Posts Tagged ‘cesarean delivery’

A Cesarean Plan

Wednesday, July 6th, 2011

Cesarean is often the last thing we want to think about during pregnancy. Most of us think it will not happen to us. Having a plan, an idea of what to ask for, to know there are ways to bridge the gap between Plan A and Plan C can be very beneficial to both mother and baby.

There is no way to make a cesarean just like a healthy vaginal birth, and frankly, that ought not be the goal. It can be however a much more family centered, family bonded, more respectful and humane experience.

Speak to your provider ahead of time about needs and desires. If you know you are having a cesarean ahead of time, meeting with the Nurse Manager and the anesthesiology department can be useful in obtaining what you want. Have the conversations, create partnerships.

Below is my latest version of a family centered cesarean plan  that can be used for a planned or unplanned cesarean delivery. All requests may not be feasible in all areas, but even small changes can be helpful.

It may be copied and pasted into your own document for personalization, however I do ask that you credit the source if you are an educator, doula or related professional using it as a sample.

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Name: Jane Doe

Estimated Due Date: January 1, 20XX

Care Provider: XXXXXX

We are seeking to make a cesarean delivery as special, low stress and family centered as possible.In the event a true emergency and general anesthesia is needed, I understand that some of my requests cannot be honored.

JUST PRIOR TO/DURING DELIVERY / RECOVERY –

  • I would like to meet each staff member in the OR by name who will be participating in the cesarean.
  • I may ask my _________ for aromatherapy to help with nausea, surgical smells and stress.
  • I ask that only essential conversation be allowed.
  • I would like to play ______ music in the OR if it won’t be a distraction to those performing surgery.
  • I would like my ______________ to take photos and/or video of the birth of my baby.  I respect that the surgeon and anesthesiologist may not want the entire surgery on video, however I would like a record of my baby being born to make it as special and personal as possible.
  • Explain all medications that will be used to me. I prefer a bolus and oral medications versus a PCA afterward.
  • Please lower the drape so I may view my baby coming out of me and hold my baby up so I can see him/her at the moment of birth.
  • Request my arms not be strapped down so I may touch my baby freely.
  • I would like my baby to remain connected to the placenta after manual extraction, as the cord will continue to pulsate for some time. I would like my ___________ to cut the cord after 10 minutes post delivery or the cord has stopped pulsating near the umbilicus.
  • I would like my baby placed skin to skin on my chest immediately with basic assessments being done while on me. My husband (partner/family member can hold baby there with a warm blanket over my baby and help maintain the sterile field.
  • I would like to breastfeed in the OR or as soon as possible in recovery.
  • I would like for my ________________ and baby to stay in the OR with me while surgery is completed and remain in recovery with me.
  • If the baby needs medical assistance requiring leaving the OR, I’d like for another person (doula, friend or family member) to attend me in the OR while my ___________________ goes with the baby, so my baby nor I will have to be alone.
  • In the event baby needs to leave the OR, I would like the wipe down towel(s) to be placed against my chest skin and baby to be pressed on me for fluid and odor transfer.
  • Asking for a delay in eye ointment and Vitamin K until after the first hour of bonding time or I am waiving all immunizations and eye ointment.
  • In the event of a hysterectomy, please do not remove my ovaries or anything else that is not medically necessary

REGARDING BABY

  • In the event the baby requires medical attention beyond that of a healthy baby, please inform me (husband/partner/family member) verbally what is needed or will be needed so I can actively participate in choices made for my baby’s care.
  • In the event of  a need for separation of my baby from me:
    • Limit the number of persons who touch or attend my baby to only those on staff as needed and my _____________.
    • Request my baby not be bathed or fully dressed until I have the opportunity to smell, touch, cuddle, etc. with my baby and I am able to participate in the bathing.
    • I plan to breastfeed exclusively, so no pacifier, formula, sugar water should be given to my baby.
  • No tests shall be performed or medications administered, etc. without my ________________ consent & prior knowledge

Thank you for honoring my requests for me and my baby.

Preparing For Birth, LLC

All Rights Reserved 2011

Grateful For My Births

Wednesday, November 24th, 2010

Focusing on Thanksgiving, I asked others to submit a “Why I am Grateful For My Birth(s)” blog post.  In the spirit of that, here is my own blog posting. Stay tuned for the Carnival of posts to be up by Thanksgiving morning.

