Writing A Cesarean Birth Plan

Posted on October 28, 2011 (REPOST) by Heidi Thaden-Pierce

(Note from Doula Laine: I am a firm believer in knowing as much as you can about labor and birth and what all the possibilities are so that if any one of them should arise (and always something will, even if it is something small) you will be informed and already have formulated your feelings on the subject. It is very hard once in labor to process new information and there isn't a lot of time then to figure out what you may or may not want. With that in mind, I believe that every woman should have given some thought to the possibility of a C-section and what their wants and needs might be in that situation. Ever the girl scout I am, you can never be too prepared for anything.

Planning for the possibility of something, no matter how improbable it is, doesn't mean you will somehow make it happen, it just means that if it does, you are ready for it. Remember folks, knowledge is power!)

(post) For those mothers who know they'll be delivering by cesarean birth, or for those mothers who like to prepare for every possible outcome, here are some questions to consider for your birth plan. Many people believe that a c-section means you have few options as far as your care, but that's not true! By learning what possibilities there are you can make your birth experience more personalized. Many of the questions asked on a vaginal birth plan are also important to discuss for your cesarean birth, but here are some that you may not have considered. Some of these may not be relevant to your situation, but hopefully they'll get the discussion going with your partner and care team:

⭐️ Who would you like to have with you for your baby's arrival? Your partner, a family member, doula, a photographer? Most hospitals in my area have a policy of one or two support people in the OR, though I've heard of more and some restrict it to just the baby's parents.

(Why would you want a doula for a cesarean birth?)

⭐️ May your support person remain with you while your epidural/spinal is placed? If an epidural has not been placed prior to labor then often a spinal is given in the OR, and generally the partner is NOT present for this procedure. They are usually waiting in the other room getting into the scrub outfit and are brought in after mom is laying down and draped.

⭐️ What would you like photos of and who will take them? Is there anything that may not be photographed? Some hospitals allow photos of everything, others say no photos on the other side of the screen.

⭐️ What type of anesthesia is available, and what pain relief options will you have in recovery? May you speak with the anesthesiologist in advance (a call the night before?) to discuss these options? Many moms do not meet with the anesthesiologist until shortly before the birth, so if you have concerns ask if you can speak with someone the night prior of a scheduled cesarean.

⭐️ Are there any other medications routinely given by IV and what are their risks and benefits? Are there any medications that may impact your ability to stay alert and nurse immediately after the birth (sedatives, etc) and would you like to decline those?

⭐️ Are your arms be left free to touch your baby? Previously moms sometimes had their arms restrained, but I've not seen this done and most hospitals seem to have moved away from the practice.

⭐️ Would you like your doctor to verbalize the steps of the procedure to you? Some moms like to know exactly what is happening, and while the doctor will be talking with staff they may also be able to tell you what is going on.

⭐️ Would you like music playing? What speaker set up is available? For a recent birth I attended we just plugged in the iPod, but some doctors prefer there to not be music.

⭐️ Would you like each person in the room to introduce themselves to you and explain their role? While the OR is busy and there are a variety of people all in masks, for some moms it helps them to know who is attending and what their role is so it's worth asking if this is important to you.

⭐️ Do you want the gender announced by the doctor or your partner?

⭐️ Would you like the screen lowered as your baby comes out? Is a mirror available for you to see? Some anesthesiologists are not comfortable with the screen being moved at all but other locations are incorporating more family-centered approaches and offering to lower the screen and even do immediate skin-to-skin in the OR.

⭐️ Do you have any requests as far as double vs. single layer sutures? Does your doctor use staples or sutures for your external closure? Do you have any questions about how this is done?

⭐️ Do you want your baby to be lifted up so you may see them right away?

⭐️ Who will cut the cord?

⭐️ Is skin-to-skin possible while in the OR? (Your partner or doula will assist in holding your baby to you and you'll be covered up with a blanket.) Here is a video on the skin-to-skin option: A new way to have a cesarean birth.

⭐️ If the baby cannot be skin-to-skin immediately, would you like the bed warmer to be kept in your line of sight so you can see baby at all times? While this isn't possible in some ORs due to the space limitations, it may be worth asking if it's an option.

⭐️ Will baby automatically be suctioned or only if needed?

⭐️ If the baby needs to be taken to the nursery or NICU, who will go with the baby?

⭐️ Do you want to keep the placenta? (would you like to see it? It is, after all an ENTIRE new organ that you grew from nothing...)

⭐️ Will you bank the cord blood?

⭐️ How long will you need to remain in recovery before moving to your postpartum room?

⭐️ When will the epidural/spinal & catheter be removed?

⭐️ Will your baby remain with you at all times? Can newborn exams be performed at your bedside in postpartum?

⭐️ What newborn procedures would you like? Vitamin K, eye ointment, Hep B vaccine?

⭐️ How soon after the birth can you eat and drink?

⭐️ How long will you remain postpartum? If staples are used, when will they be removed?

