One in three pregnant women will have a cesarean. Are you emotionally and physically ready?
When I gave birth to my first son, Jack, by cesarean section eight years ago, I was more than a little unprepared. In the months leading up to my due date, I had put all of my energy into gearing up for a vaginal delivery. My husband and I religiously attended Bradley childbirth education classes, read the books and watched the videos, and bonded with our classmates.
Five days past my due date, I went into labor and was amazed at how quickly I progressed. By noon I was fully dilated and ready to push. But two hours later, my baby hadn't descended into the birth canal and I was told that I needed to weigh the risks if I wanted to continue. Exhausted, I consented to a c-section. As soon as we got a good look at our son, it was clear that his beautiful and very large head hadn't had a chance at a vaginal birth.
With baby number two, I opted for a scheduled cesarean and I knew I'd made the right decision. Yet the morning of the delivery I was still caught off guard. As I waited in my hospital gown, all the memories came rushing back: the cold starkness of the operating room, the odd sensation of the spinal anesthesia entering my body, the postoperative shakes and wrenching gas pains. But I forced myself into the OR and gave birth to eight-pound Sean. When I became pregnant with my third child, I resolved to be more in touch with this birth physically, mentally, and emotionally. Now that 29 percent of deliveries are via c-section, all pregnant women need to consider this possibility. Here's how you can prepare so that your birth experience leaves you feeling empowered — not powerless.
Think about it
Toss the notion of an ideal birth experience. The Hollywood images are heartwarming — a woman labors a few hours; then, after a valiant pushing effort, she's shown sweaty-faced and glowing, cradling her newborn. But childbirth doesn't always unfold this way. Many women labor for hours and fail to progress, or complications develop. Ironically, it's not just filmmakers who overlook these scenarios. "Childbirth education classes can sometimes give women the mistaken impression that there's an ideal way to have a baby, and that women have complete control over the birth, when this just isn't the case," says Alexis Menken, Ph.D., cofounder of the Pregnancy and Postpartum Resource Center at Columbia-Presbyterian Medical Center in New York City. "It sets a huge number of women up for disappointment, which can trigger anger, resentment, anxiety, and feelings of failure." In fact, having a c-section delivery can be a risk factor for postpartum depression. "To avoid self-blame and disappointment, women need to focus on choosing a doctor they can trust, while also working on their own willingness to go with the flow during childbirth," adds Menken.
Discuss your fears. "Unlike with my emergency delivery, I was very nervous before my planned c-section because I had so much time to think about it," says Karen Baratta, 37, a mom of two boys, 3 and 1, from Cranford, New Jersey. "I lost sleep imagining the pain I might feel during the surgery. I also worried about something going wrong and what would happen to my older son." Baratta's concerns are very common — and normal. To allay yours, have your doctor, doula, or midwife explain all of the reasons a c-section may become necessary. You can also ask your obstetrician to walk you through exactly what happens before, during, and after surgery.
Prepare yourself mentally. Regardless of how you deliver, learning how to put your mind and body in a calmer state can be a powerful tool during pregnancy and birth. You can enroll in a prenatal yoga class, pick up a relaxation CD or DVD, work with a therapist who specializes in stress-reduction techniques, or simply take 10 to 20 minutes each day to focus on your breathing.
It doesn't really matter how you de-stress, say the experts, as long as you practice at it, which trains your body how to react. One popular method to try is called the "Relaxation Response," from Harvard-trained cardiologist and mind-body expert Herbert Benson, M.D. First, choose a word, sound, or phrase that's aligned with your beliefs (for instance, "peace" or "love"). Then, sit quietly with your eyes closed, and while breathing naturally, repeat the word silently each time you exhale, continuing for 15 to 20 minutes. (For step-by-step instructions, go to the Benson-Henry Institute for Mind Body Medicine's website
Create a C-section wish list.
Conscious choices about the things you have control over can help make your experience a more positive one. A few points to consider:
The kind of mood you want in the operating room As surprising as it sounds, some surgeons like to operate to music. If you feel it would relax you, ask about bringing your own music to play in the OR. Want to record the event? Videos may not be allowed in the operating room, but cameras often are. If you'd like to see what's going on during the surgery, ask the nurses if they can lower the curtain and put up a mirror.
Whether you can keep your newborn with you in the recovery room and nurse immediately Hospital policy often dictates these two things. In some cases, the answers depend on the health of the baby and mother. If everyone is fine, then you may be allowed to do both.
