Excerpt from the book, The Gift of Giving Life.  Section written by Sheridan Ripley

 BEFORE BIRTH

 Planned Cesarean: 

• Mentally preparing for a cesarean is important.  It takes as much mental preparation for a positive cesarean as for a positive unmedicated birth.  It requires a huge mind shift and focus.
• Having a doula, a woman trained to help and advocate for women through childbirth, can greatly improve a woman’s experience. However, moms need to research their hospital policies about doulas and cesarean sections.
• Finding a good match in care provider and hospital is important. Hospital policies vary widely, and a mom can have more support in certain settings.  For example, in some hospitals, the standard C-section has a three-hour separation of mom and baby following the birth, and the baby is given glucose water and formula from a bottle. Contrast this with a hospital where mom and baby are able to recover in the same room with skin to skin contact. Moms shouldn’t be afraid to change doctors/hospitals if their desires are not supported.
• Having a “mother blessing” with loved ones can bolster a mom’s spirits and surround her with love and joy as she prepares for her baby’s birth.  (See “Mother-Centered Baby Showers,” on p. ##.)
• Allowing labor to start on its own is sometimes an option for a planned cesarean. This allows the baby to get the hormonal and squeezing benefits of labor.

Any Cesarean:

• Remember that giving birth by cesarean is a selfless sacrifice. A mother having a cesarean is offering her body in behalf of another as she willingly undergoes surgery for her baby.  Pondering this truth can connect her with her Savior and give her unique insight into His sacrifice.This will also help prepare her for many more sacrifices she will make for her children as the years go by.
• Blessings and prayer can be used to help mom and dad feel more comfortable and confident in their cesarean decision. Have a prayer or blessing prior to the birth, specifically praying that the surgery will go well and for a spirit of peace.

DURING BIRTH

 Physical

Here are some physical things to consider or research, if planning a cesarean birth.

• Double suture of incision. This can help with healing and increase options for VBAC in future.
• Incision type. (Depending on the circumstances a bikini line incision is preferable.)
• No narcotics given to mom. This can help mom be more aware.
• Arms not tied down.
• Request that uterus remain in body. In some hospitals (often in teaching hospitals), during the repair they will flip the uterus out of the abdominal cavity to inspect it, massage it, or just to give the interns a tour around her body cavity. This is typically unnecessary and can makes a mom’s recovery much longer and more difficult. When discussing an imminent or likely C-section, a mom can state that she strongly desires for her uterus to remain in her abdominal cavity and for her organs to be handled or moved around as minimally as possible.
• If bright lights are bothersome to a mom, bringing sunglasses into surgery may be helpful.

Spiritual/Emotional

In a recent ICAN meeting, I was thrilled to hear from two trail-blazing doctors who are offering gentle cesareans.[1] These are examples of some of the things discussed:

• Soft music and aromatherapy allowed.
• Doula allowed, in addition to a husband’s support.
• Mom elevated a bit to see baby come out.
• Baby given time to acclimate to the outside by being brought out gently and gradually allowing for a gentle squeeze (which also helps to clear baby’s lungs).
• Clamping and cutting the cord is delayed.
• Baby, if vigorous, is brought skin to skin on mom with all assessments done there.
• Breastfeeding is initiated right in the OR.
• No casual chit chat amongst the surgical team—all focus on family.
• Communication with the mom about what is happening during the surgery.
• Photographs and videos allowed.
• Utilizing relaxation or hypnosis techniques to stay calm.

IMMEDIATELY AFTER BIRTH

• Immediate skin-to-skin contact after birth is ideal. As a doula, I’ve had a couple of clients who were able to hold their baby skin-to-skin in the operating room. One of the hospitals I go to has a standard procedure of putting baby skin to skin with dad in the OR.  Dad removes his shirt and puts on a hospital gown open in the front in order to receive the baby. I still think going to mom is best, but it would be good to offer the family a choice, and perhaps to encourage the shirt off prep for the partner in case the mother doesn’t feel up to having the baby while surgery is still in progress.

• If skin to skin contact is not possible, a mom can request to see the baby as soon as possible and that baby be within her sight while they do the assessments.

• A mom may want to request a chance to kiss her baby, nuzzle her cheek to cheek, and sniff the top of the baby’s head. This is a major hormone release spot, and a newborn baby has a unique smell that fades if they bathe the baby. This can aid in the bonding process. All this is best done as soon as possible, even while mom is still in surgery.

• If baby has to go to the nursery, a dad can accompany the baby and stay with the baby for as long as the mother desires, making sure that the baby’s in an incubator with hands-in access, or even allowed skin-to-skin time with Dad if possible.

• If a separation is necessary and dad goes with baby, a doula (or loving family member) is a wonderful help so that mom doesn’t have to recover alone.

POSTPARTUM RECOVERY

• Post-cesarean, I encourage family members to stay with mom on a rotation, so that she can have the baby with her at all times and facilitate breastfeeding. One family negotiated with hospital staff to allow someone to be with her all night too, so she could still have rooming-in.
• Cesarean mothers also need more long-term help and support in the first months of their babies’ lives.  Creating a schedule of postpartum helpers, childcare, and meals can allow moms to focus on bonding, breastfeeding, and healing.
• If the cesarean was a change of plans, or happened under emergency circumstances, having a completely non-judgmental support network around the mother at this time can help turn a less than ideal situation into a more sacred event.
• Keeping a mental record of and/or writing down all of the events leading up to the cesarean can make understanding and coping with it afterward so much easier.  Asking for input from others who were there and getting hospital records can also help a woman understand things better.
• A cesarean birth is not a failure. However, should a woman ever feel that way, she is not alone. There are many women who have been through what she has (including myself), and it will be of great benefit if she will seek someone supportive to talk to. (If needed, see “Healing from a Traumatic Birth,”)

 Some great resources for planning a family-centered cesarean can be found online through ICAN (International Cesarean Awareness Network)