Keeping it Simple: An Alternative Birth Plan

When writing a birth plan, it’s important to keep your list of preferences simple and succinct. Using bullet points and including the most critical information (ie: please don’t offer pain medication; I’m allergic to latex; please keep mom and baby together after birth, skin to skin; we are delaying Hepatitis B shot) will help ensure that your birth plan is read and heeded. The traditional birth plan format includes a one-page list of information grouped into categories like, “Labor,” “Birth,” “Newborn,” and “If Cesarean is Necessary.” For an alternative format, consider using the following graphic to lay out your birth plan. This visual four-square birth plan helps the reader find information quickly and simply, and leaves just enough room for the most important information.

birth plan squares

 

 

 

 

 

 

 

 

 

 

 

 

 

Ideas for filling in the four square birth plan:

Pain/Coping

  • Please don’t offer pain medication
  • Shower/tub for comfort
  • Experiment with many positions for pushing

Special Instructions

  • Mom is allergic to perfumes
  • Partner would like to cut cord and announce gender
  • Please delay cord clamping

In an Emergency

  • Please allow partner and doula to be present in case of cesarean
  • Partner will be skin to skin with baby if mom cannot
  • If baby requires NICU, mom will pump colostrum – please, no formula

Newborn Care

  • Please delay bath
  • No eye ointment
  • Please give vitamin K shot

 

These are just a few ideas to populate the squares — and perhaps your squares will have different categories! Experiment with the best format and contents to fit your preferences for birth.

60 Tips for Healthy Birth: Part 5 – Avoid Giving Birth on Your Back and Follow Your Body’s Urges to Push

In this six-part series, we are sharing 10 tips for each of the Lamaze six Healthy Birth Practices that help guide women toward a safe and healthy birth. The Lamaze Healthy Birth Practices are supported by research studies that examine the benefits and risks of maternity care practices. Learn more about each practice, including short, informative videos at Lamaze.com. To read the rest of the 60 tips, check out the other posts in this series.

10 Ways to Avoid Giving Birth on Your Back and Follow Your Body’s Urges to Push

1. Learn why avoiding giving birth on your back and following your body’s urges to push is healthy for you and your baby.

2. Discuss early on with your care provider that you would like to do what comes naturally when it comes to positions and pushing during birth. If your care provider reacts negatively, this could be a red flag that she does not support evidence-based practices.

3. Take a good childbirth class to learn the many ways in which you can push out a baby, and in particular, the many positions you can push in/on/around a hospital bed that does not involve lying flat on your back.

4. Avoid interventions that restrict your mobility so you can easily move in any way you feel comfortable, including positions for pushing, like on all fours, standing, squatting, and side lying.

5. If interventions become necessary, involve your labor support team to help you remain as mobile as possible and get into upright positions for birthing.

6. Learn the difference between directed pushing and pushing with your body’s natural urges.

7. Include details in your birth plan about your preferences to push in a position that is most comfortable to you and to follow your body’s natural urges to push (ie, please don’t count or coach for pushing). Share your birth plan with your care provider during your pregnancy, and bring a copy of your birth plan to your place of birth to share with your nurses/attendants.

8. Consider “laboring down” to shorten the amount of time spent actively pushing and to provide you with more energy to push in upright positions.

9. If you are birthing at a hospital, ask your nurses in advance of pushing about using the squat bar. Nearly all maternity beds come with a squat bar attachment, but staff may need some time to locate it and bring it to your room. The squat bar  is an excellent tool that can help support your squatting position in labor and birth. It can even be used for women who have an epidural.

10. You may find that pushing on your back and/or pushing with the encouragement or coaching of your labor support team is actually helpful — and that’s ok, too! Labor and birth is about what works best for you and your baby to have the most healthy and positive experience.

60 Tips for Healthy Birth: Part 4 – Avoid Interventions that Are Not Medically Necessary

In this six-part series, we are sharing 10 tips for each of the Lamaze six Healthy Birth Practices that help guide women toward a safe and healthy birth. The Lamaze Healthy Birth Practices are supported by research studies that examine the benefits and risks of maternity care practices. Learn more about each practice, including short, informative videos at Lamaze.com. To read the rest of the 60 tips, check out the other posts in this series.

