Yes I’m a doula, and I obviously I support natural birth, homebirths, breastfeeding – the whole nine yards. But that doesn’t mean that only births that go according to the perfect plan are beautiful. A beautiful, connected birth can happen no matter what the circumstances are, and sometimes that means a joyful birth for a mother who chooses an epidural, or has every complication under the sun. Sometimes the well prepared, well versed mother who had planned a natural birth, has a Cesearean birth.
I don’t talk about C-Sections much during prenatals. It is best to focus on believing in the ability of the female body to give birth easily and trust it to do so! Since I am accompanying this couple through the birth, what works best is for me to provide information as issues come up. But if you aren’t going to have a doula to support you in every eventuality, then it is a good idea to think through all eventualities and make a plan. This is not a birth plan for a Planned or Elective Cesarean Section – there are plenty of birth plans out there for planned Cesareans that are lovely, thought through, organized ahead of time with a supportive doctor. You can have classical music piped in, curtains drawn aside, births filmed. Here is one example of an Elective Cesarean Birth Plan.
This is also not a plan for a ‘Crash’ Cesarean Section. If the fetal heart-rate is dropping rapidly and the baby needs to come out NOW, then the mother will be put under general anesthetic (unless she already has an epidural) and the surgery will be done within a matter of minutes. There is no time for planning, for crafting an experience. At a Crash Cesarean Section, you are happy for medicine that can save lives. However, Crash Cesareans are the rarest kind of Cesarean Section. Usually there is time to prepare, and that takes us to the most common type of cesearean:
‘Emergency’ Cesarean Sections, in a class of their own. They are the most common type of Cesarean Section that couples experience with their first baby. Reasons are sometimes as follows:
Situation number1 – Mother is anxious about how to know when labor is really beginning, and with the first twinges of contractions she remains awake and counts every single one. She cannot or will not fall asleep, and since she is paying close attention to what she’s feeling, the level of pain she feels is at a higher level from the start. She goes into hospital, is told she’s not dilating and sent home, and ends up absolutely exhausted, dehydrated and sleep deprived by the onset of labor. An exhausted, dehydrated and sleep deprived body does not dilate well and this goes on for a very, very long labor. Dr’s decide she is not dilating enough, despite augmentation (induction) and a CS will eventually take place. Lesson: live in denial! When you are really in labor, you won’t be able to deny it anymore, you WILL know. In the meantime eat, sleep, stay hydrated, relax. (I can’t believe I haven’t written anything about living in denial. Will do that asap.)
Situation number 2 – Baby is ill fitted in the pelvis, and does not move down. This is often because the baby is back to back, or the head is tilted at an angle that does not fit well. In this case, sometimes the mother ceases to dilate further at some point in labor, or the baby’s head simply does not descend in the pelvis. Often baby’s heart-rate does not respond well to pushing, because the fit is poor and baby is not happy with the sensations. In America this is often mis diagnosed as CPD, or Cephalo-Pelvic Disproportion. No, the baby was just in a poor position, and if the position were better the fit would have been just fine. Lesson: read up on optimal fetal positioning or see spinningbabies.com, and watch how you use your body in the weeks leading up to labor.
Situation number 3 – Dr’s have a great name for diagnosing things that they don’t understand in birth, and the term is ‘failure to progress’. They can’t explain why, there is no reason, but things aren’t happening so we might as well have a Cesarean Section.
Situation number 4 – Cord compression. This is not usually the cord around the neck, which in most cases is not a real cause for alarm. There’s a small space, a lot of cord, and it has to go somewhere. Baby is ‘breathing’ through the umbilical cord anyways, and not using air ways in the throat until after birth. Cord compression is where as the baby decends, the cord gets caught up in the way and with every contraction baby gets not quite enough oxygen. Often this can be resolved by getting mother into a different position that takes pressure off the cord or by amnio infusion (warm saline flushed inside the uterus), but if not, and it is suggested that the cord compression will get worse during the pushing stage, then a cesearean section is required.
Situation number 5 – Failed induction. An induction has been going on for a long time, nothing is happening, baby and mother are tired, everyone wants things over and done with. Lesson: Do anything else you can before you go for a medical induction! CS rates are much higher for induction births than births that started on their own.
