Doula Services

A Step-by-Step Guide to Preparing for a Cesarean Birth

While an OR is not where we typically plan to birth, there are times when it is necessary. The bright lights, cold room, lots of masked and unfamiliar people along with the fast pace of a sterile operating room tend to make even the calmest parents-to-be a little nervous. By gaining a basic understanding of the procedures that will occur before, during and after surgery, you can feel prepared, and that may help alleviate any undue stress surrounding your baby’s birth. Here is a step-by-step outline of what to expect and how to prepare for your own abdominal birth experience.

Packing for Your Hospital Stay

While most women stay in the hospital for two days after a vaginal delivery, those who deliver by C-section usually stay for three to five days, and occasionally longer. Be sure to pack a bag with enough comfortable clothes for your hospital stay. Look for soft clothes that either zip or button to allow for skin-to-skin contact and easy nursing. I preferred low-cut, soft, stretchy nightgowns, long cotton dresses and high-waisted skirts instead of pants, but if you do pack pants, make sure they have loose elastic and can be worn high on your waist. Hospital rooms tend to be cool, and often your hormones and medications can cause your body temperature to fluctuate. Pack layers. warm socks or slippers, a couple of zippered sweatshirts, cardigans or a robe. Also include toiletries such as toothpaste and toothbrush, lotion, brush, makeup and soap.

After surgery you may feel feel exhausted, sore and emotional. Having special items can help you feel more like yourself. Sometimes a nice-smelling bath soap, your favorite lip gloss, freshly painted nails or extra moisturizer can provide just the pick-me-up you may need while recovering from your surgery.

Ask Questions and Write a Birth Plan

While an OR is not an ideal space to deliver a baby, there are ways to make the environment more conducive to having a baby. You can meet the people who will be in the OR ahead of time. play your favorite music, ask for the lights to be dim except for the surgery light, have skin-to-skin contact or photographs of the birth.

When writing any birth plan it is important to keep your tone kind, positive and direct. No one responds to orders, attacks and conflict with complete grace. It is also important to keep it to one page, if possible. Doctors and hospitals tend to be busy, so the more concise your birth plan is, the likelier they will take the time not only to read it but to understand and remember it.

You will want to ask yourself, your birth partner and your care provider lots of questions so that you have a clear image of what you want and what is possible. You don’t know unless you ask. Below is a list of helpful questions:

  • Who can be in the operating room with me? 
  • What staff will be in the operating room with us?
  • What kind of anesthesia will I have?
  • Can we reduce the amount of narcotics and have mostly paralytics?
  • What are the risks of a C-section?
  • Can I walk myself to the OR?
  • What are the risks of a C-section to my baby? 
  • How long will it take?
  • Do I want the surgeon to talk to me through the operation?
  • Will I be shaved before surgery? Can I shave myself beforehand?
  • After arriving, how long will I wait for the procedure to happen? 
  • Will I be strapped down?
  • What’s the recovery time?
  • Can I eat before surgery?
  • Where will my incision be?
  • How is my wound going to be closed up?
  • Can I hold my baby in the OR? If not, may my birth partner?
  • What will you do to ensure that breastfeeding is as easy as possible for me post-surgery?
  • What resources will be available to me at the hospital if I feel depressed post-surgery? 
  • Can I play my own music?
  • Can I wear my own gown? 
  • Can my partner announce the sex or cut the cord?
  • Can my partner or I watch my baby being born?
  • Can we keep my placenta?
  • Can we take pictures or videos?
  • Can we do delayed cord clamping?
  • Can you issue me a binder to help with my recovery?

Preparing for Surgery

Though hospital procedures may vary, there are general steps that most will follow when it comes to preoperative procedures. Before your operation day, you’ll probably have lab work, including blood and urine tests, to check for diabetes and other medical issues. You’ll meet with an anesthetist to discuss your options for anesthesia. You’ll also be reminded to refrain from eating or drinking for eight to 12 hours before your surgery.

Checking into the Hospital

Once you’ve arrived at the hospital, you’ll check in and be shown to your room, where you’ll change into a hospital gown. You can request to wear your own gown like these from pretty pushers if you prefer. They will also give you a cap to cover your hair. After you’ve undergone a physical assessment (which includes checking vital signs and reviewing your medical history), you’ll be started on an IV. Your abdomen will be shaved down to the pubic hair. You may want to shave yourself ahead of time to reduce the amount of ingrown hairs.  A nurse and an anesthetist will visit with you to review your birth plans, and you will sign a number of consent forms.

The Operation

When the time comes, a nurse will bring you and your partner to the operating room. They may have you go back first and then come back for your partner. They will have your partner put on a suit that zips over their clothes, booties that slip over their shoes, a cap to cover their hair, and a face mask. They often ask that they tie the mask on but do not have to pull it up to cover their mouth and nose until they walk into the OR. They will have your partner sit by your head.  It is likely that they will be prohibited from videotaping, and taking photos but I encourage you to ask ahead of time.

After an anesthetic is administered, you will lie down on an operating table and a catheter will be inserted to drain urine during your C-section and until you can attend to your own bathroom needs. They will then set up a curtain above your chest that blocks your and your partner’s view of the surgery, and they will secure your arms out from your sides to keep you from accidentally reaching into the sterile surgical area or moving.

If you have chosen regional anesthesia, the method generally preferred by doctors and hospitals, you’ll be awake during the operation. You won’t feel pain, but you will probably feel pressure and pulling throughout the procedure. You should be able to talk to your partner and your doctor during the procedure.

