Episode 34 - Gentle Family-Centered Cesarean Birth

0:02

Hi friends, this is Rachel doula Rachel here I'm with Dr. Shannon and today we are talking about gentle Family Centered Cesarean birth. And in this episode we are going to talk about Shannon's personal experience with having a cesarean birth and what she learned and how she shares with her clients about the options of having a family centered Cesarean birth. And we're also going to talk about reasons you might need a plan to cesarean. We might also talk about some reasons you might have an unexpected or emergency cesarean birth. And then we're going to talk about if you need a cesarean, what can you do to prepare for it in a meaningful and effective way and so part of this is discussing birth planning options talking with your provider and giving it some consideration but not in like a hyperfocus way but in a meaningful ways so that you can be prepared in the event that you might need one so that it can feel empowering, no matter what kind of birth you have. We're gonna also talk about some things you can advocate for in the Cesarean birth space before the birth and during the birth so that again, you can have that that's as smooth as possible that you know, reduce the risk of having a traumatic birth experience and really improve that overall positive feeling about your birth experience again, regardless of if it's a vaginal birth, or a cesarean birth. And so I'm excited to be having this conversation today with Dr. Shannon. So, Dr. Shannon here with me. Hi, thank you so much for having this conversation. I would love if you want to share a little bit about your personal experience and why you feel like this is an important conversation to have.

1:44

Yay, hello. Hello doula. Rachel, it's so good. To talk to you and hear your voice. It may not be good to hear my voice. Kinda lost it. But that's okay. I'm feeling great. Just sounding a little different today.

1:59

So it's okay. I'm just glad you're up for the conversation. I

2:01

am. I'm always up to talk. I was talking with the front of the bus up this morning. And I was like, maybe the Lord's trying to tell me I should stop talking. Is that what this is? But um, you know, here we are. And we still show up, right? I'm excited to have this conversation. Because I think I'm gonna learn a lot. You know, I had my C section. Oh my gosh, is almost 12 years ago, I almost have a 12 year old. So we're gonna pass on that amendment. But um, I you know, the, the literally the words gentle family centered care and we're not in the vernacular, then they're not part of the vocabulary in in the birth world. Maybe it was, but I didn't hear it. I didn't know it. Right. And, and so I feel a little bit that I don't necessarily have the knowledge base of what this is how to achieve that gentle family centered, but I do know well, this is what I experienced with mine. And it could have been a little bit different if maybe it had gone this way, which is more in line with that gentle family. Center. So because there were things that I experienced in mind that I wasn't, I didn't know were going to be I guess so triggering for me with just thoughts and feelings and emotions in the whole process. And so and I know I've shared in a couple of episodes throughout our podcast history, but I did end up with that emergency C section. So I had that cascade of events of you know, going to the hospital early I was a little bit over do According to their calculations. And just a really long labor they broke my water had the Pitocin internal fetal monitoring, epidural, dropping heart rate, spiked a fever, used to vacuum and had a C section. I guess that was in a nutshell 27 hours for you to know. But that's that cascade we talked about right? So and I know we're gonna go more into that because hitting on some of those points, there is maybe ways that we can avoid that C section or whatnot. But we're being aware of those things. But when I didn't research too much into the C section. I want to go into that a little bit later because I know we're going to talk about it. Because I have some thoughts with that. In like the outline that we've prepared for this show. But I the big thing I remember I am claustrophobic minutes. I do not like enclosed spaces. I can't stand elevators and I feel like the older I get the more I'm like it just freaks me out. So when you get wheeled into that room for the C section, and I mean it's different when you you've been in labor for 26 hours and you pushed for two hours like you're exhausted too. So there's a point of fatigue there. So there's a difference coming into it rather than it being like planned and a little bit more easy to enter. They put that drape in front of me and I remember seeing the pictures of like, oh, this is what you know, a C section looks like but I didn't investigate any further. Right that drape set off. Like I felt like I was trapped. I felt like yeah, it was like being in a tent. I remember camping girlscouts and being in that little two man tent and like feeling the walls closing in. That's what it felt like. And I remember looking at my husband, I was like I started pushing. I was like you got to get my face because I was starting to kind of feel that panic attacks and I wasn't expecting that. Though. And that's what was so like, a little triggering there.

