I know gentle cesarean or family-centered cesarean sounds like an oxymoron a little, doesn't it? I mean, we are talking about a sterile operating room and staff covered head to toe with nothing but their eyes peeking out.
But, Is it possible then to have a "natural" c-section, or is that a wish in the making?
The truth? It's hard to get hospital staff in some areas of the country to listen to your preferences, and for that I am sorry.
My goal here is to arm you with tips to make your birth as close to being a family-centered cesarean or gentle cesarean delivery as possible.
Inside each tip, I have listed who most often decides on that particular topic. It is not the rule, but the norm. Every facility is different.
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Everyone who is planning to have a baby.
The alarming fact is that the c-section rate has increased to about 1 out of 3 women.
Whether you already have a cesarean scheduled or not, unpredictable events can happen during birth. I want to prepare you on the off chance that you end up having a cesarean section.
Girl, birth can take a wildly unpredictable turn, and the beautiful, low light, oil diffused birthing suite is out the window in a flash.
So, as much as I am hoping you will have the birth you have always dreamt about, take the time to read these tips and have a contingency plan in place, just in case.
First and foremost, you need to understand that a cesarean section is major abdominal surgery. It is not an alternative birth method. It is the last resort.
Read this informative guide to understanding cesarean sections (very detailed explanations of what happens, written by a nurse who has done 100's of cesareans) outlining what happens from the minute we admit you until you are in the PACU recovering from your cesarean section.
I plan to cross-reference what usually happens and what options you may have to customize each particular section to your preferences.
I am going to be as real as I can, from the eyes of a labor and delivery nurse who has done hundreds of cesareans. It's tough in some hospitals even for me to have enough clout to get the skin to skin time for my patients in the OR, Which SUCKS!
In the last few years, however, I am seeing a trend that is becoming more in favor of gentle cesareans or family-centered cesarean sections, which thrills me.
I know, I am on repeat. But it's right, without education about the norm or the standard of what happens in the hospital during birth, how can you make an informed decision? You can't.
Don't you wonder, if these women were educated and armed to make informed decisions, would they end up in a primary cesarean section?
Read this post now: A Simple Guide to Understanding Cesarean Sections
It's very informative. I walk you through exactly what happens from admission to recovery.
Knowledge is Power Mama, that is why we recently launched Labor Nurse Mama Cesarean Masterclass: Your Guide to an Empowered Birth Story
If you desire to have a say in your birth, then take the horse by the reins during your pregnancy. Being able to voice your desires is something you should feel comfortable doing from the get-go.
You have the COMPLETE right to interview OB providers and choose one based on a common thread of understanding. You have every right to change your provider as well.
In particular, the admission period is when you will meet the majority of your birth team, who will be responsible for caring for you during your cesarean section.
If your nurse in the pre-op area or your labor nurse (if you have been laboring and end up going for a c-section) will not be the nurse who circulates your operation, ask to meet the one who will.
This is very important, as the circulating nurse is your advocate in the operating room. She is your best chance to express your desires during your gentle cesarean or family-centered cesarean section.
When you meet her, do not take a hard approach. She is there for you. Her ideas and beliefs may not align with yours, but that is okay.
Unfortunately, I've seen this all too many times. A mom comes in hardcore, balls to the walls, and sets a tone of us against them. It's unfortunate, but I am trying to be real here.
I am the most natural nurse you will meet, and I have had doulas make me feel like I am the enemy. (Not often and usually I can win them over with my charm and natural approach)
But the key is to remember that she is YOUR ADVOCATE, and it's worth being kind and respectful unless you need to bust out the can of 'my rights.' Then I say go hard.
Ok, before you go to the OR, ask to meet your team. When you meet them, let them know that you have specific requests for your gentle cesarean and that you would love to share them with your team.
Use these words or a paraphrase:
"I have compiled a list of what's important to my family for our birth. This is what I desire to happen, but I also understand that emergencies can happen, and I trust your skill and knowledge. If something occurs that you are unable to honor my wishes, please talk it through with me."
Who decides: Circulating RN
If you're laboring with an epidural in place, we will transport you to the OR in a bed or stretcher. Nothing can change that.
