Friday, April 3, 2015

Family-Centered Cesarean

April is Cesarean Awareness Month.  Currently, about 1 in 3 births occur via cesarean in the U.S and cesareans are the most common surgical procedure worldwide.

As with any birth, when planning a cesarean birth you have options to explore and the right to consider what you want for your experience and your baby's birth.

Often, moms giving birth by cesarean feel they miss out on being an active participant in the birth, making decisions from a variety of choices like those presented as part of a vaginal birth. A surgical birth doesn't mean you're merely a passive participant.  This is your baby's birth, your body, and your birth experience and often you do have choices available to you.

Enter the family-centered cesarean.  Also called a gentle cesarean or natural cesarean, a family-centered cesarean is about recognizing that cesarean birth is birth and not just a medical procedure. It's about celebrating life and family and asking you what your hopes and desires are for the special moment when your baby enters this world.

When considering options for birth I think it's prudent for all families to consider what their preferences are regarding cesarean birth because you never know exactly what your journey to birth will be.

Some options you might consider for cesarean birth:

  • In the event of a planned cesarean, wait for labor to begin on its own before birthing by cesarean.  

  • Schedule for the earliest time slot available.  The birth is more likely to happen on schedule (or close to) and you will be asked not to eat after midnight the night before so you won't have to go all day without food.

  • Discuss the procedure ahead of time.  Have your care provider walk you through what to expect, what type of closure they prefer and why, what your anesthesia options are, what kind of dressing they prefer and why, what pain medication will be available to you after the birth, will there be a support band offered during your recovery, etc.

  • Your birth partner and/or doula, or other support person be allowed to support you emotionally throughout the birth including pre-op, the O.R., and recovery.

  • Have your partner apply an essential oil or scented lotion that appeals to you on your chest, upper lip, wrists, or even their wrist for you to smell throughout the birth.  A good scent option is lavender.

  • Dim surrounding lights to create a more relaxing atmosphere.  

  • Play music out loud, an alternative might be to wear headphones.  

  • Keep non-medically necessary chit-chat to a minimum among the medical staff.

  • Place pulse oximeter on your foot to allow your hands to remain as free as possible. Place ECG leads somewhere other than your chest so it's free to receive baby after birth.

  • Do not administer supplemental oxygen unless medically necessary

  • Arms remain free of restraints

  • Warm blanket be placed on you once pain medication has been administered.

  • Have your doctor, nurse, or doula inform you of what is going on with the birth throughout.

  • Lower the drape and slightly raise the head of the table so you can watch your baby coming into the world.  An alternative could be a clear drape or mirrors.

  • Allow baby's birth to occur slowly with a more "hands off" approach.  Once baby's head is born they can begin to breathe while still attached to the placenta, allowing time for uterine contractions to squeeze fluid out of their lungs and auto-resuscitate similar to a vaginal birth.  

  • Reach down and assist with helping baby from your womb.

  • Take pictures, video tape the birth, and/or record your baby's first cries.  Ask that your birth photographer be present to document the birth.

  • Allow baby's cord to stop pulsating before it is clamped and cut.  Ask that your partner be allowed to cut the cord.  

  • Place baby skin-to-skin on your chest as soon as possible after birth.  Your partner can help support baby on your chest while your medical team is completing the surgery. If you are unable to be skin-to-skin ask that baby be placed skin-to-skin with your partner. 

  • Swab baby with vaginal fluids to seed microbiome.

  • You, your baby, your partner, and doula or other support person(s) transition to recovery together and baby is not separated from you after birth unless medically necessary.  In the event that baby must go to the nursery for medical need, ask that your partner be allowed to accompany them while your doula or another support person remains with you in recovery.  

  • Warm blankets and plenty of pillows be made available to you in recovery.  

  • Lactation support be made available to you in recovery so that baby may begin breastfeeding as soon as they are ready.  It's possible you may need some help getting baby situated and yourself comfortably supported to allow for this to happen.  

These are merely a list of options to consider.  There is no one right way to birth by cesarean just as there's no one right way to birth vaginally.  Any preferences will need to be discussed with your care provider ahead of time and then again immediately before the birth with the other care providers who will be involved, especially the anesthesiologist.  You can contact the hospital ahead of time to find out if they routinely offer family-centered cesareans.  And remember, you are a consumer.  If necessary and possible, feel confident in shopping around to find the right care provider and birth location for you.

Family-centered cesareans are gaining in popularity and accessibility with major media outlets reporting on the topic and hospitals beginning to implement some family-centered practices as standard for uncomplicated cesarean births.  Individual birth experiences can be so profoundly impacted when personal preferences are considered by a supportive birth team and family-centered births are the heart of positive experiences.

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