⭐️ Will the baby be bathed in the room or nursery, by staff or by your partner or another family member?

⭐️ Will baby be offered a pacifier, formula, or will baby nurse exclusively? Would you like a lactation consultant to visit you?

Hopefully these questions will help you in formulating the best birth plan for you!

(more on this...)

Cesarean Birth Options

Posted on May 16, 2011 by Heidi Thaden-Pierce

I prefer to call it a cesarean birth (vs. delivery) because you are still giving birth, whether surgically or vaginally. Either way, in the event that you know you'll have a cesarean birth then here are some things to consider discussing with your care team in advance. Some may still be possible if you are having a surprise c-section (you were in labor planning a vaginal birth and had a change of plans!) but in an emergency situation then you may have no time to talk. Consider the c-section rate in this country is around 33%, this is something that all mothers may want to consider in advance:

- Choose a care provider that has experience, meaning don't let the newest resident gain experience by doing your surgery! 🙂 And speak in advance about closing with two layers of internal sutures (vs. one) which takes longer but read up on it, there are studies saying VBAC success and uterine rupture may be connected to the number of layers at closing.

- Consider choosing a hospital that has anesthesiologists ready (in house if possible) so you can wait until you go into early labor before having the surgery. It won't make it an emergency but even a bit of laboring can provide benefits to your baby and decrease the chance of a premature arrival because of c-section birth scheduled too early. Laboring increases the baby's levels of catecholamines, labor hormones which stimulate your baby in preparation for life outside the womb. If this is not possible then schedule your c-section for as close to your due date as possible to ensure your baby has as much time as possible to finish baking! Many insurance companies will not allow a cesarean to be scheduled before 39 weeks, so ask your doctor.

- If you desire it, ask that they explain every step of the surgery to you. For the c-section birth I recently attended the mother requested this, so the anesthesiologist lowered the screen to allow me to watch and photograph the birth as I described it to the mother.

- Discuss your anesthesia options in advance, ideally with the doctor that will administer your spinal or epidural (or combo.) Find out the pros and cons of each and determine what will be best for you, and also discuss your post surgery pain management. For example, narcotics do nothing for my pain - the morphine drip post-surgery for me was an absolute nightmare. Ibuprofen provided better relief and didn't leave me incoherently drugged. If you are awake for surgery then discuss the possibility of a spinal-epidural combo so post surgery you can have the epidural pain relief for the first 24 hours. (Talk to your doctor.)

- Review the possibility of a blood transfusion, and whether donated your own blood is advised. (I did not know that was an option while expecting but according to this book, The VBAC Companion, up to 10% of women post-surgery will need a transfusion and I've talked with some friends that developed complications and did need them. Donating your own blood is safer, if allowed while you are expecting. When I was in the range to receive a transfusion due to hemorrhaging during pregnancy they were able to push fluids and other nutrients to stabilize my blood volume but in the midst of crisis is not when you want to discuss this.)

- Ask who may be with you in the OR, generally a spouse is welcome but the doctor can also authorize your doula, another family member, or your photographer to be there. This allows one person to remain close to you and another to be near your baby. See this post for an explanation of how a doula can help with a cesarean birth.

- Express your personal preferences for the OR, whether it is music, silence so you and your spouse can first greet the baby, lowering the curtain so you can see the baby being lifted up, have one arm free so you can touch your baby, etc.

- Request that the baby be brought near you as soon as possible and held to you (with assistance from your spouse or doula) so the baby can smell your scent and so you can touch your baby. Specify that you want the baby to be examined and bathed within your line of sight, so have them move the infant bed near you if at all possible.

- Request that the baby not be brought to the nursery but remain with you in the OR and then come to recovery with you. (Or you can request the baby be brought to the nursery while your surgery is complete then brought to you in recovery, but the nursery staff may or may not bring your baby back quickly.) More hospitals are working to ensure the baby and mom remain together throughout the birth and postpartum stage, which is wonderful!

- Arrange to do skin-to-skin care and nurse your baby as quickly as possible, generally in recovery. More and more hospitals are making it possible for moms to have skin-to-skin with their babies while still in the OR, and ask if this is possible. Request extra pillows to provide nursing support/cover your incision site. This is when your partner and doula will be especially helpful as you nurse and recover.

- Plan to have daily assistance in the hospital and at home for the first two weeks. You will be taking care of a newborn and recovering from major abdominal surgery and YOU WILL NEED HELP. Overdoing tasks physically risks delaying your healing and opening your incision site. The sleep deprivation and emotional stress can wear down your immune system, also delaying your healing, so take it easy. If you have older children you will need someone to lift and care for them. Anticipate that it will take time for you to get back to any sense of normal, and be patient with yourself. If you know you'll be having a cesarean birth then seriously consider having a close family member to come stay for those first couple weeks, or the first week your spouse returns to work. Also it is worth considering hiring a postpartum doula.

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