How rare is skin-to-skin post CS? Can you "force" it?

[MegBoz]

I read a great blog post by an OB nurse about speaking up and making skin-to-skin post CS happen. I get the impression from her post that it's really not that difficult to make happen (i.e. there is usually no medical reason to prevent it), but it happens rarely because of force of habit. Everyone just following procedures to get their job done.

So how many hospitals would even consider accommodating the request?

Has anyone heard of people just going ahead & doing it?

In the rare event my HB turns into transfer & CS, this is very important to me & I'm really tempted to tell DH it's his job to literally take our baby out of the nurses hands if necessary and put her on my chest even if they're not agreeable. After all, she's our baby and so long as she's obviously breathing fine, I don't see a need to await their "permission."

Clearly it would be better if it didn't have to come to that, but I'd rather fight than acquiesce.

[Sudonk]

I haven't seen that blog.  Do you have a link?  I'd like to read that.

I haven't had a CS, but I do know people who have done skin-to-skin following a c-section.  Most of the time, it's with the father, though, not mom until she reaches recovery.  Some of those moms planned to do skin-to-skin themselves, but were feeling nauseated or shakey and weren't comfortable holding the baby. 

[Comtessa]

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

[JollyGG]

In both of my c-sections baby was taken to the warmer and checked over accompanied by DH and then brought to me and placed on my chest with DH helping to support hold them. With the first I kept it short as I didn't have my hands free. With the second I asked to have my arms freed and then held her with the support of DH. Since the gown is more laid over mom during a c-section than a garment I'm actually wearing in both of mine it would have been fairly easy to have skin to skin contact by simply lowering the gown.

Most others that I know of had baby brought over to them fairly quickly as well.

[happyblessedmama]

I can only answer in my personal instance that it didn't happen, but my c/s was pretty unexpected (6th baby, 5 prior vaginal births). I was sort of out of it (not due to drugs, just stress) and didn't think to force the issue while on the table. I was not strapped down. Someone brought over the baby and put him against my cheek, but then he was taken out of the room to be given a checkup by the ped (hospital policy for all babies born by c/s - very small, rural hospital). I did not see baby again until my time in recovery was up (about an hour).

[MegBoz]

Here's the blog - http://obnurse35yrs.wordpress.com/2010/06/03/skin-to-skin-minutes-after-cs-in-the-or-speaking-up-and-making-it-happen/

Originally Posted by JollyGG 

In both of my c-sections baby was taken to the warmer and checked over accompanied by DH and then brought to me and placed on my chest with DH helping to support hold them.

<snip>

Most others that I know of had baby brought over to them fairly quickly as well.

So in your case and the others you know, was baby naked? Or was baby swaddled in a blanket or towel and then brought over to your chest? (Since you said it was quick, I'm assuming baby wasn't first bathed & put in a diaper & outfit.) I'm concerned not just about seeing the baby immediately, but literally having immediate skin-to-skin contact to sorta "imprint" our smells on one another. LOL, I know that sounds a little silly - it's not like we're cats or something, but I really do think that smell issue is important and I want that imprinting of our smells to happen. So I want that naked, slimy baby... hehe.

& I guess I could deal with it if baby were brought to me like a minute after birth, but I'm just curious, why go to the warmer first to be "checked over"? Obviously if baby isn't breathing, it helps to get them onto a flat surface for resusitation - that's an entirely different story. But if baby comes out screaming & obviously breathing, why go to the warmer at all, even for 30 seconds? I just don't get it.

Originally Posted by Comtessa 

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),

<snip>

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. 

Good point, but I actually still don't see my shakiness as being incompatible with STS - DH can hold baby there! Instead of DH holding baby in his own arms, he can hold her in place on my chest - even let her try to BF if she's interested. IMO, just because my arms are too shaky to feel secure holding her there doesn't mean she can't (and shouldn't be) in place on my chest.

Thankfully my transfer hospital is pretty mama & baby friendly (I had my DS there - which was our plan.)

Good point on having the birth plan "signed off" - but I'll have to ask the MWs about that. I'm seeing them for a slight degree of 'shadow care' - but when I had my DS I NEVER saw any of the OBs in the practice and I assume that will continue, so I'll have to ask the MW what it would take to get an OB's approval of the plan & specifically STS.

Um, yeah, also about that whole arms-tied-down thing. I have a huge HUGE problem with that. Like massive. Granted, maybe in the moment, with a baby in distress, I'd go with it & not even notice, but as of right now, the IDEA of it makes me completely insane. I'm not an idiot, I comprehend the concept of the sterile surgical field and the need for IVs so I'm not going to go pulling tubes out of my arms or ripping down the drape.I read that the tying-up can be done so the arms don't fall off the narrow boards. That sounds rather wacky to me - what would make them 'fall'?

[OneSmallAxe]

I too am seeking the same treatment if I am in the position of having to have a c/s because of a breech baby A in my upcoming twins birth. My doctor wants me to schedule my c/s at 38.5 weeks and part of her reasoning is that "she can advocate my wishes for a skin to skin c/s". But that is really not enough of a reason for me and I am wanting to wait until the onset of spontaneous labor to tackle the "how to birth" issue, since any number of things can happen during labor, such as baby A going vertex, and the added benefits of the labor process to both me and my babies. I am so with you on the tying down of the arms. I would raise a holy stink if they even try. I too, am requesting the babies not be bathed as well and have asked that the two not be routinely suctioned (nose & mouth)

These rigid protocols need to change and I figure we are the types of ladies to help buck the system 

[cileag]

Quote:

Meg,

I totally get want that wet squirmy baby up there, but keep in mind that the OB has to remain sterile, so typically, he hands off the baby to a sterile nurse, who I suppose COULD bring baby over you, but two factors would make it somewhat difficult to implement in my experience.

1. It's COLD in the OR.  One of the things that we do whether it's a home or hospital birth is keep that baby warm.  So you want to dry that baby off and whisk away the cold blanket so, minimally, I think that would take thirty seconds.  It could happen quickly, bu tit would even take thirty second for the MD to cut cord, suction (which they typically do on the abdomen), and then hand the baby off.  Nurse then wipes baby the first time and then hands off to mom and covers both with warm blankets---

2. Honestly, I'd say most women experience nausea, or shaking when the OB removes the uterus from the abdomen to close it up (which is pretty typical where I work).  It sucks and it's usually temporary but it seems to usually happen.

Originally Posted by MegBoz 

So in your case and the others you know, was baby naked? Or was baby swaddled in a blanket or towel and then brought over to your chest? (Since you said it was quick, I'm assuming baby wasn't first bathed & put in a diaper & outfit.) I'm concerned not just about seeing the baby immediately, but literally having immediate skin-to-skin contact to sorta "imprint" our smells on one another. LOL, I know that sounds a little silly - it's not like we're cats or something, but I really do think that smell issue is important and I want that imprinting of our smells to happen. So I want that naked, slimy baby... hehe.

& I guess I could deal with it if baby were brought to me like a minute after birth, but I'm just curious, why go to the warmer first to be "checked over"? Obviously if baby isn't breathing, it helps to get them onto a flat surface for resusitation - that's an entirely different story. But if baby comes out screaming & obviously breathing, why go to the warmer at all, even for 30 seconds? I just don't get it.

[CI Mama]

& I guess I could deal with it if baby were brought to me like a minute after birth, but I'm just curious, why go to the warmer first to be "checked over"? Obviously if baby isn't breathing, it helps to get them onto a flat surface for resusitation - that's an entirely different story. But if baby comes out screaming & obviously breathing, why go to the warmer at all, even for 30 seconds? I just don't get it.

Does anyone know how common it is for a c-section baby to come out screaming & obviously breathing? I thought that because c-section babies don't get squeezed through the birth canal & have the amnio fluid pushed out of their lungs, they basically have to be suctioned or they won't be able to breathe on their own. But I could be totally wrong (happens all the time!).

My personal experience:

I wanted skin-to-skin with my baby as soon as possible after birth, but for me that meant in the recovery room. I pretty much "checked out" of my body during the c-section. I believe that was due to a variety of factors: physically, I was completely exhausted after two nights without sleep and a long, difficult labor. I just didn't have the energy and strength to stay tuned in to the massively intrusive thing going on with my body. I got the shakes and I came in and out of consciousness during the whole thing. I do remember being conscious when they pulled DD out of my body, seeing her for about 1.3 seconds before they whisked her off to the warming table, and then what felt like an eternity before I heard her first cry. They wrapped her up like a burrito and brought her over to me, but I was barely able to stay conscious and move my hands to her, let alone hold her. My partner took her and held her while they stitched me up. I remember that taking about 10 minutes, but my partner says it was more like 45 minutes. I had requested stitches, not staples, so it definitely took longer because of that. Physically & emotionally, during that part I just "checked out." I really didn't want to be in the OR.