5:44

Right? And then that's into like emotion other stressful feeling. It's

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that fight or flight. Yeah. And then so, I mean, and I know we'll talk about a little bit that later too, because there's other options there. So we'll go into that a little bit later as far as things you can do kind of wish I had had some other things so we'll go into that but that that that was one of the main things I remember. I remember for my husband to help me like calm down he was talking about like, what food I was going to get to eat after I really wanted a nice blue cheese bacon burger was i Yeah, so I you know he was helping me kind of come out of that fight or flight stage. But yes, I was like thanks for the support see you I needed that support even in that section so I know that even more so. Haha, I know that that's a golden nugget to take home. There are ways that you can use support and you may not even realize you could use it. But the other one was that you know you have to have the epidural and when you go into this user room and so you're definitely not from the waist down because it is major abdominal surgery and the having that drape and then feeling my body move side to side. But not being in control of it was so I can't even describe how that felt like it was just it was very I just remember having to find my breath again to because I could feel and I knew I was going to get to see my baby and it was so exciting. But it just it was like nauseating, but I don't even know I don't even know. And so I didn't expect that. You know I didn't expect to feel so like out of body out of control. And so are those coming through this and thinking about oh well maybe a gentle Family Centered when what could have been different there you know and I remember them saying like, Oh you're gonna feel some tugging and pulling and then in my mind was like, feels like half my body's in an earthquake. And the other half is just like on the beach somewhere. Like, just so strange. So strange. So those are the thoughts that come to mind for me as far as like, where could it be different, right and how can we prepare for that? Yeah, so that's where I know.

8:08

Yeah, well, I think I love it and I I think some takeaways from what I heard you say is something that a lot of people say is like, well, you know, like you said the caveat, I was of course excited to meet my baby, but that the time between, like getting into the or meeting your baby was all unexpected and created a lot of stress and, and these very ingrained memories that you have about that experience. Like I feel like you could probably still feel and see exactly what you were feeling and seeing in that moment. So it's very, very long lasting. And so of course we're excited to meet the baby, but some of the what happened in between gets lost or overlooked or not considered. And so what I hear you say is like it's important to consider and it's like 15 minutes of, of time. It's like not a ton of time, not including setting you up, but before you get to see your baby. It's a very short amount of time, but that time is very, very important. So how can we prepare for the event that you might need a cesarean so that you can maybe reduce some of that trauma reduce some of that anxiety feelings that occur so I just I think that's really important and that's one of the reasons we want to talk about this. And then I also want to talk about a little bit for the this episode is we don't really go into what at least you and I had talked about not really going into how to avoid this this area, because we talk about that a lot in Episode 25 where we talk all about V backs and avoiding that primary cesarean so definitely we'll we'll link it in the notes but that's where we go deeper into sort of how to prepare during pregnancy and how to try to reduce the you know, risk of having that unnecessary cesarean and here hoping to really focus on you know, broadening the conversation, helping people learn since you and I didn't have those terms when we were giving birth about what is a gentle family centered care and you know, and why is it important and what are some things you can do now to try to prepare yourself and so I think one of the things I talk about a lot with my clients, my expecting mamas is to talk with their care provider and have the care provider being your doctor or midwife walk you through. What's it look like to have a cesarean at the hospital or birth location you've chosen and under your care and have them walk you through, like start to finish? And I think that can help mitigate some of those anxieties and fears of what you might have experienced and that's a simple thing to do. And then that can lead to advocating for all the individual little things we're going to talk about later as far as like things you can do to have that gentle Family Centered cesarean.

10:59

No, I like that because I think it would have been nice to kind of hear the like, well, you're first going to have we're going to have to do the epidural we're gonna reel down here moms have said they have felt like this or experienced this like it can literally be a five minute you know, blurb conversation from the OB or wherever thing to sit and like these are the things because then when you're in the moment it can be like Okay, remember when we said you're going to feel some gentle tugging and pulling communicate with us? Let us know what you're feeling. What do you need? You know that time? Yeah,

11:32

yeah. And I and I tell clients to and that is like they might tell you you're going to feel some tugging and pulling and you might hear that before you're in it and be like, Okay, I can handle that. But like you said when you were in it, they told you you're gonna feel some tugging and pulling, but it was way different than you had anticipated. And so knowing that it's okay to say, hey, if it's possible, can we slow down? Can you give me a second to catch my breath? You know, like I've had some clients share with me that they've asked for time in between, like when they give you the there's like some, they give you the epidural and then there's like some anti nausea medicine. There's like a bunch of things they sort of give you to help you know, regulate blood pressure and nausea and all those things, but sometimes they give it all at once and it leaves you feeling a bit out of your head for like, kind of a brief amount of time. But asking for like, wait time like wait till I say okay, yeah, wait, I've like got myself centered and I'm connected with my partner and I'm in control of my breathing and I'm, you know, I'm present and then move forward her whole thing was because she had had a couple of Syrians was like, I just wanted to feel present and it goes so

12:40

fast. Yeah, it's hard though. President. Yeah, it's

12:44

hard to feel present in the O R, but there are ways you can and some of that just saying, Okay, we're gonna go a little bit slower here. Like, this is still my birth I'm still in charge of my body. Like, I know you're the doctor, I respect you for what you're doing here. But if we can go a little bit slower and just ask me before you move forward so that I can be still a decision maker and still present. You know, and be smart if they can go super, super slow. That's not the point. Right? But you know what I'm saying like just asking for some patience and that even saying to them, you know, I respect that you guys do this every day, probably multiple times a day. This is the only time I've done this, or the first time or you know, please remember that. Please remember that this is still my birth. This is still the first time I'm going through this. This is still the first time I'm eating my baby. And treat that with the respect it's do and sometimes doctors and nurses just need a reminder

13:38

that, you know, this isn't an everyday occurrence for the person.

