How to have the Best Caesarean Ever!

There are many reasons why a caesarean section might be planned with a birthing family.

These include factors relating to the mum, the baby or the placenta.

Considerations include:

• Mum’s health: perhaps Mum has a physical condition that makes Caesarean a safer option, for example a heart condition, a Crohn’s disease flare, scoliosis or previous injury to the pelvic bones. Women who have had a previous birth injury that has affected the strength and/or function of their bladder or bowel may also consider birthing by section for subsequent children.

• Babe’s health: baby is very premature or unwell, multiple births-especially 3 or more, Babe's position is breech or lying sideways

• Maternal choice- Mum’s first birth was a Caesarean and they’ve elected to have a section this time too. Or, after discussing the potential risks involved specific to Caesarean surgery they’ve decided that this is what would really suit them and their circumstances best rather than waiting for the birthing process to start.

• Placenta praevia- where the placenta is covering or partially covering the cervix and is in baby’s way.

• There are also reasons to have an unplanned or emergency caesarean like a baby or mother becoming distressed during the birthing process, Mum or Babe becoming acutely unwell. Or, a caesarean may be offered, if the entire birthing process has just taken too long.

If a caesarean section is something that you’ve been asked to consider you might like using the following acronym as a decision-making tool. Ask your healthcare provider questions around their recommendations for Caesarean.

B stands for benefits. What benefits or advantages are there in having a section specific to my individual circumstances (not advantages based on hospital policy or general population)?

R stands for risks. Are there any risks involved with the surgery? What are they? What is the likelihood or chance they will occur- how often do the risks occur with this surgery? You can even ask the Dr for their specific statistics of the risk occurring while they’ve operated. Are there any risks related to not doing the surgery?

A stands for alternatives. Are there any other options? In asking what the options are, you’ve provided an opening in the conversation so that you can get more nuanced information. The conversation might go something like this: ‘You’ve recommended this action…what alternatives are there?’ …'oh, that’s the alternative, that’s not great, thanks for explaining. Now I understand why you’re recommending this.’ Or… ‘That’s the alternative? Actually, I prefer this option, let’s put this option in place.’

I stands for Intuition/Instinct. What does your instinct say is right for you and your baby in this moment. Is this something you can fully commit to or do you still have reservations? Do you feel like you’re feeling pushed into something or do feel that it’s the right thing to do?

N stands for no/nothing/not now. What happens if we do nothing? Can we wait? How long can we wait for? 5 minutes, 5 hours, 5 days?

Personalise these questions according to your needs and it will help you get the information you need to make the decision that’s right for you. It's also good to ask if there are any associated financial costs and what these might be. Healthcare organisations or health insurers aren’t always up-front and transparent with extra expenses that may be incurred and what is or isn’t covered. Financial consent is important too.

Regardless of why you are having a caesarean section there are things you can do to make it the best it can be for you, to personalise it as a beautiful and memorable birthing day.

If you were planning on having a vaginal birth you might like to incorporate some of those birthing preferences into your caesarean birth.

Before:

• Write a birth plan (if you want to) and make duplicates so that the staff on the day can learn what is important to you.

• You will have a midwife accompany you to the theatre. Make sure they have and understand your birth plan so they can help make the magic happen.

• If you've had challenges on your journey to parenthood or a previous difficult birth or Caesarean, take the opportunity to have a health professional actively listen to your experience with a birth debrief or a trauma recovery session. This can help reduce fear and anxiety around the upcoming birth and make space for joyful anticipation of your little one's arrival.

• Due to physical space and for safety reasons, only 1 support person is allowed in the theatre for the birth. If you advocate for yourself in advance, you may be able to get permission for a private midwife, doula or birth photographer as an additional support person. Any midwifery student working with you will be counted as staff and so will be able to accompany you.

• People who have a caesarean section may experience a delay in their breastmilk coming in purely because of the stresses of surgery on the body. For this reason, if you’re planning on breastfeeding your baby, you may want to consider expressing some colostrum in the last month of pregnancy in case you need it. There is a fabulous article and further resources at the Australian Breastfeeding Association website. If you decide to go down this path and only get a few drops of colostrum, please be assured that what you express during pregnancy isn’t an indication of your supply after babe’s born.

• The theatre is deliberately maintained at a cooler temperature to inhibit bacterial growth thereby reducing the risk of infection to you. Newborns can struggle to maintain their temperature especially if they are still wet from the amniotic fluid. For this reason it might be recommended for you to bring in a coverall onesie for baby from home. Instead of having a freshly washed onesie, turn it inside out and sleep with it next to you or your partner’s skin the night before. Then, instead of having hospital washed and bleached clothes next to your babe’s fresh skin, you will be transferring your distinctive family microbiome, your good bugs, to your baby.

