This blog was updated 26th March 2023 to include additional resources new to the market.
Whether you are planning for a caesarean birth from the outset, or you are faced with an in-labour emergency caesarean, there is much you can do to feel confident and empowered in your journey to having your baby, as well as improving your physical and emotional recovery afterward.
You have options!
There is a lot more to a caesarean than you might realise, and many different ways it can happen. Having a birth plan for a caesarean section, whether you know you are having an elective or if you are planning a vaginal birth, means learning about what options are available to you, what you can request and what your rights are, and preparing strategies for coping with fear or anxiety.
Some things to consider in your caesarean birth plan are:
method of delivery - do you want the option of a maternal assisted or gentle caesarean?
medication/anaesthetics - discussing any concerns or questions you might have about risks/benefits of your different options with doctors and anaesthetists
do you want or is it possible to wait for labour before the caesarean if an elective? discussing the risks and benefits of your individual situation with your care provider
getting to the theatre - do you want to and/or can you walk to the theatre instead of being wheeled in a bed if well?
theatre environment - can you have and/or do you want music or meditations playing during surgery, soft lighting with surgical lamps rather than full fluorescent lights, minimal people in the operating room (for example, no students)? can you have an additional support person (for example, a doula or photographer)?
involvement in surgery - do you want doctors to talk through the procedure as they go, do you want to see baby born either directly or via a mirror? can photos and videos be taken?
immediately following birth - do you want delayed cord clamping, immediate skin-to-skin, breastfeeding in theatre? what about suctioning/wiping baby down? vaginal seeding? who will announce the sex of the baby? can baby remain with you in recovery? can you have uninterrupted skin-to-skin for the first few hours?
placenta - do you want to see it? keep it?
immediate postpartum - can you partner stay with you hospital? what is your pain management plan?
breastfeeding support - do you have a plan for breastfeeding support?
longer term postpartum recovery - what support network and strategies do you have to help you during your recovery, physically and emotionally?
Expanding on some of the above:
Gentle or Natural Caesarean
In a gentle or natural caesarean, the doctor makes the incision and partially frees the baby's head and sometimes shoulder(s) and allows the baby to push itself out, with or without the assistance of the mother also pushing. This is really amazing and gentle entry into the world for a baby who needs to be born via caesarean. The mother can also watch this happen with the drape lowered so they are able to see the baby being born.
Maternal Assisted Caesarean
In a maternal assisted caesarean, the mother is actively involved in the delivery of her baby. She gets surgically scrubbed in and then the doctor makes the incision and frees the baby's head and shoulders and then brings the mother's hands to the baby for her to pull her baby out and onto her chest. This is such a brilliant option for mothers who really need that sense of actively giving birth to their baby.
Waiting for labour
There are plenty of documented benefits of the actual process of labour for both mother and baby, and in some cases, it may be feasible and safe for a woman to wait for labour to begin before having her planned caesarean (which does then become classified as an emergency caesarean). Of course, there are both benefits and risks to this and in many cases it wouldn't be safe to do so. It will depend significantly on the individual circumstances that are leading to an otherwise elective caesarean, so needs to be discussed thoroughly with your care provider.
Skin-to-skin and feeding in theatre
There are so many benefits to immediate skin-to-skin following baby's birth, both for the baby and the mother. It is absolutely possible to do this in theatre following a caesarean birth, as long as mother and baby are both well. It
Delayed cord clamping
Another possibility with irrefutable benefits to baby. Cord blood is not "cord blood" but is in fact the baby's blood. Up to a third of their blood volume at birth remains within the cord and the placenta. That is a huge amount of blood, with all of its oxygen and nutrients, that belongs to the baby and that they would lose with immediate cord clamping.
Delayed cord clamping can definitely be done during a caesarean section, but be sure to be clear on what your definition of "delayed" is. In some hospitals, they will automatically cut the cord at 1 minute, or 2 minutes after the baby is born. Optimal cord clamping involves waiting until the cord turns white and is no longer pulsing, which ensures that all of the baby's blood has been returned to its body. There is even emerging evidence to suggest that even in the case of babies born needing medical assistance, such as resuscitation, that delayed cord clamping can and should be done to reduce the risk of brain damage and improve neonatal outcomes. You can read more about this here.
