16 points to consider for your cesarean birth plan

Editor’s note: April is Cesarean Awareness Month, an international observance designed to reduce unnecessary Cesareans, advocate for Vaginal Birth After Cesarean (VBAC), and help women heal from the sometimes-difficult emotions surrounding a cesarean birth. While Attachment Parenting International (API) promotes childbirth options with the least interventions, we also recognize that there are certain situations that necessitate interventions. What is most important is that parents research all of their options to be able to make an informed decision. A cesarean does not need to prevent a gentle delivery:

A family-centered cesarean is a relatively new concept that’s helping to make cesarean births gentler and more positive. In addition to giving a mother control over her birth, a family-centered cesarean — sometimes called a gentle cesarean — may also help facilitate early bonding between parent and newborn. This can help a family to start out feeling attached and connected from birth.

Certainly, if you’ve had an unwanted, traditional cesarean or any negative birth experience, it does not mean that you cannot have an attached relationship with your baby. However, having a positive birth experience can make for an easier transition into parenthood and can also reduce the chances of postpartum depression.

What is a Family-Centered Cesarean?

The goal of a family-centered cesarean is to focus on what will make the experience better for all members of the family. Since every family’s wishes and desires are different, a family-centered cesarean can look different for each family. Also, the fact that policies vary greatly from one hospital to another may determine what is and is not possible. (For example, some hospitals do not allow a doula in the operating room.)

Gentle practices that some families may desire during a family-centered cesarean include having the baby walked out more slowly than in a traditional cesarean, delayed cord clamping, and allowing for immediate skin-to-skin with either parent. Allowing the mother to nurse in the operating room, keeping mother and baby together in the recovery room, and having newborn tests and procedures done with the baby on mom’s chest are other ways that a family-centered cesarean can support early attachment.

In my own experience, I had both a planned and unplanned cesarean. When my second child was born in 2012, I arrived at the hospital in labor expecting a vaginal delivery like I’d had with my first child. I was shocked to find out that my baby was in breech position, and he was delivered via cesarean less than an hour later. I hadn’t planned for a cesarean and had never heard of a family-centered cesarean. Fortunately, in my situation, the hospital policies already included having mom and baby together in the recovery room and other early bonding practices. However, had I known what options I had to make my cesarean a more family-centered experience, I would have felt more in control of my birth and less scared and upset upon learning I’d need a cesarean.

When I was pregnant with my daughter two years later, I was hoping for a VBAC but learned early in the third trimester that she was breech as well. I ended up having a second cesarean, but this time I was able to research my options and created a cesarean birth plan. Though it wasn’t the ideal birth that I’d initially imagined, it ended up being the most positive of my 3 children’s births.

If you’re having a planned cesarean by choice or medical necessity, or if you are hoping for a vaginal birth but want to consider your wishes in case it becomes a cesarean, you may want to consider writing a cesarean birth plan that covers both the cesarean itself and the recovery period. Talking to an obstetrician about it in advance can help you understand what is possible at your hospital.

Points to Consider When Preparing for a Family-centered Cesarean:

  1. Practice breathing and relaxation techniques to use before and during the cesarean. This can help you stay calm and manage stress or discomfort.
  2. Play music in the operating room, if allowed. It can help in creating a comfortable and calm atmosphere.
  3. Have an additional support person/doula in the operating room and/or recovery room, if allowed. A doula may help with relaxation or be a source of emotional support. Research shows that having a doula leads to higher satisfaction with the birth experience.
  4. Ask to have one arm unrestrained in order to hold the baby as early as possible and facilitate early bonding.
  5. Before beginning, have someone ask, “Are you ready to have your baby now?” This can help you feel a little more in control of your birth.
  6. Have the cesarean performed slowly with the baby walked out slowly and gently which is gentler for the baby than a traditional cesarean may be.
  7. Ask the doctor to explain the process as it is happening. This can help you to feel more present and connected with the experience.
  8. Have a warm blanket available during the surgery for your comfort.
  9. Have the screen lowered or a mirror at the time of delivery, or have a clear surgical drape, so you are able to see the baby’s birth.
  10. Allow your partner to announce the baby’s gender.
  11. Have immediate skin-to-skin contact. This is one of the earliest ways to bond physically with your baby.
  12. Delay cord clamping. Keeping the cord attached longer allows for increased blood flow from the placenta, which has many health benefits for the newborn.
  13. Breastfeed the baby as early as possible, in the operating or recovery room. In addition to being a means to connect physically with your newborn, this has other benefits including improved lactation and less loss of blood. Feeding a baby colostrum within the first hour of birth also increases the chances of a successful breastfeeding relationship.
  14. Keep the baby with you in the recovery room to allow for more opportunities for bonding and nursing.
  15. Delay baby’s first bath to give the baby more time to bond with parents. There are also health benefits to this, as research shows that leaving on the vernix (the white substance many babies have on their skins after birth) can benefit a baby’s immune system.
  16. Have newborn tests and procedures done with the baby on your chest so you aren’t separated.

