What’s a cesarean birth really like?

Excerpt from Asking for a Pregnant Friend: 101 Answers to Questions Women Are Too Embarrassed to Ask about Pregnancy, Childbirth, and Motherhood

It’s intense in ways that are similar to and also completely different than a vaginal birth. Some say a C-section is the “easy way out,” but I don’t agree. While the physical sensations during the surgery are typically mild, significant mental and emotional stamina is often required. And the recovery is much more involved than what’s experienced by women who had a vaginal birth. I say all this because if you end up needing a C-section, I want you to know you haven’t “cheapened” your birth experience or failed to “prove your strength” through a vaginal birth. You’ve gone through an incredible process that requires immense courage.

Here’s what to expect from and keep in mind during a cesarean birth:

Scheduling: If you and your care provider decide a planned C-section is the ideal option because of a special circumstance, like your baby being in a breech position or another special circumstance, the surgery will be scheduled sometime around your due date.

The unplanned C-section: If you’re in the middle of having a vaginal birth, but something puts you or baby at risk, your care provider might recommend a C-section. If it’s not an emergency, ask them to thoroughly explain the reasoning behind their recommendation, so you can make a well-informed decision.

Consent: You have to provide legal consent before the surgery.

Safety: Know that the team performing your cesarean birth is composed of trained professionals who will keep you and your baby safe. Allow yourself to enter the experience with an energy of trust, as you’ll be in skilled hands.

Support during surgery: In nonemergency situations, your birth companion should be allowed to stay with you during the surgery. If they’re squeamish, consider asking another friend, family member, or doula (if you’ve hired one) to accompany you, as you don’t want the medical staff having to attend to anyone but you and baby.

Pain and numbing medication: Before surgery, an anesthesiologist reviews your medical history and pain management options. They’ll likely recommend an epidural or spinal block to numb the lower half of your body. You’ll be awake during the surgery, but you shouldn’t feel anything from your waist down, with the potential exception of some pressure. In some emergency situations — or if you have a condition that would contraindicate an epidural, like a blood clotting disorder — you may receive general anesthesia, but that’s rare.

Further prep: After the epidural is placed, your bladder is drained with a catheter, and an IV is started to administer fluids and any additional medication you may need. You might also receive an antacid to neutralize your stomach acid, and antibiotics to prevent infection after the procedure.

The screen: To prevent you from witnessing the surgery, a screen is raised at your waist. You can request that the screen be partially lowered when your baby is lifted out. (You’ll find more cesarean birth preferences in the following pages.)

The surgery: When the anesthesia has fully numbed you, antiseptic is applied to your lower abdomen, and the surgeon makes a small horizontal cut above your pubic bone. They then cut through the underlying tissue — manually separating your abdominal muscles — until they reach your uterus. A horizontal incision is then made in the lower portion of your uterus, and the doctor retrieves your baby and the placenta. This typically takes fifteen to twenty minutes. You might be given Pitocin after the surgery to help prevent hemorrhaging and to ensure the uterus contracts back down to its original size.

Bonding: If you and baby are in good health, you’ll likely be able to hold them after delivery, while you’re still lying on the operating table.

The stitches: As you’re falling in love with baby, the surgeon applies absorbable stitches to your uterus, and stitches or staples to your abdomen. The incision is usually so low a bikini bottom can cover the scar.

After the C-section is complete, you start the recovery process, which is different for every woman. The recovery is covered in the next question.

What to do

Create cesarean birth preferences. A common source of resistance to a C-section is lack of control, as women often feel that because the birth is literally in the hands of the surgeons, they’ll lose their sense of empowerment. But this doesn’t have to happen. In the absence of an emergency, many hospitals are open to moms having a voice in how their C-section unfolds, typically in the form of cesarean birth preferences. I find that creating these preferences — even if you feel certain you won’t need a C-section — helps dissolve fear of the unexpected because you’re preparing for all possibilities.

Some cesarean preferences that can help you reclaim feelings of control and empowerment and ensure a gentle C-section are offered below. These preferences are just samples — you should take out any that don’t feel important, and add any that do. I also recommend bringing them to a prenatal appointment about six weeks before your due date to discuss with your care provider and to find out if any of the preferences go against hospital protocol. If so, you could choose to give up some preferences, or find a hospital that supports gentle C-sections.

Sample Caesarean Preferences

We request:

To have my arms free during the operation. Being strapped down can induce panic. Request that your arms remain unbound so you can hold baby as soon as possible after delivery.
To have a nasal cannula instead of a facemask for oxygen. Oxygen facemasks make some women feel claustrophobic.
To have medical staff refrain from personal conversations. Hearing the nurse’s thoughts on a new dating app is unlikely to fill you with positive anticipation for meeting your baby. So request that all people in the operating room swap personal conversations with encouraging words for you — or at least limit their comments to the task at hand.

To have medical staff talk to me, instead of about me, as much as possible. This can help you feel like you’re part of the process, instead of “just another patient” cycling through the operating room.
To have music or other recording of my choice playing. The sounds you hear during the C-section can set the tone for the experience, so ask for the ability to play songs or a guided meditation of your liking. You should also be able to bring headphones if you want a private listening experience. Use the following link to download a guided meditation created for cesarean births: yourserenelife.wordpress.com/gentle -csection/.
To have the screen lowered as baby is lifted out. Seeing your baby’s arrival is a powerful experience, especially for moms who cannot physically feel the emergence.
To have delayed cord clamping. This helps reduce the chance of baby developing an iron deficiency, because it allows the iron- and hemoglobin-rich blood in the cord and placenta to get to baby before the cord is clamped and cut. The cord usually stops pulsating within a few minutes after delivery.
To have skin-to-skin contact directly after baby is born. The release of oxytocin that occurs when you hold your baby on your bare chest supports bonding and eventual breastfeeding (if that’s something you’re choosing to do).
To have monitors placed so they won’t impede bonding. Dealing with a tangle of tubes and wires when trying to hold your baby isn’t fun.
To have baby stay with parents at all times, unless a medical complication makes that impossible. It’s ideal for a newborn to be with one of their parents as much as possible.
To have a vaginal swab applied to baby (also known as “vaginal seeding”). Stay with me on this one. When a baby is born vaginally, they’re exposed to a range of microbes that help reduce the risk for inflammatory illnesses, heart disease, infections, and other not-fun circumstances. A baby born via C-section can potentially receive the benefits of these microbiomes when the care provider collects a vaginal swab and wipes it on baby’s skin. It can also be wiped on your nipples before breastfeeding. Discuss this preference with your doctor or midwife, as the research is ongoing and controversial. To learn more, check out the article “The Microbiome Seeding Debate — Let’s Frame It around Women-Centered Care” in the journal Reproductive Health.