Choices in Cesarean -- It Doesn't Have to Be One-Size-Fits-All

2295504318_5fc5c512e6_m.jpgDid you know that you have options during a c-section? Much like when parents research and prepare for important choices for vaginal birth, like those included in a birth plan, c-sections also have inherent options that also may be up to your preference, depending on your situation, provider, and place of birth. Having choices and speaking up for your preferences during cesarean can improve the health of you and your baby, as well as restore a sense of control and empowerment in your birth experience.  

Waiting for Labor to Start on its Own 

If your cesarean is a scheduled one, talk to your provider about allowing labor to start on its own before performing a cesarean. Doing so may ensure the best timing for baby to be born, as being born too early, even by a week or two, can cause health problems for baby. Additionally, the hormones that begin labor as well as early labor contractions, are beneficial to mother and baby. 

Arriving at the OR

If your c-section is planned, you will likely have the choice of the time your arrive to the operating room (OR), as well as whether you walk into the OR or are wheeled in on a hospital bed. These choices may seem small and insignificant, but each of them can give you an increased feeling of control in your birth. 

Announcing Baby's Gender

During a cesarean, it's likely that medical staff will see the gender of your baby first. If you or your partner would like to be the one to announce baby's gender (for some, that role holds special meaning), be sure to let your providers know. 

Cord Clamping

Just as in a vaginal birth, there are benefits to delayed cord clamping. Delayed clamping only takes a few minutes, so it should be a reasonable request (depending on medical urgency) during cesarean.

 

Lowering the Drape

During a c-section, a cloth drape is placed as a barrier between mom's chest and the rest of her body so that she does not see the surgery and as a way to protect the sterile field. It is a reasonable request to ask staff to lower the drape at the moment of birth -- mom will be able to see baby being born (while still not seeing the surgical site), feeling more involved in the birth process and allowed the opportunity to see baby for the first time (as opposed to only staff seeing baby first). 

Securing Hands

Traditionally during  cesarean, the pregnant person's hands are layed out in a T shape and secured to arm rests that extend out from the bed. The idea being to prevent her from reaching down and touching near the surgical site. It is reasonable, however, to request that your hands be left free during surgery. 

Skin-to-Skin 

More progressive hospitals and providers have found that allowing mom and baby to spend time in the OR skin to skin helps baby regulate temperature and gives the new parent time to bond with baby that would otherwise be delayed. Immediate and uninterrupted skin-to-skin care is best for moms and babies. 

Surgical Procedures & Incision Repair

Talk to your doctor about her method for performing cesarean, including her choice of incision repair and why. Doctors have the choice of taking your uterus outside of your body (exteriorizing your uterus) to repair the incision or leaving it "in situ" to repair it. There are also choices in how it is repaired (sutured vs. staples), and if it is repaired with a double or single layer. There are differences in healing and post-op pain depending on the method of repair, and the method of repair may impact future births and ability to try for VBAC. 

Breastfeeding

Depending on health of mom and baby, it may be possible to initiate breastfeeding in the OR or post-op recovery room. Often, babies are kept separated from moms during post-op, which can take up to a couple of hours after surgery has been completed. This is valuable time for mother and baby to spend time skin to skin and begin breastfeeding. Talk to your provider about keeping your baby with you and your partner in the OR as well as the post-op room. 

Seeding the Gut

New research shows that the gut health of infants is affected by mode of birth. Babies born by c-section do not show the same wide range of bacteria in their gut as do babies born vaginally. Some doctors are experimenting with artificially seeding baby's gut with mom's vaginal secretions. Talk to your provider about the current research and the possibility of including this practice. 

Environment in the OR

While you can't have the lights down low in the OR, you can ask to bring in music, have essential oils on hand, and ask staff to keep conversation to a minimum. It's still your birth and you can request specifics in the environment!

IV Medication

Ask questions about the medication being put into your IV. Some medications that may be prescribed for anxiety, like Versed, can cause memory loss. 

Newborn Routines

Preferences for the routines your newborn may encounter can still apply during a cesarean birth. For example, a delayed bath, vaccines, vitamin K injection, erythromycin ointment, etc.

 

Support Persons

Many hospitals have a policy of "one support person only" allowed into the operating room during surgery. However, having two support persons ensures that neither mom nor baby are left without a familiar person nearby. Depending on your provider and hospital policies, you may not be able to skirt this rule, but it never hurts to ask.  

Partner with Baby

If skin-to-skin with your baby in the OR is not allowed in the hospital you've chosen, ask your partner to hold baby skin to skin in the OR. This should be a reasonable request for your provider to support. 

Pictures & Video

If you're interested in having pictures or video taken of your birth, find out about the policy during surgery. Some hospitals will have policies in place for when and where pictures can be taken. 

While many of these choices are routinely not offered in hospitals across the United States, a growing number of hospitals have started offering cesarean birth with these choices available to parents and have found no adverse health affects by offering such choices. In fact, they have found that health benefits are positive! While not all providers will be on board with doing things differently during c-section, nor will you necessarily want all of the choices that may be available to you, it's important to know what you can ask for and remember that your birth is still a birth and you have rights to your preferences! 

photo credit: On the Operating Table via photopin (license)

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