A doula’s guide to c-sections

by Brood

Photo by Alexa Mazzarello 

This month is Cesarean Awareness Month. You might be thinking – why exactly do c-sections need awareness? 

While c-sections can be life-saving for parents and babies in certain situations, they are also associated with higher risks of complications compared to vaginal birth. Additionally, c-sections and its ensuing healing can have long-term health consequences for both the parent and baby. In saying this, belly births continue to be one of the most stigmatized journeys to birth a family can take. Internally, some parents can face shame, guilt, and rearrangement of their expectations of their birth. Externally, some parents who choose or have a cesarean as a part of their plan can face judgment or pity, based on their decision.

Unfortunately, similarly with the continued rise of the stigmatization of c-sections, so has the rate of belly births (often without clear medical reasons), and this trend has raised concerns among healthcare providers and policymakers. Cesarean Awareness Month is important because it raises awareness of the risks and benefits of c-sections, highlights the importance of informed consent, and promotes policies and practices that prioritize the health and well-being of pregnant people and babies.  

During this month, healthcare providers, advocacy groups, and community organizations work together to provide education and resources on the risks and benefits of surgical births and alternative options for childbirth, such as vaginal birth after c-section (VBAC) and other low-intervention birth methods. This awareness helps expectant parents make informed decisions about their birth options, which can lead to safer and more informed outcomes for all. So, let’s dive in and learn more.

What exactly is a cesarean or c-section?

A cesarean or c-section (also known as a belly birth), is a surgical procedure in which a baby is delivered through incisions in your abdomen and uterus. Scheduled c-sections may be suggested if your baby is breech, you have placenta previa, you are expecting multiples, or you need a guaranteed delivery before you reach full-term gestation. Unscheduled cesarean sections are when there is a reason for imminent birth and it is necessary to have a surgical birth within the next few minutes to hours. For unscheduled cesareans, when babies are required to be born within minutes, there is a chance you will be put under a general anesthesia, so that they can perform the surgery more quickly (this is very rare, and only done for specific reasons). Like any kind of birth, there can be a lot of fear and anxiety about pain, recovery,  negative birth outcomes and long term effects, but we hope with the right education, tools and information you can feel confident in understanding your options and rights as a birthing person.

How to Prepare for a C-section 

Before any and all types of birth, we recommend using our New Parent Guide to support your transition into parenthood – this guide will support you to prepare prenatally, logistically, and relationally for this new chapter of your life. Of course, at Brood we always recommend doulas – as they can help ease anxiety and fears, advocate for your needs and preferences, help facilitate communication with your healthcare team, and provide ongoing support during the postpartum period. Learn more about doulas here!

If your belly birth is scheduled, we recommend preparing prenatally for your upcoming recovery. This can look like stockpiling nourishing and easily digestible foods in your freezer, setting up supports for your older kids and pets, and buying some healing necessities (like c-section underwear, a soft robe, painkillers, special treats etc.). If you are interested in nursing or pumping, we recommend trying antenatal hand expression to store collected colostrum and get familiar with your chest. Lastly, we suggest preparing your partner(s) and support team to do the heavy lifting in terms of house cleaning, meal times, and guest management. Remember you won’t be able to lift more than your baby and your focus will be in pain management, lactation/feeding your baby, and healing from your birth.

Your hospital bag may look different for this type of birth and recovery — make sure to bring some compression garments, broth (as your digestive system shuts down in surgery and beginning to digest again can take some time), and items to make your slightly longer hospital stay more comfortable and grounding (for example, your laptop with your favorite shows downloaded and some smells/comforts from home).

The Process + Day Of

Content Warning: This post contains graphic discussions of birth and surgery.

Chosen and/or post-labor c-sections are when part of the decision making process happens in labor. Depending on where in your labor you are and which pain medications you are currently using, it can alter the procedures needed to get you prepped for surgery. As soon as you make the decision to have a surgical birth, your environment will quickly change — as you are asked to sign consent papers and begin preparation. An IV drip will be added or topped up, your epidural will be topped up (or done in the operating room as your support person waits outside).

