My Pregnancy: Week 33

Week 33Birth plans often conjure up images of doulas and skin-to-skin contact and other simple hopes of families-to-be. After a C-section, birth plans often point to VBACs with undertones of hoping to be redeemed from the original cesarean never wanted. I have nothing against VBACs and all the beautiful ways a baby can be birthed. I am here to include in that list of beauty the planned cesarean. For all first-time moms to be, I always encourage learning about a C-section and planning what one wants from that experience. My first birth cesarean experience was less ideal than my second, and I attribute partly to the hospital and also not being prepared for the possibility of a C-section with my first.

A cesarean often seems defined as something to come back from as opposed to something that simply is. My first was an emergency, and the remaining two are medically necessary. Many C-section moms feel need to give reason for another “medical birth,” as if they need to justify the wonderful entrance of their children into the world. Some mamas still feel the wounds related to what brought about that first cesarean. I hope that in thinking about a birth plan for a planned C-section mothers and families can feel joy, excitement, and peace with having a voice in the details of their child’s arrival.

I see terms like “family-centered” or “gentle” birth in reference to C-section births. Some hospitals and doctors do a better job than others. First, simply speak with your doctor (and possibly hospital) about what a cesarean birth can look like. In all honesty, most of mine isn’t written but communicated with my doctor in the weeks leading up to birth and in discussion with the nurses in the couple hours before I enter the operating room. In case of an emergency hospital staff likely aren’t reading paperwork, but having thought through these things allows my husband and me to advocate for our family.

Before birth and during surgery

Spell out your preference for drugs that won’t hinder breastfeeding (if you plan to nurse). For me this included explicitly saying I did not want a sedative as they gave me during the first birth. I was very drowsy and hazy in many memories after the birth of babe. I spoke with my doctor and anesthesiologist beforehand to let them know I wanted conversation about what they were doing. Some moms may prefer staying in the dark about all that “medical” stuff, but I found comfort in having that open line of communication during the procedure. You may want silence so baby only hears you and hubby, as far as possible. The ambiance of the room may include lighting and music, so let your preferences be known in your birth plan and with the medical staff beforehand. My hands were restrained for my first birth but I requested them not for my second.

You may even want to research types of stitching and other details of your cesarean related to your health and safety. The placement of your IV (hand or arm, left or right) might be of concern to you as you plan to nurse and hold your babe in the coming day(s). For this third and final birth, my plan also includes plans on tubal ligation and circumstances in which I would not want that to occur.

Baby-focused

Many of these things may be the same as a vaginal birth, like keeping the cord attached for a longer period, no K or Hep related medicines administered, delayed bath, and more. Skin-to-skin allowances will vary by hospital, but consider if it can occur immediately with you, with daddy, in the operating room or as soon as in recovery. Make note for dad to cut cord if interested. For me, the biggest hope in my plan (aside from the “healthy birth” we all hope for) is to see my baby in all its gooey glory. First babe was taken immediately to the NICU and second came out a concerning shade of blue so I didn’t see him for several minutes.

Lowering the screen just before delivery is what I’ve most strongly discussed with my doctor. Remember to know what is allowed in terms of photography and ask if anyone is the room is able to assist with taking photos of baby and family immediately after birth.

Recovery

We wanted baby with me or hubby at all times and wanted left alone as much as possible in those first few hours after birth for nursing and bonding without family, friends, or unnecessary medical interruption. Others may want to have a mother, sister, friend, or other significant person visit during this recovery time as only one person is usually allowed in surgery. I immediately wanted warm blankets as I uncomfortably shivered with both recoveries. After the immediate recovery and into the first full day, I also consider keeping the catheter in for the first night a big convenience and safety reassurance (we had evening births), but then I wanted to move forward in recovery to have it removed early so I could begin getting up and around in the light with assistance. Your plans for feeding, from formula to nursing on demand, can be outlined as well.

Consider scenarios that could occur, like baby in NICU for a short or extended stay, and how you will respond to meet your plan. For example, immediate access to pumping might help should baby be moved to the NICU. If baby is separated, consider outlining your stance on the use of pacifiers, other people holding baby, and other preferences you may have.

Annie is a mom of two boys, ages two and four. She enjoys the finer things in life, like compression socks and a full night’s rest.

Tags: birth, birth plan, C-section, pregnancy, third trimester, week 33

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