Understanding Cesarean Birth

As a cesarean birther myself, I enthusiastically and empathetically celebrate my fellow cesarean clients and families. At local Iowa City area hospitals, and also nationwide, one in three babies is born by cesarean birth. It is likely that you or someone you know has given birth by cesarean. This blog addresses some of the common questions and misconceptions about cesareans and also provides some basic information for anyone who might be preparing for a cesarean. Even when planning for a vaginal birth, it is helpful to be informed should the need for cesarean arise despite other plans.

Question: Why might I need a cesarean?

While everyone’s individual circumstances are different, here are some reasons given by the American Congress of Obstetricians and Gynecologists that may indicate the need for a cesarean:

• Multiples pregnancy: if a birther is pregnant with twins, a cesarean birth may be necessary if the babies are being born too early, are not in good positions in the uterus, or if there are other indications. Triplets and above are always born via cesarean.
• Labor Dystocia (formerly called "failure to progress," but let me be the first to emphasize that there is no failing in birth): contractions may not open the cervix enough for the baby to move into or through the vagina.
• Concern for the baby: for instance, the umbilical cord may become pinched or compressed or fetal monitoring may detect an abnormal heart rate.
• Problems with the placenta, such as placental abruption or placenta previa
• Breech or transverse fetal presentation
• Maternal infections, such as human immunodeficiency virus or herpes
• Maternal medical conditions, such as diabetes or high blood pressure

Question: What should I expect if I need a cesarean?

If you need a cesarean birth, your nurse will prep you for surgery. You will need an intravenous (IV) line, you will have your pubic area shaved, and a catheter inserted into your bladder. There are three types anesthesia that can be used in cesarean births: an epidural, a spinal block, or in an emergency, general anesthesia. The first two options allow you to remain conscious and will numb you from your chest to your bottom, and your legs as well.

You will have a blood pressure cuff and other leads and monitors applied to measure your vitals during the birth. Antibiotics and anti nausea medications are administered. A drape is placed across your chest that separates your arms and head from the sterile surgical field of your abdomen. The incision site will be prepped. At this time, your partner/support person is brought in to join you in the operating room and is typically seated up by your head. The surgery begins.

A normal, uncomplicated cesarean typically lasts 45 minutes to an hour. While you should not feel any pain, you will likely feel strong sensations of tugging, pulling, stretching and pressure. The baby is usually born within 5-15 minutes of the surgery beginning. The surgeon may lift the baby up above the drape so the birther and partner can see him once delivered.

Baby is then typically taken to the warmer to be checked out before being given to the support person who can bring the baby over to the birthing parent. The placenta is delivered. The remaining of the procedure are used to close the many layers incisions.

Hospital policies vary and are always changing, but baby is usually taken to the nursery while the birthing parent gets stitched up, and then is reunited again in recovery.

The partner can choose to remain with the birthing parent or go with the baby, or if there is a doula, they can remain with mom and the partner can go with baby. While you are being closed up, you may experience nausea and trembling. This can be due to the anesthesia and/or adrenaline. Often times in recovery the birthing person finds themselves to be extremely drowsy.

Question: What do I need to know about recovering from a cesarean?

A cesarean is major abdominal surgery. You will typically remain in the hospital for three days after your surgery. Each person’s recovery is different and depends on many factors. You will be monitored closely and have your vitals taken often. Immediately following the birth and at night your legs will be in pressure cuffs to prevent blood clots. You will experience pain in your incision site once the anesthesia wears off. Oral pain medication will be offered, and it is wise to consider taking them. A nurse will firmly massage your uterus, which can be quite uncomfortable. Your catheter will be removed usually on the morning after your surgery. You should try to get up and walk, with help from the nurses, as soon as possible.

It is helpful to hold a pillow over your abdomen when you cough, sneeze or laugh. When getting up from lying down, it is best to first roll to your side and slowly push yourself up with your arms rather than sitting straight up.

You may experience referred shoulder pain, and gas pains. Breastfeeding may be more difficult due to being groggy, and the pain in the incision site. Many birthers find that they prefer to use the football hold or side-lying breastfeeding positions to avoid putting pressure on their abdomen.

