Danae’s tips for formulating your caesarean birth plan.
There are many reasons why some woman need or choose to have a caesarean birth for their babies. Make yourself aware of the reason, the choices you have and what can give both you and your baby the best opportunities to enjoy the experience.
Speaking with an experienced Doula to help support you through this experience can make an exponential difference to your experience and the likelihood of a more positive outcome, both in the short term and long term.
Before the surgery
Ensure you understand and agree with the reasons for the cesarean (i.e., elective for personal reasons, malpresentation of the baby, or a medical problem for you or the baby).
Use Yoga to Birth yoga practices for breathing techniques, meditation techniques, sound expression, to prepare/support your mind and nervous system for/during the caesarean birth
Ensure you understand the procedure, step by step.
Ensure you understand your anaesthesia choices and how each is administered. If possible, however, meet and discuss medications with an anaesthesiologist along with any concerns you have. A spinal is the most common type of anaesthesia when a cesarean is planned in advance, but there are other possibilities.
Ensure you are clear on the layout of the operating room, particularly where the baby will be taken for initial care. Will they be in the same room or an adjacent room? Will you be able to see or hold your baby? Can your partner move back and forth between you and your baby? What is the Zero Separation policy of your OB or at your chosen hospital?
Discuss the possibility of waiting until you go into labour and then going to the hospital to have the cesarean. The advantage is that the timing for birth is more likely to be optimal for the baby. The disadvantages are that you might not know the doctor on call who will do the surgery, and that you cannot plan ahead (which is the same as with most vaginal births).
If you do not await the onset of labour, you will make your appointment for the surgery. Consider being the first on the day’s schedule for two reasons: there is less likely to be a delay (from earlier surgeries taking longer than expected); and you will not be as hungry if you do not have to wait all day. You will have to avoid eating from the night before.
Danae recommends placing your baby’s muslin wraps into the bed with you a few weeks prior to the procedure (if planned). Leave them in the bed do not remove them until you leave for the hospital. When you baby is born, request that they are wrapped in these cloths. These cloths now carry your smell and micro biomes and will be extremely comforting for the baby whilst separated from you during recovery period.
During the surgery and repair
In addition to the techniques I will teach you in the yoga classes, for your personal comfort, I suggest you consider these ideas:
You can put some pleasant-scented (lavender and bergamot are popular), essential oil on your cheeks OR your partner can put on their wrist for you to sniff. This is very soothing and may counteract the “hospital smells.” Because some staff members may be allergic to some scents, you should ask if this is okay.
Bring your own music to listen to during the surgery. Music that is familiar and that you love is most soothing. Use your own ear buds and music player.
Have your partner hold you hand, remind them prior to the birth that they there to care for you, support you, and help you feel loved, safe and secure while you experience this type of birth.
Ask them to lower the screen when the baby is lifted from your body so that you can see the birth.
Some OB’s offer Maternal Assisted Caesarean Birth if you are interested.
Ask if they will delay clamping your baby’s umbilical cord for minimal 60 seconds to three minutes after birth, to allow the baby’s blood that is in the placenta to return to the baby. There are many advantages for mother and baby to delayed cord clamping. You can even ask for the your baby to stay connected to the placenta for a period of time you feel passionate about.
During the repair procedure, some doctors lift your uterus out of your abdomen to inspect it and then replace it, while others believe this is unnecessary and possibly problematic. This procedure may cause greater nausea, and more severe gas pains than if the uterus is not lifted out. You might wish to discuss this with your doctor before hand. Ask about the advantages and the disadvantages.
Ask about picture taking during the surgery or afterwards. There sometimes are policies restricting picture taking. With a digital camera you can see pictures or videos of your baby within seconds.
Once your baby is born, it may be possible to have him or her placed on your chest, skin to skin. This practice is becoming more popular for healthy babies, and the skin to skin contact helps warm your baby, and allows your baby to feel your touch and smell your skin.
If you don’t get the baby right away, your partner may be able to bring the wrapped baby back to you for your first contact. You can nuzzle, kiss and talk to your baby. Ask if you will be able to hold your baby or breastfeed until you leave the operating room.
You might talk or sing to your baby. Your voice often calms the baby at this time, and seeing the baby’s response is a poignant moment for you both. If you sing the same song (i.e.“blackbird”) aloud to the baby daily for a few weeks before birth, it soothes the baby at birth and long afterwards when hearing your voices andthe familiar song.
