Amanda was heading for a cesarean delivery. Her past inductions had gone well, ending in vaginal deliveries, but they were different babies and different stories. This pregnancy and this labor were different. Amid all the factors affecting this induction one of the most important was Amanda's mindset about whether she was ready to be in labor or be a mother to this, her third child. As "averages" go, this birth was long, and Amanda labored for multiple days with very little progress. At the middle of the third day is was time to look at what was left to try and face the possibility that she may have to deliver in a way that she had been trying at all costs to avoid.
When fully a third of all U.S. births end in cesarean, it is important to note that the statistic is much lower than the national average when a doula is supporting the labor.* In fact, during Amanda's stay at the hospital, no less than 3 mothers were wheeled off to the O.R. to deliver their babies. It's there, it's real... and for many moms it's either a choice, and option or a possible negative outcome. Whatever it is for you, what ever it was for Amanda- with ONE THIRD of us experiencing it- let's talk about it.
This is where I found myself with Amanda last night. With only one option left before there was no option but to deliver by surgery, and with time literally running out. It was time to talk about what a Cesarean would look like. In birth, regardless of the scenario- it's important that the event be something you participate in, not something that happens to you. How do you do that when you haven't planned a Cesarean in the first place and don't want one? Indeed, when a C becomes necessary, a lot of the choices are taken out of your hands. Taking stock of what choices are left is pretty important. Your doula knows a few things that can help.
1. Remind your care providers that you are a part of this decision too. Again, each circumstance is different and emergencies do happen. The vast majority of Cesareans though, happen in order to avoid an emergency. As such, more often than not YOU have a say in exactly when you're ready to go to the O.R. You have a say in when you're ready for the procedure to begin.
2. Identify your support and the role they play. For some mothers their birth partner is not a part of the birth. Culturally, they are part of the unit, and thus welcomed and expected to be with mom through the delivery. But what about her birth support? If this role is important for your emotional well being- especially if they've been with you for the long hours leading up to the delivery, let your provider know you need one more person with you.**
3. Considering the above, what about the inanimate things that have made a difference for you as you've labored? Were you playing the Beatles' "Hey Jude" on loop on your phone/speaker as you've worked? Was the picture of your sister who couldn't be with you for this momentous day left back in the laboring suite? Have someone wipe it down and bring it over. One mom wore sunglasses into the OR to shade the bright lights from her eyes. She raised them up once her beautiful daughter was born.
4. Mourn. Give yourself time to mourn the loss of the plan you had. It's natural and healthy to feel disappointed and even angry at losing the other birth story you were going for. Don't let anyone tell you different.
5. Photography- Some surgeons and anesthesiologists allow them in to finish documenting this story for you.
7. As your provider about heated blankets, clear surgical drapes, wet washcloths to cool your forehead (you may also wish to wet your mouth with them since the humidity in the O.R. is intentionally arid).
Honestly the list goes on...
For each circumstance and each delivery things "allowed" are different. Your understanding of the "why" and "why not" is important. One day a few years ago, an anesthesiologist was confronted with the "why not" of food for moms laboring to deliver in the OR. What followed was a review of advances in anesthesia and risk assessment for patients aspirating while anesthetized resulting in pneumonia. Now the American Society of Anesthesiologists admits most healthy women would benefit from a light meal during labor. ***
Do you suppose it's more likely that a compassionate and bored anesthesiologist (they're out there!) determined on their own to gather this research? Or perhaps the questioning by multiple self-advocates disguised as birthing mothers demanding to know WHY they can't have their granola bars? ~note, most laboring women don't desire food past a certain point in labor anyway.
I say over and over again, "No one wields as much power to change things in our birth culture as the birthing woman herself." When you find you may be heading for a Cesarean, give yourself a chance to think about it and wear it as a your decision even if only for a little bit. And with your doula's help- be vocal and get as close as you can to the Cesarean of your dreams.
** When multiples are delivered in ORs there are twice as many nurses and pediatricians as for a singleton. In fact, depending on the size of the OR, occasionally a fellow or resident will attend a surgery for academic reasons. Did you know that among major factors contributing to the occurence of surgical site infections (SSIs) the NUMBER of persons in the operating room is NOT one of them?** Where your support team stands, and whether they are appropriately attired have much less impact on the transmission of microbes than the airflow of the room being affected by doors opening and closing. ~info from: Annals of Surgery. 2011;253(6):1082-1093.