Pain medication can cause constipation, so consider taking a stool softener. You may experience pain and discomfort from uterine contractions as your uterus shrinks back down to size, especially while breastfeeding. You may also be surprised to find out that you will still experience lochia, or bleeding from the vagina for up to six weeks.

If you had staples, they will be removed before you leave the hospital. If you had stitches, they will dissolve on their own. Your care provider will give you post operative care instructions upon discharge which will include information about restrictions (weight, exercise, driving, etc) and how to care for your incision site. It is wise to heed these instructions and find ways to not overdo it, which can set recovery back.

Accept offers from family and friends to help around the home. You may even consider hiring a postpartum doula, as recovering from surgery while caring for a newborn can be quite challenging.

Misconception: Once a cesarean, always a cesarean

Not necessarily. Although I 100% support the birthing person’s right to choose a repeat cesarean for any reason, most people who have had a cesarean and become pregnant again are good candidates for VBAC, which stands for Vaginal Birth after Cesarean.

The American Congress of Obstetricians and Gynecologists states “attempting a VBAC is a safe and appropriate choice for most birthing people who have had a prior cesarean delivery, including for some birthing people who have had two previous cesareans”.

While there are risks associated with VBAC (primarily the less than 1% chance of uterine rupture), it is worthwhile to weigh these risks against the risks and complications associated with repeat surgery.

If you desire a VBAC, it is a good idea to have a conversation with your care provider to find out if you are a good candidate for VBAC, and also to determine how supportive your provider and medical facility are of VBACs. You should also ask what the VBAC policies are your facility.

Misconception: All cesareans cause birth trauma

While it is true that a cesarean can be a part of a negative birth experience, this is not always the case. Many people who have had cesareans report having very positive birth experiences.

One of the key determining factors is how you are treated; if you felt respected and supported throughout the process. One way to ensure this is by having a care team that you trust. This includes your OB/GYN or midwife, and it may also include a doula.
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A doula can be an incredible asset to both planned and unplanned cesareans. They can help you to create a birth plan that captures your wishes for birth and can help you best communicate these preferences to your care team. They will be with you before and after your surgery, and while it varies in each hospital/provider, your doula may be allowed to accompany you and your partner during surgery. They can help talk you through what is happening each step of the way. They can also help you establish breastfeeding or bottle feeding. Another component that contributes to a positive birth experience is whether or not you feel like you had choices or options – were you given any control over your birth experience? One way many women are able to achieve this is by implementing components of a family centered cesarean, which leads us directly into the next question!

What is a Family-Centered Cesarean?

A family centered cesarean (sometimes called a gentle cesarean) has several components, and while your hospital may not be able to accommodate all of them (especially in an emergency situation), it is worthwhile to discuss these options with your care provider in advance to find out what you can incorporate into your birth plan.

* You may ask to have music played.
* You may request to to have your partner or doula take photos during the birth.
* You may request that conversation be limited to items pertaining to your birth, you might even want the surgeon to explain what they are doing.
* Many hospitals are now offering clear surgical drapes so that the birthing person is able to see their baby being born. These are not always used automatically, so make sure to request it if you are interested. Some hospitals that do not have clear drapes offer the option of lowering the drape right as the baby is being born so the mother can see.
* You may be allowed to have delayed cord clamping after the baby is delivered.
* You can also request to not have your arms strapped down so that they are free to touch and hold your baby.
* If the hospital allows, you may be able to have skin to skin bonding, and begin breastfeeding right in the operating room.
* You can request to have the baby remain with you in the operating room as long as possible.
* For a thorough list of options, check out this birth plan menu from Motherlove.

All of these family-centered options can help the birthing person embrace and engage more fully in  the birth experience, which can sometimes feel difficult when a baby is born by cesarean. One of the most challenging parts of a cesarean birth for many people is feeling so disconnected from the actual birthing of their baby, which can contribute to difficulty bonding and postpartum mood disorders. Having choices and options that help birthers feel supported and connected to the process can help to change these outcomes.

For more tips on cesarean recovery, check out my blog here