Planning a gentle cesarean birth

The motto of the doula world is “you always have options” — yep, even in a cesarean birth! Consumer demand has opened up a whole host of options for making cesarean births more “family-centered.” Do you know what choices you have if your baby will be born via chosen or necessary cesarean?* I encourage every birthing person to formulate a “Plan C(esarean),” regardless of your greater birth vision, to ensure that you will be informed and prepared in the event of a cesarean birth. So what should you consider?

Crafting your birth vision for a gentle cesarean

Below are some options that may be available and possible at your birthing location. Think through them and try to envision how you would want your cesarean birth to unfold — it’s your birth!

Environment

A mama watches her son be born through a clear drape (Newton-Wellesley Hospital).

A mama watches her son be born through a clear drape (Newton-Wellesley Hospital).

  • Low lighting in the OR with a spotlight to guide the surgeon

  • Music of your choice playing near your head — make a birth playlist!

  • No chatter about the staff’s weekend plans

  • Essential oils of your choice on a cotton round near your head

  • Affirmations placed near your head or within your line of sight (start internalizing them in advance — your birth is worthy. your body is capable. you are making the right choice for you and your baby.)

Procedure

  • An epidural or spinal block, avoiding general anesthesia unless medically necessary

  • No additional medications (e.g. for anxiety or nausea) administered unless requested

  • Pulse oximeter (the little clip-on monitor for your oxygen saturation) placed on toe instead of finger and EKG electrodes attached higher on chest, both out of the way of skin-to-skin bonding

  • IV placed in non-dominant hand

  • Arms not strapped down

  • Clear drape or drape that can be lowered as baby is born, if you wish to view their birth

  • Slow emergence of baby so they get squeezed on their way out

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Accompaniment

  • Your partner or support person present for pre-operative preparation

  • Your doula (or a second support person) in the OR!

    • It’s worth pausing to talk about what a doula can do for you in the OR. Just like during a vaginal birth, support depends on what your individual needs are. I’ve held hands, narrated procedures, taken photos, facilitated breathing exercises, used essential oils like peppermint and lavender to cover surgery smells and calm a birthing person’s nerves, distracted birthing people with small talk so procedures could be done safely, grounded partners, and simply been present. I encourage all my clients to think about what a safe and healthy cesarean looks like for them in advance — envisioning it doesn’t make it more likely to happen, but it does make it more likely that you will be informed and prepared to handle a change of plans!

  • Anesthesiologist or surgeon explaining procedure as it happens

Birth

The Birth of Koa. Captured by Shirley Anne Photography.

  • Photos taken by support person or birth photographer, as in the case of Koa’s birth captured by Shirley Anne!

  • Delayed cord clamping

  • Placenta kept for encapsulation, burial, or other ritual

  • Vaginal seeding, or swabbing baby with bacteria from your vaginal canal in order to help them develop a healthy microbiome

Post-birth

  • Quiet so baby can hear your voices first

  • No announcement of genitalia by staff

  • Skin-to-skin time and breast/chestfeeding in the OR

  • Newborn procedures can wait — delay the bath, weighing, vitamin K shot, etc. so baby can have as much time as possible with you during that golden hour

  • Binder for abdominal support

Working with your birthing location

In our area, the acceptance of a second support person in the operating room during a cesarean varies widely from place to place (and even within places, depending on the surgical/anesthesia team on shift during any given birth). I’ve recently accompanied birthing people at Brigham and Women’s Hospital and Newton-Wellesley Hospital and have heard of some openness to doulas in the OR at Mt. Auburn, Tufts, and St. Elizabeth’s; however, this is always changing and is far from guaranteed! (If you’re reading this from somewhere besides Boston, feel free to chime in with any specifics about your geographical location.)

The best way to make sure your birth vision will be respected by your providers is to have open and honest conversations with them during pregnancy. (If your provider doesn’t align with your birth goals, it’s also worth considering seeking out a provider and place where you are more supported.) Work with your doula and partner(s) to create a birth vision for a cesarean birth (I love The Birth Plan Co.’s visual ones) and share it with your provider early on in the process! Whether your cesarean is planned or not, you have choices and ownership over your birth experience. Happy birthing!

*Sometimes cesarean births are necessary; sometimes they are not. Our current cesarean epidemic is a topic for another day. If you’re interested in learning more about your birthing location and cesarean rates, I recommend Jill Arnold’s project Cesarean Rates or Amino’s interactive map based on zip code.