10 Ways to Avoid Interventions that Are Not Medically Necessary

1. Learn why avoiding interventions that are not medically necessary is important for you and your baby.

2. Ask your care provider (the earlier, the better) about the kinds of interventions they use and when they use them. You can ask about their rates of interventions, but you’ll  most likely get more accurate and telling answers with more open-ended questions, like, “For what reasons would you recommend an induction?” and “Why would I need a cesarean?”

3. Take a quality childbirth education class to really get to know different interventions and how they interplay with one another. For example, you cannot be induced without having continuous external fetal monitoring and IV fluids.

4. Learn about the interventions used regularly at your chosen place of birth. Sometimes, those rates are available publicly and sometimes (more often), they are not. You can also ask during your hospital tour or at a prenatal visit with your care provider. But your best bet is to ask local doulas and childbirth educators, who will most certainly have insider knowledge.

5. Research and practice a variety of coping and comfort measures, as well as position changes, to use during your labor and birth.

6. Consider hiring a doula, who is trained on the use of interventions and can offer additional resources for you to make the best informed decision about your care. A doula will not advocate on your behalf, but can help you be a better advocate for yourself.

7. When you hit 40 weeks and there is no sign of labor, remind yourself that 40 weeks is not a deadline but a vague estimate and that a healthy pregnancy can go to 42 weeks and beyond. Also remind yourself that you will not, in fact, be pregnant forever. As uncomfortable as you may be at 40 weeks of pregnancy, the healthy choice in most cases is to let labor begin on its own.

8. If faced with the decision to induce your labor, first find out why, and second, find out your Bishop’s Score. And, learn why an induction might be necessary and when it is not.

9. Make sure your partner or birth support person (spouse, partner, friend, family member) knows about your birth preferences and understands how best to support you during birth. Your birth partner will be an invaluable asset to your birth experience.

10. Interventions can be medically necessary and life-saving. If interventions become necessary, find out how you can keep your labor as healthy as possible.

 

photo credit: Rick Bolin via photopin cc

Waiting to Clamp Baby’s Umbilical Cord — What to Know

One of the more revered traditions in the laboring room is the ceremonial cutting of baby’s umbilical cord. The job is usually bestowed upon mom’s partner and signifies the transition of mom and baby as one to mom and baby as individuals. The procedure involves two steps — one to clamp baby’s umbilical cord (done in two places), which stops the flow of blood from the placenta to baby, and the second is cutting baby’s cord, severing attachment to the placenta. Traditionally, baby’s cord is clamped within the first 30-60 seconds after birth. In recent years, however, new research has emerged that suggests “delayed cord clamping” (waiting between 1-3 minutes after birth), or clamping after the cord stops pulsing, provides significant benefits to baby.
Routine immediate cord clamping has been the norm for many years (earliest documentation is in the 1600s) due to the thought that delaying clamping would increase the risk of maternal hemorrhage and increase the occurrence of infant jaundice. This new review, which analyzed data on nearly 4,000 women and babies, found these concerns to be mostly unfounded, with benefits outweighing any potential increased risk. According to the Science & Sensibility report:Earlier this month, a new review was published in The Cochrane Database of Systematic Reviews on the subject of “delayed cord clamping,” and it received national media attention. The New York Times reported: “A new analysis has found that delaying clamping for at least a minute after birth, which allows more time for blood to move from the placenta, significantly improves iron stores and hemoglobin levels in newborns and does not increase the risks to mothers.” Medical News Today wrote: “A recent review of published studies suggests delaying cord clamping results in healthier blood and iron levels in babies, and this benefit outweighs the slightly higher risk of developing jaundice.”

Maternal adverse outcomes: The review found no significant early cord clamping (ECC) versus delayed cord clamping (DCC) differences in any maternal outcomes, including postpartum hemorrhage, length of the third stage of labor, need for blood transfusion, and need for manual removal of the placenta.