Vaginal seeding
This is a procedure that involves swabbing the mother's vagina, vulva and perineum and then gently wiping the swab across baby's face when born. The idea behind it is to expose the baby to the same bacteria and microbiome that they would have if they'd been born vaginally. This a very new procedure and the research is limited so it is hard to get a full picture of the risks and benefits. If this interests you, I would strongly encourage you to do some thorough research and discuss with your care providers.
Breastfeeding support
It is known that women who have caesarean sections tend to have more trouble with breastfeeding. There are a myriad of physiological, emotional and practical reasons why that is. I was fortunate in both of my caesareans to have good milk supply, eager feeders with good latches and feeding in theatre that supported that, but I struggled with positioning in the early days and weeks of recovery because of the abdominal wound. I strongly recommend speaking in advance to an IBCLC who you can consult with after birth to support your breastfeeding journey, and ideally one who can do home visits.
You might even want to think about expressing and freezing colostrum before birth in the event that you need it. You may not, but it is always worthwhile to be prepared.
I also recommend looking into becoming a member of the Australian Breastfeeding Association, and joining a couple of great breastfeeding support Facebook groups: https://www.facebook.com/groups/thebreastfeedingcooperativeaustralia and https://www.facebook.com/groups/breastfeedersinaustralia/
and check out my blog on breastfeeding here
Postpartum recovery
There is truly so much you can do to assist in your recovery from a caesarean section, both physical and emotional.
Whether you are planning a caesarean or not, it is always beneficial to make a postpartum plan for best recovery. Nourishing food, hydration, rest and sleep are always important for postpartum, but particularly when you are also recovering from a major abdominal surgery. I always recommend stocking the freezer with super nourishing meals and snacks (seriously - don't forget the snacks!) well before your due date anyway. Depending on how much room you have in your freezer, you could even prepare batches of herbal teas that are good as cold drinks, or as ice cubes to go in a water bottle.
I'd also strongly recommend doing some research into belly binding, postpartum massage, reiki, chinese medicine, and acupuncture to see if any of them appeal to you as ways to assist in your recovery after caesarean.
As far as wound care goes, you can also have a look into scar massage and different types of oils and creams that you can use with that. Here's a great video by Core and Floor Restore (highly recommend following her social accounts, too) on how to do scar massage. Make sure you get clearance from a health care professional first.
Your emotional recovery after a caesarean is also super important. Have conversations with your support network in advance about how you will all tell if your mental health is struggling (because sometimes you are too far in to realise) and how they should talk to you about it. Caesareans, especially unplanned ones, can be traumatic (as can all birth experiences), which can lead to postnatal mental health conditions such as PPD and PPA. On the other hand, though, you can get these conditions even following a completely blissful birth experience. Have some resources at hand like https://panda.org.au/ , a trusted GP or a birth counsellor like https://www.thebirthcounsel.com.au/ .
Finally, another absolutely brilliant resource on all things caesarean recovery is Leonie Rastas "The C-Section Recovery Whisperer". She has a great lot of resources on her website, https://www.caesarcare.com/ as well as a book called The Caesarean Recovery Manual which you can buy on her website here. I'm totally unaffiliated, just a keen advocate for proper recovery which Leonie has written all about. I highly recommend checking her out.
A few other things to consider:
Not all obstetricians are trained for things like maternal assisted caesareans or gentle caesareans. If this is something you think you want, you will need to confirm with your care provider early on that they are willing to do it, or actively seek out one who does. They may also only do it under certain circumstances, or require a completely low risk pregnancy. However, there is nothing to stop you asking the question.
