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Doulas and scheduled cesarean births, by Giuditta Tornetta
A few women, for different reasons, will have to face and prepare for a schedule c-birth (cesarean birth, I prefer this term to c-section). Too often a c-birth is treated only as a medical procedure and the sacredness of the birth is somewhat lost. Doula’s emotional and informational support can help couples go through this “procedure” with a new and renewed sense of empowerment and can help preserve the sacredness of the birthing experience and help you write a birth plan.
Here’s the nitty-gritty of what happens during a c-birth.
Preparation for the surgery includes starting an IV, shaving the pubic hair that shows when your legs are together and inserting a bladder catheter. Your belly will be washed with antiseptic and sterile drapes placed around the incision site. A blood pressure cuff and sensors on your chest and finger will monitor your blood pressure, heart rate and blood oxygenation. A curtain will be hung across your upper chest so that you cannot see the operation. Many hospitals permit your partner to be present. If so, he or she will be seated next to you and behind the curtain as well.
Most cesareans are performed under epidural anesthesia because it is safer than general anesthesia. If general anesthesia is used, you will be put under by injection of a medication into your IV. Once you are unconscious, the anesthesiologist will put a tube down your throat to maintain an airway and deliver a gas anesthetic.
The operation generally takes an hour or so, with the greater part of the time spent after the delivery suturing the various tissue layers. With rare exceptions, the roughly four-inch incision is made horizontally just above the pubic bone. A horizontal uterine incision is preferred because it produces a much stronger scar. However, in certain situations, such as when the placenta is covering the cervix, the incision is made vertically. During the surgery, you will feel pulling and tugging but no pain. The manipulations can make you queasy. At the delivery, the obstetrician hands off the baby to be examined. Some hospitals permit healthy babies to remain with your partner and you during the rest of the operation. In others, staff will take the baby to the nursery, regardless of the baby’s condition. As the hospital staff examines the newborn, the obstetrician delivers the placenta through the incision, suctions out fluid and begins closing the uterus and inner tissue layers with stitches. The skin incision may be closed with conventional stitches, staples, or even with tape strips. Finally, the surgical wound is covered with a dressing.
After the surgery, you will be taken to a recovery area where you will be closely monitored for the next couple of hours. In some hospitals, the staff will bring you the baby to hold and breastfeed. Policies vary as well as to whether your partner may be with you in recovery and whether your partner may be in the nursery with the baby.
I strongly suggest you prepare a birth plan, after all you will be under sedation and unable to express your desires for yourself and the baby during or shortly following the c-birth.
Cesarean birth-plan questions: there are many things you should be aware of even during a cesarean. The most important part of a schedule c-birth-plan is baby care. Here are afew questions to ask yourself before you create a plan:
Do you want your doula to be present? Would you prefer to be awake? Would you like to see and touch the baby right away? How would you like the baby to be cared for? Are you breastfeeding? Tell them you like to breastfeed your child within an hour of the birth even a cesarean birth. What about bottles of pacifiers? Does the baby need eye ointment (since it is primarily given for vaginal births) and the Vitamin K shot (read about vitamin K follow this link Vitamin K for Newborns)? Be sure to tell them you will like to nurse before you receive pain killers. What pain killers should you take and how in relationship to breastfeeding? You should be ok without them for a little while, while the baby nurses and you bond with the baby.
Remember the more loving and gentle
the tone of your birth plan is, the
more likely you will be listened to. Bring in some treats for the
nurses (box of chocolate, a gift basket) so they can munch while they are reading your birth plan. As a doula I meet the
couple pre-natally, help them with their birthplan, and spend a couple of hours on
breastfeeding and baby care techniques. I schedule to meet them at the
hospital during their prep time, and guide them through a sacred ritual
before the birth (it can be as simple as a prayer for a safe and
medically-uneventful outcome, or something more elaborate), then I wait for the
mother in recovery. Helping her with the very first latch on is essential since
both mommy and baby are slightly off due to medication. We seal the day with a
welcoming ritual for the baby and I wait till they are safely settled in
their private
room. I visit once more at the hospital before they are released to
discuss the
birthand make sure breastfeeding is proceeding well. Finally I usually meet
them at home once more to help with the transition.
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