Planning for the Unplanned Cesarean


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The #1 variation to their birth plan that expecting parents fail to prepare for is Cesarean delivery. Everyone thinks it won’t happen to them. It can be scary to think about, let alone plan for, and you may feel it is bad luck to even consider the possibility. Unfortunately 1 in every 3 mothers will be faced with the prospect of surgical birth, and many more will have the possibility raised during their labor. It is best to do everything you can to avoid surgical delivery, including preventing unnecessary interventions and having the support of a doula. Even the ACOG acknowledges that “Continuous labor support, including support provided by doulas, is one of the most effective ways to decrease the cesarean rate.”

If you are faced with an unplanned Cesarean, you can still have a positive birth experience if you have done your homework. It is important to discuss all of the following questions with your provider in advance, so that you understand the general policies you will be faced with. If you know what your options are you can have realistic expectations and find the joy in your Cesarean birth.

 

Is this an emergency?

This is the most important question to ask when faced with an unplanned Cesarean, and will likely affect the answers to all of the rest. In a true emergency time is of the essence and your and your baby’s wellbeing is the only real concern. You might think that every unplanned Cesarean is an emergency Cesarean, but in fact very few really are. Most often you will have some time to prepare for, and ask questions about your Cesarean.

In a non-emergent situation you can even ask for things that you might have previously been told were not possible. Perhaps you will have a great nurse that helps make something happen, or the practitioner on call at the time is more flexible than others might be. IT NEVER HURTS TO ASK! And if it is important to you, ask everyone, multiple times.

What kind of anesthesia will I get?

As a culture, we have come to expect to be awake and aware of our birth experience. Most people expect to get an epidural for Cesarean delivery. There are times when this is not the case. In a true emergency there may not be time to place a local anesthesia and you may have to be put under a general. If you already have an epidural in place, some anesthesiologists will simply increase the dosage while others will remove the epidural and place a spinal for surgery. This is a second and completely separate procedure that is equally as likely to cause infection and spinal headache as the initial epidural. Spinals are usually the choice for moms who do not already have an epidural in place. It is quicker and more effective pain control. It is a one dose injection into the spinal space as opposed to leaving a catheter in place and giving the slow and continuous dosage in the epidural space.

Even if you are “awake” for your Cesarean, don’t expect to be completely alert. The higher levels of medication required for complete pain relief often make moms drowsy, and you may doze off in the OR or shortly after. You will certainly need close support and monitoring while holding your baby until the effects of the medications wear off.

 

Can I have a “natural” Cesarean?

Some OBs are offering the option of “Natural Cesarean”. This means making the delivery as close to a vaginal one as possible. After the baby’s head is delivered, the drape is lowered and the head of the table raised to enable mom to watch the birth. Delivering just the baby’s head through the surgical opening allows your baby to experience some of the squeezing of a vaginal birth that helps remove fluids from the upper airway. This gives the baby a chance to transition to breathing while still supported by the placenta. Once the baby cries, the shoulders and body are slowly delivered and baby is placed skin to skin.

 

Who can go into the Operating Room with me?

Once you are in the OR your obstetrician is no longer in charge. When it comes to the operating room, it is the domaine of the Anesthesiologist, and what they say goes. Your Doctor may be all for skin to skin in the OR, but if the anesthesiologist says no you are out of luck. If you have been being cared for by a midwife during your labor, an Obstetrician will be called in to perform your surgery, but your midwife should be able to remain with you.

In most hospitals you are allowed to bring one lay person into the operating room with you; usually dad. Some hospitals are now allowing more than one person to accompany you. If you have a doula with you may want to ask if they may also be present. Having that extra support from someone you know and trust can really make a difference. Your doula can help you know what to expect, reassure you about how you are feeling and use some of the relaxation techniques you have practiced to make the situation more comfortable. After delivery she can assist you with skin to skin and breastfeeding if this is allowed in the operating room. She can also be with you while your incision is closed if your partner needs to leave with the baby.

Remember, the Anesthesiologist rules the roost in there – if your OB tells you that something you want is not possible you might still ask the anesthesiologist – perhaps they will be willing to accommodate you. Regardless of who you choose to have in the operating room with you, you will go in alone initially. Not even your partner will be allowed in until the sterile field is set up and the staff is ready to begin.

 

Can I have skin to skin and/or initiate breast feeding in the OR?