13:42

Yes, yeah. Yeah. So just you know, and finding your voice and talking with your partner. So if you have a partner, male, female, or if you hired a doula in place of the partner, one person can come with you into the O R. And so talking with them beforehand to about that and reminding you to ground you and center you and kind of getting into some of the tips that we would share but you know, that's that's really helpful and, and so yeah, I kind of got into our you know, things you can advocate for but that were I went

14:20

go into my outline, I was like, man, okay, how do we get back to here? Yeah, I know. There are some reasons right that you may need a plan C section.

14:30

Yes, yes. And I think I like to remind people that 10 to 15% of scenarios are considered necessary and that's put out by the World Health Organization. So that saying of all the people giving birth, and having to Syrians 10 to 50% of them are needed, but yet we have a rate in the United States of 33%. And that's the average. So in some areas, it's higher and in some areas slower. So that means there's a significant portion of the population having what would be considered an unnecessary so seryan So I like to share briefly about some reasons that you might need a plan cesarean to plan cesarean would be you know, sometime during pregnancy, it is determined that due to X, Y or Z reason you need to schedule at a certain time, a cesarean, sometimes scheduling a cesarean, his choice like that is in there as an option, right, like personal choice. So that would be one of the reasons and then some other reasons that you might need a plan cesarean would be complete placenta previa. So that's where the placenta lands are is lying over the cervix, which is very, very dangerous. And if with ultrasounding, that can be detected and you definitely want to have a cesarean in order to keep mom and baby safe from hemorrhaging. Because as the cervix dilates, if the placenta is covering it it will pull apart the placenta and cause a lot of bleeding. Usually, the placenta attaches or moves higher in the uterus as the pregnancy goes on, and that's a degree of normal. So that's complete placenta previa at term so some people hear that they have partial or near placenta praevia, sometime in the middle of their pregnancy and get real worried. For the most part, all those cases resolved and the placenta does what it's supposed to do and moves out of

16:23

the way I've dealt with in the office. I have Yeah, I have. I've had quite a few moms with that as well, usually at that 20 week mark there. Yeah, I have a sort of heavier and it's like, you know, kind of do like, hey, let's not worry. That's right. Just keep doing what we're doing.

16:36

Yeah, vast majority of those results. Yeah, well, that's what happens is the placenta I mean, as the uterus grows and expands, it's based on where the placenta is attached, where the placenta is attached and the uterus doesn't change, the size of the uterus changes and that's when the placenta moves with it. So it just depends on where attached and giving it that's why this is important to say at term that you have. So if you halfway through the pregnancy, if they think there might be some placenta previa, then they're going to monitor that as they should and once it's moved out of the way, then you're good to go. Other reasons might be a large uterine tumor that walks the cervix. Again, that's rare, true fetal distress confirmed with either a fetal scalp sampling and that your water would need to be broken to get that or a biophysical profile, which in some offices, they refer to that as like a non stress test where they're looking at baby's heart rate, breathing, how they're moving their muscle tone, and amniotic fluid. So if they have like a scale, a way to kind of grade all of that and if it is determined that babies it would be safer for baby to be outside of the womb than inside the womb, then they might go ahead and do a cesarean based on what those marks are for baby. If they're not significantly bad, then they would maybe do an induction sooner than later and then if they are like, okay, it's really time to get baby up and they would go ahead and do that cesarean and then possibility for large baby based on maybe prior medical history for yourself and considering any prior pelvic injuries or deformities that may prevent a large baby from passing through. The suspicion of large baby all by itself is not reason to schedule a cesarean, right you want to take in some of those other factors I just mentioned and then decide with the care provider if it would be appropriate to schedule Bessarion ahead of time. So somebody

18:24

and I've, I was gonna say I've had moms to where they have had significant spinal trauma. So it was advised to have that C section. So yeah, there are, you know, as much as large baby, it can, it could be that and

18:41

other Yes, that's super good point to make is so different. Everybody's different. Right? So again, knowing your your history, talking with your care provider, knowing your options and then deciding if you might need to plan that scenario ahead. of time. So those are some of the reasons it might need to be planned either in well in advance or as you approach the end of pregnancy. So some reasons you might need an unplanned cesarean during labor some more like an emergency C section where your primary plan was vaginal birth. You it might be transverse lie of the baby at complete dilation. So the baby's like, not head down or feet down, but like sideways and you're fully complete, right? So that's needs a cesarean, prolapsed cord, so the umbilical cord if it slips out of the cervix, before the baby that's an immediate resection during labor, and that kind of event happens quick and necessary and happens right away. It can be very, very overwhelming and scary. It's very rare. Most of these things are rare. So then another thing would be an abrupted placenta. So this is where the placenta is pulling away from the uterine wall before the baby's born. That would necessitate in a emergency cesarean eclampsia with failed induction. So sometimes, induction is necessary if a mother has developed preeclampsia, so high blood pressure and so they would induce scheduled induction but then fail if the induction is not successful, and the you know, eclampsia still present then you need to go ahead and have a C section. True fetal distress confirmed with fetal scalp sampling. Like I said, that's that internal monitoring. That's really the only 100% accurate way you can determine a baby's vital tones. So if there are concerns then they could put monitoring directly onto the baby's scalp during labor. They would either your water would need to be broken for this to happen or they can break your water

20:40

and you're not moving around at that point. You know, you're not up walk in and in positions so just Yeah, cuz that's what comes to mind too, because I remember having that as well. And it's like, no, you are. You're here.

