When I first speak with a client considering hiring us for labor support, usually at some point in the conversation I ask if she has any idea about her birth plan, yet. Often, she’ll say, “I’d like to avoid a c-section.” And I get that. A lot of the fear around birth is actually wanting to prevent cesarean birth.
But as lovely as it sounds to say that our bodies were made to give birth, occasionally, that’s not what proves true.
Sometimes there’s a medical condition ahead of time that makes a vaginal birth unsafe- placenta previa, chronic health conditions for the mom or previous uterine surgeries are possible reasons. In that case, we have what’s called a planned cesarean.
Other times, labor does not go as everyone hoped. The birthing person, or baby may not be doing well. Often, giving labor more time, or an intervention resolves it. But cesarean births are sometimes the best way to prevent emergencies.
Let’s talk through what you can expect in either case:.
Planned Cesarean Birth
With a planned cesarean, the reason it’s happening will determine when your surgery is scheduled. For instance, you may have a baby who is breech (meaning they’re not facing head down). This means everyone is doing just fine, but if you’re living in an area where there aren’t providers who deliver breech babies a cesarean will be scheduled. Since the baby isn’t in danger and neither is the mother, those c-sections may be scheduled on your due date.
Other conditions mean that your doctor wants to prevent labor altogether, and may schedule your surgery sooner. Most likely your c-section won’t be scheduled prior to 37 weeks, so that your baby can develop.
You can expect to be given a time to check in at your hospital. At most hospitals, you’ll go to a labor room, or there may be another location where you wait. You can typically have your birth support team with you while you wait.
It’s likely that bloodwork and other testing will be done. Your provider will come in to answer questions, and you’ll meet the anesthesiologist as well.
Even if you were given a particular time, your delivery time may be moved if there are emergency situations happening in the labor and delivery unit that day. This is normal, and if it’s frustrating, it is not a reason.
Unplanned Cesarean Birth
When an unplanned cesarean birth happens, you’ve likely labored at home, or at your hospital and were expecting a vaginal birth.
I like to point out to students in birth classes, or our labor doula clients, that there are often signs for concern along the way, prior to a cesarean.
If you hear these things come up, it’s good to ask questions, and get an explanation. Keeping open lines of communication with your nurses, midwife or doctor can go a long way to making sure you feel like an active part of your birth, and not like it’s happening to you.
This also helps you know if there are alternatives that can give you the opportunity to prevent a cesarean.
Your doula can absolutely support you with this- this is often the “educational support” or “advocacy” that makes a difference. As a doula, I’m not in a position to overrule a doctor. Instead, we’re always working to balance making sure clients have honest information, and avoiding fear-mongering. Every little blip on a monitor is not meaningful, but we often ask nurses to explain repeated patterns that may cause concern.
One of the hardest things about unplanned cesareans is a sense of suprise, or an out of control feeling. Unless it’s a true emergency, we can work to prevent these feelings.
If a cesarean is considered the best option for you and your baby, here’s what happens:
Prior to the c-section, the person giving birth is taken to the operating room. There, doctors make sure that the area is clean, by sterilizing your belly. The anesthesiologist will give you medication that numbs you- more than a typical epidural. It’s important that you are not in any pain. You will typically be awake though, to meet your baby.
During this time, partners and loved ones wait outside the OR. They’ll join once everyone is ready, before the baby is born.
During the birth, a curtain will be placed between the mother, any support people and the birthing person’s abdomen, where surgery will happen. Your anesthesiologist will be near your head, but the OB will be beyond the curtain. A doctor for the baby will be there, as well as nurses and technicians.
Surgery involves cutting through skin, fat and muscle, moving other organs, and then cutting into the uterus to delivery the baby. As the one giving birth, you won’t see this beyond the curtain, but you will feel tugging.
Depending on the circumstances, you may be able to see and hold your baby quickly, but this is not standard procedure at every hospital. It’s not unusual for babies to be placed in the warmer (operating rooms are cold, and sometimes the surgery is happening for the safety of the baby so they need to be examined. When babies are born Your partner/ birth partner may be the first to meet the baby.
Typically if everyone is healthy, the baby and parent(s) will remain close together, and go to their labor room, or a recovery room at the same time.
While not everyone is aware of this, even during a cesarean, you can make a birth plan. What can you ask for, when you’re having a cesarean birth?
Prior to birth, you can ask for:
- A meeting with the anesthesiologist if it’s a planned cesarean
- To know what OBGYN will be performing the surgery (this one is important in group practices)
During your birth you might request:
- Your partner and doula to be in the operating room with you
- A hand free during the surgery (as opposed to both restrained. This allows you to hold someone’s hand, and touch or hold your baby)
- To have the birth explained to you as it happens
- To have music playing
- To see your baby be born over the drape
After your birth you may ask:
- To have your partner cut the umbilical cord and/or announce the baby’s sex
- For delayed cord clamping
- To hold your baby, have skin to skin time and breastfeed as soon as possible
- To have your placenta to take home
- For pictures to be taken of your baby
- For vaginal seeding, to give your baby good bacteria
Together, you might hear these choices called a “gentle cesarean”, or “family centered cesarean”.
As a doula, we aren’t only supporting vaginal birth. We’re there for you, no matter how your birth story unfolds.
What do doulas for c-sections?
Whether it’s planned, or happens after something has gone wrong in labor, we can first help our clients understand what’s going on- often by helping them figure out what to ask their doctor, or just slowing the conversation down (unless it’s an emergency).
We can let them know what to expect, practically speaking. And we can encourage them to tell their doctor if there’s something they want. All of this can be the difference between birth just happening to you, and you feeling a sense of control.
We’re also there for the loved ones, because whether planned or unplanned, the patient goes back in a cesarean, and their spouse, or mom is often just waiting. I’ve seen a lot of anxiety creep in about whether it’s all taking too long. We can talk them through that, and help settle their nerves. And we can remind them to take pictures!
Your doula is also a welcome face when everything is finished. We can talk through what’s happened, help you get skin to skin time with your baby. If clients are breastfeeding we can assist with that first positioning. I taught a dad to swaddle once, and helped another mom who was reacting to anesthesia (she was itchy) get wet wash cloths.
Once you’re home from the hospital, your doula can help you get set up well for recovery, and talk through any questions you still have. In fact, here’s some of what to expect during c-section recovery.
At the end of the day, remember cesarean births are births. And while all birth can be intimidating, it can also be a moment where you discover just how powerful your body is, no matter how your baby arrives.
