Planning your caesarean
There is a lot to
do when planning any birth and this includes a caesarean. The procedure will
not be booked until you reach approximately 30 weeks and at this point there are still lots of questions to ask, a birth plan to prepare and stories
to get straight.
These will be
personal to you and you should create as full a list as you think necessary.
Try not to feel intimidated once in front of the health professionals. They do
this every day, you do not, so it is reasonable for you to ask lots and lots of
questions. If you are not satisfied with the answers that you are given, keep
asking the questions until you are. Subjects you may want to ask about are:
- Hospital policies on caesareans
- Anaesthetic options available
- The hospitals specific approach to the whole procedure
- How you will first meet your baby
- As well as all your fine details relating to your birth plan
A birth plan is an
important consideration for any type of birth. It is not mandatory but it is a
useful tool for ensuring that you have discussed all your hopes and
requirements with the health professionals who are going to be looking after
you. This is particularly important if you have any requirements which are not
general practice i.e. determining the sex of your baby yourself or viewing the
placenta.
Women are
encouraged to define a birth plan as an essential part of preparing for a birth
and we endorse this approach. However, you should not assume that somehow
preparing such a plan will ensure that you will get the exact birth that you want.
Whether we like it or not caesareans do happen for a wide variety of reasons.
Indeed all forms of medical intervention
occur far more often than not. The Association for Improvements in Maternity Services (AIMS) has found
that by its definition of a normal birth (no medical intervention of any sort),
only 1 in 6 first time mothers achieved a spontaneous vaginal birth. Medical intervention (including one or more
of the following: induction, artificial rupture of membranes, a caesarean section, general
anaesthesia, forceps and/or ventouse, epidural anaesthesia or an episiotomy) occurred in the other 5 34.
Things to consider when creating your birth plan (when choosing a caesarean):
- State you wish
to have a caesarean. Simply asking for a caesarean is not necessarily going to
guarantee one unless there are clear medical indications.
Where there is no medical indication, you will need to have good reasons and be prepared to fight your corner
- Specify that you wish to have your birth partner with you at all times. This is standard practise in the UK (with the exception of a general anaesthetic caesarean procedure), but it is worth checking to be sure
- If you do not
wish to have a catheter, you should state this in the plan, but make sure you
understand the advantages of having one over
not having one. Alternatively if you are planning to have a catheter it is worth specifying that you want to have it inserted after the epidural has taken effect. This is because the procedure can be mildly uncomfortable and it is not necessary to have the catheter inserted prior to the epidural
- Specify the type of pain relief, but only following
detailed discussions with your anaesthetist. In particular specify if you do not
want a general anaesthetic. There are instances
where it might not be possible to avoid but in general your wishes will be
respected. It is better (for monitoring both you and your baby during the surgery and recovery
afterwards) to remain conscious during the caesarean. A combined anaesthetic
can achieve this and allow for the anaesthetic to be topped up should that
prove necessary
- Specify that you do not want to have your arms strapped down or restricted during surgery. This is not common practise but does occur in some hosptials. It is an unnecessary practise and worth mentioning that you do not want this to happen to you
- The screen,
which is there to obscure your view of the surgery, can be lowered slightly at
the point of delivery so that you can see your baby being lifted out
- If your birth
partner wants to cut the umbilical cord you need to make sure the surgeon is
aware of this in advance so that they leave the cord long enough
- To be allowed
to breastfeed in the recovery room should you feel well enough to do so. Some
women have even breastfed during the final stages of surgery, though sometimes
the screen is too far up your chest to make this possible. Breastfeeding is
actively encouraged in the UK so it is reasonable to assume that any pain
relief that you are given is compatible, but if you are worried about this ask
about it
- Whether your
birth partner is to be present at a caesarean birth. Only under a general
anaesthetic will the hospital discourage this. In all other instances it is
your right. Your birth partner is there to hold your baby (preferably skin to
skin) and talk to you during the remainder of the procedure. In some hospitals
a second person is allowed to be present with you if that person is a doula
- If you want to
see the placenta make sure staff are aware of this, it is not standard practise
to offer you this choice
- Whether you
would you like to wear your own birthing clothes and use your own pillow
- UK guidelines 27 state that the placenta should be removed using
controlled cord traction and not manual removal (as this reduces the risk of
endometriosis) you may want to check that this is going to be the case for you
- At the moment
