My latest mission has been to learn what sorts of things can be done ahead of time to prepare one’s house and life for what is essentially the recovery of major abdominal surgery AND a newborn. Phew.
Various doula lists have been incredibly helpful in helping to compile a list, and I figured I’m not the only one out there searching for this information, so here is a compilation (I am fine with people passing this blog post on to others, but please site me - Lea Wolf - and link back as well, thanks!) -
For your home:
*Create a list of friends and family who can help with various tasks, and be sure to communicate with them ahead of time about why you’ll be calling them - making clear that though they are also welcome to ooh and ahh about the babe, they are also getting the call to come help with meals/cleaning/shopping/chores/company/nap-relief/driving.
*Have plenty of food and snacks in the house including but not limited to a freezer-ful of meals that are simple to cook/reheat. Easy to make sandwich fixings, nuts, fruit, snacky veggies (carrots, sugar snap peas, etc), cheese, granola bars, yogurt, and other healthy grab-and-go foods are important too!
*If your community is large enough, ask someone to create a meal-tree for you, so that fresh ready-to-eat meals are delivered every couple of days.
*Do everything you can to make the home-space you will occupy on one-floor (assuming you have more than one floor), on a floor with a bathroom. If this means that you are not on the same floor as your kitchen, figure out a cooler/mini fridge situation so that you have food, water, bathroom — and phone access — on one floor. The point here is obviously no stair climbing. Expect to stay in one place as much as possible to aid in a faster recovery.
*Going along with expecting to stay in one place - plan to lay low. No going for walks, running errands, going out to eat. Come to terms in advance with what it will mean in your life to recover from surgery and plan accordingly. The cesarean rate is so high now that it has become commonplace, and because of that, it is easy to lose sight of the fact that cesareans are major abdominal surgery. And moms need to recover in order to be the best parents they can be.
*Have a basket of necessities that you can take with you if you do need to move room-to-room especially as you begin feeling better. Necessities might include a small water bottle, some non-fridge snacks like nuts, a diaper and wipes, the phone, tissues, etc.
*Hire a post-partum doula to come in to to help with any myriad of tasks - infant soothing, breastfeeding support, caring for infant/siblings so mother can get a shower or rest, support in the process of learning to care for a newborn, light meal prep, light cleaning, and the general support of someone who understands what is “normal” and has a network of referrals to others in the community if needed.
*A total seemingly crazy purchase, but one that could be incredibly helpful is a lifted toilet seat - this prevents the strain on abdominal muscles that happens when sitting and rising from a toilet height. (I’m thinking about getting one of these to lend out to clients who have had cesareans.)
Preparing for the hospital:
*Find out in advance how many support people are allowed in the room during the cesarean and consider advocating for more than one. Partners are usually allowed, but when the babe is out, partners will generally accompany the babe (whether it be across the room or out of the room), and having another support person means that mom will not be left alone. If there is any reason that baby needs to be taken out of the room, partners are able to accompany the baby without worrying that mom is being left alone and that additional support person may be able to relay any information about the baby during a separation.
*Even if you have a scheduled cesarean, if you have hired a doula or considered hiring a doula, their services may still be very useful. Their presence as an extra support person can fulfill the above roles, but with more experience and knowledge available explain each step of the way. They are able to communicate with parents in plain-talk about what might be happening medically, and support parents in advocating for information when there is uncertainty.
*Understand in advance what is going to happen during the cesarean. Find out what happens during prep and what choices you have (ie can you shave yourself, or will the staff do it themselves). Many people do not realize that the baby is birthed within the first few minutes of the surgery - but the rest of the hour-long procedure consists of being stitched up. Making a plan with care providers for how that time is handled is important. Find out what the standard procedure is for mom, support person/people, and baby and what choices you have.
*There is alot of information out there about the importance of skin-to-skin contact for mom and baby for many reasons, including successful breastfeeding - it doesn’t hurt to ask whether it would be possible for mom to have baby on her chest as the stitching happens (with support of course) - there are doctors who allow for this. And if the answer is no, perhaps consider having the partner go skin-to-skin with baby. (And check out this interesting article on “natural cesareans” for some perspective.)
*Find out what policies might be regarding photography - what is okay to take pictures of (ie, baby yes, surgery no, etc). The lovely thing about digital pictures nowadays is that you are able to take photos and it is an easy delete if you’d rather. Converting photos to black and white (also an easy process with digital) can do alot for capturing emotion, while playing down blood/bodily fluids, if that is of concern to you.
*Consider refusing or delaying eye treatment so that baby is clear-eyed and able to see mom after mom is done being stitched up and is able to really explore baby. Antibiotics are used as a prophylactic treatment to prevent the transmission of STDs from the mom to the baby, but if mom has been tested for STDs during pregnancy and is negative, the antibiotics are unnecessary.
*Antibiotic use for the mom prior to and during surgery is also commonplace, so preparing your body in advance so as to best be able to have a successful and fast recovery. Probiotics are all the good stuff in yogurt, but in pill-form, and having as many of these good bacteria present in your body as possible will help combat the more negative affects of antibiotics on mom’s digestive system, and baby’s as well. Good quality probiotics will be in a refrigerated case at natural food stores and natural pharmacies.
