can still have support with you right by your head. If your baby needs immediate transfer to a special care nursery, your partner can go with the baby, without worrying about leaving you alone.
5. Bring in music of your choice that can be played during the birth. A CD or even an mp3 or smartphone placed on the pillow near your head playing softly can help you remain relaxed and positive.
6. Ask that everyone in the room take a moment to introduce themselves before the surgery begins. There are several more people than you might expect in the OR during a cesarean birth, and everyone may look the same, all gowned and masked. It can feel a little more personal to hear the staff introduce themselves and state their job ("Hi, I am Mary and I am the baby nurse.") and it can help you to feel like it's not such an impersonal procedure.
7. If you were waiting to discover the sex of the baby at birth, you can still do that. The staff and surgeons do not need to announce boy or girl, but instead can leave that to be discovered by you and your partner.
8. Ask if it is possible to delay cord clamping for even a very short amount of time, if baby is stable. Even 30 seconds of continued pulsing can provide benefit to your baby.
9. Sometimes, women may feel a bit nauseous during the surgery. It may be a result of the procedure, or nerves, or unfamiliar sights, sounds and smells. Consider bringing a little cotton ball or gauze pad with some peppermint oil dabbed on it, in a Ziploc bag. Peppermint oil can reduced the nauseous feeling and help you to not vomit. There is medication that can be given to you during the operation, but it may also make you sleepy, so if you can avoid it, that is great.
10. Ask if you can have the drape lowered at the moment of birth, or alternately, if your hospital has a clear drape. This will allow you to see your baby as he/she is being born, but will still prevent you from seeing the surgical site.
11. Talk to your baby after s/he has been born. Ask your partner to tell you what is going on, and what your baby looks like if you are unable to see -- "Oh, honey, he has the same long fingers as you do." Talk or sing to your baby, so that your little one can hear your voice as it makes the transition to the outside world. When your baby is brought over to you, you and your partner can sing happy birthday or a special song that you may have been singing to your baby during pregnancy.
12. Ask if you can bring baby to your chest immediately after birth. A select number of hospitals that routinely practice gentle cesareans will allow for this practice. This will allow you and baby to have immediate skin-to-skin contact after birth.
13. Ask that all possible newborn procedures be delayed until after you have returned to your room with your baby and had a chance to breastfeed. Unless it is critical to have the weight of the baby immediately, this measurement and other procedures, (Vitamin K, eye antibiotic medication, dressing, etc.) may be able to wait until you and your baby have had a good snuggle and a breastfeeding session back in your room.
14. Ask if it is possible to get skin to skin with your baby in the OR, while your incision is being closed. Prepare for this in advance by having removed or unsnapped your gown, and having just a warm blanket on top of you, ready for the baby. While the baby may not be able to breastfeed in the OR, while you are on the table, you can certainly have the closeness and skin-to-skin snuggles. You will always need some support during this time, so make sure that partner knows to keep their hands on the baby for safety. If you are unable or prefer not to have skin-to-skin in the OR, consider letting your partner have some skin-to-skin time with the baby while sitting next to you. Wearing a shirt that opens in the front, or even a t-shirt that has been cut a little down the neck will make it easier to slip your naked little one inside their OR gown or scrubs.
15. Ask that your uterus not be exteriorized during the procedure. Exteriorizing your uterus is when the surgeon moves the uterus out of your body and onto the sterile field for examination and repair. Studies show that postpartum pain after the surgery is greater when this has occurred and offers no benefits over doing the repair "in situ" (in position).
16. Ask that your uterus be double-layer sutured. While current research is not clear that this provides any advantage over single-layer suturing, should you wish to attempt a vaginal birth after a cesarean with a subsequent pregnancy, some physicians are more comfortable and supportive of this VBAC attempt if there has been double layer suturing during the repair.
17. When you return to your room and get a chance to spend those first minutes really holding your baby and initiating breastfeeding, try and keep visitors and guests away for just a little bit, so you and your baby can get a chance to get acquainted on the outside. This time is precious and the fewer distractions the better, to help you and your baby connect and bond.
A cesarean birth, whether expected or unplanned, offers unique challenges and circumstances for you and your baby. It is helpful to recognize that a cesarean birth is still a birth, and you can prepare in advance by including plans for a birth on your terms, even when it occurs in the operating room.
Sharon Muza, BS, CD(DONA) BDT(DONA), LCCE, FACCE, CLE has been an active childbirth professional since 2004, teaching Lamaze classes and providing doula services to more than a thousand families through her private practice in Seattle, Washington. She is an instructor at the Simkin Center, Bastyr University where she is a birth doula trainer. Sharon is also a trainer with Passion for Birth, a Lamaze-Accredited Childbirth Educator Program. In September 2011, Sharon was admitted as a Fellow to the Academy of Certified Childbirth Educators. In 2015, Sharon was awarded Lamaze International’s Media Award for promoting safe and healthy birth. Very active in her community, serving in a variety of positions that promote maternal-infant health, Sharon enjoys active online engagement and facilitating discussion around best practice, current research and its practical application to community standards and actions by health care providers, and how that affects families in the childbearing year. Sharon has been an engaging speaker at international conferences on topics of interest to birth professionals and enjoys collaborating with others to share ideas and information that benefit birth professionals and families. To learn more about Sharon, you are invited to visit her website, SharonMuza.com.