Almost 1 in 3 babies in the United States are born by Cesarean section, making it one of the most frequently performed inpatient surgical procedures in our country—and a super-common way to meet your baby. Not everyone plans for one, and not everyone is happy to have one. But C-sections can be medically necessary, life-saving events for moms and babies, and they can also be powerful, emotionally resonant experiences. "The first thing to remember is that Cesarean births are births," says Anne Drapkin Lyerly, M.D., an obstetrician, professor, and the associate director of the Center for Bioethics at The University of North Carolina at Chapel Hill—and a mom who has had five C-sections herself. "They can be really wonderful experiences that you can value. Not just because it's your baby's birthday, but because of what actually happens in the operating room and how you are treated."
Choosing a doctor you like, trust, and respect will go a long way towards having a great Cesarean. "You want to make sure you have a provider who is willing to work with you," says Pamela Berens, M.D., professor of gynecology at McGovern Medical School at UTHealth/Children’s Memorial Hermann Hospital in Houston. If you have special requests for your birth, she explains, "It's probably good to bring them up early in your pregnancy, at the first visit if possible." You want to make sure your doctor is someone you can talk with easily and honestly; after all, they are the person who will be helping you bring your baby into the world.
You might also involve additional medical professionals in the planning of your birth. Nurses, anesthesiologists, and often, pediatricians and/or neonatologists are present in the operating room during Cesarean births. Lindsey Seger, the president of the International Cesarean Awareness Network, says, "If possible, ask to talk to the anesthesiologist beforehand to discuss what medicines you'll be taking during and immediately after the procedure. Some meds that treat specific symptoms such as trembling and nausea may cause drowsiness or amnesia." You may decide that you'd rather tolerate these symptoms than be drowsy for the first few hours of your baby's life.
Yes, birth and medical procedures are unpredictable and come with risks and possible complications, but that doesn't mean you can't have an idea of what to expect. Lawrence Leeman, M.D., co-director of the mother-baby unit at The University of New Mexico Hospitals in Albuquerque, recommends asking your provider what a C-section procedure is usually like at their facility: "Women can say, 'Can you tell me what is it like having a Cesarean at your hospital? What things happen with the baby? How soon will I see my baby after he or she comes out?'"
Other things to ask: Who will be present in the room? What happens if you or your baby experience complications during the surgery? What happens if baby has to go to the NICU? Ask questions that make sense to you, based on your medical situation, your personality, and your previous experiences. Talk through different scenarios with your hospital team so you can have a good idea of what to expect should anything happen.
Family-centered Cesareans (also called gentle Cesareans) are gaining popularity all over the U.S. Done for scheduled cesareans or cesareans resulting from a labor that fails to progress or dilate and where the the baby is expected to be healthy, they can include: having an additional support person (such as a doula) in the operating room; having the family's choice of music played in the operating room; having the surgery explained while it happens; requesting that medical staff minimize unnecessary conversations during the surgery; pulling the surgical drape down (or providing a clear drape) so the mother can see her baby being born; delayed cord clamping with the infant on the mother's chest; skin-to-skin contact between mother and baby immediately after birth; and the ability of support people to take pictures or video of the birth.
In traditional Cesareans, medically stable babies are generally brought to a warmer in the operating room, then checked and weighed (and sometimes cleaned), then wrapped up before being taken to a nursery or occasionally given to the partner to hold and shown to the mother briefly. With family-centered Cesareans, a great deal of effort is made to ensure mothers and babies can see and touch each other right away. For Melissa Pizzo, a Cesarean educator in Albuquerque who had her fourth C-section in 2015, this made a big difference: "Having my baby stay with me instead of being taken away by the staff gave me a huge oxytocin high that I had never felt before during my other births."
If you're interested in having this type of birth, discuss it with your provider and hospital as soon as you can. Dr. Leeman, Dr. Lyerly, and Dr. Berens all stress that requesting elements of a family-centered Cesarean is completely reasonable for planned Cesareans in American hospitals, but providing immediate skin-to-skin contact requires some advance planning and flexibility on the part of the medical and nursing staff. EKG monitors for the mother must be placed elsewhere, her IV and blood pressure cuff must be placed so that she can use her arms, and a nurse must be present at the operating table to monitor the baby on the mother during the first minutes of life. Dr. Lyerly suggests bringing in research, news articles, and videos about this kind of surgical birth if your provider is not familiar with it, as well as stressing to them how important it is to you. "If you don't ask for it, you won't be able to expect it," she says. "You should talk about what's important to you and why it matters for the birth of your baby."
While you're the one giving birth, your partner is part of the experience too. So talk with him or her, find out their feelings, and see what might make your baby's birthday easy, awesome, and emotionally-resonant for them, too.
Dr. Berens suggests being very clear with your partner: "It can be stressful for spouses, so letting everyone know what their role is will help." Perhaps they would like to do skin-to-skin with the baby if you are not able or willing to do it, or maybe they want to be the person to announce the baby's sex.
A doula for a Cesarean? Yes! Doulas aren't just for unmedicated vaginal births, despite the cultural assumption. Doulas can help you plan prenatally, come up with questions for your provider, and process previous births. Mom Amy Bennett of High Point, North Carolina, who had a doula for her planned Cesarean birth in 2012, says, "My doula was a wonderful part of my support team, leading up to and during the delivery. Education and support before birth is an important facet of the work she does, so I felt prepared!"
Recovering from your birth will also mean recovering from abdominal surgery, so make plans to assure life can be as easy as possible once you are at home. This can include preparing for meals (like freezing meals beforehand or organizing a meal train), setting up childcare or entertainment for older children, hiring help (like a postpartum doula or a house cleaner), enlisting support of your extended family, and just generally providing for your own self-care. Some women set up a special recovery area in their home, which has snacks, water, baby-feeding supplies and other useful items—this allows them to rest and relax during the pivotal healing period.
It’s important to ask for and receive as much help as possible in the first two weeks postpartum, Pizzo says, as well as pay close attention to your incision to ensure it's healing properly.
Most of all, Cesarean parents should remember that this an exciting time... because you're going to meet your baby! Seger says, "The birth of a child is a milestone event, however it happens. With some mindful forethought, a Cesarean can be both a life-saving surgery and very respectful of the family's wishes."