It's also worth mentioning that some of these options and preferences in caesarean birth are much easier to have approved in an elective caesarean where there is time to prepare accordingly for them. That being said, only a small proportion of emergency caesareans are scenarios where there is an immediate threat to life and there is very little time or room to negotiate. The main reasons for emergency caesareans in Australia (or, terms I like to use as coined by Catherine Bell of https://birthmap.life/, "in-labour non-emergency caesarean" and "in-labour emergency caesarean") are for lack of observable progress (known as 'failure to progress'), or abnormal foetal heart rate (usually suspected or actual foetal distress). In the event of a lack of progress, there are no immediate concerns for the safety of the mother or baby, and so there should be adequate time and consideration given to the requests for things such as skin-to-skin in theatre, delayed cord clamping, and even natural/gentle caesarean technique. I have heard of women who have managed to have maternal assisted caesareans in an in-labour caesarean as well, so for those planning vaginal births but mapping their emergency caesarean pathway, it is always worth discussing in advance as well as asking for at the time (if needed) if it is something you would really like.
Further Information and Resources for Caesareans
Royal Australian and New Zealand College of Obstetricians and Gynaecologists' (RANZCOG) patient information on caesareans including reasons for having a caesarean, risks involved, process of the surgery, recovery, and more.
Pregnancy, Birth, Baby website posts on: planned or elective caesarean section, emergency caesarean, and recovery after caesarean
Additional Information for those in Greater Western Sydney
This handy little video by Nepean Blue Mountains Health District that demonstrates the journey through an elective caesarean **
**I do feel a need to address the comments at the very start of this video about having had a small pelvis and a large baby - these are comments that are often banded around by obstetricians without due cause and can make women feel that their bodies are not built for birth. The main causes for pelvises that genuinely don't fit babies are severe malnutrition and rickets - things that we tend not to see anymore in our western society. I have lost count of the number of times I've heard stories of women who have had a caesarean for their first baby and were told their pelvis was small and their baby wouldn't have fit who go on to have successful vaginal births of even larger babies afterward. The pelvis opens and the baby's head moulds - so many other factors can create an obstructed labour that have nothing to do with the size of the pelvis or baby. So if this is you and you do want to think about having a vaginal birth in the future, don't despair! Get a second opinion. My inbox is always open if you want to understand more about this, as well.
Doctors who will perform maternal assisted caesareans
This list is not exhaustive - these are simply doctors in our area that I am aware of offering maternal assisted caesareans. If you know of others, let me know so I can add them!
For private obstetricians:
Dr John Pardey and Associates (Nepean)
Dr Ishwari Casikar (Nepean)
Dr Andrew Pesce (Westmead)
For public hospitals, both Westmead and Nepean public hospitals have a Maternal Assisted Caesarean policy and should therefore be able to offer it.
Local resources for postpartum recovery (Penrith and Blue Mountains)
This list is also not exhaustive, mostly made up of professionals that I can recommend from either my own personal experiences with them, or trusted colleagues' and friends' experiences.
IBCLCs:
Use this search tool to find one near you or contact me for help finding one.
I can personally vouch for Aimee Sing at https://birthaims.com.au/
Women's Health Physiotherapists:
Kylie at https://penrithpelvicfloor.com.au/
Chiropractors:
Angela Zahra at https://www.healthlinkchiroandmassage.com.au/
Alternative Medicine:
Evolution Medical Clinic https://evolutionmc.com.au/
Lawson Acupuncture Clinic https://www.lawsonacupunctureclinic.com/
Postpartum Doulas:
Me! Contact me to chat about how I can support you during your postpartum. If I am unavailable to take you on as a client, I have a number of other doulas I can recommend.
Future Birth Prospects
It is not the case that once a caesarean, always a caesarean. However, a repeat caesarean might be the right choice for you. I offer a program to assist you in navigating the process of planning another baby after a caesarean, please contact me if you wish to know more. You can also check out my blog post on Vaginal Birth After Caesarean (VBAC).
My name is Katelyn Commerford and I am a doula and next birth after caesarean guide who has completed comprehensive doula education. If you want to know more about what I do and how I can help you, please visit my website where you can get your free cheat sheet of my favourite VBAC resources, or find me on instagram @thenbacguide where I answer commonly asked questions about planning the next birth after caesarean and share loads pregnancy, birth, postpartum and parenting content.
Business Name: Katelyn Commerford - Doula and NBAC Guide
Phone: 0431 369 352
Email: hello@katelynthedoula.com.au
Instagram: https://www.instagram.com/thenbacguide/
Website: www.katelynthedoula.com.au
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