For scheduled belly births, you get a date set, you will be given a date and time to come to the hospital and you will have been told to stop eating about 6 – 8 hours before. Then arriving at the hospital and heading to pre-op (with your doula, if you’ve got one), there your care provider and nurse will brief and prepare you. Your birth support team will be told to go to the waiting area, while the birthing person will get anesthetized and prepared (with a catheter put in, their abdomen sterilized, IV started, and spinal administered).

Once in the operating room (know that it will be a full room, with many people), a blue drape is placed from your waist up — for sterility and so that you can’t see the procedure. Your support team will then join you in the operating room and they will start the surgery. If you’d like, you can ask for a specific song or album to play out loud. It’s expected that you’ll hear the beeping of the heart monitor. Your arms may be held straight (to continuously check your blood pressure), and the anesthetic can make you shake dramatically. The obstetrician will begin the surgery and make the incisions needed, then they will adjust your baby for arrival (this could mean with forceps or their hands). Remember: Much like a vaginal birth, there is a great push before your baby is born — focusing on that sensation may help you feel more agency over your birth. Feel free to ask your OB to warn you before this happens, so that you aren’t as shocked.

Your baby is here! You can ask your OB to lower the blue drape immediately, so you can see your baby — make sure to get your doula, midwife or support person to stand up and take photos. The umbilical cord is then cut and your baby is brought to your chest or the warmer for newborn procedures. Your support person is free to go over to the warmer and be with your baby.

Now is the time for repairs — this is typically the longest part of the surgery. If your baby has good APGAR scores and seems to be doing well, they can be on your chest or in your support person’s arms (who can also do skin to skin).

Your surgery is now done, the room will clear out a bit, and you will be transferred over to a porter bed and taken into post-op recovery. Here you will stay for about 30 mins to a couple of hours, they will frequently check your temperature, blood pressure, oxygen saturation and heart rate. Your legs will slowly start coming back, and you can try to nurse your baby. There will be post-op nurses monitoring you, and they will be able to help with the first few latches. Finally, you will be transferred to a postpartum room where you will stay for two or more nights, as they monitor you and you get your first days with your babies.

Healing + After Care

Prenatal planning – emotionally, physically and logistically is one of the best things you can do for your immediate postpartum. Another is being aware of the ways in which your postpartum may be different due to your belly birth, such as:

  • Lactogenesis changes will differ depending on how much labor you experienced – because the hormones that trigger your milk coming in may not have kicked in.
  • Water retention/edema can occur more readily in surgical birthers. To combat this, drink more water, wear compression stockings, elevate — then massage your legs and be patient.
  • Mental health challenges surrounding and after surgery can be heightened due to the extended recovery and decisions it took to get there.
  • Limited range of motion is expected, to allow your body to heal. You will be advised not to lift anything heavier than your baby. Turning, rolling, laughing, crying and getting up will be painful and challenging for the first little bit.
  • Begin exploring how you can use your other body parts to help you make movements that limit the use of your abdominal muscles.

Remember that you will still experience many of the symptoms of postpartum recovery from vaginal birth — like your lochia, post-birth uterine contractions, bowel differences and pelvic floor changes. To manage and be supported through these symptoms and this healing process – you can eat and drink nourishing foods (such as broth, stews, and generally warming foods), have frank conversations with your support network about how they can support you (such as house maintenance, sharing in joy, and baby care), and reach out to wellness practitioners for additional healing support (such as pelvic floor physiotherapy, mental health practitioners, and/or RMTs).

To learn more about how a Brood doula could support you during birth, fill out our intake form.  

Still curious about belly birth? Click here to read Brood’s c-section myth-busting post and make sure to check out this incredible resource from our friends at Nurturing the Mother, The Cesarean Recovery Guide – use BROOD23 for 20% off.

 

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