I myself have had four varied labors and births, one of which could be considered a “normal” and natural birth experience.

From my first labor and birth, I learned that maternal ignorance no matter the intention can get you into the OR  I had to travel 45 minutes to my birth location, was only a 2 cm but nurse admitted me because she did not want me to go all the way home (she of course did not tell me that or we would have rented a hotel room nearby to labor in), I then allowed the same nurse to perform AROM at 3 cm’s because she figured it could speed things up because early labor you know is slow often for first time mothers.Walked stairs for hours but….. Now came the pitocin because my waters were broken and I was not moving fast enough. Then came horrid, blinding back labor. At some point I got a partial dose of fentanyl. Then another. Finally in transition about 20 hours in, I thought I wanted the epidural. I did not get one as I was complete and pushed for nearly four hours. Then finally after a failed vacuum assist to rotate his head and help me I ended up in a cesarean for deep transverse arrest for an acynclitic, deflexed baby head.

Baby number 2 27 months later and I was for sure in no way going to get to the hospital before I was in very well established labor. VBAC, whatever, I knew if things were okay. I would never have pitocin in labor again or have my waters broken. So I labored beautifully, with no fear, hey there was some ivory tower mama left in me still. After having contractions work up to 2 minutes apart and 90 seconds long, I decided it was time to leave. My husband ran back in the house and put a water proof pad on my seat (what a very intuitive man). On the way during the 15 minutes ride to the hospital, my water broke, I mean BROKE – kaplooey. Yep water proof crib pad saved the passenger seat if our minivan. In triage I was checked and behold I was a stretchy 9 cm’s. Everyone was so happy. A VBAC good for you mama. No saline lock. Some monitoring. Then the trouble started.  The on-call doc came in and was impatient. I pushed for about an hour (mind you I was a VBAC) and when he was low enough she cut an episiotomy and used forceps on him.  Very little conversation, my husband just said she insisted and there he was. So a natural labor and almost natural birth. I still felt great. Episiotomy was far less painful than surgery…. I got my VBAC. Though  my baby ended up in NICU overnight because of forceps. That was awful. We were both very mad after we could process it. He nursed well nonetheless. Took him home the next day.

Labor and birth number 3 is told in detail on my blog post A Woman’s Voice Birthed Into Fullness so I will not report on it here.

My 4th labor and birth had me in the place of I am arriving at the hospital very late in labor even though this time I was a 1VBA2C mama. Funky contractions of a few hours each over three nights including one trip to the hospital thinking it MUST be labor, had me sitting at 7 cm’s dilated WITHOUT being in labor. How did I know that? I asked my midwife to check me every day after the short bout of contractions. I just laughed and laughed about being in “transition” dilation wise but not being in labor. On the fourth night of when the contractions started, I said OKAY I am having this baby. I did some nipple stimulation and acupressure over an hour, next thing I know 3 minutes apart contractions then closer. We got to the hospital I was 8 cm’s, walked for a half hour. Then I was 9 cm’s and pattern was back strong. Midwife came. After some odd and funny asides. I allowed AROM baby was +1 and in good position. She promised me. PROMISED me as I glared her down that this would not cause another cesarean. Baby was in perfect position. Gulp. OK. I trusted her and knew she did have our best interest at heart. No baby did not fall out. Have I mentioned I have an android pelvis? I was completely shortly after that and pushed. He was born about 45 minutes later. That for me was such a short amount of time to push. He was in my hands and on my chest with the exception of maybe two minutes for FIVE hours post birth. FIVE. He had about a 14.5″ head and came out over an intact perineum.  I was, well, normal, everyday, usual. Yep. I basked in the no nonsense aspects of it.

I learned so much through all my labors and births. Through #1 that though I made many excellent choices in my care provider and birth location, heck we even took out of hospital independent birthing classes, that maternal ignorance and a willingness to believe no nurse would do something that could cause harm was really am ivory tower point of view that women can just have babies. I knew I could birth, but knew I needed to know even more.

Through #2 that on-call providers can be dangerous people and that I COULD birth.

With #3 my voice came into being. I turned into who I am now. Like a butterfly with the roar of a lioness.

And #4 oh my baby. I became normal, just like every other woman who had a natural labor and birth. Just another birthing woman. Not special. I really liked that title.