Neonatal adverse outcomes: Similarly, with the single exception of a slight increase in the need for phototherapy to treat hyperbilirubinemia (jaundice), there were no significant differences between ECC and DCC babies in neonatal outcomes, such as mortality, Apgar scores < 7 at five minutes, need for resuscitation, NICU admission, respiratory distress, polycythemia, and clinical jaundice.

What happens during delayed cord clamping? For a great visual, I encourage you to watch the brief video below by author and childbirth expert Penny Simkin, PT. Mark Sloan, MD, also describes it beautifully in the Science & Sensibility article:

At term, roughly 1/3 of a fetus’s blood supply resides in the placenta. In the course of labor and delivery, much of that blood is transfused from the placenta into the fetus/newborn, driven by the force of uterine contractions. That transfusion continues beyond the moment of birth; if left undisturbed for 1 to 3 minutes, the placenta will deliver about three additional ounces of blood to the newborn.

That may not sound like much, but three ounces of blood is equivalent to a three month supply of iron for the newborn. Iron is critical to brain growth and development; iron deficiency is a known cause of cognitive and social-emotional deficits in infants, which may be permanent. As breast milk alone may not supply a baby with all the iron he or she needs, it’s that additional iron that makes delayed cord clamping (DCC) so important.

 

After close review of their findings, the review’s authors conclude that “a more liberal approach to delaying clamping of the umbilical cord in healthy term infants appears to be warranted.”

Despite the mounting evidence along with this new review’s findings, many care providers still practice early cord clamping. Change won’t happen overnight. But asking your doctor or midwife about her routine practice with cord clamping and if she would honor your request to delay clamping is perfectly reasonable. To ensure that your request is observed, be sure to discuss with your doctor during a prenatal meeting and again when you are in labor (or ask your partner to reiterate your wishes during labor). It also helps to include this preference in your birth plan, which should be shared with your care provider and labor and delivery nursing staff.

photo credit: wickstopher via photopin cc

Cesarean Awareness Month: Evidence-based, Practical Cesarean Resources

April is Cesarean Awareness Month. While it can be a life-saving procedure for mom and baby, a cesarean is often prescribed when vaginal birth is a safe and sound option. Be aware that you have options, that you have a right to ask questions, and a right to know your risks. Educating yourself about birth is your best and first defense against an unnecessary cesarean. 

Throughout the month, Giving Birth with Confidence will be posting cesarean resources for moms. We encourage you to comment with your experience as well as any questions. For more information be sure to check out the International Cesarean Awareness Network Blog.

Knowing what happens before, during, and after a cesarean birth is helpful for moms who are scheduled to have a cesarean, but also for any mom approaching birth. It’s common not to want to learn about something you so desperately want to avoid, but educating yourself about a cesarean — even just a little — will help prepare you for all possibilities in birth, which could help ease your fears about the process should you need one.

There are several resources on cesarean around the web. About.com/pregnancy, however, seems to have the most complete, succinct, and practical resources. The author of About.com’s pregnancy resources is Robin Weiss, a Lamaze Certified Childbirth Educator, a doula and doula trainer (DONA), a childbirth educator trainer, author of several maternal/child care books, and mom to eight children.

Moms who plan to have a vaginal birth, but want to know more about a cesarean, may want to read:

 

Moms who have a scheduled cesarean may want to read:

 

All expectant moms can benefit from reading the following:

Thoughts on Birth the Second Time Around

By Caitlin Tucker

I knew right away this time around — I started to feel those familiar signs of pregnancy, cramps, tiredness and nausea. I took a test the first day of my missed period this time and those two little lines came up. My husband and I were very excited! Of course, I have the usually worries throughout the first trimester and the excitement to hear that little heart beat for the first time. For my daughter, who is now 15 months old, we took the typical route of care. We went to my family doctor to confirm that the home test was right, I stayed in their care until I was 28 weeks along and then I transferred care to an obstetrician for the remainder of my pregnancy. I felt confident with both my family doctor and obstetrician, and in spite of the quick visits  and long waits in the waiting room, I was satisfied overall.

