A Family-Centred Cesarean

When it comes to cesarean sections, we often hear all the negativity surrounding them. We hear from co-workers, and friends, from our mothers and and our aunts how scary, terrible, and unfortunate they are. Strangers will stop a pregnant person on the street just to share their traumatic cesarean story. Is it true that there are thousands of unnecessary cesareans that are performed every year? Yes, we know this much from research, and we know that there are also many birth workers, doctors, and other personnel, both medical and otherwise, fighting to lower unnecessary and unwarranted cesarean rates in this country.

But here’s a truth that our culture fails to recognize regularly: Cesareans are beautiful, too. And some are needed, and planned. Out of the pregnant person’s desire, or necessity. These situations are valid, and relevant, and can be planned to be as family centered as possible; with love, and assurance, and met with just as much excitement as a vaginal delivery.

As a birth doula, I have attended a handful of planned cesareans, all of which were incredible examples of a birthing person listening to the needs of their body, and their baby, and hopefully with trust, and guidance from their medical practitioner.

Last year, at 34 weeks, my beautiful client and her husband found out their little girl was in a breech position. We began working on a plan to turn the baby, and after utilizing all resources, and skill I had, including a medical technique their OBGYN performed called an External Cephalic Version, or ECV, we knew it was time to make the decision to either go forwad with a vaginal breech delivery, or plan a cesarean. After many phone calls, appointments, and using their instincts, my clients decided on a cesarean.

Our next step was for us to create the most ideal scenario for the birth. I sat with my clients and walked them through what to expect before, during, and after surgery. When planning a family centered cesarean there are five key ingredients that are important. First, we let the OB/staff know that the partner does not want to be separated from the birthing person. This includes when the epidural is placed. Not all hospitals allow the partner to be in the OR when the anesthesiologist is putting in the epidural, but it has proven to ease the anxiety of the birthing person tremendously, which facilitates in keeping the connection between her body, and her mind during a highly sensitive experience. Second, while not every birthing person will want a clear drape, this option helps to connect them to the process of delivery. The option should always be given, and you may have to ask multiple times for this. Third, ask for updates from the surgeon on what is happening, with no unnecessary chatter. Again, connection is paramount. The connectedness to the surgeon with the patient is the difference between a traumatic experience, and not. When a surgeon is communicating with you, as they are touching you, when they are making you feel seen, and heard, as opposed to just a body they are working on, the connectedness will permeate through all aspects of your postpartum, and life.

Fourth, skin to skin! We all know how vital this is, and especially in a cesarean birth. Request, ahead of time, that baby be brought to you as soon as possible. You have the right to hold baby to your chest, pending you, and baby are doing well, right up until they are done suturing, and they prepare to move you to recovery. Once in recovery have your partner make sure that baby is brought to you right away again. Being close to both the partner, and the baby will immediately begin to create oxytocin which will help breastfeeding, as well as support the emotional well being for the birthing person. Five, music. I have never seen a patient regret a good song to celebrate the birth of their baby, or babies. You deserve to enjoy this experience, no matter what!

When it comes to doulas, it’s a misconception that we only support vaginal deliveries, and even more of a misconception that we only support home births. I cannot speak for all doula’s, but I can speak for my own practice, and as a doula that is in the business of supporting birthing people in all varying capacities, the need for doulas in a cesarean section is important. If you can afford to have one, or if you have volunteer doulas in your area, I suggest hiring one. In the OR we act as a non-medical liaison. Most of the time, the birthing person, and the partner are very nervous. Typically, they have had no experience in an operating room, which is, in and of itself a bit scary. (Sometimes dads need their hand held too!) Doula’s help to facilitate the needs of the family, ensuring that the family centered cesarean is honored, and supported.

In the end, family centered cesareans come down to support, and connection. Is your birth team on board with your wishes? Does your partner know what his or her role is, and what to expect? Whatever the reason for the cesarean, whether it’s for baby’s position, or just personal choice, you should be honored in every way, by everyone that comes into contact with you, and your family. You deserve this, and birth, no matter how it unfolds, demands individualized loving care.