Yes I am grateful or I would not be the advocate, doula, educator, flag waving proponent of informed consent AND refusal, strive to help and support women in their childbearing years…. oh so much more. I am grateful because in all of this I have found my calling.

Thank you to K, L, J and D for being my sons.  Thank you to bad on-call doc, well meaning but harmful nurse, horrid nursery staff, and C.E. the midwife who believed in me and my body as much as I did.

Family Centered Cesarean Plan

Saturday, October 16th, 2010

Below is my version of a family centered cesarean plan – can be used for a planned or unplanned cesarean delivery.

Sample Cesarean Plan PDF

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We are trying to make a cesarean delivery as special and intimate as possible for us even though we did not have the desired vaginal birth.

DURING DELIVERY / RECOVERYIn the event a general anesthesia needs to be performed, I understand that some of my requests cannot be honored.

  • I would like to meet each staff member in the OR who will be participating in the cesarean.
  • I may use aromatherapy to help with nausea, surgical smells and stress.
  • I would like to play ______ music in the OR if it won’t be a distraction to those performing surgery.
  • Explain all medications that will be used to me. I prefer a bolus and oral medications versus a PCA afterward.
  • I would like for my husband (partner/family member) and baby to stay in the OR with me while surgery is completed and remain in recovery with me.
  • If the baby needs medical assistance requiring leaving the OR I’d like for another person (doula, friend or family member) to attend me in the OR while my husband (partner/family member) goes with the baby so I won’t have to be alone.
  • I would like to take photos and video of the birth of my baby.  I respect that the surgeon and anesthesiologist may not want the entire surgery on video, however I would like a record of my baby being born to make it as special and personal as possible.
  • Please lower the curtain and hold my baby up so I can see him/her at the moment of birth.
  • Request my arms not be strapped down so I may touch my baby freely.
  • I would like my baby to remain connected to the placenta after manual extraction, as the cord will continue to pulsate for some time. I would like my ___________ to cut the cord after 10 minutes post delivery or the cord has stopped pulsating near the umbilicus.
  • I would like my baby placed skin to skin on my chest immediately after basic assessments while in the OR. My husband (partner/family member can hold baby there with a warm blanket over my baby.
  • In the event of a hysterectomy, please do not remove my ovaries or anything else that isn’t medically necessary.
  • I would like to breastfeed my baby as soon as possible in recovery.

REGARDING BABY

  • In the event the baby requires medical attention beyond that of a healthy baby, please inform me (husband/partner/family member) verbally what is needed or will be needed so I can actively participate in choices made for my baby’s care.
  • Limit the number of persons who touch or attend my baby to only those on staff as needed and my husband (partner/family member).
  • Request my baby not be bathed or fully dressed until I have the opportunity to smell, touch, cuddle, etc. with my baby and I am able to participate in the bathing.
  • Delaying immunizations, even eye ointment and vitamin K.
  • I plan to breastfeed exclusively, so no pacifier, formula, sugar water should be given to my baby.
  • No tests shall be performed or medications administered, etc. without my (husband/partner/family member) consent & prior knowledge

Thank you for honoring my requests for me and my baby.

Tell NBC What YOU Think – ICAN meets mother-sized activisim

Sunday, February 7th, 2010

http://blog.ican-online.org/2010/02/07/mother-sized-activism-nbc/

The International Cesarean Awareness Network wants you to get involved and speak your mind about what you think of the NBC “Live in the OR” piece from last week. Here is the link to ICAN’s official response.

The only way that mass media will be responsible for what they put on the airwaves is for real people, the  consumers to speak their minds.  Please click on the above think and go for it. Be heard. It does make a difference.

Sisterhood of the Scar Revisited

Sunday, January 3rd, 2010

Many years ago I wrote this piece after attending my very first ICAN conference in San Diego in 2005. I read this and part of me weeps for her, for the me I was and for the women who are becoming part of this sisterhood willingly, wittingly or not.  My pain has been transformed into outstretched hands and heart. It has given me a sensitivity and awareness of the birth world I would probably have never achieved on my own had my births been perfect, idyllic and without this trauma.

I love you dear sisters and my life would be far less without each of you.

