Planned Cesarean Birth
When you have come to the decision to give birth by planned cesarean, you likely have mixed emotions; feelings of being at peace, excitement, joy, anxiety, disappointment, disconnection, and more are to be expected. All of these emotions are valid. I want to assure you that with a cesarean, you still have options to create a more connected, sacred birth experience, even if it is happening in the operating room. No matter how your birth unfolds, it will be a moment you remember for the rest of your life. You deserve to feel respected, held, and safe on this day, so it can be a memory you cherish forever.
Throughout this guide, I describe what to expect from a planned cesarean and what your options are. Once we have explored all of these essential questions, we will create a 1-2 page document that we use as a communication tool with your care team during your birthing time, which is the main purpose of a “birth plan,” birth preferences, birth guide, or whatever language prefer.
Before Your Baby’s Birthday
Hospitals that are committed to providing informed, and evidence-based care for their patients typically follow a protocol called Enhanced Recovery After Surgery or ERAS. In more recent years, there have been ERAS protocols developed specifically for cesarean births. These are measures to improve outcomes for both you and your baby, prevent infections, hemorrhages, and other complications that may result from having surgery.
In the weeks before your baby’s birth, your provider will schedule a pre-operative appointment to plan for your cesarean. You may also have a consultation with an anesthesiologist if you have specific conditions that make anesthesia more complex.
It is often recommended that you avoid shaving the pubic area 2 weeks before the birth to minimize infection risk.
Planned cesareans are usually scheduled for the morning and early afternoon. You will be instructed to fast for 8 hours before surgery, so you will have your last meal in the evening. You will also be instructed to shower with a special Hibiclens body wash that your doctor will provide, either the night before, or morning of your birth. This is one of the measures to prevent infection.
Your Baby’s Birthday
Your provider will prescribe you a carbohydrate drink to have the morning of your birth. You typically have to call 3 hours before your surgery time to make sure they still are able to take you that day. Arrival at the hospital is 2 hours before your birthing time.
Once you arrive, you will be admitted, either at the main hospital office, or on the L&D floor. Your nurse will instruct you to leave a urine sample and change into a hospital gown. They will then place your baby on the CTG monitors for about 20 minutes.
Your obstetrician will come speak to you and consent you for surgery. You will also see the anesthesiologist or certified registered nurse anesthetist prior to surgery to create a pain management plan. In most cases, your anesthesia will include a spinal and/or epidural in combination with local anesthesia. Your doctor may choose to place some numbing medicine in your abdomen to help with pain control for the first two to three days after surgery.
Other things that happen during pre-op:
The nurse will start an IV (intravenous) in a vein in your arm or hand for fluid and/or medication administration.
You may have some of the hair around your incision removed using electric clippers at this time to decrease the risk of infection.
Pre-operative medication will be administered by your nurse that has been prescribed to help prevent nausea and/or vomiting, as well as medication to decrease the risk of post-operative infection.
During this time, one support person (typically your partner) and myself (your doula) can be with you. When everyone is ready, you will walk back to the operating room with your nurse.
The Operating Room
Many professionals will be in the operating room with you, including your surgeon, anesthesiologist and anesthetist, scrub nurse and circulating nurse. This team constantly monitors your progress and well being during the surgery. For your baby, there will also be support staff present in the OR room. The support staff for your baby may include: NICU or nursery nurses, nurse practitioner, respiratory therapist and perhaps a neonatologist. The operating team will be wearing special hair covers, masks, gowns and gloves during the birth.
You will recieve a spinal or epidural next. This involves you sitting on operating table and leaning forward to curl your spine like a C shape. The anesthesiologist/CRNA will clean the area, and then numb your skin with lidocaine, which should be the most uncomfortable part of placement. They will then locate the spot in your spine where they will place the shot of medicine (spinal anesthetic) or place the catheter (epidural). Most people typically receive spinal anesthesia, which lasts a few hours. Combined spinal epidurals (CSE) is only used in complex cases or for those who are quick metabolizers of medication to ensure pain is adequately controlled during the entire procedure.
Once you have received your anesthesia and the team confirms that you are numb, your support person will be escorted into your OR room and may sit at the head of the OR table to be with you during your cesarean birth.
Other things to note:
Sticky electrode pads will be placed on your chest to track your heart rate.
A blood pressure cuff placed on your arm to track your blood pressure.
