Following the birth of my son, I was disappointed I’d had to undergo a c-section. The feeling was fleeting, however. I knew, as I snuggled my newborn, the consequences could have been devastating if the surgery hadn’t been performed.
Like many new moms, one of the first lessons I learned was that parenthood rarely goes according to plan. But that doesn’t mean you should skip making a birth plan.
“Birth plans are a good way to start a conversation about expectations and what a mother’s wishes are,” says Dr. Logan Kracht, OB/GYN, Women’s Clinic of Johnson County, who delivers babies at Olathe Medical Center. “Having an ideal experience in mind is certainly okay, but beware of the pitfalls. It breaks my heart when I hear of mothers feeling like they failed in some way if breastfeeding doesn’t start perfectly or if they needed to deliver by cesarean section.”
By educating yourself, taking birthing classes and asking your health care provider plenty of questions along the way, you’ll feel more prepared, whether you deliver vaginally or by c-section.
What is a c-section? A cesarean section is a major surgery requiring an incision through the abdomen and uterus. You will receive an epidural and, barring an emergency situation, you will be awake during the procedure. Depending on your specific situation, your physician will make a low-transverse incision, which is a horizontal cut across the lower end of the uterus (generally preferred for better healing and less bleeding), or a vertical cut incision. Although you’ll feel touch and tugging sensations, you shouldn’t feel pain.
Why a c-section? According to the Centers for Disease Control and Prevention, in 2011 c-sections hit an all-time high, with one in three women giving birth by c-section. Since then, the number of c-sections has remained steady.
“One of the more obvious reasons that c-section rates are up compared to prior decades is the necessity for repeat c-sections,” Dr. Kracht says. “If a mother has one delivery by cesarean, then she is way more likely to have another.”
Other reasons women may require a c-section include the baby’s position in the uterus, the size of the baby, premature delivery, fetal heart rate changes indicating a lack of oxygen during labor, or if there’s a medical complication with the mother like preeclampsia or gestational diabetes.
What about VBAC? Although many physicians are proponents of a vaginal birth after a c-section, they say it’s important to consider the reasons behind a previous c-section and the risks of VBAC.
For example, if your previous c-section was due to your baby’s being in a breech position, you might be an excellent candidate for VBAC.
But “if you’re a patient who got to a full 10 cm and the baby would not descend, it is possible that your pelvis wasn’t large enough to allow the baby to deliver and a VBAC may not be successful,” says Dr. Brian Lovitt, OB/GYN, Meritas Health Pavilion for Women, Kansas City. Your physician also will consider your risk for uterine rupture, your insurance requirements and the availability of an on-site physician during labor and delivery.
Risks. Tears and lacerations can occur during any vaginal delivery. Although rare, uterine rupture is a life-threatening risk factor, particularly for women who opt for a VBAC. A uterine rupture is a tear in the wall of the uterus, usually at the site of a past c-section incision. The incidence rate is about one percent for women who have had low-transverse incisions, rising to five percent for women with vertical incisions. C-section risks include blood loss and complications with anesthesia, as well as scarring and infections.
Hospital stay. The typical hospital stay for a vaginal delivery is 24 to 48 hours, while a c-section is between three and four days.
Recovery. Whether you’ve had a vaginal delivery or a c-section, always follow your doctor’s recommendations.
Generally, a woman who delivers vaginally has no restrictions on lifting and typically can return to her normal routine within a few weeks.
With a c-section, expect the recovery to take a little longer as your mobility is more restricted. Other than your baby, you won’t be able to lift anything over 10 pounds and, due to the pain medicines, you won’t be allowed to drive for the first two weeks post-surgery.
“If your core is still healing, an emergency maneuver, which may require strong use of your core muscles, may not be as effective and you may be at higher risk of a crash,” Dr. Lovitt says.
Even if you’ve had a c-section and you’re on pain medications, breastfeeding is safe and encouraged.
Contact your physician immediately if you experience fever, uncontrolled pain, bleeding or incisional problems.
Postpartum support. During the first few weeks postpartum, lean on your partner, a family member or a close friend for emotional support and practical assistance, especially if you have other children.
New dads can help direct visitors and ensure you get the privacy and rest that you need.
“We—and I can say we—are highly capable of assisting or doing virtually all types of infant care, including diapers, bedtime, walks, you name it,” Dr. Kracht says. "Lighten the load by taking on extra housework, planning and cooking meals and driving the other children around.”
Contact your physician right away if you experience excessive blues, which could be a sign of postpartum depression, a serious but common issue among new mothers.
Birth Plan Considerations
Although most of your wishes can be accommodated, some preferences aren’t possible because of hospital protocols.
“Many things hospitals do are based on strong medical evidence—we want two (or more) healthy people when this thing is done,” Dr. Lovitt says.
Write down and discuss your preferences with your physician and significant other.
- Be flexible. Your baby’s birth may not go specifically according to plan.
- Avoid nonmedical-related preterm delivery, especially before 39 weeks, which can put your baby’s health at risk.
- Determine whom you can ask for support post-delivery to avoid managing alone.
Freelance journalist Christa Melnyk Hines resides in Olathe with her husband and two children, both delivered by c-section. Christa is the author of Confidently Connected: A Mom’s Guide to a Satisfying Social Life.
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