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.
The natural caesarean: a woman-centred technique-This is an eleven minute video that includes a midwife and entire caesarean team talking about ways that they make the caesarean birth as close to natural and as trauma free as possible. It really is pretty amazing and informative (I got teary just watching). Although there are some parts that might not be for those with weak stomachs, it is really worth watching.
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.
You know, I *know* that a c-section is always a possibility for medical reasons… but for whatever reason (having had two complication-free labour & deliveries I guess) I just haven’t thought about it very much. You’ve inspired me to make a c-section birth plan though, so that I have those details thought through ahead of time, for what I’d want in case it did happen.
Thanks for sharing my link, too! 🙂
I’m totally like this too Beth but with a low lying placenta this time (it looks like it’s moving up) I was forced to think about it a little more. Here’s to hoping neither one of us has to use our c-section birth plans.
Yeah, here’s hoping! How did you find that out? Did you have an ultrasound? I skipped ultrasounds this time around…
It’s true, when you have complication free births there doesn’t really seem much need to think about it. I know that I didn’t with Aneliese and was kind of in denial with Cecily until about two weeks before she was born. And really, generally, it’s not like c-sections are needed that often. I know with Cecily, I had no choice but with Kathleen, the jury (being me) is still out on whether it was absolutely medically needed. I don’t really know and won’t ever. But, it’s the choice that I made.
I love this post.. especially the part about probiotics. I think that even with a vaginal birth, it’s a good idea to start a good probiotic because most mothers don’t have a perfect body “flora”. I’ve thought about instantly swabbing my next baby with a high quality probiotic due to my propensity to yeast infections during pregnancy.
and i generally just agree with the whole idea of taking charge of your birth, even if it is a Cesarean.
You are right and I meant to insert that it was a good idea for a vaginal birth as well but forgot. Thanks for mentioning it.
Can’t believe I’m writing this publicly but because of the possibility of me not actually going to the hospital, I chose to have an ultrasound. The ultrasound lady thought i was crazy because she was like “do you want to see your baby now” and I was like “NO” turn the machine off 🙂
oops, that was supposed to be a reply to beth.
haha! that’s hilarious. she probably thought you were out of your mind.
I don’t understand…why is that weird? ( wanting it off and why did you want it off right away- radiation? Hmmmm…)Well, I loved this. I am completely for all of these things and wish more women knew what was in their rights to have. It’s sad what we are subjected to when we dont think we have choices. I LOVE that you wrote this and if I knew any preggo women besides the ones here I would pass this on. LOVED this and I am sooooo glad you wrote it. On more silly question..what do you mean by swab? I am picturing q tips and probiotic paste…does that actually work well and seep in fast? Not sure what you meant by that. I just loaded up on probiotics in my diet prior to… Great ideas!
I just took a pinch of probiotic (it is in loose powder form) in my fingers and put it around in her mouth before nursing.
Thank you for writing about your experiences with this. I’m currently planning a homebirth and didn’t really have any idea on how to make a back-up plan except for the bonding. It feels as if once you become that obstetric emergency, most choices are gone. I appreciate your variety of ideas! Will be amending our emergency birth plan tonight.
I am jealous, I had wanted a home birth the last two babies! I think even “emergency” c-sections are pretty varied in how they happen (i.e. with my second, she needed to come out as quickly as possible to prevent too much blood loss and was quite premature, so my choices were a little more limited and there wasn’t as much to time to argue. Whereas with my last baby, I had several hours to discuss and think and time to share what I wanted and didn’t want.) It’s still no where close to my ideal, but I very much still felt that I was maintaining the responsibility that I needed for my child and myself.As I mentioned in another comment, I didn’t think about an emergency plan much with my first, I almost had this idea that if I did, I was asking for it to happen. I don’t think that even now I would spend overly much time focussing on it but I do think it is good to have some basic plans in place as it can be much harder to think clearly in the moment.
This is such a nice article. I’ve been interested in researching the evidence on this topic for my blog (www.evidencebasedbirth.com) Is it called baby-friendly cesarean, or woman-friendly cesarean, or something like that?
Thank you for reading and commenting! I actually have no idea what the term for this would be, I have seen one term called natural cesarean so perhaps that. I think it is great that you are collecting research, it is really needed.
I worried until my 32 week ultrasound about having a c-section,my placenta was also low but I was lucky and it pulled up.I was so incredibly fearful of having one, more then any other fear about the birth process.
I did not have a c- section plan,I was determined it wouldn’t be,lol
We did do delayed cord clamping and believe it made a huge difference.
In saying this,she is our first baby.
My baby is very strong,alert and responsive,she nursed right away at 20 minutes old she drank for over 1 hour.
Everyone has comments on how bright her eyes are,even from day one.
I have learned birth plans create stress,if something is different then you planed its easy to stress over it.
Having a plan is fine but being open to change is a must.
she is very strong and alert and bright eyed. So cute. With my first I had a very elaborate birth plan… and it all went according to schedule… now i forget when my due date is and hardly ever think about it. It’s funny how things change. I agree though that a plan is good but can cause a lot of stress. I think maybe mine is just so firmly planted in my head that I don’t have to think about it anymore.
I am looking forward to meeting her…and you!With complete placenta previa, the stats of it moving up are not good. I spent way too much time researching to see if there was some way to have it move but there was no budging it. Mostly I just kept it to myself how upsetting it was to have a c-section because the typical response is just to be thankful for a healthy baby which I was but it felt as if my body and I had failed. So I totally get the determination to not even plan for a c-section:).
I’ve never been into having detailed birth plans although I did have a short one for my first. I think more what is needed is that women have a better understanding of their bodies and birth in general. I don’t think that an elaborate birth plan can replace true knowledge because then when things don’t go according to plan it is very stressful.
I loved this post, Missy. So helpful and interesting and informative. I knew a few of these things but there was so much that I hadn’t thought of. This is definitely the best post I’ve ever seen on this subject… thank you for sharing it!! I am going to pass it on if I know anybody having a c-section, and I’m going to refer back to it to make sure I have a c-section back-up plan the next time around.
Thank you Jamie, I am glad that you enjoyed it.
This is just the best, most helpful post on caesareans I have ever read. Thank you so much, I can’t even tell you how much I appreciate you sharing all this. Oh how much I wish I would have known some of this the last two times around. Which probiotic did you get for yourself from that website? There are several different ones, in terms of how many are in a pack etc. so I wasn’t sure which one to get.
I am so glad that you found it helpful, Katherine. I think it is easy to look back and wish that you had known more, I know that I do but I guess I just choose to keep learning and moving forward. And try to share things that I learn.For the probiotic, I would get the 120 pack as that would give you four a day for a few weeks. I think they may actually be cheaper on amazon but not sure about that. If you don’t have a probiotic when you have the baby you can ask to be prescribed one and you can ask for one called Bio-Gia…you can both take it in drop form. I don’t think it is as effective from what I know( haven’t read extensively) but it does work and would usually be covered while in hospital.