of birth, you may wish to ask for a quiet and intimate environment, dimmed lights
with no unnecessary noises
- Whether you
wish to have your baby passed to you before he / she is taken away to be
checked. This is more possible with a straightforward elective caesarean. Some
medical indications may not make this possible on the day, it may be more
important that they baby is checked out first. In most cases your baby will
remain in the same room while he / she is being checked but you may want to
confirm this in advance
- Whether or not
you wish to discover the sex of your baby yourself. This is increasingly
common. Your baby will be passed to you or your birth partner and you can check
for yourself
- Anyone you do
not wish to have present, i.e. students
- Whether or not
you wish to have photographs taken at the moment of delivery and while your
baby is being weighed etc. You might want to consider having a black and white
film
- If you want
specific music to be played during your time in theatre
- Specify that
your baby stays with you at all times once back on the ward. This is normal
practise in most UK hospitals, assuming that there are no medical issues for
you both, but it is worth confirming
- If you do not
want your baby to be given any formula (even if you are sleeping) you need to
specify this. Repeat this when shifts change if necessary. Staff may think they
are helping your recovery by not disturbing you. This instruction can extend to if your
baby is in a special care unit. In this case you can express milk for your baby
- You may want
to request a private room for most of your stay in hospital. Most hospitals
will not allow you to do this in the first 24 hours, as they need to keep a
very close eye on you and prefer to do this on the ward. However it is worth requesting one after that. Bear in
mind that these rooms are limited and there is often a fee associated
Birth plans are
excellent for helping you to think through many of the issues surrounding the
birth of your baby. The plan is there to show your preference. However "preference"
is the important word here. Circumstances may arise which mean that at the last
minute it might not be possible for your preference to be accommodated.
The more flexible
your approach to your birth plan, the less likely you are to have an extreme,
negative reaction to your overall birth, in the event that it deviates from
your original plan. For example, incidents arising during a vaginal birth may
mean that medical intervention (forceps or ventouse) is required. If you have
prepared for this your birth plan can make statements about how you would like
staff to proceed in the event of such intervention i.e. ventouse without an
episiotomy and no forceps. It is possible that, in the event of an emergency,
you will not have time or feel able to work through the issues before deciding
on a course of action. The same is true for a caesarean.
Nowadays UK
guidelines 27 are quite strict about the
practises in theatre and your rights in
particular. Being aware of these will help you, both in preparing your birth
plan and on the day, should circumstances change.
- There are a number of things you can do to make your time
easier in the first days at home. Think about putting everything that you and
your baby might need on the same level in your house so you don't have to go up
and down stairs continuously.
- It is worth having
the cot or moses basket prepared in advance if your baby is not going to sleep
in bed with you.
- Make up the
changing station and consider having more than one, particularly if you house is
on more than one level.
- The pram and car
seat are essential if you want to start taking any form of mild exercise. A
papoose might cause a bit more strain on your abdomen in the first week or so but is generally a comfortable way to carry your baby around even after a caesarean.
In addition to all
the nappies, baby clothes, blanket, muslins, wipes etc. that your new baby will
need, take things for yourself:
- It is usual to
be "Nil by Mouth" prior to an elective caesarean, (though an
emergency caesarean can still be performed if you have eaten). Once back on the
ward you can snack so take in drinks (in particular peppermint tea bags to help
with trapped wind) and any homeopathic remedies that are compatible with
breastfeeding. Meal times do not necessarily follow your usual pattern,
breakfast is often early, so healthy snacks of fruit and high energy sweets
might prove essential
- Disposable
pants or large "belly warming" pants are essential following a caesarean as
their elastic line is well above the incision site. The incision site may feel
rather sensitive for a while and elastic will irritate it
- Maternity
sanitary towels, extra long to accommodate the fact that you will be lying down
for longer periods of time
- You wont get
to a shower for at least the first day so wipes for your face are a good idea
because you start to feel a bit dishevelled after a while
- Breast pads
and the all important nipple cream. Using a cream such as Lansinoh from the first day is a good idea if you
hope to avoid cracked nipples
- Comfortable
clothing, slippers, nightwear and dressing gown all of which are loose round
the waist and hips and of course your new feeding bra. Avoid dresses unless
they are specifically for breastfeeding. You will still feel about 6-7months
pregnant in the first few days after your birth and so you should not expect to
fit into anything fancy (unless you buy it in larger sizes)
- Don't forget your maternity notes