Monday, September 3, 2018

Cesarean Sections: You Don't Have To Miss Out On A Natural Birth Experience

New mother smiling after a cesarean section as a nurse lays her newborn across her chest
Whether having a medically elective cesarean section for the first time or having a repeat cesarean for medical reasons or personal choice, many mothers feel that they must give up on having a natural birthing and immediate postpartum period with their newborns.  Due to the clinical nature of a cesarean it may be shocking for you to learn that you don't have to miss out on as much as you may think, even within the surgical setting.  Just like mothers who labor and deliver vaginally, you have choices that you can discuss with your obstetrician and your surgical team to get the birth you want to experience.

Traditional Cesarean Practices

Before we discuss how you can achieve a more natural experience during a cesarean section, also known as a c-section, we should review a traditional cesarean procedure.  Unless you are having a "crash" c-section, meaning a true obstetrical emergency has occurred and they must deliver the baby immediately, the mother will be prepped in the operating room prior to surgery by having an IV and a spinal or epidural block put in place.  During a crash c-section, general anesthesia may be used since that is much faster than placing the spinal.  

While your surgical team is waiting for your spinal to take effect, you'll be further prepped for surgery while lying on the operating table.  A nurse will scrub your belly and may even clip your pubic hair if need be, and a surgical drape will be hung up above your belly to keep the surgical site sterile and keep you and your partner from becoming light-headed from watching the procedure.  Your arms may be strapped to the table to ensure you don't accidentally bump someone holding a scalpel and you will have electrodes placed on your chest so that the anesthesiologist can keep a close eye on your heartrate.  After you are prepped and numbed, your partner, who will be in a surgical gown and mask, will be invited into the surgical suite to join you.  

Your surgeon will ensure you are properly numb before beginning the procedure - keep in mind numb means no sharp pain, you will still be able to feel tugging and pulling.  After checking to make sure you are numb, your surgeon will make a horizontal incision very low across your abdomen and will cut through the skin, fat and other tissues layered over the uterine wall.   After moving the muscles of the abdomen aside, your surgeon will make another horizontal incision into the uterine wall, simultaneously breaking the amniotic sac.  At this point, they will deliver the baby's head by pushing on the top of the uterus while manipulating the incision and the head.  After the head is delivered, the rest of the baby is pulled through.  The umbilical cord is then clamped and cut and the baby is handed to the partner, nurse, or pediatrician.  

After the delivery of the baby, the surgeon will administer a shot of pitocin, which is a synthesized version of the naturally occurring hormone oxytocin, to help deliver the placenta as well as to encourage the uterus to start contracting back down to it's pre-pregnancy size.  Once the placenta has been delivered, the surgeon will begin sewing up the incisions to the uterus, abdominal muscles, tissues and skin.  Prior to suturing, an IUD or other means of birth control may be placed if so requested.  

The baby is typically taken to the warming bed for newborn screenings while the surgeon is suturing and will be handed back over to your partner once the pediatrician and their team are satisfied that your baby is in good health.  After you are completely closed up from the surgery, you will be moved to a recovery room.  If you are alert and not shaking too much, uncontrollable shakes are a common side-effect of the anesthesia used for surgery, you can try to initiate some skin-to-skin time with your new baby or even nurse. 

Gentle Cesarean Practices

Provided that the mom and baby are both in good health and a "crash" c-section is not being preformed, there are simple changes to the routine procedures normally followed in the Operating Room (OR) to make your delivery a more natural experience.  Talking with your provider prior to your scheduled procedure will help ensure that you both are on the same page regarding care during delivery and immediately postpartum and will allow you to have realistic expectations for your birth.  It may also help to talk with your anesthesiologist as well, to see what they are or are not willing to do to help you achieve your ideal birth. 

  • Ask that your IV line and blood pressure cuff be placed on your non-dominant arm/hand.  This way your dominant arm is free to hold and touch your baby.
  • Ask that the electrodes be placed along your back and shoulders vs your chest so that you can facilitate immediate skin-to-skin and/or breastfeeding with your baby.
  • Ask if a clear surgical drape can be used and request that the table be elevated once your baby's head has been delivered so that you may watch your baby being born.  
  • Request that the baby be placed on your belly/chest for immediate skin-to-skin time.
  • Request delayed cord clamping.   
  • Request that the baby be left on your chest while the doctor sutures you.  You can also request that all newborn screenings be done on your chest as well. 
  • Delay newborn bath for a minimum of 12hrs postpartum.  Your amniotic fluid smells and tastes like your colostrum.  This scent encourages your baby to latch and suckle at the breast.  
  • Discuss the possibility of vaginal seeding with your provider.  This procedure simply uses a swab of your vaginal secretions that is then swabbed in your baby's nose and mouth, simulating the exposure they would have had during a vaginal delivery.  Studies indicate that this exposure to the mother's vaginal flora and fauna help establish the newborn's gut health and microbiome.  Vaginal seeding is NOT currently recommended by ACOG as most planned cesarean mothers have not had the routine STD and GBS screenings as mothers who were planning on a vaginal delivery.  This risk is mitigated if you a) take the screenings and have negative results and/or b) understand the risks associated with exposure.  

Other Considerations

Many women decide that since they are having a cesarean delivery that they do not need the traditional labor support of a doula or from their partners.  While it is true that you will not experience labor, you ARE going to experience birth - and as such you deserve just as much physical and emotional support as any other mother out there.  A doula can help you consider and become educated about your delivery options, help support you as you advocate for the delivery experience you want, can provide "in the wings" support during your surgery so if an emergency happens with your baby your partner can stay with your newborn and your doula can come and stay with you in the OR and the PACU, can help you hold and care for the baby in the first few hours postpartum while you recover, can aid in initiating breastfeeding if you are too incapacitated from the drugs to do it yourself, and will provide reassurance as well as physical and emotional support for both you and your partner as you recover.  

If you are planning on breastfeeding, consider making a prenatal appointment with a Lactation Consultant or and IBCLC a few weeks prior to delivery.  They can help set you up for the best chance at breastfeeding success after your surgery.  This also establishes a relationship with them in case you need more support after delivery.  

Set yourself up for your postpartum period in the weeks before you deliver.  Your recovery is going to take a little longer than if you had a vaginal delivery.  Ask friends and family to help stock your freezer with meals that can be thawed and thrown in the oven.  Have your partner help you set up nursing and changing stations by comfortable chairs throughout the house, complete with water bottles and snacks for you.  Consider hiring a postpartum doula for the first few weeks postpartum for extra support - not only will she be a welcome extra set of hands to help with the baby, she will also provide you with much needed physical support as you recover as well as encouragement and reassurance as you settle in to your new role as a mother.  

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