Seems a long distance the ivory tower to the ground.  The surprise in finding the thorny bushes with burrs that dig deep and puncture again at will? Well meaning onlookers say “Well a hundred years ago you both would have died?”  And the farce begins.  Stuff it down because it is crazy not to be grateful for the surgeon’s hand.  Smile and pretend all the twisted darkness inside doesn’t really exist.  The oft daily chore mixed with joy of caring for a baby whom we are unsure is truly our own.   The continuing assault during lovemaking when a cringe comes from the depths when a loving and hungry hand brushes the incision site.  “How can he think I am beautiful?  How can he possibly want this?”  Another thing of beauty and perfection quashed underneath the burden of the surgeon’s handprint.  Oh no say it hasn’t already been a year.  The birthday.  THE birthday sounds so exciting but terror strikes.  Preparation to be happy, preparation to feel joy.  Preparation not to shortchange our amazing gift of a child under the pain of the surgeon’s knife print.

The anticipated day meant to birth us into motherhood and my child into my waiting hands to my craving breasts, I was birthed into the Sisterhood of the Scar forever.

How real is active phase arrest of labor?

Thursday, September 17th, 2009

Preparing For Birth – Common Pregnancy and Childbirth Terms

Tuesday, August 25th, 2009

Below is a compilation of common terms and acronyms that women often will come across during pregnancy, labor, and delivery.  Check back as more will be added from time to time.

