“Just In Case” Cesarean Preferences for Your Birth Plan

Late last summer, as I was preparing to give birth to my third child, I made plans to write a post about how to prepare for a successful VBAC (vaginal birth after cesarean). As you can see, that’s not what I’m writing about today. This is because sometimes unexpected things happen during the delivery of your baby.

Of course, I could still write a post on preparing for a successful VBAC because I have had one. I’m so grateful that I was able to deliver my second child vaginally. It was a powerful, profound experience for which I will always be grateful.

Though my C-sections were unplanned and unwanted, they were both positive experiences. I believe this is partly due to the fact that I included C-section contingency plans in my birth plans. I had discussed these with my doctors and we were on the same page about what a C-section would look like for me.

If you’re contemplating what to include in a birth plan, then I encourage you to consider the following.

A little bit of my story

Because of my background in nursing and public health, I’m well aware that far too many C-sections occur in this country (source). Unnecessary C-sections are harmful to both mothers and babies, so when I was pregnant with my first child I was determined to have a vaginal delivery. I read all about relaxation techniques and I read inspiring birth stories. My husband and I even studied the Bradley Method.

At the start of my 38^th week of pregnancy, I developed preeclampsia. My OB sent us to the hospital for evaluation. My symptoms escalated—my BP kept creeping higher and various labs began looking worrisome—so we ended up in the OR having a C-section. This happened quickly (I remember that we didn’t even take time to notify our families that she was going to be born), but my healthcare providers were wonderful and the experience was positive.

As I noted above, my second child was born vaginally. Her delivery began with my water breaking. It was a really long labor and I had to push for a little over 3 hours, but I did it. Thanks to a supportive healthcare team that trusted my body and inner strength I didn’t know I possessed, I had a successful VBAC. When we conceived again, I was eager to have another VBAC.

Unfortunately, about 10 hours into my third baby’s labor, my blood pressure and pulse started to vary erratically and then my baby’s heart rate dropped. We headed to the OR and quickly learned that bleeding due to uterine rupture was the cause of these changes. Thankfully, I was in a good facility with excellent providers. They got my baby out safely and I was able to hold her skin-to-skin on my chest while my OB stitched up the rupture and the anesthesiologist administered albumin and blood. It was serious and a little chaotic, but somehow it remained a peaceful and family-centered experience.

Things to consider when writing a C-section birth plan

It’s important to discuss C-section delivery with your provider. For example, find out things like if he or she will deliver breach babies vaginally and how long he or she will allow a woman to labor and push before recommending a C-section. If your provider shows signs that he or she is planning to perform an unnecessary cesarean, then consider finding a new provider.

You also need to find out how your hospital handles C-sections. For example, find out if moms and babies are routinely separated while mom is in recovery and if they will allow things like skin-to-skin contact (by mom or dad) immediately after delivery. This information may make you reconsider using a particular facility and it will definitely help you as you document your C-section preferences in a birth plan.

Here’s some additional food for thought:

• Evidence on: Skin-To-Skin After Cesarean
• The Natural Caesarean
• The Gentle Cesarean: More Like A Birth Than An Operation
• Planning a Good Caesarean Section

Sample C-section birth plan

Here is how I worded my “just in case” C-section birth plan:

The information that follows is a copy of our C-section birth preferences. Should a medical emergency arise, you will have our complete cooperation with evidence-based interventions after we have had an explanation of the medical need for these. In the absence of special circumstances, we ask that our preferences be honored. 

• For my husband to be present at all times during the C-section.
• To remain conscious during the procedure.
• To have a low transverse incision and for my uterus to be sutured with a two-layer method.
• To have the drape lowered (or use a mirror) so I can view my baby being born.
• To have skin-to-skin contact with my baby as soon as possible after birth.
• To have one or both hands free to better hold and touch my baby.
• For my baby to remain with me at all times. If my baby requires NICU care, for my husband to remain with the baby at all times.
• To exclusively breastfeed. Please do not offer a bottle or formula!
• To be able to hold my baby as much as I’d like and to nurse on demand while in recovery.
• To have the urinary catheter removed and the IV disconnected as soon as possible.

If you’d like to read another sample, then check out Rachel’s birth plan here.

Final thoughts

I’m so grateful to have three healthy children. I wish all three could have been born vaginally, but they all arrived safely and this is more important than the details of their arrivals! I will forever be grateful for the wonderful nurses, doctors, and other staff who honored my birth preferences and helped me have three wonderful deliveries.

If you’ve had a C-section, what would you like to add? What other things can parents do to have enjoyable, family-centered C-sections?

If you’re pregnant and working on a birth plan, what questions do you have?

Shared at the following:

Encouraging Hearts and Home, Over the Moon, and Busy Monday.