The Emergency Cesarean Plan
The above are a few reasons for an Emergency Cesarean Section. You know this kind of Cesarean because there is time to hang around before the surgery. Your midwife or doctor may hint at the possibitily of a C-Section, just to get you used to the idea, but tell you there is time to try a few more things first and no need to get worried yet. It will be hours before the surgery is done, because there is no immediate danger to the life of mother or child. Yet, because it is classed as ‘Emergency’, fathers are generally not allowed into the room during the surgery. In Israel, fathers are only allowed if it’s a planned Cesarean, and doulas never.
1. Ask: is my baby’s life in danger right now? If not, then there is time to suit up my husband to accompany me to surgery. I am scared. I do not agree to surgery if I have to go in by myself. *Note: if your life or your baby’s life is in immediate danger, do not argue. That is a ‘Crash Cesarean’, a whole different kind of situation. But if there is 5 minutes to spare, there is time to bother to get your husband dressed and take him with you. If you are Orthodox and husbands are not allowed for religious reasons, then insist that a female relative or doula will go in with you to hold your hand. Do not go into surgery alone.
2. Have the epidural. If it is an Emergency Cesarean Section, there is time to set things up, and there will be possibly a few more hours of labor before you get to surgery. Once a mother has given up and given into the the idea of the CS, she feels much more pain than when she has hope and fight, and that wait will feel like an eternity.
3. Dads: it is your job to make sure that mother gets to see her baby. Sometimes in the hustle and bustle of the surgery especially in Israeli hospitals, Dr’s and midwives forget to let the mother have a look in. If baby needs help breathing, as often happens (usually without mishap) at a CS, then as soon as baby is stable insist that the mother gets to be cheek to cheek with her baby, and sniff the top of her baby’s head. Take a photo of the two of them together.
4. Go with the baby. Usually the mother was looking forward to skin on skin contact and bonding right after birth – this can still be had with dad. Take the camera. Take lots of pictures and have a relative ferry the camera back and forth so the mother can see the photos of her baby still fresh and new. Follow the original birth plan for baby care already preplanned before the birth when it comes to bathing the baby, immunizations, creams and drops. There may be a need for antibiotics for the baby, about which you cannot argue.
5. Together with family members arrange to support breastfeeding from day one! A post-Cesearean Section mother cannot pick up her baby on her own for the first few days, so how is she to breastfeed? She may be feeling let down by her birth experience, but with full on support she can still realize her dreams of breastfeeding successfully. If separation from the baby is prolonged, have the nurses help her express colostrum and insist that it be given by spoon or dropper to the baby, NOT by bottle. Do not let a plastic teat touch the baby’s mouth. You want to help, not even possibly hinder by a little bit the chances this mother has at breastfeeding. Someone will have to be with the mother at all hours of the day on a rota, to bring the baby to her breast for feeding. Pester staff to send over the breastfeeding counselor for specific advice how to breastfeed a baby without hurting the mother’s tummy. I know of one family who became so endeared themselves to staff that they managed to have a female family member sleep in a chair at night by the mother’s bedside post-Cesearean Section, so that she had complete rooming-in from day one. It may officially be against the rules, but it is possible, and that baby never had any breastfeeding problems, and the mother and baby bonded beautifully, thanks to her family’s tenacity and dedication.
6. Listen to how the mother is feeling. Never, never, never say to her, “Well, at least you and the baby are alive and well! All that matters is a healthy baby. Get over it.” Yes, she knows that. She’s thought that already. She will hear that sentence a few more hundred times from well-meaning friends and family. That sentence will always shut her up effectively, but the emotions from processing the birth experience still need to come out or they will grow and cause harm inside. Let her talk. Let her feel. And nurture her with affection, affirmation, compliments, healthy food, enough sleep, and skin-on-skin time with her baby until she is through the mourning phase and the sad feelings fade on their own.
Cesarean women are Brave. Read this beautiful post by Avital Klein, a Canadian doula, who describes the sacrifice that it takes to lay down your body for your baby, how much strength it requires. That is, in the end, what every woman learns through childbirth.
If you have any more suggestions, or experiences you could share, please do! An Emergency Cesarean Section does not need to be traumatic or horrible. The good, the joy, the birth is still happening and both the mother and the baby can feel supported, loved, safe.