Planning a Great Caesarean Birth

Whether your caesarean birth is scheduled or unplanned, it may be possible to express your preferences on many different aspects of the birth. Participating in the decision making process can increase your sense of ownership of the experience.

When a caesarean is an emergency procedure the possibilities for decision making are reduced. However with a planned caesarean section, you may be able to consider options around the timing of the birth, aspects of the theatre environment, your degree of participation in the birth and the immediately care of your baby after the birth can improve your satisfaction levels.

You might like to consider your preferences around the following and express them to your midwife or obstetrician ahead of the birth.

Questions about the birth

• Do you feel that the reason for the caesarean section has been fully explained? Do you feel that all alternatives have been explored?
• Would you like to have time alone with your partner / support people to discuss events and explore your feelings? Is there time?
• Would you like to know who will be present during the birth?
• Do you have a choice in the timing of the operation (e.g. AM, PM etc.) If the caesarean is scheduled, an early appointment will reduce the risk of unscheduled emergency caesareans bumping your birth into the evening or the next day. There tend to be more staff available for caesareans performed during normal working hours. The availability of staff might assist with any plans you have for skin-to-skin contact with your baby or breastfeeding in recovery.

Preparations in theatre

• What options do you have for the timing of pubic shaving and catheterisation, wearing your own clothing and walking to theatre?
• Do you understand the relative benefits and risks of each option for anaesthesia? (e.g. general, epidural, spinal)
• What options do you have for personalising the birth environment e.g. bringing your own music, pillows etc.?
• What options do you have for increasing the use of your dominant arm and keeping your chest area free for immediate skin-to-skin contact with your baby?
• The pulse oximeter is often placed on a finger, could it be sited on one of your toes?
• Can the electrocardiogram (ECG) lead be placed so that it doesn't interfere with skin-to-skin contact?
• Can the anaesthetist free one of your arms after the block is sited so that you are free to hold your baby after the birth?

During the birth

• Would you prefer to have a commentary on progress of the birth or silence?
• What are your feelings about watching / participating in the birth? It should be possible to llower the curtain screen once the incision has been made so that you can watch your baby's birth. Could the head of the bed be tilted to enable you to watch? Do you want your partner take photographs?
• What are your preferences about discovering your baby’s sex? Do you want to find out or are you happy for the doctor to announce it?

Birth of the placenta

• What options do you have for the timing of cord clamping and cord cutting?
• Do you have any preferences about what happens to the placenta?

Baby care following birth

Early skin-to-skin contact with the you or if this is not possible, with your partner, is recommended within 30 minutes of a caesarean birth (Velandia et al. 2012)

• What are your preferences about skin-to-skin contact with your baby and the timing of the first breastfeed (e.g. immediate, in recovery or later in the maternity ward)?
• What are your preferences for cleaning baby (e.g. leaving the vernix, wiping the baby's face, bathing etc.)?
• What are your preference for the timing of weighing and measuring baby?

References

• Gouchon, S., Gregori, D., Picotto, A., Patrucco, G., Nangeroni, M., Di Giulio, P. (2010). Skin-to-skin contact after cesarean delivery: an experimental study. Nurs Res. 2010 Mar-Apr;59(2):78-84. Link
• Velandia, M., Uvnas-Mober, K., Nissen. E. (2012). Sex differences in newborn interaction with mother or father during skin-to-skin contact after Caesarean section. Acta paediatrica. The Cochrane Central Register of Controlled Trials (CENTRAL) 2013 Issue 3.  Link