The Family-centred Caesarean: when the reason for a C-section is valid.

(I would like to thank Denise Love for sharing this information)

If you have a valid reason for needing a caesarean section it is important to make yourself aware of the procedures that surround a caesarean section, the choices you have and what can give you and your baby the best opportunities to enjoy the experience!

It is important for your well-being that you take the steps to accept the need for the caesarean, and meet your child with happiness and joy. Take the time to work through your feelings about the possibility. Pray.

The anaesthetic

• Ask for No pre-Med so you are awake & aware during the procedure. Use your breathing to alleviate stress, get partner to work with you to encourage relaxation, get excited rather than fearful. Your baby will be in your arms any minute.
• Instead of a general, being awake will enhance your experience. Consider a Spinal epidural.  It acts a pain-free agent for 4 hours and then you are able to recover quickly using only Endone, Panadol and anti-inflammatory suppositories to relieve discomfort and pain for the first few hours if needed. Remember the less drugs to the baby the better and the most ideal way to commence breastfeeding!
• An epidural is an alternative.  The catheter is left in your back and you have the opportunity for pain relief after the operation. Get this out as soon as possible, the next day at the latest! The longer the medication is left in the more the baby will be drugged and this can affect the whole breastfeeding experience.

The procedures

These are just the basics, it may go in a different order and some may be left out;

• An intravenous line (drip) inserted.
• Pre-operative medications may be used to calm you down. They may also make you groggy and unable to recall the experience of your baby being born. Discuss with the anaesthetists in advance what drugs will be used, and request an absolute minimum…use breathing techniques to cope with fear, or discomfort. 
• An antacid is given for your stomach acids in an attempt to reduce dangers should you aspirate during the surgery (generally not a problem with regional anaesthesia (spinal/epidural).
• Monitoring leads (heart, blood pressure).
• Anaesthesia given (Spinal anaesthesia is recommended for several reasons when epidural isn’t previously in place, or the caesarean is planned.)
• A catheter inserted to collect urine (insist that this is done after your anaesthesia so you don’t feel it).
• Anti-bacterial wash of your abdomen and partial shaving of your pubic hair.
• Skin incision (low transverse below bikini line is most common)
• Uterine incision (low transverse)
• Breaking the bag of waters.
• Disengage the baby from the pelvis.
• Birth! (accomplished by hand, forceps or vacuum extraction)
• Cord clamping and cutting. It is possible to have a lotus birth!
• Newborn evaluation ( ask to be done on mothers chest)
• Father to be handed the baby if it is not staying with the mother (preferable against his bare skin as quickly as possible).
• Placenta removed and the uterus repaired.
• Skin sutured (usually the top layers will be stapled and removed within a week)
• Post-operative medications (ask about Duramorph, least effect on baby)
• You will be moved to the recovery room (insist the baby is  to go with you)
• If father takes the baby out of the theatre…cuddle the baby and not left in the bed…get shirt off and enjoy skin-to skin special time.
• Mother to try and focus on the joy her partner is experiencing, and the moment they are spending together…dream of your time when you will meet your baby and share those moments.
• When you get to your room and staff have done their medical checks, get your gown off, unwrap the bay and place skin-to-skin.

Not many doctors seem to understand the importance of these requests, however mothers and babies bond more effectively and easily if these needs are respected. Dad, get involved in the discussions with the doctors. Clarify your needs with your partner, and discuss with the doctors until you believe they understand the motivation behind your need! Most are co-operative if you are clear about your objectives.

Family centred caesarean birth is a term that is used to describe a birth that is more towards a family setting. People usually believe that this can not apply to surgical procedures. This is not true. Dad, stay in the room for the entire procedure. Ask that the baby stays too! It is very important for mum to have the baby close. 

Even with a caesarean surgery you can have a family centred birth, if you know your options and choose to apply them. You may have to work harder to have a family centred birth in the event of surgery, but planning ahead (even if you don’t foresee a caesarean) can go a long way!

• Bring your partner ( and sometimes one or two other people)
• Using a mirror during the birth or having the screen dropped.
• Using music during the delivery.
• Pictures, videotaping.
• Partner cutting the cord.
• Minimal separation from the baby… ask that the baby be left on your chest, the paediatrician can check it out there.
• Keep the baby in the recovery room.
• If the baby has to go to the nursery, dad to go with him/her.
• Breastfeeding in the recovery room.
• If the baby is separated from mum, don’t show anybody until she is there!
• If there is separation, have a ritual when mum and baby reunite..take the babies clothes off and place the baby on the mothers bare skin.
• Leboyer bath after birth – float the baby in water for a while and then place him/her on your bare skin.. dad to do as well.
• Freeing one of your hands to touch the baby after birth.
• Partner carrying baby to the warmer after birth.

Your recovery

Everyone’s recovery will be different, depending on your age, body type, and general health. However, some basics of recovery will be to remember that you have just had major abdominal surgery as well as given birth to a new baby. You may experience;

• gas pains
• incision pain
• uterine contractions (your uterus will still need to work to get back to it’s original shape)
• you may be extremely tired from medications, labour (if you had one), or just in general.

Try to take it easy. Although walking as soon as possible is very helpful in your recovery, doing as little as possible is important. Ask your partner to stay in hospital with you or spend as much time as possible. Some women come home on day3 or 4 feeling amazingly well, but the general rule of thumb is to not lift anything heavier than your baby. When you get home take the steps only once a day, if at all. Make a nest on the couch and nap there during the day. ideally you have a man around for at least a week…and other help that is available to you after that for a couple of hours a day. sleep in the afternoon with your baby! Get as much help as you can with your cleaning, food preparation, looking after siblings. Make a list and keep it handy, when someone offers to help it is easier to read off a list than to think of something you need done. It is wonderful to be nurtured as a new mother or father!

You can start doing kegels and breathing exercises the first day in the hospital, learn how to do this before the operation of possible, otherwise a physiotherapist can help. Then each day you can find small exercises to o to get back into shape. Small walks with your baby are great! Do not return to your previous exercise routine without permission from your caregiver. Overdoing it will only slow your recovery.

By the end of six weeks, some women say they are feeling great, although some are still dealing with some pain and sleeplessness. After this you can resume some activities. Let your body be your guide.

Some women, not all, will need more help with emotional recovery after a surgical birth. While it is very important that you and your baby had a healthy delivery, you may still have emotions that need to be dealt with surrounding the experience.