While having a positive birthing experience is desirable — as it is a part of our initial parenting experience — it’s important to remember that it doesn’t define our parenting journey. There will be many more events and moments for us to bond and connect with our children.


         Additional API Resources on Gentle Cesarean Births:

API’s First Principle of Parenting: Prepare for Pregnancy, Birth and Parenting

Personal stories on APtly Said, API’s blog:

— “A special door

— “I took back control of my cesarean

— “5 lessons learned about Attachment Parenting after a cesarean birth

Professional insight on The Attached Family, API’s online magazine:

— “What Goes Into a Family-Centered Cesarean Birth Plan

— “What to Do When a Cesarean Becomes Necessary

Preparing for childbirth: The delicate dance between pushing out and letting go

Observing a friend struggling with, and complaining about, the last days of her pregnancy –constantly posting on Facebook about how she finally wanted her baby to make an appearance in the “real world,” listing details about all the activities she undertook in order to make this happen ASAP — made me reflect on the delicate dance that childbirth is. 

I get it. I’ve been there.

Ready to Push?

Feeling big — no, huge! Not being able to see my toes anymore, let alone tie my shoelaces. Feeling very swollen in the summer heat and out of breath after walking up the stairs to our apartment on the 4th floor. Rolling around on the mat in my prenatal yoga class feeling like a huge whale. Nights spent sleepless with heartburn, an active baby in the belly, and a bladder that never wanted to go to sleep.  

And then, there is all the excitement about finally getting to meet this tiny human being that you have lovingly and patiently grown in your belly for all these long months. The excitement about becoming a parent — for the first, second, third… time. There are all the people around you, asking when the baby is due — which does not really help or make waiting any easier — and so many other good reasons to finally push the baby out of your belly and into the world. 

But First…  

But there is another side to the story, which tends to be forgotten or at least does not enjoy a lot of spotlight.

A more delicate, more sensitive — even darker — side that might not be as limelight-worthy or Facebook post-worthy…a side, which in my opinion, is just as important as the “push side.”

It is the side that mindfully focuses on letting go.

On gentleness, on feeling, on making space for the baby to come into this world…and making space for what is to come and follow.

On becoming aware of and consciously reflecting what is transpiring inside of us: physically, spiritually, and emotionally. 

Facing Our Feelings

This includes facing our anxieties and deepest fears and doubts about birth and about parenthood, about our ability to “do a good job” at delivering and then protecting, nurturing, and growing this delicate, wonderful new being that we already love more than we could have ever imagined. It may also include acknowledging and confronting our fear of failure, our fear of pain, our fear of loss, and our fear of fear. 

Furthermore, it includes facing the reality that things are (again!) about to change tremendously. That not only our everyday life is about to get the next big overhaul, but also our whole universe: The way we relate to the world, and the way we relate to ourselves is going to drastically change.

It includes coping with our bodies changing — yet again — from the pregnant state to a postpartum state, which will look and feel very different from what we are accustomed to and from what we might actually enjoy or expect seeing and feeling. We might feel empty, tired, depleted, sore, and possibly a far cry from attractive and sexy for quite a while.  

I vividly remember mourning my “empty“ belly for several days following my daughter’s birth. It felt empty and somewhat sad to not feel my baby inside my belly anymore. While I was certainly very happy to finally be able to hold her and cuddle up with her in my arms, I missed this innate and exclusive feeling of connection to her.  

Bringing Together the ‘Pushing Out’ and the ‘Letting Go’

I believe that, in order to consciously and mindfully prepare for birthing our child, it is important to take the time to look at and ideally merge both sides of the equation: the “pushing out” and the “letting go.”  

