What to Do When a Cesarean Becomes Necessary

By Michelle Smilowitz, CD-DONA, reprinted with permission from International Cesarean Awareness Network, © ICAN-online.org

Baby born by CesareanThe birth of a child is one of the most significant events in the lives of families. It is considered a rite of passage by many women and involves the first interaction between parents and their baby. There is much buzz today about the necessity of making birth a “family-centered” experience, where the focus is often on creating a special environment for bonding between parents and child in the first moments and days of life. But what if you are one of the  women who experiences your baby’s birth as a Cesarean section? Is it possible to make your surgical experience into a family-centered birth?

The answer is a resounding yes. While planning a family-centered Cesarean is easiest for the woman who must, for whatever reason, schedule her baby’s birth, there are a number of ways that a woman who encounters an unplanned or even emergent Cesarean surgery can make her experience into a celebration of her baby’s birth.

Become Familiar with the Procedure

It is first important that every pregnant woman and her partner become aware of the procedures that surround a Cesarean surgery. Many women who experience unplanned Cesarean deliveries lament that, “I skipped the section of the book on Cesareans; I assumed it couldn’t happen to me!” Having some familiarity with the procedure and all that it involves can help reduce much of the surprise and fear that can surround the unknown.

For More Information on Cesarean as a Procedure

If your Cesarean is planned, it is important that you have the opportunity to fully discuss with your care provider the reasons for your surgery. Knowing that this surgery is the best choice for your or your baby can create a less tense environment for the delivery. If you desire a vaginal birth and feel that a Cesarean surgery may be unwarranted for you, consider getting a second medical opinion that all medical consumers are entitled to.

Write a Birth Plan

Next, plan this birth just as you would a vaginal birth. Write up a birth plan including your preferences for the surgery as well as for yours and the baby’s postpartum care. In the case of a pre-planned Cesarean, it is usually possible to schedule an appointment ahead of time with your anesthesiologist. He is the person who actually controls the environment of the operating room. For example, generally, women’s arms are strapped down for their surgeries, so that they do not dislodge IV wires or sully the sterile surgical field. Ask if you can have at least one of your arms free or have your support people hold your arms in place.

Discuss the pros and cons of both epidural and spinal anesthesia as well as the effects of various other medications you may receive both during and after the surgery. Some of the medications that treat specific symptoms such as trembling and nausea may cause extreme drowsiness or amnesia. You may decide that you would rather tolerate these symptoms than be asleep for the first few hours of your baby’s life.

When you write your birth plan and discuss it with your care providers, there are a number of things you may want to consider. Many women negotiate to have two support people with them in the operating room, generally their partner and a doula or friend and family member. Doulas are a great addition to a Cesarean birth team. They are familiar with the process and can reassure you and your partner. Additionally, if you and your baby need to be separated at any point, your partner can accompany the baby while your doula stays with you. Doulas also often have some expertise in post-Cesarean breastfeeding and can help with this.

Many women ask for and are given the right to play music of their choosing for the birth – this can soothe you and serve as a pleasant way to welcome your baby into the world. Feel free to ask those at your birth to refrain from extraneous conversation, and request that if possible someone (generally a member of the medical team) narrate for you exactly what is going on throughout the birth. Ask if you can take photographs or videotape the birth – many women enjoy the opportunity to “see” the birth later on. Sometimes, black-and-white pictures are preferable for this – they preserve the drama of the birth while eliminating a direct view of blood, troublesome to some.

Many women feel a disconnection from their Cesarean baby because they did not actually see or feel the baby born. If you are interested in actually seeing your baby as he emerges from your body, you can ask to view this by having the drape across your abdomen that blocks your view lifted for the actual delivery or by using a mirror.

Before the Cesarean, ask that the medical personnel not announce the sex of your baby — instead allowing you or your partner to discover this. Request that all necessary newborn exams be done in your line of vision or even on your chest, and to make physical or verbal contact with your baby as soon as possible. Your baby has been accustomed to hearing yours and your partner’s voice for the past nine months – even if you cannot touch your baby, you or your partner can soothe your baby with your voice. With the help of an excellent nurse or doula, some women are able to nurse on the operating table, while others wait until the recovery room. Regardless, ask to touch your baby as soon as possible, and to keep the baby with you in recovery if all is well.

Get Help After the Cesarean

During the immediate postpartum period, you are going to need a lot of help! After a Cesarean surgery, women are often confined to bed for as much as a day or two. Once you have been given permission to get up, even such simple movements as rolling over in bed can be quite painful. Clearly, trying to take care of yourself as well as a new baby is generally too much. Having a partner, friend, or relative stay with you in the hospital can help ensure that your baby will room in with you. This person can help with changing diapers, bringing the baby to you to nurse and positioning the baby at the breast, as well as assisting you with your needs.

Once you are home, extra help will enable you to have a more rapid recovery, as well as give you the opportunity to nurture yourself and bond with your new baby. Many women find that they need extra help with breastfeeding after a Cesarean, and there are a number of resources for this.

Not all of these suggestions will work for every situation, and of course, in the case of the emergencies that can occur during surgery, plans may need to be changed or abandoned. Nonetheless, using some or all of these suggestions can help your surgery feel more like your baby’s birth!

Originally published in the Birth Journeys newsletter of ICAN of Seattle, Summer 2004.

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