  • AROM – Artificial Rupture of Membranes – using a finger or tool to open the amniotic sac to to allow the fluid to release.
  • PROM – Premature Rupture of Membranes – when the amniotic fluids releases before labor starts.
  • SROM – Spontaneous Rupture of Membranes during labor.
  • ROM – Rupture of Membranes
  • Miso – Misoprostol is the pharmacological name for Cytotec a drug used for cervical ripening and induction though a controversial, off and against label used ulcer Medication
  • VBAC – Vaginal Birth After Cesarean
  • HBAC – Home Birth After Cesarean
  • WBAC – Water Birth After Cesarean
  • UBAC – Unattended Birth After Cesarean
  • CBAC – Cesarean Birth After Cesarean – This is a repeat cesarean after a woman desires and tries to have a vaginal birth after cesarean.
  • ERCS – Elective Repeat Cesarean
  • RCS – Repeat Cesarean
  • Natural Birth – Labor and vaginal delivery free from intervention except for intermittent fetal monitoring. In the hospital only a saline lock and intermittent monitoring.
  • Vaginal Birth – Baby born vaginally with or without medication and intervention.
  • First Stage – Early, Active, and Transition. This encompasses the effacement to 100%, dilation to 10 centimeters/complete, position movement of cervix from posterior to forward as contractions begin while staying longer, strong and closer together prior to pushing and delivery.
  • Second Stage – Pushing phase after cervix is completely dilated to delivery of baby.
  • Third Stage – Delivery of baby to delivery of placenta.
  • Fourth Stage – First hours after placenta is delivered.
  • Oxytocin – A hormone made in the brain that plays a role in childbirth and lactation by causing muscles to contract in the uterus (womb) and the mammary glands in the breast. It also plays a role in bonding with mate, child, and socially.
  • Pitocin (oxytocin injection, USP) is a sterile, clear, colorless aqueous solution of synthetic oxytocin, for intravenous infusion or intramuscular injection.
  • Prostaglandin – Any of a group of hormone like fatty acids found throughout the body, esp. in semen, that affect blood pressure, metabolism, body temperature, and other important body processes such as cervical ripening.
  • Uterus -The muscular organ in which a fertilized egg implants and matures through pregnancy. During menstruation, the uterus sheds the inner lining.
  • Cervix -The lower portion of the uterus that provides an opening between the uterus and the vagina. Also known as the neck of the uterus that softens, effaces, dilates and changes position during labor.
  • Vagina – A muscular canal between the uterus and the outside of the body. Also known as the birth canal.
  • Perineum – The area between the anus and the vulva (the labial opening to the vagina).
  • Pelvis -The basin like cavity formed by the ring of bones of the pelvic girdle in the posterior part of the trunk in many vertebrates: in humans, it is formed by the ilium, ischium, pubis, coccyx, and sacrum, supporting the spinal column and resting upon the legs.
  • Pelvic Floor Muscles -The sphincter mechanism of the lower urinary tract, the upper and lower vaginal supports, and the internal and external anal sphincters. It is a network of muscles, ligaments, and other tissues that hold up the pelvic organs.  Includes bladder, rectum, vagina and uterus.
  • Fundus –  Top of the uterus. During labor contractions the fundus thickens and gets more firm as the strength of contractions increase and dilation increases.
  • Placenta -The organ that develops during pregnancy that transports nutrients to the fetus and waste away from the fetus. The placenta is attached to the uterus and is connected to the fetus by the umbilical cord.
  • Umbilical cord – The cord that transports blood, oxygen and nutrients to the baby from the placenta.
  • Bloody Show – Mucous and blood mixed together as dilation and effacement occurs.  Starts off as blood tinged mucous and becomes heavier as labor progresses.
  • Stripping membranes –  Pressing the amniotic sac away from the inside of the cervix.
  • Mucous plug – The mucous that blocks off the non-dilated and non-ripened cervix for protection.
  • Lochia – Post birth bleeding that though a wound site from the placenta detaching from the uterine wall, it mimics a heavy and long menstrual period.
  • Cesarean – Baby born via a surgical incision made through the abdomen into the uterus.
  • Obstetrician – Is the surgical specialty dealing with the care of women and their children during pregnancy, childbirth and the immediate post birth time.
  • Midwife – Is a person usually a woman who is trained to assist women during pregnancy,  during childbirth, and postpartum as well as the newborn post birth.  There are many types of midwives – some work in the home, at birth centers or in the hospital.
  • Doula – Is an assistant who provides various forms of non-medical and non-midwifery support (physical and emotional) in the childbirth process. Based on a particular doula’s training and background, the doula may offer support during prenatal care, during childbirth and/or during the postpartum period. A birth doula provides support during labor. A labor doula may attend a home birth or might attend the laboring at home and continue while in transport and then complete supporting the birth at a hospital or a birth center. A postpartum doula typically begins providing care in the home after the birth. Such care might include cooking for the mother, breastfeeding support, newborn care assistance, errands, light housekeeping, etc. Such care is provided from the day after the birth, providing services through the first six weeks postpartum. In some cases, doula care can last several months or even to a year postpartum – especially in cases when mothers are suffering from postpartum depression, children with special needs require longer care, or there are multiple infants.
  • Birth Center – Free standing location usually run by one or more certified nurse midwife. True birth centers are almost always independently run. They are not overseen by a hospital or in a hospital. May be near a hospital. Often set-up like a home birth space and epidurals or other pain medications are not available.   Hospital “birth centers” are labor and delivery floors not birth centers in the true sense of the term.
  • Intervention – Anything that does not exist in a naturally occuring labor and delivery that is done.
  • Saline Lock/Buffalo Cap/ Hep Lock – Is the apparatus that the IV line hooks into.  It is silicone tubing that is lightweight with a plastic needle that stays under the skin to allow easy vein access.
  • Foley – A foley catheter is used to release the bladder if a woman unable to urinate due to an epidural, post surgery, or with a swollen urethra post birth.  It can also be used for successful cervical ripening in lieu of cytotec.
  • Induction – To attempt to artificially start labor usually by pitocin, artificial rupture of membranes with or without cervical ripening (Cytotec or Foley Catheter).
  • Epidural – A medical method of giving pain relief during labor. A catheter is inserted through the lower back into a space near the spinal cord. Anesthesia is given through this catheter, and results in decreased sensation from the abdomen to the feet.
  • Contraction – Tightening and loosening of your uterus. Productive contractions are often felt at the bottom of the uterus, start out like period cramps and progressively grow stronger, longer in length, and closer together.
  • Braxton-Hicks – Practice contractions that do not dilate or efface the cervix often felt at the top of the uterus versus the bottom.
  • Episiotomy – A surgical procedure to widen the outlet of the birth canal to facilitate delivery of the baby and avoid a jagged rip of the perineum. (Natural abrading or tearing is preferred and episiotomies are not evidence-based to be used except under specific circumstances).
  • Ina May’s Sphincter Law -Tapping into the concept that if one sphincter is open and relaxed, the others will also open, relax and be able to handle, quite adequately, the task at hand. This also includes the aspect of birth requiring privacy, sacredness, and honor as well so a woman feels safe, unwatched and supported.
  • Kegel Exercises – Named after Dr. Arnold Kegel, consists of contracting and relaxing the muscles that form part of the pelvic floor (sometimes called the “Kegel muscles”).

Preparing For Birth – Has episiotomy been replaced by this practice?

