You Had an Unplanned Cesarean, Now What?

There are many ways to feel about surgical birth, none of them right or wrong. When you imagine a low intervention birth, sometimes your body and mind need time to catch up to a new and different reality. First and foremost, some babies MUST be born via cesarean to ensure the safety of both baby and birthing parent. An unplanned surgical birth is not a failure. The World Health Organization states that about 10% of all babies need to be born by cesarean in order to protect both parent and child.

Birthing From Within teaches that it is not how you give birth, but how you meet birth. How you flow with the unexpected. The founder, Pam England, insists that in a surgical birth you must still give birth, and I couldn't agree more. Your body is the only one that can do the job of bringing your baby earthside, even while you may get help from a provider - which is true of any type of birth. Pam encourage's those who are giving birth in the operating room to imagine that they are pushing their baby out with their heart. Energetically, it is a nice idea, but its also factually true. Your heart beating is delivering all of the oxygenated blood that baby needs until they are out.

You May Be Thinking...

"If I had known it was going to end this way, I would have just had a cesarean in the first place!"

Dearest one, us too. I would never encourage anyone to suffer through a long and difficult birth if the known outcome was a cesarean. Think back to 3 days before your labor. Maybe you were out to dinner, or preparing one last thing in the nursery. Could that version of you have ever agreed to a planned surgical birth? To put away all of your preparation for labor? It is ok that how you feel now is different than how you felt then. It is ok to be frustrated or exhausted.

"I was just so relieved to finally be done, to finally meet my baby."

Relief, especially after a long ordeal, is nothing to feel guilty about. You are allowed take a deep breath. To marvel in your baby. I ask, what are the feelings underneath the relief? You can be perfectly happy with the outcome of your birth and yet you still may need to grieve. Or you may be experiencing a self-righteousness: no one should go through the struggle of labor! Allow yourself to go a little deeper only when the relief wears off. Try not to rush yourself to "get over it."

"I can't even think about it without crying. It is too much."

Your experience is still a raw nerve, and rubbing it will only hurt. Allow some time to pass. Focus on staying in the present. When you do feel that you want to talk, choose your listener carefully. Discern who can listen without judgement: a doula, therapist, trained birth story listener. Know that there are many resources, including the 24/7 Evanston Hospital non-crisis hotline: 866-364-6667.

"When I was pregnant, I always skipped over the chapters on Cesareans. I was sure that would never happen to me."

I see this often in my classes. Now that it has happened, it is nothing to beat yourself up over. You were trying to protect yourself and your birth the best way that you knew how. There are plenty of resources that you can access now. Do not hesitate to ask for help from friends and family. Find support groups online. The less isolated you feel, the less likely you are to suffer from postpartum depression and anxiety.

Note: if you are reading this as a pregnant person, please take this as an invitation to learn a little more so that you are not overwhelmed in the moment.

"What went wrong???"

At first, it may feel helpful and even good to blame someone. This feeling will eventually end its usefulness. There is no single person, decision, provider, or moment responsible for an entire birth outcome. You are not at fault. Neither is your body.

Some time in the future, you may find it helpful to request a copy of your medical records to better understand what happened. For all of my doula clients, I offer that we can talk about their birth any time in the future when they feel ready - no limit on how long into the future.

Immediate Recovery

The most important thing for you and your baby is skin to skin, early, often, and without apology. Any time you can, strip down to a bare chest and take off all your baby's clothes. Spend as much time as you can snuggled together under a blanket. If you cannot, ask you partner to do it. In the operating room, you can snuggle cheek to cheek until more skin is accessible for you both.

When you first leave surgery, you'll go to a PACU or recovery area where your nurse will monitor you closely. Some of my clients are shaky or groggy during this time. Others feel fairly stable and like themselves. You will likely be both hungry and thirsty but the nurse will want you to take it easy on fluids and food, starting with just sips of water to see how that settles. If water agrees with you, you can quickly move to juice or gatorade. It will take some hours for the medication to wear off and for you to feel your legs again. You'll stay hooked up to a urine catheter and IV, as well as electrodes that are monitoring your heart.

