Monday, March 08, 2010

When A Cesarean IS Necessary ~ making a plan.

Our guest blogger is Desirre Andrews, President of ICAN ~ the International Cesarean Awareness Network. The International Cesarean Awareness Network, Inc. ICAN is a nonprofit organization that was founded by Esther Booth Zorn in 1982. Their mission is to improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery, and promoting Vaginal Birth After Cesarean (VBAC).

In the event a cesarean is needed to bring your baby into the world, there are still many options available for you and your baby that can help bring the spirit of a vaginal birth into the OR. The tip sheet below is a guide in planning the big day, as a conversational piece with your provider, and a working “Birth Plan” to make into your own. You may find that in addition to speaking with your OB, you may need to contact the nurse manager and the anesthesiology department to set-up the important details for the day your baby’s birthday.

Cesarean Planning Tip Sheet

It is very important to me that though this is a surgical delivery that it is as family centered and intimate as possible. My requests are to help bridge the gap between a vaginal birth and a routine cesarean for me and my baby. I also understand that though my requests may not be standard protocol, that they are reasonable and doable.
  • I prefer to walk into OR and greet and be greeted by every staff person by name.
  • I would like my husband/partner present/doula present.
  • Epidural/Spinal – please no amnesia meds as I want to remember everything.
  • I would like at least one arm free and my gown open on top.
  • Lowered sterile drape to see my baby being “born”.
  • Please describe events as they are occurring with only essential conversation.
  • I would like my husband/partner/support person to take photographs and/or video.
  • My baby put skin to skin and assessments done on my chest (unless baby needs resuscitation)
  • To increase bonding and limit overstimulation to my baby
  • Limit contact with others outside of me and husband/partner/support person
  • Delay immunizations and eye ointment
  • Baby to stay with me and my husband/partner/support person in OR and in recovery
  • Immediate breastfeeding
  • No bathing of my baby until I can participate. Only basic swaddling .
  • No bottles, pacifiers or formula.
  • In the event of medically necessary separation of me and my baby
  • Initial wipe down towel given to me for smell/fluid transfer
  • No bathing or complete dressing of my baby until I can participate later.
  • No contact with others except for my husband/partner/support person and nursery nurse.
  • If baby must be fed. Hand express from me and spoon or syringe feed colostrum to baby
  • I would like my secondary support person (doula) to remain with me so I am never alone.

Some other considerations:

Think about asking for a vaginal swabbing with a sterile towel to then colonize baby with expected bacteria in the mouth and eyes. Anecdotal, however, may be helpful to baby since did not pass through your vagina.

Ask physician what type of suture material and technique will be used. Synthetic material with non-interlocking weave appear to be the best for next pregnancy and VBAC safety. Single layer suturing also has less infection rate and easier recovery associated with it.

In looking ahead to recovery, your hospital stay will likely be between 2-4 days. Practicing deep breathing techniques and getting out of bed to move around your room are helpful in initial healing. Oral medications are often given for pain relief. It is important to stay ahead of surgical pain in order to breastfeed comfortably. It is fairly common for there to be tissue swelling from the intravenous fluids. If breastfeeding becomes difficult, seek out the lactation consultant. Tissue engorgement is not the same as milk engorgement.

Recovery Helpful Hints:

  • Stay hydrated.
  • Get a small amount of exercise every day.
  • Have extra support at home to take care of everyday details so you can be with your baby.
  • Make meals ahead and freeze and/or have others bring in meals.
  • Take it easy for at least the first two weeks. Recovery can take many weeks. Overdoing it is very easy to do.
  • Have a pillow available to add pressure support to wound area in order to simplify getting up and down, coughing, being in the car, and rolling over.
  • Be patient with your baby and breastfeeding. Your mature milk may not come in right away (up to day 5 to 7 since no labor occurred). Allowing baby to feed frequently with most often provide enough food and help bring your milk in faster. Please have lactation help available and it is a good idea to have a home visit the day you come home from the hospital.
  • As with vaginal birth your postpartum bleeding should ebb off. If it picks up and becomes bright red. Slow down and rest.

Be aware of signs of post surgical infection. Contact your provider immediately and be seen if you experience any of these or a combination of them.

  • Exhaustion with overall achiness
  • Fever
  • Unpleasant odor from wound site
  • Pus or more than clear discharge from wound site
  • Heat, redness or swelling in area of the wound site.

Beware of signs for postpartum mood disorders – anxiety and/or depression. Be seen immediately.

Lastly be gentle on yourself. Having a baby to care for is a big work by itself. Having a baby to care for and major abdominal surgery is an even bigger work.

For more information visit and resources visit: ICAN at for recovery support, education, and more!

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