20:56

Yeah. It's gonna restrict movements and for sure, largely babies again can come up even during labor so let's say they had suspected large baby but there wasn't any major reason to schedule this area but yet they mentioned it beforehand had that suspicion they told you about it during pregnancy, but then they let labor start so if that suspicion existed before and it was vocalized in labor, they're going to probably vocalize it again, and just speaking it out actually significantly increases your risk of having a cesarean or not, I shouldn't say race, but the incidence of having a cesarean birth due to suspicion of large baby. So just even mentioning it can create either mental blocks for mom, or it changes how the provider how they manage labor, and therefore they might go to Cesarean birth sooner than later if they suspect the baby. So having a truly big baby is very rare, right? Right far, far more rare than we're actually probably performing scenarios due to suspected big baby, but it does happen and so being aware of that talking with your care provider, um, other a couple other reasons of a uterine rupture during labor, and then also could be an issue would be if you have an outbreak of any sort of active herpes once labor starts so you can have herpes and have a vaginal birth and not have any issues but if you're having an active outbreak at the time of labor starting, they would, they would send you for a C section. I'm sure there are other reasons. These are some of the more common or popular or, you know,

22:38

hear of most Yeah, yeah, yes.

22:41

And that's going to happen during labor for most of those so for you, Shannon and your experience what was the final? Was it a failed vacuum?

22:54

Um, yes, I mean, I guess in in the grand scheme of things because I do remember we did the vacuum. He was you know, Sunny side up. So there was that back labor, I was not up and moving around and trying other positions. So, and then I was 41 Plus five days or something like that. So, um, you know, there wasn't a lot of where they're trying to turn the baby's head a little bit, you know, to help them kind of do that rotation to come actually face down that posterior. I actually had that in my VBAC is that second one was also sunny side up, but and they were very similar her birth sizes, although I always say my oldest, he's just got a big head. That's part of it. But um, you know, it wasn't it was like this whole cascade of things I honestly think I had a lot of fear. And I really do looking back on that. I think that that played a really big role in that I was not relaxed and I was not in tune with my body. So I know as woowoo as that sounds, if you know if I'm in stress, and I'm tense, I'm you know, things aren't they just not progressing as naturally as it could or is that flow you know, and so, and I think a little bit too was that like, unprepared portion of like, oh, well, you know, if things will just work out fine. But and I remember to when I delivered, they even said, I think even before I'd had him, they were like you're a perfect candidate for a feedback. So if there was nothing, it was just kind of like that was just the cards I was down there was never like, oh, yeah, it was because of this so I think it was just that field induction. Honestly, it was we both spy I spiked a fever. And I think at that point, I was just so exhausted, because you know, yeah, and then new food. And I've been doing this for 26 hours. So like, it was just that natural progression and just kind of saying okay, the body is kind of telling us here. We need to change some things now. Had I not been confined to laying on my back. Maybe if I'd been able to move, maybe he would have twisted around or something. I don't know, you know, so hard. Yeah. But just knowing that that was kind of their prognosis of like, hey, every we've done everything we can and it's not like you failed, or it was this one specific thing. It was just like, hey, this is what we've got. You'll be a perfect candidate because baby's not too big pelvis is fine. It was just Yeah, it was just kind of that oh yeah, vacuum.

25:45

Yeah, the vacuum and when I say filled vacuum is what I know about in labor. Mom's been pushing for a while, and they decide to try the vacuum because that feels like the next best choice. And that they try they get new times to try with a vacuum and then on that third time if it doesn't work where the term failed vacuum, that's the vacuum failing.

26:07

Do not you Yeah. No, I do remember that. Yeah. Because I remember it was like, I just remember pushing and you know, waiting and hoping. So

26:19

yeah, yeah, that's a lot of factors there and so that could be something that happens for someone else too. And then you have that long birth and you still end up with this this area. And so that's so as we've shared here, a lot of different ways that a cesarean might end up as part of your birth journey and your path. And we definitely want to you to advocate for avoiding unnecessary care and you know, having the birth that you want, having the support that you want, and that is like a whole conversation on its own. And like I said, we talked about it a little bit in that VBAC episode about kind of how to avoid that primary and and what to do during labor and all of that. So here what we want to talk about and kind of go into next is that if you need a cesarean either planned or it comes up during labor, what can you do to prepare in a meaningful and effective way during pregnancy? And this is where I think you were you you felt like you wanted to be more prepared and that you want to share with others and this is what I share with my clients. And sometimes I get a little bit of deer in headlights on I'm like, Okay, now we're going to talk about planning for your Cesarean birth after they've just told me or not just but they're like, I want a vaginal birth. I want an unmedicated had an over