•There will be bright lights located above the operating table.
A catheter will be placed in your bladder before surgery (after you are numb) and will most likely be removed later that same day of surgery.
The surgical area of your skin (and in some cases your vagina) will be cleansed with the appropriate skin cleanser to help prevent post-op infection.
Leg massagers will be applied to your legs to help prevent blood clots. These are also known as SCDs, or Sequential Compression Devices, and you may hear them referred to as such.
Sterile surgical drapes will be applied, and a drape will be placed that will block your view of the procedure and birth.
The Birth
To begin the surgery, the doctor will make an incision right above or in the pubic hairline. To get to your uterus, they must also cut through your subcutaneous layer, fascia, muscles, peritoneum, and finally your uterus. Your doctor makes the uterine incision, which is also usually horizontally across the lower part of the uterus (low transverse incision). From the first incision to baby usually takes about 10 minutes, though it may be longer if you have scar tissue from prior cesareans, conditions like endometriosis, etc.
Your baby is born! You can request for the drape to be lowered so you can see baby as soon as they are born. Typically, up 90 seconds of delayed cord clamping occurs, before the pediatric team recieves baby and brings baby to the warmer. Here, they will assess baby and take a set of vitals.
Many pediatric teams will, by default, also take weights, measurements, and administer baby medications while baby is at the warmer, before being brought to you. You can request to delay these non-essential procedures until after the golden hour.
Baby will be placed skin to skin with you for the remainder of your surgery. This typically takes 45 to 60 minutes. If baby begins cueing to feed, you may also begin breastfeeding while in the operating room. Usually the baby nurse is happy to assist with this.
When your repair is complete, they typically send baby and your partner back to the room you will be recovering in. To minimize separation between you and baby, you can request that baby stays in the OR with you until you are ready to be moved from the operating table to the gurney, and then have baby placed back skin to skin with you.
Immediate Postpartum
You will be wheeled back to your recovery room, which is usually the same room where you were pre-op. During the first 2 hours, you will have frequent vitals taken and fundal checks, where they press on the top of your uterus to make sure it is contracting and your bleeding is normal. The Sequential Compression Devices will remain on. You may be given a variety of medications for pain management: ibuprofen, acetaminophen, Toradol (a strong NSAID), and oxycodone.
One aspect of the enhanced recovery protocol is to chew gum in the first hour after surgery. This helps to “wake up” your digestive system after surgery and promote normal function. The hospital provides gum, but if you have a specific kind you prefer, you can certainly bring it.
Your baby’s vitals will be taken frequently in the first hours of life, but these checks can happen while baby is skin to skin with you. I will assist with breastfeeding, which is especially helpful when recovering from cesarean birth, as your mobility is limited.
After 1-2 hours, you will be moved from the labor and delivery unit to your postpartum room.
Birth Preferences
Some of the questions listed below are for me as your doula to know, and some of preferences will be written on a birth preferences document to utilize as a communication tool with your care team
Please write here if you have any medical conditions that may impact the birth:
I would like all staff to introduce themselves and their role prior to beginning surgery
I would like to have the music of my choice playing
I would like to utilize essential oils for nausea (provided by doula)
I would like to utilize acupressure balls to squeeze during the surgery (provided by doula)
I would like an eye mask to use until baby is born
I would like the surgery explained as it is happening
I would like a clear drape for the surgery until baby is born or
I would like the drape lowered to see baby as they are being born
I would like to delay cord clamping for the standard 60 seconds or
I would like to delay cord clamping for as long as possible
I would like the cord to be left long so my partner or I can trim it
I would like to delay weights, measurements and medications until after the golden hour so baby can be with me as soon as possible
I would like help iniating breastfeeding in the OR if baby is cueing to feed
If I am unable to hold baby due to nausea or other factors, I would like my partner to do skin to skin with baby
If baby needs to go to the NICU, I would like my partner to go with the baby and have my doula ready to enter the OR to be with me
I would like to minimize separation; I would like baby to stay in the room with me until I am ready to go to the recovery area and not leave ahead of me.
I would like to see my placenta
I would like to keep my placenta
Vaginal Seeding:
If you would like to do vaginal seeding, we will request a sterile piece of gauze in pre-op and remove it before surgery and place it in a plastic bag. Your partner will keep this in their pocket in the operating room, and when you recieve baby your partner can wipe baby’s face and mouth with the gauze..
