Writing A Cesarean Birth Plan

For those mothers who know they'll be delivering by cesarean birth, or for those mothers who like to prepare for every possible outcome, here are some questions to consider for your birth plan. Many people believe that a c-section means you have few options as far as your care, but that's not true! By learning what possibilities there are you can make your birth experience more personalized. Many of the questions asked on a vaginal birth plan are also important to discuss for your cesarean birth, but here are some that you may not have considered. Some of these may not be relevant to your situation, but hopefully they'll get the discussion going with your partner and care team:

Who would you like to have with you for your baby's arrival? Your partner, a family member, doula, a photographer? Most hospitals in my area have a policy of one or two support people in the OR, though I've heard of more and some restrict it to just the baby's parents.

(Why would you want a doula for a cesarean birth?)

May your support person remain with you while your epidural/spinal is placed? If an epidural has not been placed prior to labor then often a spinal is given in the OR, and generally the partner is NOT present for this procedure. They are usually waiting in the other room getting into the scrub outfit and are brought in after mom is laying down and draped.

What would you like photos of and who will take them? Is there anything that may not be photographed? Some hospitals allow photos of everything, others say no photos on the other side of the screen.

What type of anesthesia is available, and what pain relief options will you have in recovery? May you speak with the anesthesiologist in advance (a call the night before?) to discuss these options? Many moms do not meet with the anesthesiologist until shortly before the birth, so if you have concerns ask if you can speak with someone the night prior of a scheduled cesarean.

Are there any other medications routinely given by IV and what are their risks and benefits? Are there any medications that may impact your ability to stay alert and nurse immediately after the birth (sedatives, etc) and would you like to decline those?

Are your arms be left free to touch your baby? Previously moms sometimes had their arms restrained, but I've not seen this done and most hospitals seem to have moved away from the practice.

Would you like your doctor to verbalize the steps of the procedure to you? Some moms like to know exactly what is happening, and while the doctor will be talking with staff they may also be able to tell you what is going on.

Would you like music playing? What speaker set up is available? For a recent birth I attended we just plugged in the iPod, but some doctors prefer there to not be music.

Would you like each person in the room to introduce themselves to you and explain their role? While the OR is busy and there are a variety of people all in masks, for some moms it helps them to know who is attending and what their role is so it's worth asking if this is important to you.

Do you want the gender announced by the doctor or your partner?

Would you like the screen lowered as your baby comes out? Is a mirror available for you to see? Some anesthesiologists are not comfortable with the screen being moved at all but other locations are incorporating more family-centered approaches and offering to lower the screen and even do immediate skin-to-skin in the OR.

Do you have any requests as far as double vs. single layer sutures? Does your doctor use staples or sutures for your external closure? Do you have any questions about how this is done?

Do you want your baby to be lifted up so you may see them right away?

Who will cut the cord?

Is skin-to-skin possible while in the OR? (Your partner or doula will assist in holding your baby to you and you'll be covered up with a blanket.) Here is a video on the skin-to-skin option: A new way to have a cesarean birth.

If the baby cannot be skin-to-skin immediately, would you like the bed warmer to be kept in your line of sight so you can see baby at all times? While this isn't possible in some ORs due to the space limitations, it may be worth asking if it's an option.

Will baby automatically be suctioned or only if needed?

If the baby needs to be taken to the nursery or NICU, who will go with the baby?

Do you want to keep the placenta?

Will you bank the cord blood?

How long will you need to remain in recovery before moving to your postpartum room?

When will the epidural/spinal & catheter be removed?

Will your baby remain with you at all times? Can newborn exams be performed at your bedside in postpartum?

What newborn procedures would you like? Vitamin K, eye ointment, Hep B vaccine?

How soon after the birth can you eat and drink?

How long will you remain postpartum? If staples are used, when will they be removed?

Will the baby be bathed in the room or nursery, by staff or by your partner or another family member?

Will baby be offered a pacifier, formula, or will baby nurse exclusively? Would you like a lactation consultant to visit you?

Hopefully these questions will help you in formulating the best birth plan for you! To consider some other aspects of cesarean births here's another post.

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