Caesarean Section Choices
A Caesarean section deserves a totally full and frank discussion. I didn’t want to rush over anything about C-sections in my previous article about informed choices so I decided to put the info over here. I want to make sure options around Caesareans are discussed just as in-depth as any other type of childbirth.
You might think you won’t need to be aware of the options around C-sections, but even if you’ve planned a vaginal birth at hospital or home, it’s always wise to keep an open mind. There are many potential paths a childbirth could take. To feel fully informed it is good to have an awareness of them all. Friends who attended antenatal classes felt as if they were uninformed about C-sections, as they simply were not mentioned in the sessions. In my MummyNatal birth preparation classes we discuss ALL types of childbirth, so no matter what course your birthing journey takes, you have a full toolkit available to you and have an awareness of a range of birth types.
If you are having a planned C section, you are likely to have more choices open to you than an emergency section (EMCS). If there is a risk to you or your baby, then your midwives and doctors will advise you about an EMCS. In that situation you might have to make fast decisions. You can ask for some time to think, but delaying might not realistically be a safe option. This article is written with a planned section in mind. This piece is presuming that you will have time and space to consider everything, and aims to outline some of the choices you might have available to you.
Not the Only Choice
Sometimes sections are presented as the only option for you. As an example, you may have been told your baby is breech, or if you are told you'll be classed as ‘high risk’ (you can question if this really is the case, and ask for further evidence and information for your situation.) But here I am assuming that you have made the informed choice to book a C-section, and your consultant or midwife has given you information about the reasons why. You might have attended my MummyNatal classes, learned about and applied ‘BRAIN’ to your situation, and decided that given all the Benefits, Risks, Alternatives, and what your Instincts and Intuition says, C-section is the right path. If not, and you haven’t really had chance to think about it, then perhaps now is the time to apply BRAIN and consider all your choices.
Moving on and now making an assumption that you are happy with your choice to have a Caesarean section, we can now consider what options are open to you before, during and after your baby’s birth. You might have several ideas of things you'd like in connection with your C-section so it's useful to discuss these things beforehand with your birth partner and your midwives/doctor. Remember you can change your mind about your specific options at any point, but because you’ll be scheduled for a slot in theatre it’s a good idea to keep your hospital up to date with your thoughts where possible. Knowledge is power, and our aim in MummyNatal classes is to help all mums-to-be and their birth partners feel empowered through the ability to make informed choices.
A friend has said her birth partner felt a little as if he was swept along like a passenger. Other friends have commented they didn’t know they were ‘allowed’ to choose things. You can help to empower yourself by finding out information about all the options, and communicating those ideas to people best placed to assist you.
1. Your Birth Environment
Do you know what your birthing environment will look like? If you’ve not been on a tour of where you’ll deliver baby, ask your hospital about having a look around. Ask what facilities are available to you – will you be able to have your birth anchors close to you, such as lavender scent on a tissue or pillow? Is there an option to play music? In MummyNatal classes we discuss taking things with you that make you feel relaxed. Just because you won’t physically feel the sensations of contractions, it does not mean you will not need some calming and grounding during the procedure. The situation could cause you some stress or anxiety, so the more familiar things you have around you, hopefully the more relaxed you will feel.
You are bringing a new life into the world, and you may be in an unfamiliar situation. Anything you can bring with you to relax you there can only help.
2. Pain Relief Options
Ask what your hospitals gives for pain relief as standard with a section. Find out about the possible side effects and benefits each type involves. For example a friend who advised me during the writing of this article pointed out that her pain relief caused her to have a bad stomach, which was, to say the least, very difficult for her after having had major abdominal surgery! If you are having an epidural or a spinal block, you might want to familiarise yourself with how that is administered. Usually an anaesthetist will give you this via an injection in your back. That in itself might feel uncomfortable, particularly if you are required to lean over your bump. Talk to your midwife or consultant about other positions you could move into to receive the epidural.
