Caesarean Options – There’s Still Choices

Once you opt for a caesarean, it is often easy to feel like that was your final choice in your birth. Realistically, there are still choices to make around your caesarean which you may not know about!

Going into Labour Spontaneously

A lot of the time when you are choosing to have a caesarean, the date is booked in well in advance. This could be anywhere from 37 weeks until 42 weeks, but usually is booked in before your “due date”.

Have a think about the reason for a caesarean, if there’s no rush to get baby out and it’s more about how baby is born, then maybe you could hold off for as long as possible. Instead of booking in to have an elective caesarean, this option is to go into labour and then head to the hospital. Your baby is ready to be born! It allows your body to start producing the cocktail of hormones for bonding, healing and breastfeeding. It also means that you know your baby is ready.

I realise this may not be appropriate for everyone, depending on why baby needs to be born via caesarean.

It’s also worth noting that a caesarean after you have gone into labour (any caesarean that wasn’t pre-booked) is classed as an “emergency caesarean” but there doesn’t have to be a rush or urgent feel about it if it’s already in your plan.

Maternal Assisted Caesarean

Yep, it’s a thing. You can be the one to physically pull your baby out. In a typical caesarean, the obstetrician who performs the caesarean surgery releases the baby’s head, then shoulders and pulls the baby out to pass to the mother. In a maternal assisted caesarean, the mother is able to lift her baby out and onto her chest once the obstetrician has released it’s head and shoulders.

This option might not be a good choice for you if you get queasy! It is a good option to gain back some power and control in your birth. Your surgeon may not offer this as an option, but you can still discuss making your caesarean as ‘woman focused’ as possible.

A maternal assisted caesarean at Northern Beaches Hospital

Natural or Slow Caesarean

By slowing down the caesarean, it becomes more like a vaginal birth. Ask the obstetrician to take their time. They can release the baby’s head and give your baby time. They lift out one shoulder, then the other. They can then slowly ease baby out. This allows the fluid to be squeezed out of the baby’s lungs as it is born, which is what happens in a vaginal birth.

You Can Watch

Most caesareans are performed with a screen shielding your view. You can ask for the screen to come down or be replaced with a clear screen. This makes less of a barrier between you and your baby. You may also want to ask your obstetrician to describe the surgery as it is happening. Some women have told me their anaesthetist helped them to lift their head up and hold it there so they could more easily see. I have heard of some women negotiated that instead of having the screen down, they had a TV screen where they can see their birth above them. To me, this sounds like more effort than dropping the screen – but having the TV above you means you can see it more easily than looking down to your belly.

A caesarean with a clear screen so the mother can see her birth

Make the Birth SPace Your Own

I always talk with my clients about creating a comfortable birth space when we plan for a vaginal birth. This is just as important for a caesarean too! Your caesarean is your birth of your baby. Even though a caesarean will occur in an operating theatre, you can still control some aspects of your environment. Our environment plays hugely into our emotions and hormones, so make choices to increase your oxytocin flow, release endorphins and relax.

Some examples of what you can do:

  • Play your own music
  • Keep the room quiet – no unnecessary talking or extra people in the room
  • Dimmed lights
    Someone is requested to take photos
  • Use learned techniques – all your relaxation techniques are still so important.
    • Breathing, hypnobirthing techniques and light touch massage on your shoulders, arms and face can all be beneficial
    • Positive encouraging words/ atmosphere – remember language matters! You are giving birth, they are not delivering your baby. Even things like having your partner announce the sex of your baby instead of hospital staff if you don’t already know
  • Partner and another support person (e.g. doula) to stay in the theatre with you. You have your best support team with you and also if your baby needs to go to the special care nursery, your partner can go with them and your doula can stay to support you (or the other way around if you’d prefer).
     

It is the anaesthetics team that has the final say in theatre, not your obstetrician. This is important to note as your obstetrician may be supportive yet told no by the anaesthetist just beforehand. It is important to ask your obstetrician to check with the anaesthetic team prior to surgery so there are no surprises to them or you.

Immediate Skin to Skin

Skin-to skin care can be classified into three timeframes:

  1. Immediate – within the first minute after birth
  2. Very early – begins 30-40 minutes after birth
  3. Early – any skin to skin that takes place in the first 24 hours

 

More often than not, skin-to-skin is routinely started once the mother is in the recovery room. Usually this falls somewhere between 30-80 minutes after the caesarean. If the baby is passed to the mother in theatre, quite often the baby is swaddled, which is not skin-to-skin. If you choose, you can discuss having skin-to-skin whilst still in the operating theatre. A reason babies are swaddled is that operating theatres are cold, however your body heat will keep your baby warm and you can ask for a blanket to go over the both of you.

Babies who are distressed do not necessarily need to be taken to NICU and separated. There are circumstances where the baby can be attended to while having skin-to-skin on the mother’s chest, just like after a vaginal birth.

Some tips to help with immediate skin to skin:

  • Keep the chest free of monitors- if you have an ECG, it can be on your upper back and shoulders or on your side
  • Delay the routine checks and weighing of baby
  • Request that drips and monitors in non-dominant hand/ arm
     

I could (and probably will!) do a separate post on the benefits of immediate skin-to-skin, but there are huge benefits to both mother and baby including improved success of breastfeeding and bonding between mother and baby.

Skin-to-skin in theatre

Delayed Cord CLamping

As with skin-to-skin, I could write an entire new post about the benefits of delayed cord clamping! Just like a vaginal birth, you can request delayed cord clamping for a caesarean as well. The World Health Organisation (WHO) includes caesarean birth as equally important to have delayed cord clamping as a vaginal birth. An elective caesarean can wait 2 minutes before cord clamping with no increased risk of maternal blood loss. As well as delaying the cord clamping, you can also request that your partner be the one to cut the cord.

There is also the option for what is called a lotus birth, though this is very rarely done in Perth. A lotus birth is when the baby is born and the placenta is removed (keeping it at the same level or above the baby) without clamping or cutting the cord. Your baby and their placenta remain connected until after both have been born and are separated later. 

To Wipe or Not to Wipe

During a caesarean, when baby’s head is released or after birth, someone may suction baby’s mouth and nose to clear them of gunk. This can be too much for some babies and cause them to have decreased oxygen intake. Wiping the mouth and nose has been shown to be just as effective to clear the airway.

Your baby may be born covered in vernix which looks like a white, waxy substance. Often people are quick to rub this off, but it could be beneficial to leave the vernix to soak into baby’s skin. The purpose of the vernix is to provide a protective coating for your baby. Now they are no longer protected by their amniotic sac and your mucous plug, the vernix is the last layer of external protection they have. There are other benefits of leaving the vernix – another post to follow!

Lastly, vaginal seeding is when the mother’s vaginal fluids are “swabbed” and wiped over the baby’s face (including nose, mouth and eyes) and body shortly after birth. The intention is to expose babies born by caesarean to the same bacteria that they would’ve been exposed to if born vaginally. The transfer of this bacteria can alter the baby’s microbiome. There is limited research into this, but there are some thoughts that is affects the baby’s developing immune system and may play into preventing allergies.

About Me

I’m Sam Zieg – doula, physiotherapist and mum of two beautiful girls! I love birth and my goal is to help women to love it just as much. Follow socials or join my mailing list to stay up to date!

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