We also took the typical labour and delivery classes through our local hospital. I remember only learning what to do once we got to the hospital and how to be admitted,  but not much about how to cope during labour. I figured, since I wanted a natural birth, it would just happen that way. I read a lot of books and spoke to a few of my friends that had already had babies. I wanted a non-medicated, natural and healthy birth. At 38 ½ weeks pregnant I felt my first contraction. After a few that were about 15 minutes apart, I let my husband know I thought early labour was starting. We arrived at the hospital when they were 1-3 minutes apart after about 5 hours of early labour. After about 7 hours more at the hospital, our little girl arrived at 5:43 a.m., weighing 6 pounds 15 ounces. We were relieved and so excited she had finally arrived! I think we were both just so happy she was healthy that it took a few months to come to the realization that my labour  did not go  the way I had hoped and planned. After I arrived at the hospital, I was set up on the fetal monitor and was continually monitored throughout my labour and wasn’t allowed off the hospital bed. In hindsight, I came to understand that being on one’s back during labour is one of the least comfortable positions in order to achieve a successful natural birth. I  laboured for 3 hours on the bed without medication, but as labour  got more intense and I wasn’t able to move around, the contractions became very difficult to cope with. My nurse was very nice, but didn’t offer any labour support and just kept her eyes on the baby monitor. My OB was also very nice, but as usual, she was on-call and was in and out of the room and also offered no support during labour other then medication options. Throughout my labour I was asked several times if I wanted an epidural and I kept saying “no” but after 3 hours and not knowing when it was going to end, I gave in and signed the form for the epidural. After taking the medication, I was relieved the pain was finally over. Two hours later, I was fully dilated.  After 2 more hours of directed pushing, our little one arrived.

Initially, we were satisfied with how things went and didn’t think too much about the disappointment that our natural birth plan didn’t happen. When I started to think about having more children, I realized how important it was to me to have a natural, healthy and safe birth. I started to read more books on natural births, watch documentaries, and educate myself. I spoke to my friends who had natural births and talked about what they did differently than myself. One major point that differed from my experience was that they prepared themselves by taking classes on how to cope with labour and had professional support with them during labour who encouraged and supported natural birth under safe situations. I continued my education on natural birth and it lead me to look into other care professionals that promote natural birth as a healthy part of life, instead of viewing the pain and experiences of natural childbirth as a burden.  When we found out that baby number two was on his/her way, I knew this was my opportunity to be as prepared as I could for labour this time around. I am now seeing a supportive midwife, enjoying their peaceful office with minimal wait times, and receiving encouragement to have a natural birth and continual support throughout labour and postpartum home visits. I believe that our bodies were designed to give birth that is inherently safe, and under most circumstances, women have the ability to give birth without medication, to move freely throughout labour. I believe that women need support from their friends, family, care givers and society as a whole to give birth naturally. It should be celebrated by women. Even though I’ve given birth once, I truly want to experience birth and have the support of my husband and midwife as they help me labour through the discomfort and bring another life into this world. I’m choosing not to be simply satisfied with my birth story – I want to be in awe of it.

 

Caitlin lives in Toronto, Canada, and is a wife and stay-at-home mother to one little girl and baby number two on the way. She and her husband are involved in their church and Caitlin helps run a mothers group on a bi-weekly basis. She recently enrolled in the Douglas College Lamaze Childbirth Educator Program and hopes to bring knowledge, empowerment, and encouragement to other women throughout their pregnancy and birth.

Don’t Just Hope for the Best — Plan for it: How to Write a Good Birth Plan

If writing a birth plan seems like a frivolous step to birthing your baby, you may want to reconsider. It is true that your baby will come whether or not you “plan” (or write a plan) for his entrance, but the act of writing about your upcoming birth can help you learn more about the care you’ll receive and the needs you may have during labor and birth. Writing a simple, informed and succinct birth plan helps you: consider and research the many choices available surrounding labor and birth; open a discussion with your care provider that can sometimes reveal surprising differences in your “vision” for birth; and provides useful information to your birth team.

While there’s no right or wrong in creating a birth plan, there are some things to consider to help you get the most out of the process and make it more likely that your care providers will read your plan.

