Planning For Your C-Section. A Detailed Birth Plan.

This post is all about our birth plan for my upcoming C-section. I’m having a C-section due to the placement of my placenta, so although a lot of things are out of my control, I really want to be clear about our wishes for the surgery.

Learn about my placenta and other fun facts about my pregnancy: My Pregnancy Journal: Week Twenty-Five

I am a labour and delivery nurse and totally aware that having a plan does not necessarily mean everything on that plan will happen. It's more a list of preferences if everything goes well. Some things might not happen exactly as planned. For example, the baby might need help transitioning outside of the womb, or there might be an emergency during the operation. That being said, there is nothing wrong with being prepared and knowing all your options.

Being Prepared

Always be prepared with a plan, but also be prepared that there might be deviations from that plan. Try to be open and flexible to all the possibilities birth can bring. Just the mere act of writing a birth plan will empower you. It's a great way to research birth practices and different scenarios that might come up. You will know the choices available to you and it will open up a dialogue between you and your health care team.

"The power of a birth plan isn't the actual plan, it's the process of becoming educated about all your options."

I read this quote somewhere and I love it! This is what this post is all about, becoming educated about your body and baby. Search the posts on Babytalk, I've written about lots of things that are discussed in my plan.

More about writing your birth plan right here on Babytalk: The Perfect Birth Plan. A Step by Step Guide.

Disclaimer: This is my personal birth plan and is by no means meant to represent a plan for everyone. If you have questions about any part of this plan, ask your health care team if the option you are interested in is available in your hospital.

Anesthesia - Special Wishes

A C-section is major abdominal surgery so there will be an anesthetist involved in your care. Usually, for a C-section, they give you spinal anesthesia. The other options are having a combined spinal and epidural or general anesthesia.

Learn more about C-sections right here on Babytalk! C-sections: What Happens in The Operating Room?

A spinal is just one shot of medication in your spine that numbs you completely from the waist down. This medication lasts the duration of your operation. A combined spinal-epidural is a shot in your spinal space, but the anesthetist inserts a thin line into your epidural space as well. This is done so they can top up the medication if the surgery takes longer, or is more complex for whatever reason. General anesthesia is the last resort for a C-section. The anesthetist will put you to sleep if absolutely necessary. For example, if the spinal stops working or if there is an emergency where the baby needs to come out very quickly before there is a chance to put in an epidural or spinal. General anesthesia is the last option because it can affect baby's breathing and might cause undue stress on your body.

My OR requests

My main request for anesthesia is that I'm not put under general unless absolutely necessary. The other request is that I don't want any residents or medical students putting my spinal in. I think it's fine that they are in the operating room and learning, but I would like the staff anesthetist to put the spinal in. If you are delivering in a teaching hospital, there is always a chance that a resident will be taking care of you. It is alright to ask for a more senior staff to take care of you. That being said, if it doesn't bother you, it's a great learning opportunity for the residents and students.

Natural C-Section

A natural C-section is when the baby is born and goes immediately onto the mother's skin from underneath the sterile drapes. As long as mom and baby are well, skin-to-skin can continue for as long as they want. They can even continue it from the OR all the way to the recovery room and beyond!

The video below is from a hospital in Toronto, Ontario. Check it out to see a natural C-section in action.

https://www.youtube.com/watch?v=0jCjk73Xpn8

Evidence actually encourages skin-to-skin in the OR. According to one report from the Cochrane Collaboration, skin-to-skin in the OR helps C-section moms to be more successful at breastfeeding. It helps initiate the first feed earlier. These moms were able to breastfeed longer than those that didn't initiate skin-to-skin in the OR.

Check out this evidence based article on Babytalk about skin-to-skin: Skin-to-Skin: The One Place Your Baby Wants to be After Birth

Husband Announces Sex of Baby

This one is easy. Since we don't know what we're having, I want my husband to announce the sex as soon as the baby is born.

I'm so excited about this one, it's been a long wait to find out!

Delayed cord clamping

Delayed cord clamping is exactly what it sounds like, it's when the doctors don't clamp or cut the cord immediately after birth. The reason this is beneficial is that, while the cord is still pulsating, the baby will receive about 33% extra blood from the placenta. It is rich with red blood cells, iron and stem cells as well as all the other good stuff in our blood. Only in extreme circumstances is this impossible. For example, if the baby needs to be resuscitated or if there is anything wrong with you during the surgery. If the baby comes out crying and happy, it is recommended to wait to clamp the cord for at least two minutes. Now, why wouldn’t you want your baby to get all that good stuff? Unfortunately, not all doctors and midwives do delay cord clamping, which is why it’s so important to include it in your plan if it's important to you.

Delay All Newborn Care

There are lots of things that have to be done for your baby right after delivery. For example, measurements, weight, Vitamin K and Erythromycin (you might hear the nurses call this eyes & needles or eyes & thighs).

As long as your baby is breathing and healthy, most of the interventions can be delayed. This will facilitate the first feeding and make breastfeeding easier for you and your baby.

We prefer to have uninterrupted skin-to-skin for at least 1-2 hours before any newborn care is performed.

Erythromycin Eye Ointment

Erythromycin is an antibiotic eye cream that is routinely given to babies in their eyes after birth. It is given to prevent serious eye infections caused by STI’s, namely gonorrhea. Historically, before antibiotics were readily available, silver nitrate was given in babies’ eyes after birth to prevent these infections. Inform yourself about whether or not you think your baby needs this intervention. Some say it’s not necessary anymore because gonorrhea is not as common as it once was. Also, women are routinely tested for it prenatally. The Canadian Pediatric Society released a statement saying that routine administrations this antibiotic is not needed and that there are other ways to prevent these eye infections. Talk to your health care provider to decide whether your baby needs this after birth. You have choices and the right to decline any intervention based on your informed decision.

Breastfeeding

This one is none negotiable for us. I plan on breastfeeding and do not want our baby to receive any supplementation with formula unless absolutely necessary. If there is any reason for supplementation, I would like it to be thoroughly discussed with my husband and myself.

More about breastfeeding from Babytalk: Best Way to Be Successful at Breastfeeding

Special Circumstances

If the baby has to go to the NICU I would like my husband to stay with the baby at all times and make any decisions necessary while I am not available. I would also like to come to see the baby in the NICU as soon as possible. With a C-section, this can be a little more difficult due to the anesthesia, but as soon as I'm able to get into a wheelchair I would like to be able to see the baby.

Take Your Time and Write a Detailed Plan

Some of these things might seem obvious, but it's important to write everything out so that the health care team understands your wishes thoroughly. Speak up if you think something is deviating from your plan without reason. The health care team is there to serve you. Never assume that something will happen or that they know what you want. If it's one thing I've learned in life is to never make assumptions! It's important that the health care team understands your wishes. Your birth plan should be tailored to your needs, and it should be well researched and thought out. Some websites offer a copy paste type birth plan, be wary of using those without doing research on each option. I recommend writing each point out very clearly. Try not to use too many words, you want to make sure that your health care team has time to read it. You can either write it out on paper or print it, but make sure it is very clear. Make multiple copies and ask your team to put the plan at the front of your chart after they've read it. This way, anyone taking part in your care will know your preferences. Happy writing!