With my medical history, I was considered a “high risk” pregnancy from the beginning of my first pregnancy. I fought against what that seemed to entail with each of my doctors, both of whom I have known and had a good medical relationship with for years (28 years with one to be exact, he says that he delivered me, my mother says that he didn’t make it.). For the most part, I was successful in having a somewhat intervention free birth with Aneliese. Then, while pregnant with Cecily, the ultrasound showed that I had complete placenta previa making it impossible to birth her vaginally and I was scheduled for a caesarean at 38 weeks. Instead, I went into labor at just over 34 weeks resulting in a quick emergency c-section. Thankfully, I had made a few plans with my midwife who was present for the birth. I requested that I be given Cecily immediately and prior to any of the customary weighing etc. and I was able to hold her briefly before the preemie check-up was done. We held her again for a few short minutes prior to her going to NICU (with Dan) and I to recovery. Dan was with Cecily the entire time that she was being observed and I was able to nurse her within an hour or so. With Kathleen, I had another c-section after a long attempt for a VBAC. Again, I asked that I be given our baby immediately and although there was some resistance, it was as I asked. We were given time to hold her and bond while I was stitched up after which she and her daddy spent the next while cuddling. She was brought to me in recovery so that I could hold her and nurse her.
While not without challenges, I would say that my caesareans went well; each time, I had doctors and nurses who were very positive and agreeable to my wishes even if they found them strange. For that I am very thankful. However, as I have heard other women’s stories and even as I have had time to think about my own, c-sections don’t always go as smoothly as mine. At times this is because further interventions are necessary, but often it seems that standard practice includes unnecessary interventions.
Although I strongly believe that caesareans happen far more regularly than they need to, there are times when they are needed for a healthy baby and/or mama. I for one am thankful that Cecily and I had that available to us as, had we not, her birth would not have resulted in life. My sharing all of this is not actually to debate the relevance of caesarean births or the overuse of them but is actually to share a few things that I think are vitally important when having a caesarean. Especially if you are strongly for birthing naturally (home, hospital, unassisted, drug-free, intervention free; however natural looks to you), you might not even prepare for the case of a caesarean.
There are so many great books and resources out there on birth and how to take responsibility for your body, pregnancy, birth, and baby. However, I personally didn’t find a great deal of information on how to really take responsibility for my cesarean births. I tend to be strongly inclined to follow my instincts in situations like this but I will admit as soon as I became a “medical emergency”, I struggled against just doing what I was told. It was harder to speak up when I was basically immobile on an operating table. So here are a few things that I think are important as well as some helpful links to other information. I know that in mainstream terms, many of the things that I am suggesting seem a little extreme and I won’t argue that. I'm not saying that in order to take responsibility for the decisions surrounding your baby and your birth, you must do any or all of these things (though I would strongly encourage it.). I just know that some things, I wish I had thought of and known sooner and others, I look back on with true thankfulness that I did them; that's why I would like to share them. I'm not naturally a fighter, I don't find it easy to stand up for what I want. Especially not when I am facing those who have done years of training and often have years of experience to back their looks (and statements) that I am over the top or crazy. Somehow, being a mama brings out the determination to politely stick to my guns if I am prepared ahead of time. So here you go:
1. Antibiotics: You will be given antibiotics via IV during your caesarean; as far as I know there is no way around it. If you have a scheduled caesarean, I would really suggest beginning a good probiotic at least several days prior and continue it for a few weeks afterwards. If your c-section is unplanned, ask to be prescribed and immediately begin a probiotic to regain “good bacteria” in your gut flora. *See links at the end of the post for probiotics.
2. Bacteria for Baby: Generally, as the baby exits vaginally, they will receive your bacteria as they go through the birth canal and then through touching, kissing, and breastfeeding. This gives them their best start health wise (and of course in many other ways). With a caesarean, the baby bypasses this step and immediately is exposed to foreign bacteria which will then have opportunity to flourish, especially as your bacterial balance will be messed up due to antibiotics. This results in poor digestive flora, including the common and unpleasant thrush, as well as an compromised immune system. Here are a few things that I know of to counteract this:
- Use your own baby blanket and hat (I don’t use clothes the first few days really). Also have receiving blankets for them to be cleaned up with. I had planned this for the baby’s birth regardless and so had been sleeping with a baby blanket and hat to insure that it had my bacteria. Kathleen was wrapped in this rather than the hospital blankets.
- Start your baby on an infant probiotic immediately. I wasn’t prepared for this and so wasn’t able to start her for a few days, but I wish that I had had it to begin using immediately. I also didn’t think to ask for a prescription for one temporarily while in the hospital unfortunately.