A Birth Plan is Not a Script — or a “Plan”

You can plan your wedding day, you can plan a vacation, you can even make plans to build a house. The idea that you can “plan” a physiological event like birth is a bit of a misnomer. You can’t plan — or predict — exactly how labor and birth will unfold, but you can request preferences for you and your baby’s care during birth. With that in mind, it’s important to understand as you create your birth plan that birth is unpredictable and flexiblity is key. While certain birth plan requests, like allowing the baby’s cord to stop pulsing before being cut or delaying (or refusing) the Heb B newborn vaccine, should be observed regardless of the birth situation, other preferences may have to be amended depending on the health of both mom and baby.

Rixa Freeze, MA, PhD, a well-known birth advocacy blogger at Stand and Deliver who has written at length about birth plans, has this to say:

“…planning for birth is like preparing proactively for breastfeeding. There are the individual choices you make and have control over during pregnancy, such as provider or place of birth. There are the institutional protocols and provider preferences that will influence what happens to you during labor and birth. And then there are the unpredictable, uncontrollable events that may throw you a curveball during labor. Birth plans are primarily for the second category of events–navigating institutional routines and employee protocols that may or may not be what you want, and may or not be beneficial for you or your baby.

Involve Your Partner and Your Provider

Writing your birth plan is not a one-woman-show, but rather a group effort. Talk to you care provider about your birth plan preferences — are they in line with your care provider’s philosophy or what she will even allow? Are they in line with typical hospital protocols? If your birth plan is chock full of requests that go against standard hospital protocols or ask for tools (bath tub, wireless fetal monitoring, birth stool, nitrous oxide) that aren’t available, you might be disappointed on the big day. Involving your providers in your birth planning process will help you understand alternative options to achieve the care you desire or perhaps, seek a different care provider or place of birth.

Write an Outline, Not an Essay

Remember the “succinct” part I mentioned above? There’s good reason to keep birth plans short and sweet. For one, your care providers and birth team have will have limited time, especially on the day of your birth. If they are presented with a two and-a-half page, text-heavy document to read, it will most likely not happen. Create a birth plan that is easy-to-read and short (one side of a one 8.5 x 11 page is great!), with bulleted text and only the necessary details. For example, I didn’t include on my birth plan that I wanted to eat and drink as necessary — I just did it.

The Specifics

To help you get started, use the following questions as a prompt for writing your birth plan.

What message would you like for your care providers to read first? Here’s a sample of an opening message:

Thank you for taking the time in advance to read our birth preferences. We realize that unexpected circumstances do arise and do not intend this as a “script” for our birth. We hope you will be able to keep us informed and aware of our options. Thank you!

What would you like for pain relief during labor (narcotic or non-narcotic)?

What routine interventions do you want to avoid (IV, continuous fetal monitoring, etc.)

How would you like to be able to push? As you feel the urge? In a position that feels most comfortable to you?

Who would you like to announce baby’s gender (if you don’t already know)?

Would you like baby’s cord to stop pulsing before being cut? Who would you like to cut the cord?

Unless there is an emergency situation, would you like immediate, uninterrupted skin-to-skin contact with your baby?

Would you like the staff to delay routine newborn procedures (weighing, washing) until after your baby has breastfed?

What routine newborn procedures would you like to avoid or include (eye ointment, Hep B vaccine, vitamin K shot, baby bath)?

How will you feed your baby? Do you wish to avoid bottles or pacifiers?

Even if you don’t “plan” on a cesarean, it’s important to include cesarean preferences, just in case. The following are examples of those preferences:

  • Please allow partner/dad to be present at all times.
  • Please allow doula to be present. (This is sometimes against hospital policy, but it doesn’t hurt to ask.)
  • Please allow dad to announce baby’s gender.
  • Please allow baby’s cord to stop pulsing before cutting. Dad would like to cut cord.
  • Please allow mom to have skin-to-skin contact with the baby in the OR. (Skin-to-skin in the operating room after a cesarean surgery is not standard, though it is starting to happen in a few locations across the United States. When mom is not under general anesthesia for a cesarean, this should be a reasonable request and will help with the initial mother-baby bonding that might have otherwise been missed.)

