When you picture a cesarean, what words come to mind first?
Cold. Quiet. Bright. Scary. Scrubs. Scalpel. Shaky. Drugged Up. Curtain. No Skin to Skin. Sore. Inactive.
But wait! Ending up with a Cesarean, whether by emergency, or by choice, does not mean that you have to miss out on being an active participant in your birth!
While a gentle cesarean is not going to take away the shift in postpartum recovery compared to a vaginal delivery, it can reduce the trauma or disappointment you may experience, if a cesarean was not in your expected birth plan. And even if it was, how neat is it to have a more active and informed surgery, right?!
A gentle cesarean is something that should absolutely be discussed with your provider prior to you going into labor, whether you are delivering at home or planning a scheduled cesarean, everyone needs to be on board and knowledgable about your intentions in the event of a cesarean happening! OBGYNs that do not routinely do cesareans need to be informed on their role during the cesarean and what things will be different, which will not be much on their part honestly, just a little extra time and flexibility. If you have a doula, she can aide you in advocating for your gentle cesarean, as you will be numb, but if not, make sure your partner or support person is fully informed on what exactly it is that you are aiming for.
First things first, you will still be prepped like every cesarean mama would be, you will need to sanitize your body to prevent your opening from becoming infected, and everyone coming into the room will be scrubbed up from head to toe to keep germs to a minimum. You will be given a form of pain medication in your spine to numb you, your best bet is to ask for a spinal tap, in comparison to the epidural or general anesthesia. This will be a shorter lived pain medication (about two hours) that will get you well through the surgery, but not linger as long as the epidural and generally does not have as many side effects.
Insist on a small, low transverse scar, that is to be double sutured. If this is a repeat cesarean, make sure they remove built up scar tissue before suturing, so you are less likely to experience placenta accreta on your scar tissue in future pregnancies, making a VBAC safer, if that is potentially a future desire of yours. Babies can squeeze out of a hole the size of a bagel, trust me, they do not need to cut you from hip to hip.
Leave the shawl down or ask for a transparent sheet to go in between you and the OBGYN operating, so that you can see everything happening! Ask the OBGYN or a nurse to talk you through the procedure and everything that is going on.
Music may play during the birth to encourage a loving, soft, environment. If possible, you can request that the temperature be warmed and the lights reduced just for a few minutes as baby emerges. Of course, when the OBGYN is opening and stitching you back up, you will want them to have full visual. Have monitors turned silent and away from your face so you can be relaxed and at peace.
Allow baby’s head to be pulled to the top of the opening and turned towards you, to emerge slowly and gently. If possible, you or your partner can do this part, and still deliver your own baby!! They can still do the breast crawl this way or just be pulled up to your chest for skin to skin. Delayed cord clamping should absolutely still be an option and you can almost always keep your placenta! They should allow the placenta a few moments to attempt to detach naturally, before pulling or manually removing, and it should be removed gently as to not cause any damage to your uterus.
Simply have them place the placenta in a bowl or container next to your bed for delayed cord clamping and keeping the placenta, it should not be allowed to go to pathology, except for a small sliver, if they absolutely must test.
Baby should remain skin to skin with you or your partner while you are stitched back up. After they stitch you, be sure to ask for them to swab your vagina for vaginal seeding, this provides baby with probiotics and healthy culture from your vagina that they would normally get passing through the birth canal. Baby should not be washed, especially with soap! Rub their vernix and any other fluids into their skin.
If baby must be separated from you for any reason, have someone else provide skin to skin, or at minimum stay with them, especially if you are declining vaccinations, or eye ointment.
Check out this video as an example of a gentle cesarean: