An abdominal or caesarean birth
Sometimes a parent may be recommended, or chooses, a caesarean birth.
An abdominal birth, Is birth, but also surgery. It’s a welcome into the world and a meeting between parent and baby. Like all birth, It can be a gentle and respectful occasion. One where parents and babies are at the centre of their care. Their wishes are respected and where possible adhered too. If this is something that you do not want, or agree with, it’s always a good idea to get a second opinion and ask more questions. A doula can be a huge emotional support in this situation as well as helping you find an evidence base to support your decisions.
It’s a good idea to meet with your care team before your birth and talk through your wishes with the anaesthetist, surgeon and midwife. Skin to skin immediately after birth can often still happen, but your gown and the placing of medical equipment needs to be thought out a little first. For example, your gown may be loosely tied or on back to front so that your chest can be easily accessible for your little one. Your anaesthetist can place cannula, drip and ECG stickers accordingly. Partners can also wear appropriate clothing so that they can have skin to skin if for any reason the birthing parent isn’t able to immediately. You can also request for the lighting to be dimmed appropriately and to play your own chosen music. Some parents also like to take in a relaxing spray or scent that can be put on a tissue and kept in a partners pocket to smell when needed, essential oils like lavender etc. can be helpful.
Jenny Smith at Queen Charlotte’s Hospital has been pioneering gentle Caesarean methods for many years now and many hospitals are able to support parents with this method if the parents wish for it and it is medically possible. Babies can be birthed slowly and if wished the drape can be lowered so that parents can witness the birth or births. Once the head is out of the abdomen the partner can relay what they see if the mothers view is restricted until she can see herself. You can also ask that the sex of your baby isn’t revealed so that you can notice this for yourself.
The baby then can auto resuscitate and begin to breathe air through its mouth and nose while its’ trunk is still in utero and has placental circulation. This momentary delay allows the pressure from the uterus to expel lung fluid in a similar way to a vaginal birth.
Once the baby has been observed for breathing and tone, their shoulders are eased out and the baby often opens its arms and cries out, their torso can help to tamponade the incision and minimise bleeding. This is often referred to as walking the baby out and can be done with skill with singletons and multiples.
This slower entrance can also naturally lead to a slower cord clamping and cutting. For baby’s that are premature or are compromised at birth, it is essential that the cord is left for at least 60 seconds but preferably until it stops pulsating. Premature and compromised babies benefit most from optimal cord clamping. The baby may then be placed on the birthing parents bare chest in skin to skin contact. With twins, hopefully the same process can be repeated until both babies are welcomed on your chest.
Skin to skin will welcome your baby or babies into the world in an ideal way.
You can gaze into each other’s eyes and get to know each other. Your skin touching their skin will keep them at the ideal temperature as well as stabilising their heart rate, respiration and blood glucose levels. It promotes breastfeeding, bonding and is associated with less infant distress. There is a wonderful phenomenon known as thermal synchronicity with multiples. A mothers body has the ability to meet the individual needs of each of her babies and each side of her chest will respond to each baby, warming or cooling them as needed.
The screen or drape will then go back up so that you can be sutured and the surgery completed. Skin to skin contact can be continued until after the first breastfeed or for as long as you wish.
It’s also an idea to ask for silence as much as possible when a baby is born so that the baby first hears its parents familiar voices.
Often babies can receive any needed procedures in skin to skin contact.
If there is a medical reason for anything else, they can be returned to parents as soon as they are able. Hopefully with the birthing parent but the partner if they are not able. If there is a need for more medical care, skin to skin can happen as soon as you are able. It’s good to remember that some babies may need some extra care and support in NICU. The transport for this can be intimidating and can look a little like a huge spaceship with a tiny baby inside.
Weighing of babies doesn’t always need to happen immediately and there is evidence to say that babies who have a caesarean should be weighed at 24 hours after birth. This is because some of the intravenous fluid given to the mother can be taken on by the baby or babies and can artificially inflate their birth weight. They often pee out the extra fluid taken but it can mean that there is a greater loss of weight in day 5 from the immediate birth weight measurement and this can undermine a natural process and increase supplementation.
This film and these articles on skin-to-skin following a caesarean might help to know what to ask for:
Its always good to remember that this type of birth can take a longer time to heal from (it is surgery) and that healing and taking care of a new baby can be challenging. Be kind to yourself and have as much support as possible lined up to help support you. Cuddle up to your little one(s) as much as possible in skin to skin contact as it is not only great for them, but also helps your body to heal and bring down any inflammation.