27:36

I like I want this beautiful, like twinkle lights. Yeah, first up, and you're like so now we're going to

27:42

talk about Yeah, and I do I get a little bit of like, and then I always follow it up with you've got to be willing to give it all the possibilities, a little little bit of energy. I say focus on the primary plan primarily with most of your energy. But for some of these things that we know 10 to 15% of the time are necessary and that are also still happening 30% of the time, regardless of what is deemed necessary. It's still happening one in three in most hospitals. So you want to be prepared, so that if it is needed for you, or you choose it, whatever that you are prepared for those elements and those things that happen during a cesarean birth so that you can feel good and confident and empowered on the other side of it just like we want you to feel no matter what birth you have, and Cesarean birth is not to be left out of that conversation.

28:43

Exactly. And you know, and I've said I think that it was fear that big part that lead to that first birth experience I had but you know, you always hear the word fear in the acronym of like, you know, false evidence appearing real. Well, you're gonna have false evidence when we aren't prepared. And when we haven't we haven't dive, you know, gone through the information. Yeah, and I think that was that was my biggest takeaway was that you can I mean, we you know, you have life insurance and you have savings accounts. You do these things, not because you want anything bad to happen, right. But you're preparing, you know, for the event. I was very much like, I didn't want to put energy into that because I felt that that was manifesting it and going to make that occur. And that's just not the case. I think you got to check in with your intentions here and say, Yeah, this is my birth plan. I wrote this out, but um, and it's so easy to go down that that rabbit hole of like all the crazy rare things that can happen. Google and web Yeah, don't do that. All of a sudden, you know, it's just so bad. Um, so there's there's that extreme and then there's the my extreme where, like, I'm gonna look at it because that's not gonna happen. I was kind of, you know, stubborn, and they're like, Oh, that's not even an option. I can do this poll, but that's, that's well and good but there's, there's a good middle ground there. I don't know they you've got to sit with it. And you got to come to terms with it. And you gotta, you gotta be open to it. And I don't know. There's just something there that you kind of have to work through personally to show you're open to that.

0:02

Melody and just support that, you know, is nice and, and, and calm and in stressful situations. You know, that's why I think either way, if you have a cesarean birth that's going to be planned or unplanned. Doing the steps and obviously having a doula is it can help you know, and I don't think it's like the fix all like with everything. There's there's, it can still be traumatic, it can still be very, very challenging, but it can really, really reduce the risk of that and that's our goal. You know, you can't ever fully guarantee something but taking some of these steps beforehand can really help ensure a more positive empowering experience even if it goes totally sideways totally different than what you expected. It that can really help. Another tool I like to share for if you are faced with a care provider offering or recommending a cesarean birth, either prior to labor starting or even during labor is the brain acronym. And I know we've talked about it in other episodes, but we share the brain acronym with our clients all the time. So that if it's being proposed you can ask these five questions using the brain acronym and when we say use your brain, that's how you remember it. And that's what are the benefits of having a cesarean birth now or planning it in a few weeks. What are the risks associated? What are the available alternatives? If any, what's my intuition say about this? So if they're offering necessary birth, and you are not feeling like that's the right thing to do, what's your gut saying? And can you ask more questions to kind of get to peace with it or to avoid it if if that's possible, and then the end is what if we do nothing? And or do we have to do it right now? And with those five questions, you can hopefully feel like you are the decision maker and the one kind of leading the charge even if that's the recommendation the doctors making, you know, that should always be the the approaches that they say, here's why we think this is needed. Here's what's happening, you know, give you all that information ahead of time, and then lets you make the decision. I love

2:10

the brain acronym. You've talked about it before, and it's one of my favorite things. But here's the thing. The kicker too, is that I remember our interview with Latoya, Marie Johnson, who's a wonderful doula. And there was a situation where it was like the hospital was refusing a mom to be able to get up and move around. And she was like, Well, why? And it's that what are the benefits and what are the risks? So tell me what are the risks here? And it was like, Oh, we just don't want her to fall. Okay. Is that a really really big risk, you know, like, and so I love that acronym, because it's like, if they if the doctor is recommending this, then they should be able to explain very completely what the benefits and the risks are. Yes, this is their recommendation. Yeah. Then what are the benefits

2:56

and I should be able to paint it very, very clearly for you. And it should be something that it's when I've seen a positive experience. It's when it's when I'm I know because I've been in a lot of birthing environments. I know the provider knows that the Cesarean is necessary or it's needed or it's going to be the next step. But when the provider comes in and says this is what we're seeing, this is how long you've been in labor. This is. We've tried XY and Z, we really don't have any other available options. You know, they sort of lay it out and they say, how does it make you feel? Or what like, what do you think about that and like giving them a second to process it and let them it's almost like getting them to the point of being like, Okay, so seryan Like, I know, that's next like I know, that's where we're headed and getting it gets into piece of with it a lot faster than coming in and saying, Okay, we're gonna go do a C section. Now, I will say in truly emergent situations. There's less dialogue, right, there's less time,

