This article was first published as ‘What If I Must Have A Caesarian Birth? Making It As Woman-Centred and Empowering As Possible’ on www.birthgoddess.com.au.
As a first-time mum preparing for a natural birth, I did pre-natal yoga, I memorised birth affirmations, hired a TENS machine and prayed for the best. One thing I did not do, however, is read the ‘Caesarean Section’ of the birth books on my bedside table. When the midwives set up a faux Caesarean birth as an antenatal education activity, I daydreamed about better things – my active labour, my drug-free experience of pain and my baby coming out of my vagina.
It therefore comes as no surprise that, when my normal, low-risk pregnancy ended in an ‘emergency’ Caesarean, I was totally unprepared, shocked and – ultimately – traumatised. While time, hindsight and more robust knowledge has shown me that my surgical birth was at best a statistic and, at worst, a medically unnecessary event , our first-born’s arrival Earthside changed the course of my life, and for this I am thankful.
Courtesy of that experience of birth (which was a crash course in being a savvy health services consumer!), I found a new calling connecting with mothers who are planning their ‘next birth after Caesarean’. In the five years since this birth, I have supported many women who have sought to make sense of their Caesarean births and assess the birth options available to them next time. I am always struck by the similarities of our stories: it is the shared nature of our experiences which allows me to share the following ideas for making the birth experience as positive, empowering and woman-centred as possible. Whether you are planning a Caesarean out of necessity or unexpectedly, you’ll see that there are lots of things you can proactively do to ensure the experience is the best possible one for you and your baby.
N.B. Please discuss the following with your partner, birth team and doctor – as always, make sure you seek medical advice from trained professionals and, if in doubt, seek a second or third opinion.
PLANNING FOR A POSITIVE, EMPOWERED CAESAREAN
Make the environment as comfortable as possible
– Have your partner present. Ask the hospital ahead of time if you can have extra support people (such as doulas) present in theatre.
– Take music to listen to as they prep you for surgery.
– Ask for lights to be dimmed or directed away from your face. Alternatively, consider closing your eyes and visiting your meditation place.
– Ask for conversation to be kept minimal and quiet or, if preferred, indicate your desire for a light-hearted, jovial atmosphere.
– Ask your hospital if you can provide the receiving blanket for your baby.
Connect with your body and baby during birth
– Request that the sheet is lowered so that you can see more of what is happening – this may make you feel more involved and less passive.
– Ask the surgeon to give you a verbal commentary on what is happening to your body.
– Ask a theatre nurse to raise your upper half slightly so that you feel more ‘active’.
– Visualise your whole body during surgery – scan your awareness from your head to your toes and back again, filling every corner of your body with white light. Even though you will not be able to feel your lower half, mentally reminding yourself of your wholeness may help you to overcome any feelings of physical disconnection.
– Research ‘maternally assisted Caesarean’ – this option may be available with some providers and may appeal to some.
– Discover the sex of your own baby.
A physically mindful experience
– If your Caesarean is elective, waiting until spontaneous labour begins before being admitted for the birth is one way to offer your baby some of the benefits of natural labour.
– Ensure your surgeon performs a ‘lower segment Caesarean section’ (LSCS) – the lower segment is the strongest part of the uterus which means LSCS scars are less likely to rupture in subsequent pregnancies and births. (The upper segment is usually only cut in ‘classical’ Caesareans which are quite rare in Australia.)
– Some surgeons flip the uterus outside of a woman’s body in order to complete the stitching of the incision – avoiding this method of closure can help minimise the feeling of internal bruising post-Caesarean.
– Ask for stitches instead of staples, and discuss the advantages of a double layer closure for healing and future VBAC chances.
– Request a Caesarean lotus birth – this is one way to ensure delayed cord clamping and these are possible.
Bonding with your baby
– In the absence of foetal distress, many post-birth assessments can be performed on your chest (or later!). Ask those present to assist you to hold your baby so that you can enjoy skin-to-skin contact as soon as possible after birth.
– Some hospitals routinely separate mother from baby, taking Baby to nursery while Mum is in Recovery. Ask ahead of time whether this is standard procedure at your hospital, and negotiate to have Baby stay with you instead.
– Begin breastfeeding in Recovery. If this is not possible, arrange to express colostrum and have this fed to your baby.
A gentle babymoon
– Whilst a Caesarean is a birth, it is also major abdominal surgery. In the excitement of birth, your recent experience of surgery can be quickly forgotten. If you had gone in for uterine surgery under different circumstances, you would take time out from home duties, accept offers of help and give your body time to heal. Caesarean birth is no different!
– Give people things to do when they come to visit – folded washing, a mopped floor and a meal for the freezer are great ways for people to support your babymoon.
– Invest in some SRC shorts, TubiGrip or shapewear – these can help to offer abdominal support when your incision site feels vulnerable. The Bengkung method of belly binding may also be beneficial once the initial tenderness of your wound has settled.
– Rest, rest, rest. Plan to do nothing but breastfeed your baby and rest. (The rest can wait!)
– Take your placenta home with you so that you can return it to the earth, giving thanks for its role in nourishing your baby.
– Plan a ‘birth sealing’ ceremony to symbolically close your body after birth – this is a particularly useful exercise if your Caesarean has left you feeling open, vulnerable and/or disconnected physically from your body.
 Whilst my ‘unnecesarean’ birth is a symptom of a system of maternity services which sections approximately one third of Australian women giving birth each year, there will always be a proportion of women and babies for whom a Caesarean delivery is genuinely the safest option – the World Health Organization has historically cited a 15% Caesarean section rate as the upper limit for a system which is providing Caesareans to women and babies who need them*.
*“… when caesarean section rates rise above 15%, risks of adverse health outcomes begin to outweigh the benefits.” – Einarsdóttir K, Kemp A, Haggar FA, Moorin RE, Gunnell AS, et al. (2012) Increase in Caesarean Deliveries after the Australian Private Health Insurance Incentive Policy Reforms.