I have a line on my birth plan under "in case of Cesarean section" that reads, "Please place the baby skin-to-skin on [Mom's] chest as quickly as possible after it is born, health permitting. If she is unable to hold the baby, please place baby skin-to-skin with [DH]." I ran this by my MW this morning so she knows it is our preference and can speak up in the OR to advocate for it if necessary. DH and our doula will also be aware of this so that they, too, can advocate for it.
As with most things when dealing with the medical world, it is important to know the limits of what is necessary and what is normal. In this case, as the PP already mentioned, there are your own physical limits (plenty of mamas are too shaky immediately post-CS to hold a newborn), and the limits of the baby (depending on the reason for the CS, the baby could need legitimate immediate medical intervention that precludes immediate skin-to-skin). These could be considered "necessary" limits. However, there are also the limits of "what is normal" in the hospital policy and practice. And this is where you have plenty of room to speak up.
If this is super important to you, it is totally possible, regardless of where you deliver and regardless of who attends your birth. Here's my advice: most importantly, tour the L&D where you would be transfering "just in case." Ask questions about policies during a C-section. Ask specifically about skin-to-skin. Don't ask "is it allowed?" but rather "what has to happen in order to ensure that our wishes can be met?" If necessary, ask "whose signature do we need to have in order to ensure that this can happen?" There's always a way around the policies, if you push hard enough, as long as you make it clear that you are willing to be flexible in a true medical emergency.
1) have a good transfer birth plan, and, if at all possible, have it signed by a doc who works at that hospital and placed in your patient file. That way, if you transfer, they already have "doctor's orders" to do things a certain way for you.
2) If you need a CS, make sure you speak up about skin-to-skin while they are prepping you. You'll probably have plenty of time for this conversation. Something like, "it is very important to me that this baby get skin-to-skin contact with me or DH as soon as it is born, and that anything you need to do with the baby be done while we are holding her/him. Which of you will be able to ensure that this happens? What do I need to do to make sure it is possible?"
3) If the nurse who is attending you in the OR during prep sounds like she won't be willing to help accommodate this request, politely ask her to send in someone who will. Ask to speak specifically to the nurse who will be sent in to attend the baby -- that's the one you have to convince.
4) Be aware that sometimes they strap a mama's hands down during surgery -- actively demand that they leave one arm free so that you have the option of holding the baby.
5) Not integrally important, probably, but it was to me so it's on my birth plan too: demand that the hospital allow two support people for you in the OR (unless there is a rare true emergency and you are under general anesthesia, in which case usually nobody else can be in the room with you). That way, if the baby has to go somewhere without you for medical reasons, you are not left alone while you are recovering from surgery, and your DH can feel free to go with the baby and get her/him skin-to-skin as quickly as possible.
But of course, in the end, none of this will be necessary!!! Because you're going to have a peaceful, problem-free homebirth after all. :)
Edited by Comtessa - 1/5/11 at 1:25pm