Post-Op

After giving birth, you’ll be allowed to see your baby before your doctor takes your newborn to be tested, measured and weighed. This is often done in the OR to the side of your table. You may request that they do this on your chest while the doctor stitches you up. If your baby or babies need to leave the OR, your partner can go with them and your surgical team will finish caring for you. For many new moms, this alone time can be hard; be sure to speak with your doctor or attending nurse to see if you can have another support person visit with you at this time, or if your spouse can return to the surgery room while your doctor closes your incision.

The Recovery 

Soon, your anesthesia will begin to wear off and you’ll start to feel sensation returning to your toes. It is not uncommon to feel shaky immediately after the cesarean section, this is due to the medication, nerves and temperature of the OR. Women are usually moved from the operating room to a recovery room (depends on the hospital) at this time so a nurse can tend to you as your anesthesia wears off.  They will often administer a medication called Piton to facilitate you uterus clamping down and shrinking back to size. It does this to prevent excessive bleeding. Early nursing can also help with this. Your nurse will also push on your abdomen to feel how soft or hard your fundus (the top part of your uterus) is. If it is soft the nurse will massage it to make it firm. This can often be uncomfortable.

Your fundus is checked often the first hour after delivery, and checked regularly after that. You may have “after pains” after giving birth. Contracting and relaxing of your uterus causes these pains. You may feel these pains for up to three days. The contractions get rid of the blood from inside the uterus and also help stop bleeding. These contractions may be stronger and hurt more while you breastfeed your baby. As the effects of the anesthesia wane, you may begin to start feeling discomfort around your incision. Medications will be available to help with this pain.

Breastfeeding

The anesthiea and any pain meds you are given should not affect your milk. There are many pain medications that are compatible with breastfeeding. Be aware that some medications can cause your baby to sleepy and can make breastfeeding challenging in the beginning.

Ideally, you’ll want to put your baby to breast within the first hour of their birth. You may have to nurse lying on your back, because you will likely still be under the effects of the spinal/epidural. Try positioning baby lying face down across your breasts (similar to cradle hold, but baby is higher up and away from your incision). Have your partner, nurse or hospital lactation consultant help you with positioning using pillows. You might want to bring a few extra pillows from home (or a nursing pillow), as hospital pillows are pretty small and flat.

Once you can turn over, try turning to one side and nursing in a side-lying position.

Many moms find the side-lying position the most comfortable during the first day or so. It’s an easy way to nurse and rest at the same time. Using a small blanket, or pillow – even a rolled up towel – can help protect your incision while you nurse lying down.

Below are step-by-step instructions on getting into the side-lying position (in a hospital bed) after a c-section:

  1. Begin with the bed in a flat position and side rails up.
  2. Use extra pillows behind the mother’s back for extra support.
  3. Carefully roll to one side while grasping the side rail and relaxing the abdominal muscles. Move slowly to avoid strain.
  4. To protect the incision from the baby’s kicking, cover the abdomen with a small pillow or towel.
  5. Place a pillow between the legs to minimize the strain on the stomach muscles.
  6. Lean back into the pillows behind the back.

When using side-lying position, baby should be placed on his side, facing your body, chest to chest, so he doesn’t have to turn his head to nurse. Baby’s feet should be drawn in close to your body with his head either lying on the bed, or on your arm, whichever feels most comfortable to you. You can either roll your body forward to latch, or pull the baby toward you.

Studies show that babies that do not get to breast within the first 4-6 hours have more difficulty breastfeeding and mom suffers from engourgment issues. If something prevents the baby from being put to breast within the first 4-6 hours, you should ask the nurse to help you begin pumping with a hospital-grade breast pump. Positions that can be helpful later on are the football hold and side lying.

The abrupt hormonal shift that occurs at the separation of the placenta from the uterus is what signals your milk to come in. Thus mom’s body will get the same signal whether she has a cesarean or vaginal birth. A stressful birth either abdominal or vaginal tends to lead to milk coming in later.

Visitors on Your Baby’s Birthday

It is not uncommon to become groggy and nauseated after a Cesarean operation, due to effects of the anesthesia. It is a good idea to limit visitors on the day of your procedure. Instead, plan on having guests come to see you and the baby in a day or two. Allow yourself the time you need to begin recovering from the surgery.

Recovery Time

Within 24 hours of the delivery, your catheter and IV will be removed and you’ll be helped out of bed so you can walk and move around. This is vital to get your circulation going and decrease your risk of blood clots. This can also help your bowls move some trapped gas from the surgery.  Though it will be difficult initially, standing and walking will actually help you to heal more rapidly. You will likely be hungry due to not eating prior to the procedure and possibly nursing. Make sure you ask for food before the kitchen closes or ask someone to bring you dinner.

Expect the Unexpected

Though the ability to plan ahead and schedule the date and time of your babies birth can be a bonus the unexpected could still happen. You may go in to spontaneous labor and require an emergency cesarean. They may also move your date around to prevent an emergent surgery. If your baby or babies arrive before 37 weeks they may have some symptoms associated with early babies.

It’s not uncommon for women who deliver via Cesarean to feel guilty about the procedure, even those with planned operations. Unfortunately people can say some really inappropriate things when a woman tells them she had or is planning a cesarean birth. A common one is “Well all that matters is that you have a healthy baby right?” wrong. That is not all that matters. You, the mother have to be healthy both phsyically and within to care for your child. You are allowed to grieve that the process may not have been what you imagined.  There are many online and local support groups where you can share your birth story. Often in telling or writing your story it can help you process your emotions and can reduce the emotional pain. There is also the possibility of planing a vaginal birth after cesarean commonly referred to as a VBAC.

Though planned Cesareans can still take unexpected turns and may not be your ideal birth, it can be reassuring to know that, for the most part, you still have the ability to prepare for one of the most exciting events in your life.  With a good birth plan and open communication between your provider and your birthing team, you’ll be able to have the best birth for you and your child (children).

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