Whether you'd like additional support from a relative, a friend, or a doula or midwife If you go from the birthing room to the operating room and you've been working with a midwife or doula, many hospitals will allow her to accompany you. If your hospital requires that your baby be observed in the nursery immediately following the birth (to insure that body temperature and breathing are normal), your birth coach or another relative may be able to stay by your side in the recovery room to keep you from feeling lonely while your partner goes to the nursery (or vice versa). If you're scheduled, also consider whether you want family to wait during the surgery or if you'd prefer time with the baby before you see them.
Remember that a C-section delivery is still childbirth.
Eating healthy foods, exercising, and staying within the recommended weight range will help your baby and increase the likelihood of a smooth surgery and recovery. "The more fit you are before a surgical birth, the better you'll be able to handle things afterward like getting up and out of bed, which is key to lessening your risk of blood clots and getting your intestines functioning at normal capacity," explains Sindhu Srinivas, M.D., an ob-gyn at the Hospital of the University of Pennsylvania in Philadelphia.
Eat lightly for 12 hours prior to surgery if you're scheduled for a C-section.
Your intestines move food and waste through your body by working in a constant squeezing motion. For a few days after surgery, your intestines will slow down considerably, which means food and liquid will have a much harder time getting where they need to go. A light diet of clear vegetable and pasta soups, yogurt, Jell-O, and pudding is much easier for your body to digest than a burger, fries, or pizza. You'll have less gas buildup, and your intestines will begin functioning normally sooner.
Mark the transition from pregnancy to birth.
If you know you're having a cesarean, keep in mind that there's less of a physical transition from pregnancy to birth, which can leave you feeling emotionally distant from the event, says Deborah Issokson, a licensed psychologist and the owner of Counseling for Reproductive Health & Healing in Wellesley and Pembroke, Massachusetts. She suggests taking time the night before to acknowledge the upcoming birth — something as simple as sitting with your partner (and other children), talking about your baby's imminent arrival, or lighting a candle in her honor — as a way to be more in tune with the momentous occasion that will soon take place. Another good time to "transition" is in the hours leading up to the surgery. Most hospitals typically require that you be there at least two hours beforehand for routine preparation such as inserting an IV line and measuring your blood pressure. While distraction (knitting that half-finished baby blanket or zoning out to The View) can help ease the anxiety for some women, "for others this type of passive activity only heightens their nervousness because it creates a real disconnect with what's about to happen," says Jacqueline Kelleher, director of postpartum services at DONA International, a doula-certifying organization. Instead, use this time to connect with each other and your baby. "Talk to your baby, and tell him or her what's about to happen," she suggests. "Tell yourself that you're strong and that you can get through this."
Think up a meaningful mantra.
Even if you have an unplanned c-section, you can still take a moment to recite a simple mantra — a word or verse repeated over and over to help quiet the mind, says Jill Wodnick, a certified doula and holistic birth educator in Bloomfield, New Jersey. "Mantras engage the breath, calm the mind by reducing stress-related hormones such as cortisol and adrenaline, and allow for more oxygen to flow through the body." Wodnick recommends choosing anything from a favorite psalm to a phrase from Sanskrit, the ancient Indian language, such as om shanti (which means "with peace") or something as simple as "I can do this." You can silently repeat it to yourself or say it out loud throughout the procedure.
I'm happy to report that all went well when I delivered my third son, Henry, even though little went according to plan. Two days before my scheduled c-section, I awoke to the sensation of my water breaking all over my bed. Before we left for the hospital, the four of us (my husband, our two boys, and I) stood together, holding hands, and said a simple prayer for a safe delivery. The prayer lasted all of ten seconds, but months later I still remember this moment. On the way to the hospital, in between killer contractions, I thought about the popcorn I'd downed at the movies with my kids the night before. (It came back to haunt me in the form of gas, but getting out of bed and walking right away helped.) When I leaned forward on the operating table so that the spinal anesthesia could be injected, I chanted a mantra I'd been practicing: "In peace, out smile." I was turning my health and my baby's health over to the surgeons at that point, but to my surprise, I still felt a sense of control and a calm. Now that I'm raising three boys, I may want to tattoo that mantra to my forehead.
Maureen Connolly is the coauthor of The Essential C-Section Guide.