 

If you’ve written a birth plan, what tips can you offer? How did your birth plan help you?


Questions to Ask During Labor and Birth

Labor and birth can be unpredictable. It’s smart to be prepared with questions to ask to decide if what your provider is recommending is needed and right for you. Keep the following questions in mind, especially when you hear words like “induction,” “fetal monitoring,” “episiotomy” and “C-section.” Also keep in mind that it can be helpful to have a support person with you who can help you navigate the important choices and decisions you will be making.

  1. Is my baby in any danger? Am I in any danger?
    Asking about the safety and health of you and your baby can steer you to the safest, healthiest outcome. If the answer is “no” to both questions, it’s more than likely that the intervention your provider is recommending is not needed.
  2. What happens if I go through with this intervention? What are the risks and benefits?
    Most health care providers want a laboring woman to feel comfortable, so there’s a tendency to answer questions like this with, “It’s really safe,” or “I don’t usually see a problem with this.” But, all interventions have pros and cons. If you know what they are, you can weigh your options and make the best, most informed choices.
  3. What does the research say?
    Not all medical practices are based on the best research. In fact, the majority of interventions are shown to be overused and often unnecessary. As your care provider, he or she should know whether the intervention is backed by science.
  4. Is there another alternative?
    There are plenty of alternatives to common interventions. For example, epidurals are not the only option for pain management; movement during labor, pressure points and breathing exercises are natural ways to help with pain relief. Consider the alternatives first, so you can get the care that’s right for you and your baby. Lamaze childbirth education classes can help you identify very practical, effective alternatives to ease the pain.

Communicating with Your Care Provider: Are You on the Same Page?

By Anna Deligio, MSW, Labor Doula, LCCE, Reiki Master

 

First, do no harm.

This instructional value statement is often attributed to different versions of the Hippocratic oath medical doctors take as they embark on their healing careers.  It seems simple enough and certainly it would be easy enough to assume that its interpretation is universal.

We all know what happens to you and me when we assume, though, and to do so within conversations with your medical practitioner can often lead to more than just a need for clarification. Ensuring that a shared understanding exists of the language being used is critical to ensuring that you receive the care that is best for you.

Take the idea of “doing no harm.” Let’s say you’re in active labor and have been going strong for some time without any medicated pain management. You are working through your contractions well but are tired, overwhelmed, and lacking good support. You are starting to feel like you may not be able to continue without medication. The next time your nurse comes in, you say that you’d like to talk about getting an epidural. The nurse alerts anesthesia and soon you are talking with that person about the potential of getting an epidural.

Drawing on what you learned during your pregnancy from your own research and your childbirth preparation class, you know that epidurals can come with increased risks. You ask the anesthesiologist if the epidural will harm your baby. The anesthesiologist gives you a quick and confidant “absolutely not.”

Does that mean that you move forward with the procedure? Not necessarily. First it is important to make sure both of you are operating from the same understanding of “harm.” You might be thinking that “harm” includes the potential for a sleepy baby after the birth and one who may struggle to establish good breast-feeding. The anesthesiologist may be thinking that “harm” means the epidural would kill or permanently damage your baby.  Without clarifying follow-up questions such as “What impact will it have on the baby?” and “How long can I expect that impact to last after the birth?” you are risking approving a procedure that is not in line with your values of birth.

An online search for “tips on communicating with doctors” reveals a theme of writing down questions before the appointment, remembering that you are the consumer, bringing someone with you to appointments, and writing down the answers you get. Added to this needs to be, “ask clarifying questions until you are confident that you and your provider are using the same definitions for words.”

In many childbirth preparation classes, the acronym BRAIN is used to teach participants what questions to ask when faced with a decision. The letters cover the Benefits, Risks, Alternatives, your Intuition, and the potential of doing Nothing and are a way to remember which questions to ask in order to ensure that the procedure undertaken is the one you want.  This model is a wonderful first step, but can still lead to miscommunication if clarification of terms is not established through follow-up questions.

This can be a laborious process and not one you necessarily want to step into during your labor. More the reason to have these conversations during your prenatal visits, write a succinct and clear birth plan, and make sure that you have a support person with you during labor who understands your intent during the birth and can support you in communicating that intent to your medical staff.