Anaesthesia and other medication issues
The spinal block has many advantages for a planned cesarean, which make it the usual choice. It is quick to administer and to take effect. It usually involves only a single injection, and does not require a catheter in your back as does an epidural. It causes numbness that lasts a few hours. You remain awake and aware. The injection may also contain some long-acting narcotic such as morphine that provides good postpartum pain relief without grogginess for up to 24 hours after the surgery. If you have been in labor and already have an epidural, they will likely add medicine to the epidural for a cesarean to increase the numbing effect.
There are some things about spinal and epidural blocks that you should know
It is not uncommon to have a period after the block is given when you feel breathless or as if you cannot breathe. It can be scary. This sometimes happens because the anaesthetic may numb the nerves that let you feel your breathing, while the nerves to the muscles that make you breathe are probably not blocked. In other words, you are breathing, but cannot feel it.
What to do: Say that you cannot breathe. The anaesthesiologist, who is at your head, will check and reassure you. I will coach you with every breath, watching closely and saying, “Take a long breath in —
yes you are doing it, and now breathe out. Good.” I might also hold my hand in front of your mouth so you can feel your breath, and reassure you, “You are breathing, even though it doesn’t feel like it.” This feeling does not last for the entire surgery.
On very rare occasions, the level of anaesthesia rises high enough to involve the muscles of breathing, so that you really are not breathing. You cannot talk either. The anaesthesiologist, who is watching the
monitors closely, discovers this and takes measures to assist your breathing. We will also have a signal. If you can’t breathe and can’t talk, blink your eyes many times. That means, “I can’t breathe!” Your partner
will be watching you, and if you blink in that way, they can say say, “I think she can’t breathe!” This may alert the anaesthesiologist a few seconds before he would pick up the problem.
During the repair, you may feel nauseated and shaky or freezing for a period of time. These are normal reactions to major surgery and vary from feelings of queasiness to vomiting, and from trembling to shaking and teeth chattering. There are medications to ease these symptoms. They are often put into your IV without you knowing, which may be okay with you. They may, however, cause amnesia (e.g., Versed), or make you very sleepy. They can keep you from being able to nurse your baby (or to remember that you did), and to remember the first hours of your baby’s life. If you want to stay awake for this time, discuss this with your anaesthesiologist ahead of time.
You might ask the anaesthesiologist not to give you anything for nausea or trembling unless you ask. You may very well be able to tolerate these temporary symptoms, but if you cannot, then you can ask for the medication.
Post-operative pain medications are available to help you during the days and weeks after the birth. Some women try to avoid using them due to worries about possible effects on the baby. However, since very small amounts reach the baby, the effects seem to be minimal.
Your baby feeds and remains awake and alert for periods of time. The downside of avoiding pain medications is extreme pain, which greatly reduces your ability to move about and to care for, nurse, and enjoy your baby. With adequate pain relief, you can have more normal interactions with your baby.
The first few days
Most hospitals have a bed available for a support person so he or she can remain in the hospital with you. This is lovely for many reasons. You are together as a family / or you are comforted by someone you love during this time. Your support person can share in baby care. If your partner stays, your baby can probably room in with you the entire time. If he or she is not there, you will need help from the nurse to change the baby’s nappies, move him from one breast to the other, and carrying him, even for short distances.
Breastfeeding is definitely possible! There can be some challenges after a cesarean, however. Nursing positions such as side lying, and the “football” or clutch hold avoid painful pressure on your incision. Using a pillow over the incision also reduces pain while holding your baby on your lap. Ask for help from the hospital’s breastfeeding consultant in getting started with nursing and thoroughly read my breakdown of feeding post caesarean section below.
Rolling over in bed can be very painful, if you don’t know how to do it. The least painful way uses “bridging.”To roll from back to side, first draw up your legs, one at a time so that your feet are flat on the bed. Then “bridge,” that is, lift your hips off the bed, by pressing your feet into the bed. While your hips are raised, turn hips, legs, and shoulders over to one side. This avoids strain on your incision.
Help at home is essential to a rapid recovery. If possible, someone (relative, friend, or postpartum doula) in addition to your partner should help keep the household running smoothly. If that person knows about newborn care and feeding, all the better. All three (or more) of you need nurturing and help during the first days and weeks to ease and speed your recovery and help you make the incredible transition into
motherhood.