3. During the Delivery
You can ask for the curtain or screen to be lowered. In America some doctors are performing sections with the use of clear drapes; parents can see everything but baby is still screened and protected. However I have yet to find any info about this being offered in the UK. If anyone knows of hospitals doing this, please do let me know! In the meantime if you have chosen to have a screen up, your birth partner could take photos or video to show you. You could opt to have the screen lowered, so you yourself can watch what is going on and see your baby being born. If you aren’t happy that your decisions or wishes are being fully listened to during the procedure, then you or your birth partner are free to speak up at any point. Also if you feel unwell during the surgery, make sure you speak up then too. The effects of the pain relief may cause you to feel sick, and if that’s happening you might be given an anti-sickness drug if you’ve not already received it before the section began.
4. After Baby is Born
You have similar options to you as if you had delivered vaginally. So for example, if there are no contraindications, you may wish to have delayed cord clamping. New research is emerging all the time about the benefits to mother and baby of waiting until the blood has stopped pulsing through the cord. If that is something you are interested in you can check it out here. You can write this into your birth plan and discuss it with your healthcare providers ahead of time if this is something you are interested in. Then you might have wishes around the placenta - do you want to choose to see or save it? Who announces the sex of your baby, if you were being surprised? Who cuts the cord? These are all your decisions, and things you may want to think about ahead of the day.
5. The Golden Hour
You might like to notify your midwives/consultants if you know you will want skin-to-skin immediately after baby is born. There is information about the importance of ‘The Golden Hour’, the first hour or so after your baby is delivered, where you might want to just hold baby in your arms. Maybe you'll want to try to breastfeed, and have things such as weighing him or her done later. You might want to get help to raise your head and shoulders if you wish to hold baby or breastfeed right away, as there’s a chance you could be feeling light-headed or tired after your surgery. Sitting up slightly could also help if you are feeling sick, as you don’t want to be stuck on your back if you are going to throw up!
Your section surgery will take more time to heal than vaginal episiotomy or tears, so you may wish to keep yourself topped up with pain relief or discuss something stronger.
6. Pain Relief Again
I am reliably informed that you might wish to keep up your pain relief, even if it’s just paracetemol, the same as you might wish to after having any vaginal tears stitched up. I had a few stitches after a second degree tear each vaginal birth, and had ibuprofen and paracetemol alternating every few hours for around 3-4 days afterwards. Your midwife or doctor should advise you about the pain relief options for recovery after a section. It will be dependent on your own needs as to what level of pain relief you could take. They should also inform you about the injections you will need to have after the section, which helps to prevent blood clots. You may also need to wear compression stockings to help prevent clotting.
7. Big Pants
Honestly I wore big pants after vaginal delivery and haven’t really gone back as they are so comfy. Sorry probs TMI here, but there’s really nothing wrong with giant pants whatever birth experience you had! You’ll likely have tender areas from your section stitches, so be wary of packing anything in your hospital bag that is going to press against your tummy. You may also get trapped wind which could cause some discomfort, but is normal, however could be worrying if you aren’t aware it might happen. So loose clothing might also be helpful if you are feeling swollen or bloated with wind.
8. The Super Woman
You may also have a catheter for a while. If you are staying in the hospital for a few days your nurses will help you with this. In fact your nurses and midwives will be able to help you with most basic things as they’ll want to help you recover gently. It’s so important to take things very slowly, for example take your time siting up, walking, even moving on the bed. You will have experienced major surgery after all. As well as this recovery for yourself, you are also caring for a newborn! So please be gentle with yourself and take whatever help is offered. If you aren’t offered assistance, do ask right away and don’t feel like you can’t get help. There is absolutely no shame in not being Superwoman and doing everything yourself; your new baby needs you in good health, so rest as much as possible and take it slow.
Read through info on reliable websites such as https://www.nhs.uk/conditions/caesarean-section/ to get yourself informed. If you’re attending antenatal classes and C-sections aren’t mentioned, then simply ask. Even if you don’t think you’d want one, knowledge is power; we want every expectant mum to feel empowered through informed choices.