Language is wonderful in its ability to convey specific ideas and still leave room for interpretation. While it may be fun to explore the intended meaning behind words when reading a piece of creative writing, it is critical to explore the intended meaning when discussing your care with your medical provider.

Insurance and funding permitting, the ability to pick a provider from the start that shares your values will go a long way in making sure language meaning is shared. That said, you will likely interact with many medical providers during your labor and, like us, each brings his/her own lens, values, histories, and definitions to the conversation.

Practicing asking clarifying questions during your appointments will give you the confidence needed to draw on that tool during your labor with each provider with whom you interact. Each question will get you closer to creating a shared understanding with your providers and build your confidence in your ability to participate actively in the labor you intend to have.

 

Anna Deligio is a Lamaze Certified Childbirth Educator and Labor Doula through her business Nourishing Roots, work that is greatly informed by her previous experiences as an MSW working with families in crisis and babies in foster care, a Special Education teacher of high school students with learning and emotional challenges, a marketing writer, and a waitress at a French restaurant. She loves working with pregnant people and their support people during the transformative time that is pregnancy and birth. When not enjoying the company of pregnant people, she enjoys relaxing with her partner Cathy at their home in Salem, OR.

 

Cesarean Awareness Month: Making Your Cesarean Mother-Baby Friendly

April is Cesarean Awareness Month. What should you be aware of? Be aware that a cesarean, while it can be a life-saving procedure for mom and baby, is often prescribed when vaginal birth is a safe and sound option. Be aware that you have options, that you have a right to ask questions, and a right to know your risks. Educating yourself about birth is your best and first defense against an unnecessary cesarean. 

Throughout the month, Giving Birth with Confidence will be posting cesarean resources for moms. We encourage you to add comments with your experience as well as any questions — we will tag cesarean questions and answer them in a subsequent post. For more information and stories this month, check out the International Cesarean Awareness Network Blog.

Making Your Cesarean Mother-Baby Friendly

By Sharon Muza, CD(DONA), BDT(DONA), LCCE, FACCE

You may find yourself headed for a cesarean birth, even when that was not what you planned.  A cesarean might have been in the cards all along for a variety of reasons, or  this change in plans might occur before labor begins, or during labor, when you, your partner and health care providers feel that a cesarean is now the best option.

As a long time birth doula and Lamaze certified CBE, I always encourage my clients and students to plan for a potential cesarean, even though many mothers feel like that outcome is unlikely.  Current cesarean rates in theUnited States tell us that more than 1 in 3 women will give birth by cesarean this year.  Having a simple plan with some wishes that continue to honor the birth of your baby, can go a long way toward making the experience a positive one.

Here are my top tips to make your cesarean birth as mother-baby friendly as possible. Discuss these items in advance with your health care provider to see what is possible in your situation and in your place of birth.

1. If you know you are going to have a cesarean, without an opportunity to labor, discuss with your provider if there is any risk in letting the baby pick his/her birth date and you heading to the hospital when your water breaks or gentle contractions start.  There are many benefits to your body, your baby and future labors if you allow your baby to initiate labor.  There are certain situations that may preclude this from being an option available to you, like placenta previa, where the placenta covers the cervical opening.

2. When the decision is made to have a cesarean, and if time allows, take a moment to talk to your baby.  Let him or her know what will be happening, that you have confidence in your team and your baby and that you will soon be holding him or her in your arms.

3. Walk into the operating room if possible.  It is very empowering to move to the OR under your own steam, if you and the baby are stable.  If you have been laboring without an epidural or the cesarean is planned, anesthesia is usually done in the OR, so you should be able to walk there on your own.

4. Ask for two support people in the operating room with you.  Your partner can be one, of course, and then your doula, family or friend may also be included.  Having two people in the OR means that your partner can go over to greet your baby at the warmer, and you can still have support with you right by your head. If your baby needs immediate transfer to a special care nursery, your partner can go with the baby, without worrying about leaving you alone.