However, if admitted for a scheduled cesarean section or for some reason (that is not an emergency), you are no longer laboring but headed to the OR, then ask to walk.
Walking gives you a sense of control and normalcy that being wheeled in a chair or bed steals from you. Remember we are shooting for your gentle cesarean to be a more normal experience.
Who decides: CRNA/Anesthesiologist
While in the OR, you will go through some predictable steps (read my guide) one of which is that you will have your spinal placed and then lay back for the rest of the pre-procedure steps. After we lay you back, your arms will be extended on to arm boards and restrained.
Ask if you could keep your arms unrestrained unless you require drugs, which might make you less aware. (next point)
Who decides: OB/CRNA/Anesthesiologist
In most cases, only one support person is allowed into the OR. It is regardless of whether you desire a gentle cesarean or family-centered cesarean section.
Having two people in the OR is optimal but highly unlikely. The OR is so full of staff that having extra people can decrease safety. It is possible, and it is entirely up to the OB and the CRNA/Anesthesiologist.
If you have a doula and a support person with you and they are not both allowed into the OR, here is my suggestion. Ask if your doula can come in when your partner goes to the nursey with the baby. (if they don't allow the baby to stay with you).
Who decides: CRNA/Anesthesiologist
Ask ahead of time that you are given the least sedative drugs possible. If you are given extra drugs they can make you feel fuzzy-headed and drowsy.
You may experience nausea and need medications, ask for Zofran. (Unfortunately, if Zofran is not working for you, you may not care if you get drowsy, because vomiting while lying flat is scary.)
Who decides: The facility
If the hospital has clear drapes, then your OB would then decide if they will use them. I have never had a patient ask for one, but this is becoming more normal.
If they do not have a clear drape, then ask for the drape to be lowered when the baby is about to be delivered.
Who decides: OB
Create a playlist that relaxes you and bring it with you. Ask if it can play in the OR. If they do not have the capability of playing through a speaker, then play it near your ear.
Who decides: Circulator
Your OB via the circulator can keep the room quiet. This is one that you can control, but your RN will be the one who will advocate for a peaceful and quiet room. Ask your RN to ask the team to keep the conversations relevant to the procedure.
Who decides: OB
I am not going to go into the vast reasons this is so important. I wrote an entire article about this topic. It's truly unbelievable how much this benefits the baby. Like sci-fi crazy. So be sure to read why, at the very least, delaying 30 seconds is beneficial. It certainly can be done in a gentle cesarean. INSIST!
Who decides: CRNA/Anesthesiologist
Ask the CRNA/Anesthesiologist if they can place the leads so that you can do skin to skin on your chest. Honestly, I have assisted with skin to skin regardless of lead placement, so this one doesn't have to be a win or lose.
Who decides: Baby Nurse/CRNA/Anesthesiologist
Skin to skin in the OR is entirely do-able. Your gown can be unsnapped ahead of time and ready to slip the baby inside. You can breastfeed and initiate bonding immediately following birth. (which leads to number 13)
Who decides: Baby Nurse
Ask that to delay the newborn procedures if the baby is stable. If you have gotten the okay for skin to skin, then this one should not be difficult. Delaying the newborn procedures allows for the most optimal family-centered cesarean section experience.
The importance of skin to skin during the golden hour is crucial. FIGHT FOR THIS ONE!!!
Most hospitals do not bathe the baby during this period. Still, some take advantage of mom being sutured to complete the bath and other tasks.
ABSOLUTELY do not agree with the bath. There are significant studies showing the benefits to your newborn if the bath is delayed.
Who decides: Your RN/Baby Nurse
When transported to the recovery area, whether it is your labor room or a PACU, ask to hold the baby in your stretcher while maintaining skin to skin.
Also, request that visitors be limited until you are out of the recovery area and into your postpartum suite. WHO DECIDES THIS? You and your partner. This is a tough one for new parents, but it is so crucial for your new little family to have this initial time together.
Did you have a cesarean section? Was it a family-centered cesarean section or was it by the book? Comment below with your thoughts!