Tuesday, August 25th, 2009

In recent months I have noticed that during the end part of pushing and through delivery, care providers and/or nurses are doing very, very aggressive vaginal and perineal stretching.  This is not the gentle perineal massage I have seen in the past.  Even though I do not believe even that is necessary, it certainly was a far cry better than this.

To demonstrate, take your index and middle fingers from both hands and place them in your mouth on both sides with fingers facing in an outward pulling position inside your cheeks.  Now pull outward, stretching your cheeks and lips while “massaging” the inside.  Start gently, then get more aggressive. This is happening while soon a large malleable and smooth object will be pressing along those worked tissues.

How long do you think it would take for you to become swollen and bruised from this activity?  Can you imagine that there might be small tears and abrasions would be present from this if you continued for up to 30 minutes?

Now imagine after all that activity you have a large object in your mouth inhabiting the entire area including the widely opened and stretched lips. Next instead of you gently pushing the object out under your own control and power, you are told to NOT push it out but to allow for it to be removed for you. So imagine you already hyper extended lips being pressed further open with quite some force until it move through your open mouth.

How do you think the over worked, sore, possibly swollen,  and forcibly stretched tissues will react? Do you imagine tearing and damage?

Incredibly challenging and graphic descriptors to be sure.

Now imagine the alternative, there is no stretchy and pulling.  The large malleable and smooth object enters the space slowly so your mouth has time to adjust and accommodate it.  As the object approached your open lips, you slowly offer pushes to allow your lips to slowly stretch more than the norm.  Though it may sting and pull it is bearable.

Imagine now what your tissues would be like after that?  Sore? Some abrasion or some natural tearing?  Swollen a bit?  Even some bruising? Sure in reality you could be.  Accommodating a human baby through your vagina is a different experience than the usual.

How did the two processes sound to you?  To me I would much prefer the second one. Hands down.  How about your husband or partner?  Do you think this would be remotely decent to witness and then think ahead to actually having sexual activity with you again?

Though in my area, I rarely see an episiotomy done, I do see this very aggressive handling of the vagina and perineum routinely now.  To add to this, I am seeing more tearing severe tearing as well. When I ask the women about how their bottom is healing and feeling, I hear about more soreness, swelling, and bruising in the women who experience this.

So what do you do about it? Saying no to episiotomy during appointments and in making your birth plan is not enough.  Talk to your care provider ahead of time about the type of care you expect in late pushing and delivery. Talk to the nurse who is with you when you begin pushing. Tell your husband or partner to be on the look out for this aggressive technique so you can say NO. I also find that having warm compresses covering your perineum and vaginal opening can help abate it to a degree.

Here’s to a much healthier vagina, labia, and perineum post birth!

Increasing your opportunity for a vaginal birth in a cesarean stricken culture.

Tuesday, August 4th, 2009

Today the cesarean rate is an alarming 31.8% (CDC 2007 preliminary data).  Only a maximum of 15%  of birthing women should be having cesarean deliveries in order to keep mortality (death) and morbidity (poor outcomes) to the healthiest levels according to the World Health Organization. With the staggering discrepancy in what should be and what is, you NEED to care about this topic.  You could have a questionable cesarean like so many others.

It is important that you the childbearing woman understand how to have the healthiest birth for you and your baby which is most often a no-to-low intervention vaginal birth.

When a cesarean occurs for a truly medical and/or life saving reason it is necessary and the benefits far outweigh the consequences for mom and baby.  The cesareans that occur for other than truly medical and/or life saving reasons are often not necessary or became necessary due to external influence that skewed the labor and delivery outcome (routine induction, epidural,  impatience by provider, mal-position of baby, staying in bed during labor, routine continuous monitoring, pushing in one position, lack of food and water during labor, routine augmentation of labor, lack of support, etc.)

Below is a list of ways to promote having a vaginal birth even if you have already had a baby this information needs to be known.