Start breastfeeding early after a caesarean section
Any mother who has a planned caesarean or a stressful unexpected outcome birth experience, such as an emergency caesarean section, may experience their milk coming in a little later than what is considered in the range of normal. For most, milk transitions from colostrum (early milk) to milk coming in by 72 hours of birth. After your baby and your placenta are birthed, your milk-making hormones go into overdrive and cause the cells that make your milk to switch on into production.
Research tells us that early and frequent sucking helps to switch on these milk-making cells, and mums who are able to feed or pump in the first hour have been shown to start lactation earlier, breastfeed for longer and have greater milk production compared to mums who start feeding or pumping later. By putting your baby to the breast as soon as they are born, you will maximise the switching on of your milk making cells.
Even if you have had an epidural or spinal anaesthesia, you may be able to breastfeed as soon as your baby is born. If you have a general anaesthesia (GA), you may be separated from your baby for a brief period while you wake up from the anaesthetic. Many hospitals now have breast pumps in theatre and recovery and the nurses and midwives will be able to assist you in expressing within the first 1-3 hours after birth.
If you are anaesthetised for a long period or take longer to recover, a nurse or midwife may be able to express you while you are unable to do so. Once you are reunited with your baby, feed your baby often.
Zero separation
Many hospitals realise the life long benefits of keeping mother and baby together and employ extra nurses or midwives so that if you do have a cesarean section, your baby can safely remain with you. It is the nurse or midwives role to ensure that your baby is safe while you are affected by the medications given to you during your cesarean.
If your baby does remain with you while you are affected by medication, it is vital that you are not alone and that you and your baby are under constant supervision.
After your baby is born, they may be able to / you can request, they are placed on your chest in the skin to skin position and will remain there while the doctors stitch your cesarean wound. Evidence on skin-to-skin contact suggests that newborns that are placed skin to skin with their mum immediately after birth and breastfeed within the first hour after birth have better breastfeeding outcomes. This includes a reduced risk of the delay in your milk coming in, improved milk production, and increased breastfeeding duration. It is therefore important that the mum is given the opportunity to breastfeed and have the baby skin to skin immediately after birth in the recovery area or post natal ward.
Avoiding any maternal-baby separation in the first hours is recommended. Zero separation ensures that you and your baby can stay together. The allocated nurse or midwife will be able to assist you to safely put your baby to the breast even if you are groggy from the medication.
If you are unable to have skin-to-skin contact, have a backup plan for someone who can (your partner), and make sure the hospital team knows your wishes.
When choosing a hospital to birth at, ask them what their policy on zero separation is and let them know your preferences.
Feed and/or express frequently
Regardless of the type of delivery that you have, it is important to feed your baby often. Feeding your baby frequently will help to boost your supply and help switch your milk supply on.
Typically, newborn babies will breastfeed eight to twelve times per 24 hours, with the interval varying from two to three hours on average. However, this varies widely between babies.
Offer your baby the breast every time that they signal to you that they are ready to feed (stirring, rousing from sleep, licking their lips) and let them feed at the breast for as long as they desire.
If your baby is unable to feed effectively or is separated from you, it is important to start expressing, a minimum of 8 times in 24 hours, until your baby is feeding effectively. If you are concerned that your baby is not feeding effectively or if breastfeeding is painful, ask your midwife/nurse/lactation consultant for assistance.
Post caesarean section pain management
While you are recovering from your cesarean section, it is likely that you will experience some pain. Pain from the incision site is common, and you may also experience pain from your uterus contracting (after pains) backdown to size. Pain can make breastfeeding a little more challenging.
Many pain medications are compatible with breastfeeding, so don’t be afraid to ask for pain medication. If you are on top of your pain control, your recovery will feel smoother, and it will be easier to position your baby to feed effectively.
Belly bands (or abdominal binders) are highly effective for C-section recovery, offering support that reduces pain, stabilizes the incision, and improves mobility. Typically, they are worn 6–12 weeks postpartum, beginning shortly after birth or once approved by a doctor.
Example C section Birth Plan from a family Danae supported
As you can see, there are many possible options for a caesarean birth. Some are personal touches and personal self-care measures that will improve your satisfaction and self-confidence. Others are measures that involve the support of your partner, the hospital staff and your doctors.
After thinking about your own preferences, you might like to prepare a birth plan and review it with your caregivers
x Danae
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