3:55

right? If we've got lino major blood loss or something, I mean, those rare rare instances,

3:59

yes. And I always say if it's truly emergent, you will know like, you will know there won't be time. But you can also tell when there's like, if you can ask some questions, but you know, again,

4:11

I felt that way. So with this, I will say my experience although my I tend to say that my you know C section was traumatic is I don't know that's maybe semantics because I was so impressed with my provider, and even the hospital I was at even though is very well known for having lots of sex. So, because I did feel I do remember that conversation as far as like, Hey, sweetie, we've pushed for a really long time. You're getting tired. The baby has a fever. You have a fever. You know, like I remember that conversation because remember, I had to sign a piece of paper saying, Yes, I do. You know, I'm okay. Moving on to a C section. So I remember doing that and thinking in my head, okay. Okay, well, I've done what I can. Yeah. Right. So and that's important for that and I felt I did feel good in that it was just more of the like, and why is this happening? You know, like, that was more of that that trauma aspect? Not so much. You know, there's a difference there.

5:12

Yeah. I think you felt like when your hindsight was everything leading up to that point. Yeah. I'm super glad that at that point, you had that respective care and that you felt like you had what you needed. And they were affirming and the fact that to be a good VBAC candidate and like, you know, at least in that moment, you had bad yeah, no, and that's, and that's the scar

5:32

was amazing. I mean, they'd set it up to where, you know, it'd be perfect for a C section. And even you know, even though I say the doctors like looking for some tugging and pulling like they were I mean, as much as I still can vividly remember those things like it was still they still didn't really good job like it was never I never once bashed my provider or the hospital or anything like that. Like it wasn't that it was more of a, what could I have done to prepare differently?

6:02

Yeah. And you can see that that's how we learn and the fact that you're taking that and sharing it with others is how other people can learn. And even if they take one little tidbit away that says, Okay, I can do this differently. I can ask this question, even like you said, if you just ask your care provider to walk you through that or tell you about it, that can start a conversation that you can lead to other questions or other things you can advocate for all by itself organically without having to be super rigorous with it. So just taking that one step is can be a big game changer. So we haven't really gotten to some of those things that make up a gentle Family Centered area. So I would love to kind of talk about the things you can advocate for for your cesarean to be you know, that more gentle Family Centered type of service area and so that you can start thinking about what that looks like for you and having that conversation with your care provider about how they support that. And that's another key thing I always like to say is when you're having this conversation, ask your care provider how they support these things. Not do they allow it because just like to keep that prep that perspective and reminder that it's them supporting you, not them allowing you are not allowing you even during a cesarean birth, don't give it away even during a cesarean birth and some people say I feel like once I get to this area birth that it's just all turned over to the surgeon and the staff which who thank you for those those doctors and nurses who are performing these surgeries safely. But that doesn't mean you can't still advocate for yourself and ask for things you know, that you want during this time one of them being immediate skin to skin so in this area birth a lot of times they will quickly cut the cord and take the baby over to the warming station. So you know you can obviously with baby being healthy and mom being okay asked for that delayed cord clamping and asked for immediate skin to skin in the O R right. Yeah, so that might mean ensuring that whatever gown you have on is loosely is loose on or accessible like an accessible gown so you can kind of pull it open and get that baby skin to skin with you as soon as possible. Because getting on your skin smelling you you know mixing with your your bacteria and stuff is just super beneficial for baby. And so again, you got to kind of advocate What are you wearing? Do you have an arm free? That's one of the other things so and you can tell me Shannon and yours were both of your arms secure down or did they let you just do one? I don't even remember. Ko I think I think I

8:48

can like I remember there. I remember a picture or my husband took a picture of him on the little scale. And then I remember looking around, you know like there's my head and I don't know that I actually held him. I just remember like a picture of him like being held up like to my face my husband there with me. And so I feel like he was holding him. Yeah, and that