The tiredness of being pregnant and the energetic eagerness to have baby out of my belly have certainly helped me tremendously in getting over my fear of giving birth and all the pain that would be — and certainly was — involved. However, being mindful, open, and receptive to the side of letting go, creating space, and facing anxiety, doubt and fear — even mourning during this transition — has certainly proven to be very helpful as well. I believe it might be one supportive part in the puzzle of alleviating or possibly even preventing feelings of the “baby blues.” 

So, I’m calling on all expecting moms: Take a deep breath and give yourself a mindful moment — and ideally many more — and some space to merge both ends of the continuum. By doing this, you will be giving your body, mind, and spirit a chance to holistically and soulfully prepare for what is to come instead of forcing it into birthing-action mode.

Photo source

Parental presence: A compromised human right

free images com - Sona PsotovaA little more than half of all babies in the United States — 53% — are born into families that income-qualify for WIC, a federal supplemental nutrition program that serves low-income pregnant, postpartum and breastfeeding women and their children from birth to age 5 in the United States.

Think about that for a second: Half of all U.S. babies are born into low-income families, the population segment least likely to be able to take parental leave of any type — paid or unpaid — after the birth of a baby.

We like to think that the U.S. Family and Medical Leave Act (FMLA) covers all families so that even if a couple does not get paid maternity and paternity leave, they can at least take off some time from work without losing their jobs. This isn’t remotely true.

Unless you work for an employer with more than 50 employees within 75 miles of the company, you are not even guaranteed leave under FMLA after the birth of your baby — even unpaid. (There are some state laws that do guarantee maternity and paternity leave, usually unpaid, for companies with fewer employees, but there is nothing consistent from state to state.)  That means that millions of moms, if they are not employed by large companies, risk losing their jobs if they stay home for the medically recommended 6 to 8 weeks following childbirth.

I’ve known moms who’ve been forced by their circumstances to go back to work at 1 week postpartum, or even sooner.

This is a tragedy of human rights in itself, but what does this do to the mother-baby bond?

Bonding time with a newborn in the early months isn’t just a “nice thing” to have or for a mom to get to do if she’s privileged enough. That mother-baby bond — whether secure, shaky or absent — has a significant impact on the trajectory of that child’s life…not only through childhood and in school, but who that child will grow up to be, what socioeconomic status he or she will have, and how he or she will be as a parent, employee and fellow member of society. Just think of what the future may hold for any of those 53% of U.S. babies born to mothers who are not even guaranteed time off from their jobs for even a week after childbirth — let alone the minimally acceptable 6 weeks that is still woefully short of what research shows to be the key bonding time during the newborn months.

Privilege shouldn’t have anything to do with parental leave — paid or unpaid. Because presence, or lack thereof, can have such great influence on the future of each baby born, parental leave is a human right that should be granted to every mother and father, and parental presence is a human right for every newborn baby.

So first the United States needs to work on guaranteeing that all parents have access to at least parental leave after the birth of a baby. But a very close second is to ensure that all parental leave is paid.

Right now, only 12% of U.S. workers in the private sector have access to paid family leave, according to the U.S. Department of Labor. This means that for the millions of moms whose jobs are protected under FMLA, they still likely cannot take off work for the 6 weeks to 3 months allowed because they cannot afford to do so. Their parental leave is not unprotected as is the case with many low-income parents whose jobs aren’t even covered by the FMLA, but it is still under-protected in that they cannot enjoy their full rights and their bonds with their infants may still suffer.

apm logoOur goal at Attachment Parenting International (API) is to keep the discussion on parental leave moving forward, while supporting mothers and fathers no matter whether they have access to paid or unpaid parental leave or even no leave. We were able to generate great momentum during our Attachment Parenting Month in October 2015 with activities centered on the theme of “Parental Presence: Birthing Families, Strengthening Societies.”

Leave-Presence cover - smallIn the latest issue of The Attached Family, we provide a recap of these AP Month editorial pieces as well as a few new articles, with features on:

We hope that this issue of The Attached Family will inspire you to find ways to balance your child’s attachment needs with your family’s financial needs, as well as to join in the national and international discussion on parental leave as a human right to be guaranteed to all families — no matter their employer size or personal financial resources.

donate buttonHelp API continue being able to offer The Attached Family free of charge as an online magazine to families around the world. API is a nonprofit organization and depends on your tax-deductible donations. Even $5 goes a long ways!


*Top photo source: FreeImages.com/Soňa Psotová