Ways to make cesareans less about surgery, and more about birth:
(Thanks to Trish Cremeens for these wonderful suggestions and insight on cesareans.)
*Remember that a babe is (usually) created out of love and closeness. And birth is a culmination of that love and closeness, and having your babe via surgery doesn’t have to take that away. Everything above the drape is not a part of the sterile field. Partners can touch one another, and connect physically; mom’s head, hands, arms, and shoulders can be stroked and massaged. Partners can talk about how their baby is about to be born - avoiding words/phrases like cut, pull and instead using words like birth and born and welcome.
*Mom’s arms are usually strapped down to prevent any interference with the sterile field and because many people become shaky during surgery. However, if you make it clear to your doctor that you understand the concept of the sterile field, one or both arms may be able to be free. This can be helpful in different ways - allowing for normal touch between partners, and also to allow for mom to touch babe after the birth. Even if mom’s hands have to be strapped down, there are ways partners can get that mom-baby touch: babe and mom can nuzzle cheek to cheek, partners can support baby’s weight on mom’s chest (”feel how big that baby is!”), and babe can be kept close to mom, even if she is groggy.
*You can also ask for the staff to talk through what is happening during the surgery, explaining things step-by-step, and you can specify if you want the staff to use or to avoid using medical terminology.
*There are ways to personalize the experience for everyone involved. Prior to the surgery, you can ask everyone in the room to introduce themselves. Listening to music that you chose, and making the decision about what will be talked about during the surgery (assuming all is going well) by the staff and between mom and partner/support staff can also make the experience personal.
*Typical birth practices such as the announcement of the gender (if unknown) and the cutting of the cord are still options during most cesareans. You can also talk with your doctor about dropping the sterile drape as the baby is being born - though you might think that the surgical cut is gory or overly graphic, it may be less so than you’d think. If you’d prefer to not see the birth as surgical, you can ask the staff to show you the babe over the drape (which is typical procedure). Both ways are valid and neither are more “natural” or “right”.
Things to think about and be prepared for with the recovery period:
(Thanks again to Trish!)
*It is not uncommon for there to be breastfeeding issues after a cesarean. Milk takes longer to come in, the incision may make typical nursing positions difficult, the meds used can make baby sleepy or disorganized in their movements. Understand that asking for help is the best thing that you can do - ask for a lactation consultant to assist; most of the nursing staff have knowledge of breastfeeding and have been certified as lactation counselors, but most hospitals have IBCLC certified lactation consultants and these folks specialize in breastfeeding.
*Bonding might be harder as the typical hormonal process is interrupted. Parents should not be too hard on themselves - and just being aware that this might happen makes it easier to understand what is going on. Practices like spending a lot of time skin-to-skin, practicing infant massage, and doing babywearing (when physically capable after the surgery in mom’s case) can all help the bonding experience.
*Parents need to give themselves the space to process. Yes, the ultimate goal is a healthy mom and healthy baby, but that is the goal for ALL births. Finding friends and support people who will allow that process of storytelling over and over will help to integrate the experience into reality - this is necessary for every kind of birth, but in the case of a cesarean it may not be a story full of only happy feelings.
*A seemingly good article - though Australian-based and thus not always entirely appropriate for US cesareans - on cesarean recovery, both physical and emotionally, is here: Caesareans: What to Expect After.
Final thoughts:
*Though scheduled cesareans are convenient for both the medical staff and for families, be well informed the research on “trials of labor” and the ways in which they can help give a baby it’s best start in life - even if it is known that the baby will be born via cesarean. A good article on “Why Labor is Good for Babies” is a good place to start. Waiting for your body to signal that it is time for the baby to be born by waiting for labor to begin ensures that your body has done all that it can to prepare baby for the outside world - their lungs are ready to breath and their systems are ready to operate successfully without help.
*Make sure that all has been done to prevent the cesarean as is possible. This might mean exploring alternatives that your health care provider is not mentioning. If your care provider presents a scheduled cesarean as the only option, remember that it is well within your rights to ask questions and, unless it is an emergency situation, request time to do your own research before the cesarean is scheduled.
In some cases it really may be the best/only option for the health of both mom and baby: placenta previa when the placenta is covering the cervix, placenta abrevia when the placenta detatches from the uterus, severe fetal distress when it seems baby is more than a few minutes away from delivery, baby lying transverse (neither head up or head down) even after all has been done to change baby’s position.
However other common reasons given for scheduled cesareans are not always cut and dry in their necessity: breech, multiples, previous cesarean, mother/baby size; in these cases, be well-informed of all the options (even those your care provider might not be mentioning) so that you can make a decision with all of the information necessary. The Spinning Babies website has a more detailed article entitled “When is a cesarean necessary“.
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Another great article on Having the Best Cesarean Possible was written by Penny Simkin and has lots of great information. This post is getting too long so I’ll just say go read hers as well!!!
And I am happy to take more suggestions. Please comment and let’s build a great resource….