9:13

is I think more standard for sure is that they take the baby over check the baby, wrap the baby up and then come over and show you the baby. And then they will so the mother which takes some time. So some things you're gonna have to wait for is to have that cord. Do the delay cord clamping Right. Talk to your care provider about that. And then have the baby come right to you nekkid and all like naked and gooey. They don't need to wipe it off. Bring it with all its vernix and meconium and whatever's on it as long as it's and they can tell right away if you're if your baby is color and how they're moving their arms and they can check their heart rate while they're on you. But being skin to skin with mom helps regulate baby's body temperature helps regulate their heart tones helps regulate their breathing. So even if they are a little little distressed being on you might be all they need in some instances and they can still monitor and watch baby closely and take him or her away if it's needed. But still getting skin to skin with you right away is nice and so in some instances that's not available so just advocating for that skin to skin as soon as possible. So not bringing you a perfectly swaddled baby whenever like you're in recovery, but bringing your baby and putting them on your skin and covering everybody up with a blanket. So, you know we always just say if you can't do immediate skin to skin don't let that freak you out. Just take it and say okay, so you know advocate for that as soon as we can I need to do skin to skin with my baby. Because there are things that arise that prevent it. So just saying okay, I can't do it now but when can I do it? So there's that and that leads me to my next the minimizing separation of mom and baby as part of that same conversation. And if if the partner can go with the baby, that's ideal, but sometimes the partner needs to stay with mom. So trying to figure that out, but minimizing that separation and getting baby to mom as soon as possible. doula care, I think it's something to advocate for. We've already talked about that a little bit because they can help you prepare leading up to an after like if you're in labor and preparing versus area and like unexpectedly they can help like we talked about that a moment ago just like help you process and know what's going to happen and then when you'll join them on the other side of the surgery. We talked about delayed cord clamping which is waiting to cut the cord until it stops pulsating. So some hospitals will do 30 seconds some will do 60 seconds some will do men two minutes. You know, I think it's great to aim for having this the cord be done pulsating. That's a sign that the blood is done regulating between placenta and baby and the baby has exactly what it needs. So not putting a time on it but just waiting for that cord to stop holding in the oh our providers tend to want to move pretty quickly. So something you'd have to advocate and talk to them about and making sure that I mean you can't see that happening because of its you're lying down and there's usually a drape so something you would just have to advocate for trust your care provider and then your partner can advocate because they can watch all of that too and make sure that that's that's actually happening and that is also part of the conversation too is that drape. So like you said the drape was very claustrophobic. It the drape is put I would say breast level would you say yes level way too close to my face. Very, very close to your face. And it's taller.

12:41

Yeah. And it was like I know I'm like just move it down a little but it's super tall. Yeah. And it is

12:48

dark for most you can't see there and you're lying down so you see the ceiling. I just can't see anything. There's a lot going on. And so some places will do offer a clear drape, and the clear drape is in front of the blue drape. So there's still a blue drape because they keep that up for most of the surgery and then they'll drop it as babies being born so you can see your baby.

13:14

So doing a clear one to clear drive the whole time. You don't you don't need to see. Like clear drive witness hell no. But it was just like, can we just move it down just

13:26

a little bit? Yeah, just asking for some room there and so when you ask for clarification, just being like good communication of like, that doesn't mean you're watching the whole thing. That just means they're going to lower the blue drape to drapes. They're going to lower the blue drape so that you can and then the clearer you got to keep the sterile or in most places they would say we would need to do this to keep the surgical area sterile. But then you can still see your baby right away versus waiting right for it to come to you and a wrapped up bundle. Some places will not do the clear drape, but they will just lower the blue drape during the same time when baby is out. So you can see your baby newborn so the question would be can they do a clearer drape? Or can they lower the blue drapes so that you can see your baby? And you may not want to see that that's all just choice and knowing what's available at your birth location. Keeping the environment calm and quiet and keeping the decision making and the event focused on the parents and the birthing person is vital. That's one of the root things in a in a family and gentle centered, family centered and gentle cesarean is that like I said earlier there they aren't forgetting that this is probably the only time you've done this that this is a major life event for you. So nurses and doctors are staying quiet. They aren't talking shop quote unquote. They're not talking about the football game. From last night or their dinner plans or their kids being sick, which they're at work. So these conversations happen. You know we as a doula I sometimes have to remind nurses and I can hear them in the hallway talking loudly about whatever real life things are happening. For them. It's like okay, these people are in labor. So same thing for the Oh same thing for the oh our room is is reminding the and this the partner can ask for this you can ask for this is that people refrain from talking shop and that everyone stays quiet that you have any unnecessary lights turned off trying to keep it the birth setting, you know, in a warm way, but I guess the or that's usually not very attainable, but in some instances, they can turn off anything that's not necessary for the actual surgery. You can ask for music to be played. So just like if you have music during your labor and delivery, you know you can have music or something that helps you feel calm being played during your birth. And then other things you can advocate for is vaginal seating. So vaginal seating is super cool. And it is where they do a vaginal swab cotton swab of your vagina and then they rub it all over the baby's face and abdomen and hands because there's our benefits from the baby passing through the vaginal birth canal and they pick up good bacteria from mom. That helps seed their gut and helps just with immunity and all kinds of positive things and so you can ask if they'll do a vaginal vaginal seeding where they swab the vagina and then wipe it on the baby's face and and abdomen and that can be trying to mimic right that vaginal birth experience. And then the last thing I have on my list is helping initiate breast or chest feeding as soon as possible. And if they can just let the baby try and the O R and the baby seems ready and wants to try that would be optimal and if not trying to initiate as soon as possible and recovery. So having support from the nurses and your partner for that.