5. Bring in music of your choice that can be played during the birth.  A CD or even an mp3 or smartphone placed on the pillow near your head playing softly can help you remain relaxed and positive.

6. Ask that everyone in the room take a moment to introduce themselves before the surgery begins.  There are several more people than you might expect in the OR during a cesarean birth, and everyone may look the same, all gowned and masked.  It can feel a little more personal to hear the staff introduce themselves and state their job…”I am Mary and I am the baby nurse…” can help you to feel like it is not such an impersonal procedure.

7. If you were waiting to discover the sex of the baby at birth, you can still do that.  The staff and surgeons do not need to announce “boy or girl” but leave that to be discovered by you and your partner.

8. Ask if it is possible to delay cord clamping for even a very short amount of time, if baby is stable.  Even 30 seconds of continued pulsing can provide benefit to your baby.

9. Sometimes, women may feel a bit nauseous during the surgery.  It may be a result of the procedure, or nerves, or unfamiliar sights, sounds and smells.  Consider bringing a little cotton ball or gauze pad with some peppermint oil dabbed on it, in a Ziploc bag.  Peppermint oil can reduced the nauseous feeling and help you to not vomit.  There is medication that can be given to you during the operation, but it may also make you sleepy, so if you can avoid it, that is great.

10. Talk to your baby after s/he has been born.  Ask your partner to tell you what is going on, and what your baby looks like; “Oh, honey, he has the same long fingers as you do…” Talk or sing to your baby, so that your little one can hear your voice as it makes the transition to the outside world.  When your baby is brought over to you, you and your partner can sing happy birthday or a special song that you may have been singing to your baby during pregnancy.

11. Ask that all possible newborn procedures be delayed until after you have returned to your room with your baby and had a chance to breastfeed.  Unless it is critical to have the weight of the baby immediately, this measurement and other procedures, (Vitamin K, eye antibiotic medication, dressing, etc.) may be able to wait until you and your baby have had a good snuggle and a breastfeeding session back in your room.

12. Ask if it is possible to get skin to skin with your baby in the OR, while your incision is being closed.  Prepare for this in advance by having removed or unsnapped your gown, and having just a warm blanket on top of you, ready for the baby.  While the baby may not be able to breastfeed in the OR, while you are on the table, you can certainly have the closeness and skin-to-skin snuggles.  You will always need some support during this time, so make sure that partner knows to keep their hands on the baby for safety.  If you are unable or prefer not to have skin-to-skin in the OR, consider letting your partner have some skin-to-skin time with the baby while sitting next to you.  Wearing a shirt that opens in the front, or even a t-shirt that has been cut a little down the neck will make it easier to slip your naked little one inside their OR gown or scrubs.

13. Ask that your uterus not be exteriorized during the procedure.  Exteriorizing your uterus is when the surgeon moves the uterus out of your body and onto the sterile field for examination and repair.  Studies show that postpartum pain after the surgery is greater when this has occurred and offers no benefits over doing the repair “in situ” (in position).

14. Ask that your uterus be double-layer sutured.  While current research is not clear that this provides any advantage over single-layer suturing, should you wish to attempt a vaginal birth after a cesarean with a subsequent pregnancy, some physicians are more comfortable and supportive of this VBAC attempt if there has been double layer suturing during the repair.

15. When you return to your room and get a chance to spend those first minutes really holding your baby and initiating breastfeeding, try and keep visitors and guests away for just a little bit, so you and your baby can get a chance to get acquainted on the outside.  This time is precious and the fewer distractions the better, to help you and your baby connect and bond.

A cesarean birth, whether expected or unplanned, offers unique challenges and circumstances for you and your baby.  It is helpful to recognize that a cesarean birth is still a birth, and you can prepare in advance by including plans for a birth on your terms, even when it occurs in the operating room.

 

Sharon Muza, CD(DONA), BDT(DONA), LCCE, FACCE is a birth doula, doula trainer and Lamaze certified childbirth educator in Seattle, WA.  Sharon is also the co-leader of the Seattle chapter of the International Cesarean Awareness Network, (ICAN.)  Sharon can be reached through her website, www.newmoonbirth.com, if you would like more information or need some support in planning your birth.