  • Take the ICAN webinar on cesarean prevention.
  • Interview before choosing your care provider – you are doing the hiring! Know his or her statistics.  If you do not get a clear answer, that is a RED flag.  You need individualized care. ou and your baby deserve no less.
  • Interview both midwives and OB’s.
  • Research your chosen birth location well.  There are other options outside of the hospital – home and birth center.
  • Hire a doula who shares your philosophy and is comfortable with the type of birth you desire. Some searchable places for a doula are: www.cappa.net, www.dona.org, and www.alldoulas.com.
  • Without medical reason standing in the way, labor at home into active labor if traveling to a hospital or birth center.  Well established labor upon arrival to the hospital or birth center decreases the opportunity for interventions, medications, and cesareans.
  • Get educated! Take a childbirth class that promotes confidence, consumer awareness (knowing rights and responsibilities), and evidence-based practices. A “good patient” class is not what you want to take.  READ books that share positive stories and good information.  A few of the searchable sites are: www.cappa.net, www.independentchildbirth.com, www.lamaze.org, and www.ican-online.org.
  • Turn off your TV – stop watching the dramatic birth shows.  They are not real.
  • Use mobility in labor.
  • Drink and snack in labor.
  • Say NO to routine interventions – meaning interventions or medications without a true medical reason. These can include, IV with fluid running, artificial rupture of membranes, continuous monitoring, wearing of hospital gown, and vaginal exams.
  • Say no the the epidural completely or at the earliest at 6 cm’s dilated.
  • Push and deliver in positions other than the reclined or “C” position unless that feels good and baby is coming well that way.
  • Only have those around you who will support what you need and desire in labor and birth. When you close your eyes who is there with you in your labor “cave”? Who doesn’t fit well there?
  • Study yourself for what comforts, assures, and adds to your feeling of safety.
  • Eat healthy and exercise during pregnancy.
  • Read What Every Woman Needs to Know About Cesarean Section – http://www.childbirthconnection.org/article.asp?ck=10164
  • For more information on Cesarean recovery and support, VBAC education and support, and Cesarean prevention go to www.ican-online.org.
  • Bottom line – take your money and walk if you are not being listened to and treated as a partner in your care.

What might a cesarean get you? Often more than is bargained for.

Tuesday, July 28th, 2009

This is a  slight re-do from a popular blog post from early 2008. The information is vital and pertinent to the near 1.5 million women (based on previous CDC data) who will have a cesarean surgery this year.

Having a cesarean section will almost always  get you a baby.  Generally there is much more to it and anyone could bargain for or anticipate even in the best of recoveries.

Let me count the ways in no particular order:

  • A scar that in no way makes a bikini look better. Sometimes described as a shelf or a pouch.
  • The feeling of failure, guilt or less than deserving of motherhood.
  • The struggle of living with the huge dichotomy of loving your baby and perhaps hating the birth.
  • Higher probability of losing your ability to have more children either through physiologic secondary infertility, pregnancy complications, self-induced secondary infertility, hysterectomy or lack of sexual intimacy in relationship.
  • Higher probability of difficulty in breastfeeding.
  • Postpartum depression or PTSD, especially in an unwanted cesarean.
  • The feeling of failure as a wife or partner.
  • Having others discount your feelings and needs. After all you “just” had a baby. Really you just had MAJOR surgery, perhaps by coercion, a true medical indication, or completely from interventions and medications.
  • Living with the idea that you failed to pass induction, you failed to push out your baby, you failed because _________ (fill in the blank).
  • Obtaining your records to find what you were told and what was written are different. Could your trusted care provider have lied and cheated you?
  • Simply finding out that no one told you and you didn’t think it would happen to you. That being induced, getting the epidural, allowing AROM, not getting out of bed, etc. is why you had the cesarean. Is maternal ignorance and fear enough to quell what you feel and make it okay?
  • How can you trust yourself as a mother when you ignored your maternal intuition and kept saying yes, because the nurse, midwife or doctor told you to?
  • The way your marriage or partnership takes a turn toward hell or in the least a divided place.
  • Living with dread when a hungry hand sweeps over your scar. Being sexual can be extremely difficult physically and emotionally.
  • Having great fear of becoming pregnant again.
  • Having great fear of going for a VBAC and ending up in the OR at the end.
  • Not being understood and having others say to your face how lucky you are that you got to take the easy way out.
  • Pain.
  • Difficulty moving, walking, getting up, rolling over, coughing, laughing, tending to personal cleaning…. You get the idea. It is surgery.

Though not every woman will experience what is on the list, many do.  For all of these – there a stories layered and interwoven for too many women.

Every thirty seconds a woman is surgically having her baby delivered. Light her a candle. Offer her a meal. Let her speak. Listen to her intently. Don’t judge her. Send her to ICAN. http://www.ican-online.org/.