- It is also possible to use vaginal excretions (swabbed prior to antibiotics) to swab the baby. That may seem strange and gross, but think about what happens in a natural birth.
- Breast feed as soon as possible.
3. Epidural and Drugs: If possible know what will be used for the epidural. In many cases, you can even meet with the Anesthesiologist prior to discuss what will be used. It is possible to ask for the lowest amount of anesthetic so that you regain feeling sooner and so that it is out of your system quicker. I wish that I had known more about each drug used so that I could make a more educated choice about immediate breast feeding.
My experience each time was that each time I was told that I could leave recovery as soon as I could move my legs. I didn’t bother to tell them that I could make my legs move when I couldn’t feel them and boy, were they impressed with how quickly I was able to do that as I was being wheeled from the OR into recovery;).
4. Laboring: Now, you may be thinking that I am crazy, but if you can, labor (drug free) prior to your caesarean. This will encourage the production of oxytocin and endorphins prior to birth. It will help clear their lungs, add blood flow to their brain, heart and kidneys, give energy, help with bonding, and I have read helps build immunity. It is a good stress for babies.
5. Bonding: This is an area that I felt very, very strongly about and the one that is easy to miss out on.
- Ask to be given your baby immediately. Go skin to skin. Unless the baby is actually in distress there is no reason for the cleaning, weighing, etc. to happen right away. Your baby needs you, even premature babies. Even though many hospitals still have the policy of observing premature babies separate from their mamas there is solid research done that in most cases, they tend to thrive when skin to skin with the mama. I chose to wait to breast feed for close to an hour, even though both Kathleen and Cecily tried to immediately, due to the drugs in my system. I would do that differently now although we had no breastfeeding issues.
- Have your baby remain with you while you are being stitched, I discovered that this isn’t standard but very possible and again generally, there is no reason not to.
- Consider having your baby with you in recovery. I didn’t push for this with Cecily because she was premature but I would now. Kathleen was skin to skin with Dan for a time before she joined me in recovery. I wanted to keep her with me the whole time but because of my reaction to the epidural was going in and out of consciousness (I don’t think this is common) was unable.
- If it is not possible for baby to be with you the entire time, make sure they are enjoying skin to skin bonding with their daddy or whoever is present with you at the birth.
- In case of a general anesthetic (being unconscious): It is still very possible to have contact with your baby. You may not be aware, but they will be. This is more complicated and as I didn’t end up doing a general anesthetic, I can’t tell you in practice how it works. Especially if you have a mid-wife, they will be present in OR and you can plan for them make sure that this happens.
6. Cord clamping: This is something that I didn’t think of until after with Kathleen but there can also be a delay in cord clamping. I had intended this with a vaginal birth but forgot to request it with the cesarean. I don’t know anyone personally but I have read about it in a few birth stories.
7. Don't Stress: It was so easy for me to get really tense and worried that everything wouldn't be done exactly as I wanted and to feel like it was me against them. Sometimes that is how it went. For example, the nurses didn't understand that I wanted Kathleen to be cleaned up with our own blankets, so used theirs and wrapped her in what I had given them. Some details are worth a fuss, others maybe not so much and you need to decide that keeping in mind that it is a bit of a flurry with neither you or your spouse thinking totally clearly. That's okay and it doesn't give you a bad mommy award.
8. LINKS: I have tried to keep my links here pretty simple without including really long ones that have a ton of medical lingo.
Best Baby Probiotic: Nutrivene Baby Biotic
http://www.probiotics-help.com/baby-probiotics.html -A little more info on Infant probiotics.
http://jn.nutrition.org/content/138/9/1796S.full -A study on Intestinal Bacteria in Cesarean and Vaginal Births.
http://womantowomancbe.wordpress.com/2010/05/30/skin-to-skin-in-the-o-r-after-a-c-section/ -Skin to Skin in the OR. It includes a beautiful video.
http://wellroundedbirthprep.blogspot.ca/2011/02/how-to-have-natural-cesarean.html -An Article full of links on how to have a “natural cesarean”. I’ve not read all of them but liked the ones that I did read.
http://mockabeenews.blogspot.ca/search/label/Twins- A beautiful cesarean birth story
http://pregnancy.about.com/cs/laborbirth/a/aa042300a.htm -a brief explanation for why labor prior to cesarean is good.
Do you have any other thoughts or links to add? What went well for you during a caesarean and are there things that did not go as you would have liked? Have I missed any points to consider? Have you or do you include the possibility of a cesarean in your birth planning?
** I previously posted this on my old blog and from the response that it has gotten, I decided to touch it up a bit and add some new links. When I moved blog platforms, my comments didn't follow which is normally fine but this one had some good additions that are valuable to the post so I have copied them into the comments below. I'm also joining up with Your Green Resource.