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Discussion Starter · #1 ·
I know that the VBAC forum is a strange place to post a question for a planned c-section, but there isn't really a forum that's more appropriate and I figured you all might have some good suggestions, having been through c-sections!

For reasons beyond my control I'll have a planned c-section for DS2. I do have a wonderful, caring OB who will perform the surgery and it will be in a very baby-friendly hospital. (No quick trip to the NICU, baby stays with me.) I'm wondering what I could do to make the experience as AP-friendly as possible. What could I do to help the birth be warm and sweet instead of operating-room-sterile? (Metaphorically speaking, of course!)
 

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Have you heard of the "Gentle Cesarean"? It's pretty new in the US; has been performed longer in the UK and (I think) in Australia. It involves taking the baby out slower, allowing your contractions to help squeeze fluid from the lungs (like in a vaginal birth), lowering the curtain so you may have immediate skin to skin contact (like in a vaginal birth, as long as there are no respiratory issues) and delayed cord clamping. I'm looking into it in the event I cannot have my VBA2C.

Here's a video discussing it:

http://www.youtube.com/user/jennylgl#p/a/u/0/yhxTDxu2I_w

The volume is a little off, but you should get the gist of it.
 

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There is a "natural family living cesarean resource thread" here. It is filled with tons of information about books, surgical birth plans used by mdc moms, recovery, and BTDT ideas for making a cesarean (planned or otherwise) as positive an experience as possible for mom and babe.

In addition, check out the "ideal cesarean" outlined by Cesarean Voices (there is a link in the resource thread, or go directly to their page here). It's a bit "over the top" in terms of what you may want or what your hospital can provide, but it might be a good place to start. The whole Cesarean Voices website is an interesting look at the psychological/spiritual/emotional impact of cesarean birth on the child... again, it may be a bit "out there", but it's one of the few resources to focus on this aspect of cesarean birth.
 

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I would talk quite a bit with your doctor about the painkillers that will be used after your surgery. Having talked to a lot of friends who has CS, many of them can't remember much from their first 24 hours with their baby (which is obviously not what you want!). I didn't have that problem at all. I can remember everything quite clearly. Some of them were on heavier duty drugs than me, so I'm thinking that must be the difference. So I'd talk a lot with my doc about the options ahead of time to make sure s/he knows that you want to be fully aware of everything that's happening.

Nursing after a CS can present some challenges. You want quick skin to skin, of course. But if your baby has difficulty getting a good latch, you might not know it because you may not feel any nipple pain (due to the painkillers you're on), so you really have listen for swallowing, etc. Also, the extra fluids from your IV may cause your breasts to get a bit swollen, sometimes making a good latch difficult.

If you have a partner, make sure s/he is planning on being with you and the baby at the hospital all the time (if that's at all possible) because you'll need lots of help moving around, etc. and your partner can do a lot of the AP stuff with the baby. It's possible your other child may be able to be with you 24-7, too, so check with your hospital on that.

As far as the actual birth:

- consider hiring a doula. There are doulas who do planned CSs.

- dimming the lights?

- music?

- quiet at at the birth

- maybe you want to see the surgery?

- delayed cord clamping

- examine the baby on your chest?

Good luck!
 

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Having an OB you like and trust is the best indicator for a good c-section, IMO. I had my first c-section performed by a doctor who came in my room and announced, "This is my first day!" so you can imagine how much trust that put in me. (I found out quickly that she'd practiced for a couple of years in Chicago, so I wasn't her first c-section, but that was a bad way to start out!)

I didn't have a preexisting relationship with the OBs who performed my second c-section after my VBAC plans weren't working out well, but they were warm and kind and because it was an urgent rather than emergency c-section, they gave me lots of time to ask questions and state my preferences (mostly technical stuff like how they were going to cut me and such, but it felt good to be listened to, for sure.) So my suggestion is to tell your OB you have some preferences and ask which ones could be incorporated into your cesarean.

After my first c-section, I was able to nurse my baby in recovery, but after my second c-section, I couldn't hold and nurse him for a few hours. I wasn't in any shape to nurse in recovery the second time around anyway - for some reason I got the shakes much worse than the first time around. I was a bit disappointed I couldn't snuggle him immediately, but they were concerned about possible meconium aspiration. At any rate, it wasn't as scary as I expected - I just tried to nap and when he was brought to me, he nursed very well and we had no bonding problems. I just wanted to throw that out in case you have any little bumps on the road post-surgery
 

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I just wanted to second the "be particular about the meds" suggestion. You might also ask whether the anesthesiologist will allow you to keep one arm free to snuggle your baby after s/he's born. Mine did, and although I couldn't hold DD, it was a great relief not to be entirely strapped down.
 

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Discussion Starter · #7 ·
Thanks for the great ideas, everyone. It helps knowing that other AP parents have CS births. I get/hear so much pro-VBAC "support" that it really feels alienating and often judgmental.
 

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I'm really glad you posted this. I have a good chance of ending up with a c-section again and sometimes I get that vibe on here too, as if it's taboo to even say out loud. My first c-section was an emergency after an extremely long labor and was pretty scary for me. I was disappointed, but that was a long time ago and I've come to terms with it. My second was planned, but it was great. My OB was great, I got to watch (well not the cutting but everything else), my DH video taped it, my daughter was right outside waiting, and they handed me my son to nurse right away. It was a much better experience than my first, so I know c-sections can be gentle :)
 

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My fifth (and last) c-section didn't suck quite as much as the other four. For me, the biggest keys were that they allowed dh to come in for the spinal (something I find as terrifying as the surgery itself, so being alone for it the other two times was traumatizing) and being able to breastfeed dd2 on the OR table. I was told that wouldn't be possible, but the L&D nurse helped out, and she and dh held dd2 over my shoulder with her head pointed at my toes. It made a difference.

