When planning a cesarean section, the formation of a birth plan is often overlooked. However, it is important to let your birth team know what you want to have happen, regardless of what kind of birth you are having. Additionally, there may be options available that you had not considered.
One of the first options to consider is anesthesia during the operation. Some doctors and hospitals have firm policies in place about what types of anesthetics they will use. Others offer you a choice of epidural or spinal block. There are pros and cons to each type of medication. Epidurals are often seen as the safer choice, but they can leave what are called “hot spots” – areas that have not been numbed sufficiently. Spinal blocks carry slightly more risk, but offer more consistent pain relief. The main anesthetic can also be followed by morphine, which will help the transition from IV medication to the pain relievers you will take later in pill form. Be sure to discuss your options with your doctor, and include your decision on your birth plan.
A requirement of any cesarean section is urinary catheterization. While being catheterized is not itself an option, many hospitals will let you decide when to be catheterized before or after you have received the anesthesia. Having a catheter placed can be very uncomfortable, so do not be afraid to request that the attending nurses wait until the anesthetic has started to take effect.
Another common prep for surgery is to tie down the mother’s arms, to prevent the mother from reaching into the surgical area or pulling at an IV line. In many hospitals, restraining the arms is automatically done, but if you are clear that you do not want your arms tied down, your wishes will be respected.
During the birth itself, you will be able to have at least one person of your choice with you. For most women this is their spouse or partner. If you have the option of having a second person with you, consider a Doula. Many women have a Doula for their vaginal deliveries, and it is now becoming more common to see a Doula assisting during cesarean sections as well. If you are restricted to only one support person, and your partner will be accompanying the newborn to the nursery for testing, you may wish to have the Doula come in to be with you at that point.
Perhaps the most exciting option many women are asking for is to have the doctors “drop the drape” for the delivery of the baby. During the initial stages of delivery, there is a drape of cloth hung over your chest so that you cannot see the surgery itself. If desired, when the time comes for the baby to be pulled out of the incision, the nurses can remove the drape and hold up your head so that you can see your newborn as he or she enters the world.
If you do not choose to view the actual birth moment, you can opt to have the baby brought around to your view immediately, or you may choose to wait until the baby has been cleaned up at the warming table and bundled in a blanket and cap. If your partner or spouse chooses to watch the birth event, you can ask the doctors to let your partner discover the sex of the child.
After the baby is taken to the warming table, the umbilical cord will be further trimmed down. If your partner is interested, he can cut the cord at this time. Although largely ceremonial, as the cord was initially cut by the doctor during surgery, this can help your partner feel more involved and participate in the experience.
Some women wish to view the placenta after it is removed from the uterus. Most operating room staff will be more than happy to show you the placenta, if you wish. Some hospitals, though not all, will allow you to take the placenta home with you if you wish to plant it under a tree or in a garden plot. However, you should not consume a placenta that has been removed by cesarean as it will contain traces of any medications that you have been given.
If you wish to have a tubal ligation, you will be able to have it done at this time. Be sure to discuss this with your doctor beforehand. The benefit of having a tubal ligation done at this point is a reduction the financial cost of a tubal and because it adds no extra healing time to your recovery.
After a few minutes with your newborn, he or she will most likely be taken to the nursery for blood tests and administration of the Hepatitis B vaccine, antibiotic eye ointment, and/or Vitamin K shots. If you do not wish your child to receive any or all of these, be sure to state this clearly on your birth plan and to the doctors involved. If your partner accompanies the newborn to the nursery, he can act as an advocate for your wishes there.
Once the surgery is complete, you will be taken either to a dedicated recovery or post-op room, or to a combination Labor/Deliver/Recovery (LDR) room. Discuss your hospital’s policies with your doctor. If your hospital has a dedicated recovery or post-op room, you may need to arrange ahead of time for your partner and newborn to be brought there, if you wish for a speedy reunion. However, if you are taken back to an LDR room, you partner and newborn will most likely be there waiting for you.
Most birth plans also include requests and requirements for after the baby is born. Back in your room, you may start breastfeeding immediately if desired. If you do plan to breastfeed, it is important to note on your birth plan that you do not with the newborn to receive formula, sugar water, or pacifiers, as these can negatively impact the nursing relationship in the early stages. The medications you receive during a standard cesarean section are all considered safe for nursing mothers.
One other item that you may wish to specify on your birth plan is whether or not you plan to circumcise your child if you have a boy. There is no national or international medical association that currently recommends routine circumcision, but it is still common in some areas of the United States. It does have risks, and does cause the infant pain, so it is important to discuss circumcision with your doctor to make an informed decision and arrange pain medication for the child if you do wish to circumcise.
While there are many choices to be made, a cesarean birth plan does not need to be long or complicated. A few simple bullet points outlining your wishes for yourself and your newborn are all that is required. Discuss your plan with your doctor ahead of time, and have a copy placed in your medical file. Then on the day of delivery, bring several copies with you so that the various nurses and attendants will be on the same page. The following is a sample cesarean birth plan.
Birth Plan for Mother Jones and Baby Jones
C-section:
Mom’s arms must not be tied down
Drop the drape so Mom and Dad can see the actual birth
Let Mom see the baby up close for a moment before he/she is taken to the table
Dad “cuts the cord” at the table
Mom is to be reunited with the baby as soon as the surgery is complete
Dad will remain with the baby at all times
Baby Care:
No vaccines
No pacifier
No sugar water
No formula
No circumcision
Baby will room-in with Mom
This plan can be altered or elaborated upon as needed, to fit your own needs and desires. The most important thing to remember is to speak up to your doctor about what you want and need from your birth experience. Getting the optimal birth experience is every woman’s right, so you should not hesitate to make a birth plan that
