With Cesarean rates in the upper 20th to low 30th percentile in recent years, many families have found themselves facing an unexpected Cesarean birth. With numbers like these, it is vital that every expecting family understand how to navigate the topic of Cesarean as well as the possible scenario of an unexpected surgical birth.
The first step for families is to educate themselves on ways to avoid unnecessary Cesarean surgery. Understand the risks of major abdominal surgery and access resources that explain how multiple interventions increase the risk of Cesarean birth. A wonderful resource is ICAN’s “Things You Can Do to Avoid an Unnecessary Cesarean” available at http://www.ican-online.org/pregnancy/things-you-can-do-avoid-unnecessary-cesarean. ICAN also has a webinar available titled “Cesarean Prevention” at http://ican-online.org/webinars.
A family’s education should also include an understanding of the processes and procedures involved so that the family understands what to expect if they are facing a surgical birth. Families who write a birth plan need to include a page of preferences for a Cesarean birth and postpartum. Make sure that all caretakers receive a copy of the Cesarean birth plan and postpartum plan.
Education should also include an understanding of methods a family can use to make a Cesarean more family centered. There are some good sources out there already that can help with this. In my personal experience, here are the things that help the most:
1. Consistent support for mom throughout the birth process. This means someone by mom’s side in the OR at all times. If there is only one support person, most moms will encourage that person to leave with the baby if the baby is taken out of the OR to the nursery or recovery. But the baby is born in the first 10 minutes of surgery, and there is a good 30-45 minutes of stitching afterward, during which the mother’s uterus is removed from the abdominal cavity for stitching and then returned. No matter how good the anesthesiologist is, this feels strange and can be scary, especially if no one is talking the mom through it. It is an extremely vulnerable time. If the anesthesiologist will not allow more than one support person in the OR, then suggest another family member or support person take the partner’s place at the mother’s bedside if the partner needs to exit with the baby before surgery is over. Most hospitals will allow this even if they prefer to limit mom’s support people to one in the OR at a time. Ask that support people and baby be able to remain in the OR and go with the mother to recovery. Evidence shows there is no need for mother and baby to be separated immediately after birth. A support person should make sure the mother is comfortable. Encourage her to leave at least one arm free during surgery. Ask if she is breathing comfortably; since epidural and spinal anesthesia work by gravity, a mother lying flat may get the sensation of numbness up to her neck, causing a fear of not breathing. This is easily remedied with a pillow under the head. Warm blankets can help with the cold environment of the OR.
2. A record of the birth. This can be done in a variety of ways. Some doctors allow video taping, and even those who do not wish to have the surgery taped will often allow taping to begin as the baby exits the womb. Still photos are typically allowed in the OR. A mirror held at the correct angle allows mom to see the birth of the baby. Have the drape lowered at the time of birth and ask the surgeon to hold the baby above the drape before moving the baby to the warmer. Ask if your birthing location has the option of a clear drape. All of these can help mom embrace the birth experience and fully understand her importance, which can sometimes be difficult when a baby is born surgically. One of the most difficult aspects of a Cesarean birth for many mothers is the aftershock of feeling as though they did not birth their own baby, which can lead to difficulty bonding and postpartum mood disorders. A chronological record of the birth helps parents reminisce about their baby’s birth, especially if the surgery was emergent or hurried.
3. Keeping the focus on the birth. Let’s face it, Cesareans are routine for RN’s, OB’s and CNM’s in the hospital setting. Staff can sometimes lose sight of the importance of each individual birth. You can help by encouraging your birth team to direct the focus onto the birth experience. Parents can request that conversation in the OR be limited to the birth, and can help steer discussion back to them and their baby if it veers off course during the surgery by asking questions, etc. No one wants to listen to a story about their scrub tech’s crazy Friday night during the birth of their baby. This is the family’s moment. The environment in the OR can also be enhanced by the use of calming music (most anesthesiologists have a radio in the OR) and aromatherapy (even if you can’t bring in bottles of essential oils, the mother’s favorite on a napkin or cotton ball can be sniffed throughout the surgery).
4. Maximizing contact between the parents and the baby. Request the baby remain with you as long as possible in the OR so that you can touch and hold your baby and begin bonding. Some hospitals now keep the family together throughout the process or bring the baby into recovery rather than to the newborn nursery so that parents can be with the baby during the mother’s recovery process. Request skin to skin in the OR. A small number of hospitals nationwide are now promoting this evidence based practice. Some other ways to encourage bonding and promote breastfeeding include leaving the baby’s first bath until later when the family is in their postpartum room, or delaying the administration of eye ointment, Vitamin K or any immunizations the family has requested for a minimum of the first hour in recovery. This allows bonding and breastfeeding time during the “golden hour” after birth. Baby and mother can be skin to skin and begin breastfeeding during recovery if they can’t do this in the OR. This helps both of them recover more quickly, creates a more fulfilling experience, and supports breastfeeding success.
5. Have support in the postpartum period. Cesarean birth is major abdominal surgery. Make sure you understand the recovery process and access resources early on. Take it easy and spend waking time bonding as a family. Rest when your baby sleeps. Accept help from family and friends in the way of prepared meals, assistance with chores, etc. and limit visitors in your early days at home to those who are willing to pitch in and lend a helping hand.
Preparing for the possibility of a surgical birth is not “negative” thinking, nor is it a self fulfilling prophecy. It is simply addressing the reality of birthing in the United States today. There are many ways to decrease the risk of a Cesarean birth, including choosing your birthing location wisely and hiring a doula. If you do have to have a surgical birth, however, know that a Cesarean birth can be a beautiful birth, and understanding how to navigate the waters of Cesarean will take you a long way to achieving the birth experience you desire.