How To Have A Gentle C-Section

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 C-Section, whether by emergency or by choice, does not mean that you have to miss out on being an active participant in your birth!

What is a Gentle C-Section?

While a gentle cesarean is not going to do much to change the postpartum recovery, it is still a major surgery, it can reduce the trauma or disappointment you may experience, if a c-section 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 planning to deliver at home or planning a scheduled c-section, everyone needs to be on board and knowledgable about your intentions in the event of a cesarean happening! OB/GYNs 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.

What Makes a Gentle C-Section Different?

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 block instead of 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 c-section, 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. This will increase your likelihood of a successful VBAC, 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 OB/GYN operating, so that you can see everything happening! Ask the OB/GYN or a nurse to talk you through the procedure and everything that is going on to help keep you fully engaged in your baby’s entrance.

Music may play during the birth to encourage a loving and 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 OB/GYN 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:

 

 

Racism in Maternal Care

You’d think we are in a time where everyone would be treated equally. Those in a professional position would not complete their duties based on the ethnicity of a person – so we would think.

If you look at the birth outcomes of each ethnicity, you will find that things are not equal. It is almost as if the providers are trained to take advantage of and disservice women of color.

If we look back in history at the “Father of gynecology”, James Marion Sims and the things he did, it isn’t hard to see where it began. Dr. Sims practiced under the racist assumption that black people did not feel pain. He would complete surgical experiments on black women without anesthesia or any type of numbing agent. When he would operate on white women though, he would use anesthesia.

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Sims wrote a book about his life and shared in it that he would “take ownership of the women”, and went on to share the advantages he found in working on people that were basically his property. “There was never a time that I could not, at any day, have had a subject for operation.” he stated.

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He would take slaves, “patch them up”, and send them back to their owners so the black woman could continue to reproduce for the owner. These women would endure hours long surgeries, screaming and crying out in pain, as he documented in his literature.

When his patients would die, it was never his fault. (You know…kind of like how OB/GYNs are today) He would blame it on, “the sloth and ignorance of their mothers and the black midwives who attended them.” – it was not anything to do with him or his experiments. Unwilling to recognize his own iatrogenic care.

The ‘Father of Modern Gynecology’ Performed Shocking Experiments on Slaves – History
The Medical Ethics of the ‘Father of Gynaecology’, Dr J Marion Sims – Journal of Medical Ethics

Today we find that women of color are treated unfairly with blatant racial discrimination, almost as if licensed providers are trained to treat these women differently; it happens that often. Performing similar acts to what Sims did back in the day – treating them as less than.

In one study, women shared their experiences. One black woman shared that during an appointment she expressed to her Midwife that she did not feel comfortable going to her appointments anymore. The midwife replied with a racial slur, “Do you do crack?”. Blatant racial slurs were reported by multiple women in this study. How is this acceptable or professional? With so many providers doing this, it makes you wonder if they are trained to act this way towards the minorities.

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Black women are 4X more likely than white women to die during pregnancy or childbirth in the US. Between 2013 and 2015, 54 black women died for every 100,000 births compared to 15 white women. These numbers are rising each year.

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We could say “Maybe the black race just has poor health.” or “The black women’s body is biologically doomed”, but those would be comments lacking knowledge. It is not hard to see that racism is the invisible risk factor. OB/GYN, Dr. Joia Crear-Perry, wrote the article below explaining and in agreement with this unspoken truth.

Race isn’t a Risk Factor in Maternal Health. Racism Is. – Rewire.News

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In the link below you can read a few first-hand testimonies from black women who experienced racism in their maternal experience:

Black Mothers Share the Devastating Impact of Racism in Maternal Health Care – Vice

Such sad stories, and the saddest part is that these stories are so incredibly common. So many women of color are disserviced by medical professionals, on a daily basis, during their childbearing years, especially in big cities or low income locations. Same as it has been since 1845 when Sims, The Father of Gynecology, began practicing with a racial bias towards black women.

It makes sense why more black women are choosing unhindered, unassisted birth after experiencing a facility birth. It has to be hard to walk into a facility knowing the disservice that is likely to occur, according to statistics.

We’d like to hear from you! What are a few possible ways that might correct this issue that is apparent and rising in the US?