My partner says that she tried holding DD skin-to-skin in the recovery room, but she just felt silly. So she wrapped up DD and held her.

Once I got out of surgery and into the recovery room, things improved a lot. The shakes went away, I was able to think more clearly again. I got my first skin-to-skin contact with her and attempted breastfeeding for the first time. I was still exhausted and emotionally wrung-out, but I was also so relieved that DD had been born and was alive (and so was I!), and some of my favorite photos are the pictures of me holding her skin-to-skin for the first time. That was probably about an hour after she was born.

This was not perfect, but I do think it was good enough, given the circumstances. I was able to bond with DD and establish breastfeeding even though technically we didn't spend the first hour of her life together. I believe that the time she spent being held and nurtured in my partner's arms was valuable and positive. But I'm one of those who takes the "long view" of bonding and other "natural" processes. I don't think they are the work of an instant, but are established through many connections and interactions over time.

[MegBoz]

Originally Posted by cileag 

I totally get want that wet squirmy baby up there, but keep in mind that the OB has to remain sterile, so typically, he hands off the baby to a sterile nurse, who I suppose COULD bring baby over you, but two factors would make it somewhat difficult to implement in my experience.

1. It's COLD in the OR.  One of the things that we do whether it's a home or hospital birth is keep that baby warm.  So you want to dry that baby off and whisk away the cold blanket so, minimally, I think that would take thirty seconds.  It could happen quickly, bu tit would even take thirty second for the MD to cut cord, suction (which they typically do on the abdomen), and then hand the baby off.  Nurse then wipes baby the first time and then hands off to mom and covers both with warm blankets---

2. Honestly, I'd say most women experience nausea, or shaking when the OB removes the uterus from the abdomen to close it up (which is pretty typical where I work).  It sucks and it's usually temporary but it seems to usually happen.

Ah, thanks for pointing out the cold - I hadn't thought of it. That's a good point & makes sense.

Blech, I can't help but feeling a little repulsed at the thought of one of my internal organs being removed and placed on my abdomen to be sewn. Ick. But I guess that makes it easier for them to see what they are doing to suture it? Well, I guess perhaps if I'm nauseous & shaking, I won't be too interested in having baby on my chest anyway - so I'll ask DH to try to hold her instead.

Originally Posted by CI Mama 
I was able to bond with DD and establish breastfeeding even though technically we didn't spend the first hour of her life together. I believe that the time she spent being held and nurtured in my partner's arms was valuable and positive. But I'm one of those who takes the "long view" of bonding and other "natural" processes. I don't think they are the work of an instant, but are established through many connections and interactions over time.

Excellent points & thanks for sharing your story. Yes, hopefully I'll maintain some perspective and be content with what is good enough given the circumstances - as you stated.

I just didn't want STS to be denied to my DD and I purely because of stupid hospital protocol and everyone "just wanting to get their job done" (as written in that blog post). But yeah, again, it's not like not spending the first hour or even 2 with her would ruin everything. Heck, I had immediate STS with my DS and he didn't BF at all in that first hour! Just wasn't interested. I think it took a couple hours before our first BFing session.

[LisaG]

Originally Posted by CI Mama 

Does anyone know how common it is for a c-section baby to come out screaming & obviously breathing? I thought that because c-section babies don't get squeezed through the birth canal & have the amnio fluid pushed out of their lungs, they basically have to be suctioned or they won't be able to breathe on their own. But I could be totally wrong (happens all the time!).

Our daughter came out crying.  I remember thinking "oh good, she's not having any breathing problems".  I was wrong.  She was having breathing problems and ended up being transferred to the NICU. 

One of the reasons they take the baby to the warmer is because c/s babies are more likely to still have fluid in their lungs because they haven't had the assistance of being pushed through the birth canal.  As a result c/s babies are more likely to need suction and I think nurses are a little more cautious with evaluating the baby's breathing.

Also to Meg, not all docs take the uterus out to repair.  My doc does not - it's not as easy/quick to repair without taking it out, but he prefers to avoid the complications that go along with taking the uterus out of the abdominal cavity.