After two hours, you will be moved to a postpartum recovery room where you will finish your recovery over the next 2-3 days. Plan to have someone with you at all times to help you with caring for your baby. You will likely have the baby in the room with you and may find that lifting your baby is difficult. Nurses might not always be available to help, so if you partner is going to go home and feed the pets or shower, make sure someone else can come and sit with you.

In the first days, you may be in quite a lot of pain. Your provider will likely have you on a pain medication schedule to help you avoid the pain of having medication wear off and then needing to "chase the pain" with higher doses of medication. You will receive guidance from nurses. I strongly suggest you stick to the recommended schedule for a least a few days.

You may also be encouraged to get up and moving more quickly than you anticipated. That is because movement helps to prevent blood clots and also breaks up the gas that may build up in the body after surgery. Until then, you will have boots on your legs, which I call the blood clot booties, but which are actually called Intermittent Pneumatic Compression Devices.

The First Weeks

After 2-3 days, you will be sent home. You will still likely need around the clock help with getting to the bathroom, staying on a medication scheduled, and caring for baby for a few more days, although some folks are feeling a little more independent.

One of the biggest hurdles related to surgical birth is that if you are planning to nurse, your milk may be delayed. Typically, milk transitions around day 5, but if your baby is losing weight quickly you may be encouraged to supplement with formula. I cannot overstate the value of a lactation consultant. If nursing is important to you, you need to be pumping to encourage milk supply and you need a professional to help you figure it out. Use lactationnetwork.com to request someone who is covered by insurance and who can come to your house.

Scar Care and Massage

Once your wound is completely healed, usually around week 6, and your provider has fully cleared you, you can begin scar massage to help with healing. When you have surgery, the layers of tissue sort of "melt" together. Massaging encourages those layers to separate and move independently again while also helping with your nerves and sense of feeling.

I have had clients report pain in their scar after the external healing is completed and they are usually referred to a nerve specialist.

If touching your scar feels too vulnerable, start with something very light like a feather or handkerchief to just brush against it. Or ask a partner or friend to do it for you. If that is too much, begin by just looking at your scar and taking deep breaths. You can start this massage whenever you are ready, so there is no rush. When you are ready to begin more intense massage, you'll want to make zig-zags and circles over the incision spot every day with some sort of oil or lotion.

A Note About Emergency Cesareans

I teach in all my classes, there are different levels of emergency, but once there is a decision to have a cesarean things usually move quickly and it can feel urgent. Often, saying that a cesarean was an emergency feels better if it is not an outcome that you wanted. Regardless, it may be helpful to ask for your medical records at some point in the future to better understand what happened and to help you process.

The most urgent kind of cesarean often involves a person needing to be put under general anesthesia so that they are not awake during the birth of their baby. In my experience, these are the very toughest recoveries because neither you nor your partner will be present during the birth of your baby. You might ask your nurse to describe the birth for you during your time in recovery. You might also want to explore the book How to Heal a Bad Birth.

For Partners

Sometimes cesareans are harder on a partner or support person than they are on the one giving birth. Seeing your loved one in surgery can be anything from scary to traumatizing. I have sat with many partners after the birthing person is wheeled to the OR, waiting for the nurse to come and get them. This is often a moment where partners feel that they can finally release the emotions they have been holding in. Other times, their frenetic energy stays present because they don't yet know if their partner and baby are safe. I usually gently encourage them to come back into their body by drinking some water, having a bite of something, and then taking some slow deep breaths.

If you are a partner who did not get a moment of release before surgery, know that that energy is still trapped inside you and needs to be let out. Call a trusted friend to talk through it, dance or shake to discharge some emotion, or get into your car alone and scream. You must clear that energy from your body to come down. When my partner had top surgery, I had difficulty sleeping. After a few nights, I remembered that I had some edibles and took one. I felt my nervous system downshift and slept heavily that night. Without other support, something like that might not be possible with a newborn, but start thinking about how you might downshift. Postpartum depression and anxiety occurs in non-birthing partners at a rate of about 1 in 10. Don't suffer in silence - ask for help!

If you are my client, there is a whole cesarean birth guide headed your way. If not, I recommend you also find a copy of the book The Essential C-Section Guide. It is dated (think: what to do about your answering machine), but the information is solid.

Regardless, I wish you a smooth and swift recovery.