• If you want to be more hands on during your caesarean birth experience, enquire if mother assisted section is offered at your hospital.

• Seeing baby being born can help with the feelings of connection and bonding with baby. Ask for clear drapes so you can see babe being born, if you feel this will help you.

• Consider taking a probiotic to support your body as it grows your baby and in preparation for surgery. Antibiotics are given routinely for Caesarean births to help prevent wound infections. Antibiotics can be indiscriminate and kill the good bacteria as well as the bad so probiotics can optimise your gut health. There are some great blogs to read here.

• Ask what wound dressings will be used and what benefits each type might have. Do you have a preference? Or do you have any skin sensitivities, allergies or concerns with healing where you may benefit from a specialised dressing?

• Do you want to keep your placenta? Some families like to honour the placenta in different ways. You might like to bury it at home and plant a special tree over it. You may need to bring a plastic ‘ice cream’ container with a lid with you, which will be labelled and stored for you (someone) to pick up later. Check your hospital’s requirements.

During:

• Do you have a playlist for theatre? Is there specific music you want playing as babe is being born? You can take in your phone and have music either on speaker or using your earbuds. Your support person can have your things in their pocket and help you manage your stuff.

• There will be a lot of different sounds in the theatre that might contribute to jangling nerves. Consider noise cancelling headphones to manage.

• Do you find bright lights harsh, irritating or overstimulating? Are you photosensitive? The theatre needs to be well-lit. You can wear a sleep mask or your sunnies and rock the superstar look.

• You can’t have scented candles or diffusers in theatre but you can bring your favourite fragrances or oils on a tissue in a zip-lock bag with you and breathe for relaxation and comfort.

• If fidget toys help you, bring one.   ; )

• Take your baby onesie and receiving blanket (bunny rug) to theatre with you and ask for them to put it in the blanket warmer for you. Baby will benefit from pre-warmed clothes.

• Rather than the surgeons announcing the gender of your baby, let them know that you want to discover that yourself, in your own time.

• Delayed cord clamping is a process where the umbilical cord isn’t clamped and cut straight away but rather delayed until the cord has stopped pulsating or until it has gone white. This indicates that the placenta has delivered all of baby’s blood to them and can increase their blood supply by 20%. Here is more info and associated references: Delayed Cord Clamping

• If your partner wants to ‘cut the cord’ they can still ‘trim the cord’ after babe is away from the operating area.

• Skin-to-skin is where your fresh, unclothed baby is put on your chest and stays there for about 1hr after the birth. Their temperature and blood sugar level are more stable if they’re with you and, not surprisingly, they cry less! Remember that theatres are deliberately temperature controlled to be cooler, so ask for a warm towel to place on your chest to pre-warm you and then have someone remove the towel, place babe on your chest and put a fresh warm towel over you both! You can even be supported for babe’s first breastfeed to occur during this time if you wish. However, if it all feels a little awkward or overwhelming, your partner or birth support person can cuddle baby and you can continue with skin-to-skin and/or breastfeeding in recovery.

• If you’re concerned about the impact of antibiotics on your babe, ask for your routine prophylactic antibiotics to be delayed until after babe’s cord has been cut. That way you will still benefit from antibiotic protection without exposing your baby.

After:

• If all is well with you and babe, they should be able to stay with you in recovery. And if skin-to-skin wasn’t able to happen in theatre (ie the theatre was too cold and they dressed baby) the midwife can unwrap/undress baby and put them directly against your skin. And help with that first breastfeed as well, if you like. Other things like weighing baby or giving them Vitamin K or Hep B vax can wait until later.

• Ask for stronger pain relief if the standard meds aren’t covering you. You recover best if you can be mobile. You can only be mobile if you have good pain relief!

• Continue with the probiotics- some brands recommend a double dose if you’ve had antibiotics.

• After the hospital dressings have been removed you might like to use silicone scar tape to help optimise the appearance of your scar by softening and flattening the scar.

• Acupuncture or acuneedling with an accredited health care provider can also aid wound healing.

• Scar massage can help to re-enervate the area.

• If you’ve decided to keep your placenta, don’t forget to pick it up before you leave the hospital.

You might like to continue with a supported journey to parenthood by having the 'Best Postnatal Experience Ever!' by having a team to support you at home. Family and friends to do a Meal Roster. Someone to organise play dates for the big brothers or sisters in the family. A doula for an extra set of hand or for an in-home massage. Or a private midwife (pick me) to check in you and your baby's recovery and health for the first 6weeks.

There are plenty of things here to think about! And lots of different ways to make baby’s birthday a very special birthing day for you too.

What did you do? What would you add to the list? How did you make your day special, I’d love to hear.