C-sections

So, what about Cesarean birth? The decision of whether to have a Cesarean birth or "C-section" is often a highly charged topic. Why? Well, first of all the Cesarean birth rate in the United States is very high. In fact, it's much higher than the Cesarean rate in other "developed" nations. The World Health Organization (WHO) recommends that the Cesarean rate be under 10%. Depending on which state you plan to give birth in, the Cesarean rate can be as high as 20 or even 30%. And, it differs from hospital to hospital.

Why might you need a C-section?

You might be advised in advance of your due date to give birth by C-section because you're pregnant with twins, or perhaps your baby is breech, or perhaps some complicating factors were identified during your pregnancy. In any of the cases I've just listed, you would be expecting to have a "planned" Cesarean.

However, in many cases Cesarean births are unplanned. It might happen that you were planning a vaginal birth and your labor just didn't progress as expected. In that case, your provider might recommend a Cesarean birth.

Whatever the reason, know that however you give birth it is my wish and hope that you feel absolutely supported.

So, what's the big deal anyway?

I recently invited a mama-to-be to participate in this course. After I reached out, she followed up to let me know that she was going to be having a C-section. She felt that it was going to be a very surgical procedure and so she didn't feel the need to participate because she was having a Cesarean birth.

Although I don't know the particular circumstances of why this expecting mom was having a planned Cesarean birth, I do believe that no matter what type of birth you're having, it's so important to prepare.

Just because a mom is planning for a Cesarean birth, doesn't mean that she shouldn't get mentally prepared for it. Additionally, moms that have surgical births generally need even more physical support in the home afterwards because of lifting restrictions and their recovery time.

The Doula Hat

I'll put my doula hat on now and say that you can absolutely benefit from having a plan for your Cesarean birth. If you choose to have a doula attend your birth, they should absolutely be considered part of your birthing team. Unless taking you to the surgical suite for a Cesarean birth is an absolute emergency, your doula should absolutely be invited in and included.

Even though you won't be actively pushing your baby through the birth canal your doula can still offer encouragement and share what's going on behind the surgical drape. Usually the surgical drape is not see-through, however with the gaining awareness around having a "gentle Cesarean" some hospitals are offering the option for a clear or transparent drape so that the mom can see her baby being born.

Your doula can also support your partner in supporting you. If it's ok with the nursing and medical team, your doula could focus on taking photographs or doing a video while your partner supports you by sitting at your side and offering encouraging words.

Post-birth

After you've given birth your doula can accompany you to the post-surgical recovery area while your partner stays with your newborn. Ideally, your newborn will be able to join you in the recovery area right away, but sometimes they need a little extra care or attention after a Cesarean birth so you might need to wait a little bit. In that case, your doula can stay with you so you're not left alone and also help communicate with your recovery nurse so that your needs get met. She can also help you process your birth experience if you're ready to chat about it.

What does "processing" your birth experience mean? It just means reviewing the details of your labor and birth, how you were feeling, what you felt good about, what was challenging, and how things went overall from your perspective. I believe that talking about your birth experience as soon as you're ready after you give birth is really important, especially for moms that have been planning their ideal birth. Sometimes we miss details of our labors or we lose track of time, or we focus so much on one intervention that we forget the other parts of the process that were empowering or positive.

Having had the opportunity to support a mama through her unplanned Cesarean birth after a long and arduous induction and labor, I believe that having a doula support a mama in the surgical suite and during the first few hours postpartum is so important and valuable. In the case of the family that I was supporting, I could sense that an extra set of hands was needed and I was also available to support mama while her husband went with the baby to the neonatal intensive care unit (NICU) for a short time.

In fact, at the end of this module I'll include some tips for your partner and your doula to help ease the transition process from the labor suite to the surgical suite.

In the meantime, although I don't advise my clients to focus too much on Cesarean birth, I do recommend writing out some questions in advance. So, let's do that right now!

What are some questions that you know you'd want answered before having a C-section?

Write down your questions in your PPJB notebook now...

Here are some ideas of questions you could ask...

5 Q's to Ask in the Face of C-section

1. Can I labor a little longer or do I need to have a C-section now?
2. Why is a C-section recommended?
3. How can my partner support me?
4. What should I expect during the surgery? (this is a great question for the nurse that is wheeling you to the surgical suite and getting you set up)
5. How do I let you know if I'm in pain?

Top 10 Tips for Doulas Supporting Families Anticipating a C-section

For Doulas...

1. Connect and communicate with the bedside nurse and charge nurse if needed
2. Help your client and partner understand the reason for the C-section if it's unexpected by supporting them in asking questions and clarifying the "why"
3. Briefly share some of the top birth preferences of the couple with the bedside nurse and the surgical nurse (as soon as you meet her/him) and ask how those preferences might be accommodated
4. Clarify what's allowed and not allowed and what's negotiable in the OR (operating room)
5. Ask if it is ok to take photographs and when
6. Ask if it is ok to play music if desired during the procedure
7. Inquire how the family would like the birth announced and discuss who will go with baby (usually the husband or partner) if baby needs extra care
8. Ask if there's an opportunity for skin-to-skin time with mom briefly after birth if baby is doing well
9. Ask where you can stand during the birth and who your contact person will be (likely the circulating nurse or scrub tech)
10. Reassure your client and partner and let them that no matter how your client gives birth (whether vaginally or by Cesarean) she is still giving birth and it is her birth experience