Giving birth by cesarean brings with it a unique set of experiences and challenges that are specific to c-section. If you are pregnant, whether you expect to have a cesarean or not, it's critical to know what to expect during a cesarean birth, including short and long-term recovery, and postpartum complications warning signs.
It's also important to know what to expect for your baby's immediate and long-term health and challenges after a c-section. Today, we're sharing some of those key things. If after reading this, you are left with questions or concerns, talk with your OB or midwife, and reach out to your local ICAN (International Cesarean Awareness Network) group.
Gut bacteria/microbiome is different -- and it can affect health. The microbiome has received a lot of attention lately, and for good reason. The gut bacteria inside humans has been found to be responsible for many health factors. When a baby is born vaginally, their gut becomes colonized with the beneficial bacteria found in the birth canal, as well as on their parent's skin if placed immediately skin-to-skin. This gut bacteria forms the basis for a typical microbiome that plays a role in a healthier immune system. When born by cesarean, baby misses out on this bacteria, and instead is colonized initially by bacteria that's found in the hospital. Without normal bacteria, babies and children have a harder time fighting off disease and may experience developmental delays. Research continues about the potential benefits of artificially colonizing baby's gut with birth canal bacteria by swabbing with gauze after a cesarean.
>>What you can do: Talk to your doctor or midwife about seeding your baby's gut.
Skin-to-skin is important, and it may be delayed. Holding baby skin to skin immediately after birth is important for transferring healthy bacteria (see above), maintaining baby's temperature, initiating breastfeeding, and parent to baby bonding. With a c-section, it is most common for baby to be transferred immediately after surgery to the warmer in the hands of the doctor and nurses. Increasingly in hospitals in the United States (but still far from common), doctors are performing "gentle cesareans" (also called "family centered cesarean") in which baby is allowed to be on mom or parent's chest after birth and while the incision is being repaired. Talk to your doctor about your desires for skin to skin to find out what's typical in the hospital where you plan to give birth.
>>What you can do: Talk to your doctor about a gentle cesarean, or at the very least, getting skin to skin immediately after surgery. If it's not possible, see if your partner or birth support person can provide skin-to-skin after birth.
Baby will have extra fluids to expel, which could cause problems. During a vaginal birth, baby gets the long, extended squeeze through the birth canal, which isn't just a necessary evil -- it helps squeeze fluid from the lungs in preparation for healthy breathing. With a c-section, babies don't get the squeeze and will have extra fluid to contend with. This may mean that they experience difficulty breathing, cough up extra fluids, or sound "juicy" as they breathe in the first few days.
>>What you can do: If possible, go into labor and experience some labor before having a cesarean. Talk to your doctor and your baby's pediatrician about what to look for with breathing complications.
Baby's head may or may not have "molding." The plates on a baby's skull at birth are intentionally soft and flexible to allow for easier passage at birth. After a vaginal birth, it's very common for baby to have a "cone head" appearance for the first day after birth. With a cesarean, depending on how long and how low baby sat in the birth canal, there will either be molding, a lot of molding, or no molding at all. None of these has any implications for baby's health.
Prematurity. Babies born by elective c-section (a cesarean performed for no medical reason, but rather upon request) have a higher risk of being born preterm or late preterm, both of which carry with it health issues that go along with prematurity, like breathing difficulty, development problems, and difficulty breastfeeding.
>>What you can do: Don't schedule a c-section unless medically necessary. If your doctor advises that a cesarean is necessary, find out if you can go into labor on your own before having a c-section. This will help ensure that your baby is born at the right time, developmentally.
Breastfeeding can be more difficult. Research continues to show that babies born by cesarean have more difficulties with breastfeeding. This can be due to a host of challenges, like delayed skin-to-skin and breastfeeding initiation (due to separation in the OR); pain from surgical recovery, which can interfere with holding baby for breastfeeding; weak suck and/or poor latch, which is often seen with even slightly premature babies; and delayed/difficult infant-parent bond.
>>What you can do: Consult with a lactation consultant early and as often as needed to establish a good breastfeeding relationship.
Additional short- and long-term health problems. Increasingly, researchers are finding that c-sections are linked to both short and long-term health problems for baby. Short-term problems include breathing difficulty, risk of head/facial laceration from surgery, breastfeeding difficulties, and delayed bonding. Long-term problems possibly associated with cesarean are increased risk of asthma, obesity, and developmental delays.
>>What you can do: As with most infant and childhood health problems, early intervention and treatment is key to future health.
Delayed bonding. Delayed skin-to-skin, parent-baby separation, and difficulties processing birth and any related trauma all can affect how well a parent bonds with their new baby. Delayed bonding can be difficult for a parent to deal with, often leaving them with feelings of guilt and inadequacy, which can play into postpartum depression and other postpartum mood disorders.
>>What you can do: Forget the guilt. Delayed bonding is not your fault and it's not a crisis. Give yourself time to bond with your baby. Seek support from family, a postpartum doula, and/or a therapist. Make sure you attend to your own health and well being as much as you are your baby's.
Cord clamping can still be delayed. Research has shown that delaying when baby's umbilical cord is clamped (as opposed to clamping immediately, which is what has been done), is beneficial for baby to receive the extra nutrient rich blood volume from the placenta. Even after a cesarean, it's possible to delay cord clamping (delay is approximately 2-3 minutes after birth).
>>What you can do: Ask your doctor about delaying cord clamping after surgery.