Ideas for the Best Cesarean Possible
By Penny Simkin
If you have learned that you must have a cesarean (a “planned cesarean”) for your
safety or the baby’s, you may feel disappointed that you cannot have the birth you
had hoped and planned for. Here are some ideas for tailoring the cesarean birth of
your baby to make it very special and personally satisfying for you, your partner,
and your baby.
Before the surgery:
* Be sure you understand and agree with the reasons for the cesarean (i.e.,
malposition of the baby, a medical problem for you or the baby).
* Learn about the procedure. Read about it in Pregnancy, Childbirth and the
Newborn or the Birth Partner and discuss it with your caregiver.
* Learn about your anesthesia choices and how each is administered. General
information is available in the books mentioned above. If possible, however,
meet and discuss medications with an anesthesiologist along with any
concerns you have. A spinal or epidural block is the most common type of
anesthesia when a cesarean is planned in advance, but there are other
possibilities. (See “Anesthesia and medication issues below).
* Learn the layout of the operating room, particularly where the baby will be
taken for initial care. Will she be in the same room or an adjacent room? Will
you be able to see her? Can your partner move back and forth between your
side and your baby’s?
* Discuss the possibility of waiting until you go into labor 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 decide to await the onset of labor, make your appointment for
the surgery. If there is a choice of times, you may want to consider having
the first appointment of the day 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 probably have to
avoid eating from the night before.
During the surgery and repair:
For your personal comfort, consider these ideas:
* Have your partner put some pleasant-scented (lavender and bergamot
are popular) lotion, massage oil, or cologne on your cheeks. He can also
put it on his wrist for you to sniff. This is soothing and may
counteract the “hospital smells.” Because some staff members may be
allergic to some scents, you’d better ask if this is okay.
* Ask if at least one arm can be left unrestrained.
* Bring your own CD or tape of music to be played during the surgery.
Music that is familiar and that you love improves the ambience. Many
operating rooms have CD players.
* Plan to use relaxation techniques and slow breathing (like sighing)
during the surgery. Hold your partner’s hand.
* Ask that they lower the screen when the baby is lifted from your body so
that you can see the birth.
* During the repair procedure, there is one technique that some doctors do,
while others believe it is unnecessary and possibly problematic. This is to lift
the uterus out of the abdomen to inspect it and then replace it. This
procedure may cause considerable nausea while it is being done, and later gas
pains. You might wish to discuss this with your doctor beforehand. If he
customarily does it, ask for the advantages.
* Ask about picture taking during the surgery or afterwards. There sometimes
are policies restricting picture taking. A digital camera has the advantage of
allowing pictures of the baby to be shown to you within seconds. If your
baby is out of your sight, it may be possible for your partner (or a nurse) to
take a picture and show it to you.
* Once your baby is born, your partner might go to the baby and talk or sing to
him. A familiar voice often calms the baby at this time, and seeing the baby’s
response is a poignant moment for the partner. Some couples have sung a
special song (i.e., “You Are My Sunshine”) aloud to the baby frequently
before birth. The baby seems to be soothed when hearing that song.
* The 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, but it is unlikely you
will be able to hold her or breastfeed until you leave the operating room,
because the operating table is narrow and you may feel quite weak.
Spinal or epidural anesthesia 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.
It causes numbness that lasts a few hours. You remain awake and aware. It
hardly affects your baby. 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. An epidural is very similar
and has these advantages, but is more complex to administer and takes
longer to provide adequate pain relief. There are, however, some concerns
about spinal and epidural blocks that might be frightening:
- It is not uncommon to have a period during which you feel breathless
or as if you cannot breathe. It can be scary. It happens because the
anesthetic may numb the nerves that let you feel your breathing,
while the nerves to the muscles that make you breathe are not
blocked. In other words, you are breathing, but cannot feel it.
- What to do: Say that you cannot breathe. The anesthesiologist, who
is at your head, will check and reassure you. Your partner should
coach you with every breath, watching closely and saying, “Take a long
breath in -- yes you are doing it, and now breathe out. Good.” He
might hold your hand in front of your mouth so you can feel your
breath, and reassure you, “You are breathing, even though you can’t
feel it.” This feeling does not last for the entire surgery.
- On very rare occasions, the level of anesthesia rises high enough to
involve the muscles of breathing, so that you really are not breathing.
You cannot talk either. The anesthesiologist, who is watching the
monitors closely, discovers this and takes measures to assist your
breathing. You and your partner should 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 should be watching you, and if you blink
in that way, says, “I think she can’t breathe!” This may alert the
anesthesiologist a few seconds before he would pick up the problem.
- On other, even more rare occasions, the anesthesia is not adequate,
and you feel the surgery. This is very scary. The doctors will probably
want to make sure your reaction is not an anxiety reaction to the
surgery, and may seem not to believe you at first. If you are feeling
the surgery, tell them to stop. Your partner must help you with this.
Make them give you better anesthesia before proceeding. This might
mean repeating your block or giving you a general anesthetic.
* During the repair, you may feel nauseated and shaky 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 anesthesiologist ahead of time. You might
ask the anesthesiologist not to give you anything for nausea or trembling
unless you ask. You may very well be able to tolerate the symptoms, but if
you find 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 to be minimal. The baby nurses 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 the partner so he or she can remain
in the hospital with you. This is lovely for many reasons. You are together
as a family. Your partner can share in baby care. If your partner is there,
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 diapers, move
him from one breast to the other, and carrying him, even for short
distances. In some hospitals, the baby spends more time in the nursery if
the partner is not there.
* Breastfeeding is definitely possible, but presents some challengs after a
cesarean. Nursing positions such as sidelying, 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 lactation consultant in getting started with nursing.
* 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 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 establish yourselves as
a happy family.
As you can see, there are many possible options for a cesarean 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
the hospital staff and your doctors. After thinking about your own preferences,
prepare a birth plan, review it with your caregiver, and bring it to the hospital for
the nurses to read.
I hope these suggestions will help you have the best cesarean ever!
