Congratulations on your pregnancy and in taking an important step in preparing for meeting your baby – creating your birth preferences. Whether you are planning a vaginal birth or elective caesarean, considering some of your different options for when birth occurs in the operating theatre can be really helpful in preparing for all eventualities and making your birth as personal to you as possible.
There are no right or wrong approaches to take when creating a Caesarean Birth Plan and although many parents are happy to just ‘go with the flow’, there are some aspects you might like to consider discussing with your obstetrician to see whether they can be incorporated for you.
Who would you like to be with you?
A Caesarean Section occurs in an operating theatre, usually at your local maternity unit. This may be the first time you have ever been in an operating theatre so it can feel like a dauting process, but don’t worry you will be well looked after and supported. During a caesarean birth, if you are having a regional anaesthesia, or spinal, and are awake you will usually be allowed one birth partner to attend with you. This doesn’t have to be your partner, you might prefer your mother, sister or friend to come in with you – this is completely up to you. They will be sat next to your head and won’t be able to see any of the operation. In most circumstances, they will be with you from start to finish and can cuddle your baby after birth if you/they would like to. Sometimes, if it is an emergency or there is a serious concern over you or your baby or if you are having a general anaesthetic, your birth partner may not be able to be present for safety reasons and your doctor or midwife will discuss this with you at the time. If this is the case, they will ensure to reunite you as soon as possible afterwards.
Would you like to alter the theatre atmosphere?
Although the operating theatre may not be your ideal birth environment, there are several things you can do to make you feel more comfortable and relaxed. Most obstetric theatres have an ability to play music. This can be really helpful in distracting both you and your birth partner from some of the different noises such as medical equipment or surgical instruments which unfortunately can’t be avoided and routinely do occur inside a theatre. You should talk to your midwife or obstetrician about whether this would be possible, or if you should bring your own speakers if this is something you would like. You can also request that the theatre staff work as quietly as possible and keep conversation to a minimum if you would prefer.
You could consider discussing whether the theatre you are due to have your baby in has the option to lower/reduce the lighting at all. It is important the surgeons have the necessary light to perform the operation safely, however some theatres can dim the general room lighting slightly, creating a slightly softer environment for your baby’s birth.
Would you like to see your baby being born?
During the start and initial part of the operation, there will be a surgical drape screening the surgery from view. The surgeons will be the other side, so you don’t need to worry about seeing any blood or the wound. If you would like, just as your baby is about to arrive you can have the screen lowered to watch your baby being born. It can be sometimes difficult to see initially, but as your baby is lifted by your surgeon you should be able to see your baby for the first time. You can also ask if it is possible to take photographs of your baby being born or of you as a family during the operation.
Would you like to discover whether you have a boy or a girl yourself?
You may already know what sex you baby’s is, but if you don’t you can request that no one else says anything before you have the chance to see for yourself. As your baby is being lifted upwards, they are usually facing towards you and once there are fully born the surgeon can show you your baby straight away if you would like, allowing you to be the first to know. Some parents may wish the baby to be dried and cleaned first and that is also completely fine.
Would you like immediate skin to skin?
Once your baby has been born, it is routine now to wait 1-3 minutes before cutting the umbilical cord to allow for delayed cord clamping. Due to infection risks and ensuring the surgical area around your wound stay sterile, the surgeon will be the one to cut your baby’s cord unless you specifically request the baby and placenta stay connected. After delayed cord clamping has finished and the cord has been cut the baby will be wrapped in a towel or light blanket as the theatre can be particularly cold for a baby. You can ask your midwife to help you to have the baby placed skin to skin straight away if you wish, and your baby can remain there, on your chest for the remainder of the operation. Some mothers feel too sick or tired for this and prefer their birth partner to cuddle and hold the baby and this is fine to. If you would like skin- to skin, then ask your midwife to make sure your arms are outside any sleeves of your hospital gown and that your monitoring wires are as out the way as possible before the start of the surgery.
Would you like to see or keep your placenta?
After your baby is born, the surgeon will remove the placenta from your womb before they begin to stitch the different layers closed. Your placenta will be placed in a sterile container and you have the option or seeing or keeping your placenta if you wish.
It is important to remember that all healthcare professionals will always do everything they can to support your birth choices and preferences and to ensure you have the best birth experience possible. Unfortunately, pregnancy, labour and birth can be unpredictable sometimes and not all requests may be possible on the day for certain reasons. Your team will discuss with you anything that may or may not be possible and why unless there is a life-threatening emergency in which case their focus will be on the safety of you and your baby, but this is rare.
It can be especially useful to create your preferences together with your birth partner and discuss each aspect to ensure you both feel comfortable with the decisions you have made. It is really important to document all of your preferences in your maternity notes in case you do need to go to the operating theatre, even if you are planning a vaginal birth so your midwife and obstetrician know in advance how they can create your ideal birth environment.
If you have any questions about anything you should or shouldn’t include, talk to your midwife or obstetrician ideally before labour and if researching any parts online, make sure to use a recognised resource such as the Royal College of Obstetricians patient information section or NHS websites for accurate, up-to-date information that you can trust.
About the Author
Dr Ellie Rayner is a practicing Obstetrician and Gynaecologist and founder of The Maternity Collective.
She is the only Obstetrician to offer private and group, expert-led Antenatal and Hypnobirthing Classes both Online and face-to-face. She is passionate about providing parent-centred, evidence-based care for all pregnancies and supports all methods of birth.
The Maternity Collective provide complete online antenatal and birth preparation courses led by a team of NHS healthcare professionals, including a Community Midwife, Obstetrician, Internationally Board-Certified Lactation Consultant (IBCLC) and Newborn Sleep and Behaviour Expert. Their 7-hour online course of 37 videos has been undertaken by more than 4200 parents to date and has fanatic reviews.