17:08

Now I love the vaginal seating option because I have a blog that I wrote about. It's what I learned from my C section and I had just kind of like four main takeaways of those things that I gathered and I kind of mentioned, you know, some of them here, but it's definitely you know, I'm not less than because I had a C section. That's the whole you know, mental aspect of Absolutely. But and one also being too that is major surgery. And so maybe in a future episode, we talk about those recovery measures. You know, for C sections reading vaginal birth, I mean you know, there's recovery for everything, they're also addressing the emotions, you know, kind of processing things as well but and being okay with asking for help and talking about things can be important too, but a big one is that a C section birth is different from a vaginal birth. for mom and baby like there's no way around it. So this is a great option. I always talk about the vaginal birth of babies get that good squish so they get that good prenatal molding which is good but then they also get that good. Vaginal bacterial wash, I call it so that the vaginal seating is an awesome option to just kind of give you that that peace of mind to like okay, at least we were able to do something you know, I don't I know that. We didn't do that at all with my because it was more like take them out, clean them off, swaddle up areas and they took them away. So and then the other aspect of that is the, the breastfeeding because I know I wanted to breastfeed and so but I had I had to go to recovery. I'll never forget I was so swollen after my C section. I was so swollen. And it was just I was tired. So tired. So I remember like I got wheeled away in this like recovery room by myself. I don't even know where my son with and so it was like there was that he he has his first nursing was from a bottle and it was formula. So that was another like was not how it was supposed to go at all. So that was a whole other traumatic aspect. But it didn't interrupt our nursing journey though. So and I think that it got to the room. Yeah, no, I was super excited. And that's really important to highlight. Like dad wasn't given up like it's okay if that person bit didn't go according to plan. Yes. Let's let's keep trying. So I remember getting back to the room and seeing him and everything and my milk was coming in. We

19:45

had the colostrum like the lactation consultants came, I took a breastfeeding course, prenatally so that the only thing I felt like a rock star. It was like it wasn't the burger that didn't go how I wanted it to you know, like that whole

19:58

thing, but like, We rocked the nursing journey like after that. I would love that. Yeah, so I remember being like, Oh yeah, I can do this whole because you know, you've got the C section scars, sometimes different holds are better football, whatnot. And we talked about all that in her nursing episode that we did, but that was really big for me in that you know, we still had that journey so you can still think you still do

20:23

Yeah, yeah. So a couple things that I want to reinforce is that if that happens for someone I don't want I don't want you to think that you failed or that it's wrong or that it's all gone sideways just like if you end up unnecessary and that is not that does not mean it doesn't. Isn't can't be a positive experience or an empowering experience that with breastfeeding too like if your baby needs some formula to get going in the beginning while you're either healing or your milk is getting, you know, trying to get some colostrum going. Like it's okay, it's okay and the more you can just be like, try and breathe and be patient and forgiving and like reduce the cortisol levels, the easier like you can just like flow with it and know that it does not mean you cannot have a successful breastfeeding relationship. And so the second thing I want to know is that that would also be something you want to advocate for is that to only give that bottle of formula if it's determined necessary, if there's a true identifiable like, you know, mom's milk is not coming in mom's recovering. There's problems with mom or baby preventing the breastfeeding or even pumping and giving us spoon or a syringe of the colostrum which is your first mount. So some options in there to to advocate for as well. But then if it is needed, or it happens, try to just be like, Okay, I'm gonna do the next the next thing I can do, which is just try and breastfeed my baby, right Give it get skin to skin and

21:53

just do it and see where it goes. Because I mean, you never know. So yeah,

21:59

yeah, yeah. And so we've included I've got a resource. We've got a resource for breastfeeding after cesarean birth, that we will include in the show notes because that's like a whole conversation too. You have a great blog that you've mentioned here that we will share about what I've learned from a cesarean birth. And I think that's always really helpful to read, even if you haven't had a cesarean birth if you're pregnant and planning a birth to just hear that point of views and that it can help help you prepare more meaningfully for your upcoming birth and hopefully you don't have to go through a bad experience to learn the things that you've learned. Like. I want people to learn from your wisdom, your experiences. So we'll link that in the show notes as well. And then I've got another podcast. It's called the Burstall podcast that I would love for people to listen to because it's also all about family centered to Syrians. And it's beautifully done and I highly recommend if you've liked this conversation and you want more, you can listen to that. So we'll link it. We've mentioned our other episode. 25, which is all about vaginal birth after cesarean. But in that we talked about how to avoid that primary cesarean so that you don't have to worry about a VBAC. But, um, so there's some helpful information there too, regarding preparing for birth. And then I have a couple other resources with videos and stuff. I included like a birth planning worksheet for Cesarean birth. We've got a video from Dr. Boots Taylor, about gentle Family Centered series and then an NPR article. I found all of that while I was doing the research for this podcast and I thought it would be really helpful to share if people are wanting some more information.

23:44

Yeah, I love all of those resources that we have mentioned. I know that's what we want to do provide the information for you to make informed decisions.

23:53

Yes, girl. Yes. Well, thank you so much for this conversation. Thank you listeners for being here. If you like what you hear, definitely hit subscribe, and we'll be back next week.