Surgical Birth and Support in the OR
Sometimes, during the course of a normal pregnancy or labor, complications arise that make it clear that a baby needs to be born via Cesarean. This can be assessed over time, as in the case of a fetal position that just won’t change no matter what and cannot be born vaginally, or it could be relatively quickly in labor, when fetal heart tones indicate that baby is not handling the stress of contractions well and needs to be born abdominally in order to avoid periods of low oxygen.
As midwives, we believe and witness the power of women to birth their babies without intervention. Almost always, if a birthing person and baby are given the space and time, everything will unfold perfectly and safely. One of our main roles at a birth is to assess when that’s not the case and when it seems as though the labor is moving out of the range of normal, and to make recommendations. In the course of our work, we have had to recommend Cesarean birth to a small number of families, and there are some things we’ve seen that we think each family planning a birth should know about in case surgery becomes part of their story. Here’s what we’ve learned:
1. It is absolutely essential that the birthing person is the primary decision-maker. Women know what’s best for them, their bodies, and their babies, and they have information about the experience that providers can never have. The role of a provider is to provide informed choice, meaning give the most information possible and appropriate for the moment, and to allow the birth person to decide what will happen. If there is a rush for safety reasons, it needs to happen quickly, but there is always time to get consent for a procedure before it happens. One of the things we know about trauma is that it is mitigated if there’s a sense of decision-making, and because surgery holds the potential to be traumatic, it is part of the responsibility of the care provider to lessen trauma as much as possible.
2. If you are transporting in labor from a planned community birth and you want to have your midwives in the OR with you, you MUST advocate for that! Each hospital has their own policy, but usually the person who decides whether your midwives will be in the room is the anesthesiologist. Some hospitals have an absolute “no” policy on community midwives being admitted into the OR (and believe us, we are trying to change that!) but many have less strident rules and if a family advocates, their midwives will be permitted to accompany them. This can create a sense of familiarity in the OR and the midwife can stay with the mom when the baby is taken to the warmer. Having an abdominal surgery is a big experience, and having your midwife there can feel supportive, just because you know her and she cares about you. She can offer anticipatory guidance as you go through the procedure, telling you what might be about to happen and what to expect.
3. Most Cesareans are not true emergencies, so there is time to set the situation up for optimal maternal experience. We’ve seen moms asked what music they want playing when their baby is born. There is time for sweetness and communication, and we think each parent should know that they can ask for that and expect it. For the people performing the surgery, it’s truly an every-day occurrence, but for you, it’s the birth of your baby! What do you think would make it more comfortable for you?
4. Most babies who are born via Cesarean are shown to the parents over the cloth that separates mom’s abdomen from her head, and then taken to the warmer for a quick examination and resuscitation, if needed. If they are stable, they are returned to mom relatively quickly. Immediate skin-to-skin is rarely seen, but it can be asked for and some hospitals are moving toward it as a standard of care. Importantly, each birthing family can advocate that they want baby skin to skin as soon as possible to establish the hormonal flow and process that happens for babies when they are on their mom. Breastfeeding may not be established right away, but the process of licking, smelling, gazing at mom, and learning each other is an important step in bonding and attachment and it should be maintained as much as possible.
We hope these points are illuminating. If you have had a Cesarean or accompanied someone in one, and you have points to add, please let us know at firstname.lastname@example.org!
Sarah and Charli