I can't give you much else, though. I still hated it, just not as much as the other four. Oh - and I got a pump for my painkillers. I only hit the pump when I needed to get up the first couple of times, and to get to sleep the first night. I hate the heavy pain killers they usually give me post-op, and they don't really provide me with terrific pain relief, anyway, so I figured there was no point.

ETA: The reason I was originally given for not being able to breastfeed on the table was that there is insufficient room between the drape and my breast for the baby. So, if you're told that, you could talk to the OB about possibly doing what we did, and holding the baby the other way. It really was kind of amazing.

My hospital doesn't routinely separate the mom from the baby in a planned section, but it did happen with that one, for a short time, because OR is too cold for the baby to stay very long, and I was on the table for a long time (had a tubal, and the OB was also excising existing scar tissue from the previous surgeries). I was soooo glad I got to nurse her before the separation.
 

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Discussion Starter · #10 ·
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Originally Posted by Kkrpata View Post

I'm really glad you posted this. I have a good chance of ending up with a c-section again and sometimes I get that vibe on here too, as if it's taboo to even say out loud. My first c-section was an emergency after an extremely long labor and was pretty scary for me. I was disappointed, but that was a long time ago and I've come to terms with it. My second was planned, but it was great. My OB was great, I got to watch (well not the cutting but everything else), my DH video taped it, my daughter was right outside waiting, and they handed me my son to nurse right away. It was a much better experience than my first, so I know c-sections can be gentle :)
Yeah. As much as I love MDC it can be hard to feel supported when you (have to/choose to) make some birthing decisions. I'm really glad to hear that a planned CS can go so much better. My first CS sounds just like yours - long labor, emergency CS, and then a brutal recovery. I hadn't learned a thing about CS in advance because I was so sure my homebirth would go well. Now that I can plan for it I know more about how to help my body be ready and how to help it recover.
 

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Discussion Starter · #11 ·
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Originally Posted by Storm Bride View Post

ETA: The reason I was originally given for not being able to breastfeed on the table was that there is insufficient room between the drape and my breast for the baby. So, if you're told that, you could talk to the OB about possibly doing what we did, and holding the baby the other way. It really was kind of amazing.

My hospital doesn't routinely separate the mom from the baby in a planned section, but it did happen with that one, for a short time, because OR is too cold for the baby to stay very long, and I was on the table for a long time (had a tubal, and the OB was also excising existing scar tissue from the previous surgeries). I was soooo glad I got to nurse her before the separation.
Both of these things are really helpful to know. Thanks! I think my baby can stay with me in OR but not necessarily in the recovery room. I'm working on finding out more about that. And the "insufficient room" reason is basically what my OB said, though he was willing to work with me.
 

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Originally Posted by BlueSkyDay View Post

Both of these things are really helpful to know. Thanks! I think my baby can stay with me in OR but not necessarily in the recovery room. I'm working on finding out more about that. And the "insufficient room" reason is basically what my OB said, though he was willing to work with me.
The recovery room can depend on factors beyond the OB's control. With dd1 (my first conscious section), the policy was to move the mom and baby back to the L&D room (where they did the early prep for the c-section) from OR, and let the mom breastfeed during the monitoring period. But, while I was in OR, another mom moved into that same L&D room, and there wasn't another one available. So, they had to move me into the main post-op recovery room, with several other patients from all over the hospital. Therefore, dd1 and I were separated for a bit over an hour, while I was recovering from the anesthesia and being monitored. I missed her soooo bad. (The separation from my first was longer, but I was unconscious or under sedation for all but about 10 seconds of that, so I didn't feel it as strongly (although I'm sure ds1 did. *sigh*)

It really made a huge, huge difference to me when I could have my baby close to me right away.
 

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If you're meeting with the anesthesiologist, having the sterile field set a few inches lower can make room for nursing without compromising the surgery. We had a wonderful OB in my town for a while and she always advocated creating a surgical birth plan that was essentially four index cards... one for the OB, one for the anesthisiologist, one for the pediatrician, and one for the nursing staff. That way you could sort of focus on the 2-3 things each professional is responsible for... the OB isn't "in charge" of where your babe goes once your babe is handed to the nurse, the pediatrician isn't "in charge" of what pain meds you get, the anesthisiologist isn't "in charge" of what style closure is done on your uterus, and so on. In her experience, specialists like to be treated as such and tend to listen more closely/are more willing to adapt their routines if it's clear you know what they actually do and are addressing your concerns to those specific areas.

And asking for the drape to be set at the bottom of the rib cage rather than just below the collar bone is something the anesthisiologist can do for you. Having warm blankets ready to cover the babe along with assistance in positioning the babe for supported breastfeeding is something the ped and nursing staff could provide. But it does take planning (or luck!)
 

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I think one of the important things is to just go in there knowing that the day is going to be a special one. Be excited about seeing your little one. Let the excitement and happiness of that help to carry you over any of the cold sterileness of an operating room. Watch for the little bits of humor, and write them down to be able to tell your baby the stories of the birth. If you have a few minutes in the operating room before hand, talk to the staff, find out their names or stories, or what their roles will be in the birth. Make sure whomever puts in your IV is experienced and can do a good job of it (if it hurts, ask about having it redone, because the last thing you want is to be stuck with a poorly done IV.)

Personally, I think part of what can make a c-section warm and sweet is the attitude you go in with. I think the more at peace you are with the idea of a csection, the more okay you are at making the best of things, the better its likely to go.

Does the hospital have a policy with regards to cosleeping? Will it be a problem to have the baby in the bed with you? Will you have a partner staying with you able to help lift baby up and stuff for you?
 
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