April is Cesarean Awareness Month and this month's "Brilliant Activities for Birth Educators" idea focuses on a birth planning activity that gets the families you work with thinking about their birth preferences for either an unplanned or planned cesarean birth. You can find all the "Brilliant Activities for Birth Educators" ideas here and the previous ones specific to Cesarean Awareness Month are Cesarean Section Role Play Helps Prepare Families and Cesarean Pie. Doulas and others may also be interested in conducting this activity in a prenatal with their clients.

Introduction

I teach a childbirth class called "Cesarean YOUR Way" that is designed for families that know they are having a cesarean section for any number of reasons. The families enjoy spending time in a childbirth class designed just for them and meeting other expectant people facing similar circumstances. One of the activities we do is a Cesarean Birth Choice exercise. Similar to the birth choices exercise any educator might do in a childbirth class for families planning and hoping for a vaginal birth, this exercise discusses options for a cesarean birth, from beginning to end. Families have an opportunity to learn more about the procedure and explore options that feel good to them surrounding the surgery and expressing their wishes, which they can then discuss with their health care provider.

Materials

• 24 choice cards with opposite actions/preferences on each side.

An example of such a card would be side A - walk into the operating room, side B - travel to OR in a bed or wheelchair. e Another might be side A - listen to music during the operation, side B - don't listen to music during the operation. You can have more or less than 24 cards, but I felt that 24 seemed to cover most of the topics that families might want to consider without being overwhelming.

How to conduct the cesarean preferences activity

1. My Cesarean YOUR Way class is approximately three hours long. This activity occurs about midway through the class after the families have an idea of the procedures and timeline of the surgery. Every family gets a packet of cards and moves to a space where they have plenty of room to spread out all the cards. They are asked to review both sides of each card and place them "choice" side up. If they have any questions about the items on the cards, they are encouraged to ask me.

2. After they have all the cards choice side up, I ask them to remove eight cards that they are okay with having the other (not chosen) side occur. I encourage them to discuss with each other to select cards for removal that feel good to both of them if they are partnered. These cards are put aside.

3. They now have 16 cards remaining. I ask them to randomly remove card number one, five and thirteen. (You can choose any three at random) and to discuss between themselves if these three choices were removed how would they feel? What would they need to feel good about their experience? We discuss how things sometimes don't go as planned and they need to be prepared for the unexpected.

4. Families are then told to put these three randomly removed cards back. They breathe a sigh of relief at getting to put them back in the pile of choices still available to them.

5. Next, the families are asked to remove eight more cards. They should be left with only eight final cards at the end. There is a lot of moaning and groaning as they really have to work to eliminate another eight cards. I let them sit with this for a bit and then often suggest they consider leaving the eight cards that are most important to them. They often find that a lot easier to select the eight most important choices rather "giving up" eight more, even though the end result is the same.

6. I then ask them to put these final eight cards in order of most important to least important. This can form the basis of their cesarean birth plan. They often want to take a picture of the final eight and in fact, often take pictures of each step.

7. I then encourage them to talk to their health care provider about their cesarean birth choices in advance of their surgery date. I remind them that they are consumers and may be able to choose to find a facility and provider who may be more open to the choices that are important to them.

Family feedback

Families who know they are facing a cesarean birth may be grieving the loss of a physiological birth experience. They are delighted to find out that there are many choices to be made that honors their child's birth and feels right for them. This activity also offers an opportunity to discover that they have choices that they didn't even know were an option for them with a planned cesarean birth. They share that doing this activity helps them to feel like they have a choice in how their baby is born and gives them a feeling of control, often in a situation where they have been feeling out of control.

Conclusion

Offering families who know they are having a cesarean an option to plan their births with choices that feel right to them is an important part of the birth process. These cesarean preferences are equally as valid as those that families have if they were planning a vaginal birth. Having families learn about all their options offers an opportunity to create a positive experience for themselves and their baby. An educator or doula could also do this in a typical childbirth class series, as families may find themselves having an unplanned cesarean and still want to have their preferences honored.

Would you consider doing this in a specialized cesarean class? As part of a childbirth class? With a doula client? Please share your thoughts and experiences in our comments section and contribute to the discussion.

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