My focus today isn't on the prevention front, which is an important initiative all on its own, but rather on the subject of what can be done to make a cesarean a birth rather than just a surgery when a cesarean is medically necessary and there is time to discuss options in advance of the procedure.
It is important to recognize that a cesarean section is still the birth of a baby. It is performed via medical means, but it is still an emotional and metal transition that deserves respect and special consideration by the surgical team.
Here are specific considerations for having a Family Centered Cesarean. Each of these points should be discussed with your care provider.
- Maternal Monitors - Requesting that the heart monitors and pulse ox monitor be placed in locations that do not restrict the mother's ability to hold and touch her baby immediately without interference. (i.e. Heart monitors placed on the sides of the body and/or on the upper shoulders, pulse ox placed on the toe vs. the finger.
- Preparing to Seed the Baby's Microbiome - Requesting a gauze 4x4 be placed in the vagina for an hour prior to surgery, then removed and saved to wipe over the baby's body, and in the mouth and nose. The purpose of this is to attempt to return some of the beneficial microbes that baby would have been exposed to through a vaginal birth so they can be seeded in the baby's gut to help initiate their immune system. (http://www.pcnguide.com/wp-content/uploads/2016/03/2-Seeding-and-Feeding-the-Microbiome.pdf)
- Lowered Voices in the OR - Only conversations directly related to the procedure occurring, explination of what is happening, if desired by the mother, and allowing the mother and father to really focus on the experience vs being subjected to non-pertinent conversations by the medical staff.
- Music - Music of the mother's choosing to be played during the procedure. This can help create a calmer and more relaxed environment during the procedure.
- Unrestrained Arms - The mother's arms to be unrestrained during the procedure, allowing her to touch her face and partner as desired, and to be able to hold and begin bonding with the baby immediately after birth.
- Lowering the Drape - Allowing the mother to visually see the birth of her baby by lowering the separation drape. This visual is an important mental connection and bonding stimulant, allowing the mother a sensory experience of the birth of her baby since her physical sensation of the experience is impaired.
- Mother Assisted Delivery - The mother is scrubbed and gloved up so that once the baby's head and shoulder's have been delivered, she is guided to assist in helping to deliver the rest of the baby's body and bringing to baby to her stomach or chest and waiting for delayed clamping of the cord. (http://www.exxpectations.com/news/maternal-assisted-caesarean-sections)
- Delayed Cord Clamping - Delaying the clamping of the cord, as long as the mother and baby are transitioning well and there is no medical reason to intervene, for at least one full minute. (http://cord-clamping.com/2011/09/08/cesarean-delayed-clamping/)
- Immediate Skin-to-Skin in the OR - As long as the baby is transitioning well, the baby is placed immediately on the mother's chest, skin-to-skin, and then both the mother and baby are covered with blankets, allowing the mother's natural thermal regulation to assist in warming the baby, and allowing bonding to continue immediately and uninterrupted in the OR vs waiting until the transfer to recovery or postpartum. To aid in this measure, the mother's hospital gown should be put on to open in the front. (http://evidencebasedbirth.com/the-evidence-for-skin-to-skin-care-after-a-cesarean/)
- No Sedation Medications - Declining any sedation medications that the anesthesiologist may offer for the mother's comfort or rest, that may interfere with the mother's ability to be fully awake and aware, holding her baby and beginning breastfeeding as soon as desired, even potentially while still in the OR.
- Additional Support Person - In addition to the father/partner, allowing a second support person (doula, midwife, etc.) to help support both the mother and the father through the experience or a professional birth photographer to capture the special moments.
- Pictures - Taking pictures during the procedure, just as one would take pictures during a vaginal birth, so the family has the ability to share and reflect on the experience in a positive way.
- Releasing the Placenta - Keeping the placenta to be processed by a non-hospital placenta specialist, a measure to help the mother boost her emotional and physical recovery postpartum. (http://www.ancient-hearts.com/placenta-services.html)
- Keep Mom & Baby Together, Always! - No routine separation of mother and baby unless medically necessary (i.e. there's an issue with the baby and testing/treatment can only occur in the nursery or NICU, etc.) Any routine separation should be avoided so that bonding and breastfeeding can have the best start possible.
- Lactation Support in Recovery - Requesting that a lactation consultant be ready to assist breastfeeding as soon as the cesarean is complete and the mother and baby are transferred to the recovery room.
Contact me for more information on East Texas providers who are currently practicing, or who are open to discussing, Family Centered Cesareans.