More and more hospitals are allowing skin to skin and even breast feeding in the operating DSC_0063room, and you should not hesitate to request it. The benefits of early skin to skin for both stabilizing baby’s heart rate, breathing and temperature, and mother baby bonding can not be disputed. In addition, it also supports bacterial colonization and breastfeeding success as well as reducing crying. All that is really needed to make this happen is for mom to have the monitor leads placed somewhere other than her chest, and to have at least one arm free. If your facility still will not allow this, they may be willing to let Dad hold the baby skin to skin.

 

Will I be separated from my baby? If so for how long?

If the answer to this is no, consider yourself very lucky. Most hospitals still do the initial exam in the warmer – only because even with skin to skin there just isn’t room to do a thorough exam of the baby while mom is holding it on the operating table. Many more hospitals still remove the baby from the OR entirely for an initial exam in the nursery. Dad can usually accompany baby to the nursery, but mom will remain in the OR for at least half an hour after delivery for closure of the incision.

 

DSC_0107Where will I recover?

You may be required to spend time in a “recovery room” supervised by nursing staff during the required “recovery period”. This is a time when your vital signs and incision are watched closely. Your baby will not be with you and your partner will probably be with your baby, so unless you have a doula along you will probably be on your own. Some hospitals however; are offering recovery in your regular hospital room. There is still a lot going on during this time including frequent vital checks, but you may be able to hold your baby and breastfeed if you are up to it.

 

How will Cesarean birth impact me and my baby?

Babies who are born via cesarean are at higher risk for some health issues, most of them respiratory. This is because the lung fluid that is normally squeezed out as the baby passes through the birth canal can remain in the lung sacs; making it difficult for baby to breathe normally.

Medications administered to you affect your baby’s behavior at the time of birth. The effects may include drowsiness or inability to suckle in an organized and effective manner at the breast. you too may feel drowsy and or weak for the first several hours after Cesarean delivery. These effects should wear off shortly.

A majority of caesarean mothers report very high levels of pain in the first 24 hours following birth, something that can have a negative impact on bonding and breastfeeding. Consider this when making your decisions about postoperative medication. You’ll be offered medicines via IV and pills in the days after your delivery, and typically they’re fine for nursing mothers and their babies. At most, they’ll make your baby a bit sleepy. The benefit of the painkillers is that they’ll help you relax enough to breastfeed and enjoy your baby.

DSC_0120Don’t forget that emotions run high during this major life event. Feelings of guilt, disappointment and anger are all normal responses to what is a very traumatic experience for most women. Don’t put up a good front. Share your feelings with those around you and reach out for helpful support.

It’s always great to have someone assist with housework and baby care during those first weeks home, but if you’ve had a c-section, it may be very necessary. You may have trouble walking, lifting the baby, and caring for older children. Consider hiring a postpartum doula to support your recovery. They are great at taking up the physical slack of home and baby, as well as trained in understanding, emotional support to help you process your feelings about your birth experience.

We place so much importance on the experience of birth in our society, but it is not a deal breaker for your parenting experience. Many people who have had unforeseen wedding problems go on to have fulfilling and happy marriages.
People who’s vacation plans go a rye still manage to relax and have a good time. You too will find the joy in your birth – whatever path is takes; because it is the story of your family and your baby.

A Tale of Two Cesareans

“My first c-section was frustrating because I didn’t get to hold Logan until they wheeled me into recovery. My husband did get to do skin-to-skin with him, but I really wanted to be the one holding him first.

Having a doula there the second time made me much more comfortable asking for a family-centered c-section before surgery even started. The first time, I didn’t even know it was an option. DSC_0049

Even with my doula there, I still felt a little intimidated making requests for skin to skin but was happy when they agreed to it. Having her there in the OR put me more at ease too. She was another set of eyes to tell me what was happening. It was reassuring knowing that my doula was in there and was someone just concerned about me as a person, not as a patient they were operating on or monitoring.  I also liked having her there because I felt so sick during this surgery and it felt hard to breathe because of the anesthesia. I think I would have been more scared if I didn’t have another person there to support me and my husband.

I just loved getting to hold Cameron so soon after he was born. We bonded immediately. I still remember how soft and kind of sticky his skin felt. It made me feel somewhat in control of a situation that I didn’t really want to happen. Even if women don’t get the vaginal delivery they want, having a doula during a c-section can still make it a positive experience. Birth is life-changing. Having people there who truly support you can make all the difference.”