Most people give birth vaginally, and the majority of birth plans focus on wishes and goals for a vaginal birth. Some desire very strongly to avoid a Cesarean birth, choosing to exhaust all other options before deciding that surgical birth is their best option.
But roughly 1/3 of the time nationally (and 18.1% of the time in Idaho according to cesareanrates.org), whether due to a medical emergency, complication, or other circumstance, people find themselves giving birth in the operating room.
The circumstances of your pregnancy and labor, how prepared you are for the procedure, who is there to support you during the surgery, and how your wishes are respected during your Cesarean birth, are all things that can affect your birth experience. Even when the unplanned happens, you can still have a positive birth!
So even if a Cesarean birth is your "worst case" option, it can be helpful to plan for it anyway. Here are some things to consider, and ways a doula can help you plan for the unplanned:
1. If you are familiar with the steps of the procedure, you won’t be caught off guard. Policies and procedures can vary by hospital and care provider. Will you be alone at any point? How many support people can accompany you? Is it commonplace to have your arms strapped down? What medications will you receive? What will it feel like, sound like, smell like? Will you be able to see and touch your baby right away, or even initiate breastfeeding in the OR? What can you expect after the surgery?
Your doula can help prepare you for what to expect, and help you formulate questions for your care provider. Some policies and procedures are negotiable, and having a discussion with your care provider ahead of time can make for a more positive experience. She can also help you create a Cesarean birth plan to accompany your standard birth plan.
2. You may have more options than you think. Some of what happens during a Cesarean birth is dependent on the reason for it. If it’s a true medical emergency, you may not have as many options as if you had an “urgent” or even planned Cesarean.
In a true emergency, you are likely to be put under general anesthesia and the baby born within minutes. This is a small percentage of Cesareans. Usually there is a lot more time, and more variability in the experience. You may have a choice in:
3. Your postpartum needs may be different. Do you have a support system at home that can also accommodate your needs after a Cesarean birth? Will you need extra help moving around, breastfeeding, someone to make you meals, someone to help out with the baby? Your doula can be a great resource to plan for what additional support you may need, as well as provide referrals to specialists. You can opt to hire the support of a trained professional in your home, like a postpartum doula.
4. Your emotional needs may be different. This is where a doula can really help to listen, provide a supportive presence, validate your experience, and if needed, help you find additional resources so that your emotional recovery is treated as importantly as your physical recovery.
Planning for a Cesarean birth when you desire a vaginal birth isn’t thinking negatively, or setting yourself up for one. It’s preparation for one outcome, out of many. It’s the first aid kit in your backpack as you hike up the mountain. It’s a mental exercise.
And it’s something you can do with a supportive, knowledgable, compassionate person on your side, looking out for you no matter what happens or how you give birth— your doula.
I am a certified labor (birth) doula and professional postpartum doula serving Boise, Eagle, Meridian, Nampa, and the greater Treasure Valley.
Feel confident and prepared no matter how you give birth. Let's talk about how I can help!
It’s one of the top sources of anxiety in pregnancy . . . . . . POOP.
Whether it’s the constipation that arrives well before you have any sort of baby bump, or the fear some have about pooping in labor, there’s a lot of attention paid to poop when you are pregnant.
So let’s talk about it! Here's what you need to know about poop in pregnancy and childbirth.
1. Constipation is common. The hormones released throughout pregnancy, especially progesterone, make food move more slowly through your intestinal tract. You are able to absorb more nutrients for your growing baby, which is a good thing. The downside of this slower digestion is constipation. It can start in the first trimester, when you’re not even showing, and last throughout your entire pregnancy.
Constipation can be frustrating and uncomfortable. Straining to poop can in turn cause hemorrhoids, which can be downright painful.
Some things that can relieve constipation include:
2. Diarrhea toward the end of pregnancy can be exciting! That’s because it is one of the signs of early labor. Up to several days before you feel your first crampy contraction, your body may clear itself out in preparation for birth. Be sure to stay hydrated if you experience diarrhea, and keep yourself nourished by continuing to eat. You will need your strength for labor.
Note: If you have a fever or suspect that your diarrhea could be caused by food poisoning, then be sure to consult your care provider.
3. You will probably poop a little while you push. This is a big concern for some people. They get really anxious about the thought about pooping while they are pushing, and having their partner and birth attendants see it happen.
First of all, yes, it happens. It happens all the time. Your friends and relatives, celebrities, that put-together mom at school drop-off, your great grandma-- they probably pooped while they pushed out their babies, too.
And trust me, nobody in the room cares. The birth workers have seen it many, many, many, many, many times before. It is a total non-issue. They will just discreetly wipe away any poop, replace the Chux pad if necessary, and continue on.
In my experience, your partner doesn’t care, either. At this point, you are actively pushing out your baby, and your partner will be laser-focused on the baby, and on supporting you. They will be concerned, and excited, and hopeful, and probably won’t notice there is any poop at all, especially amidst what is infinitely more attention-worthy at that time-- like your baby being born. And when that baby is laid upon your chest and you hear those first cries, the last thing on anybody's mind will be whether or not you pooped a little.
Second, pooping during pushing is a sign that you are pushing effectively. You often hear birth attendants tell their patients to “push like you’re taking a huge poop.” Those are the muscles you need to engage to push out your baby. It’s a positive thing when you poop!
Third, if you are still really, really, stressed about pooping in labor, talk to your care provider about administering an enema in early labor. For some people, this gives them peace of mind about not having to think about poop at all.
4. Postpartum Poop. The first poop after birth can also be anxiety-producing for many. Your vagina has gone through a lot, and your perineum can feel sore as well. You may still have hemorrhoids, you may have minor tearing, or perhaps stitches.
If you had a Cesarean birth, pooping for the first time can also be uncomfortable. After a Cesarean, your first poop might take longer to arrive than with a vaginal birth. The muscles in your abdomen will be sore after surgery, which can make that first poop a not-so-fun experience.
Some care providers will prescribe a stool softener after delivery to make those first few bowel movements easier. Some will require you to have a bowel movement before you can go home, especially if you’ve had a Cesarean (true with any major surgery).
Staying hydrated after birth can help keep your stools loose. Waiting until you really have to go, and avoiding straining ,can be helpful as well.
5. Your poop situation will improve! The more you are able to rest and heal postpartum, the better you will be able to recover from birth. Eventually your poop won’t be such a source of tension in your life.
Your focus will shift to your baby’s poop, which will provide months (and years) of interest, antics, and discussion. If you don't talk much about poop now, just wait until you have a toddler. It's one of their favorite subjects.
I am a certified labor (birth) doula and professional postpartum doula serving Boise, Eagle, Meridian, Nampa and the greater Treasure Valley.
Do you have anxiety about anything in pregnancy or labor? Having a doula might help!
As a doula, I look forward to a long career serving expectant families. With each birth, I gain valuable experience which helps me guide the next family I serve. As I've written on my website, my goal is to increase the positive experiences of women and their partners in pregnancy and childbirth, in a way that aligns with their goals and values. This includes hours of physically demanding work, an unpredictable schedule, having to leave my own family for hours or days, and emotional skills like holding space without judgment, and putting my clients' needs before my own. Often it can take days to recover from a birth. And you know what? I love it.
But I know that my enthusiasm and expertise in supporting a client is not all it takes to maximize the chances of a positive birth experience. The client plays the biggest role. Obviously, the birthing person is working the hardest, growing a baby then meeting the demands of labor. But it's the choices my clients make, often before they even think about hiring a doula, that have a great influence on what they will experience on the day they meet their baby.
Recently I shared an article on the Elevated Birth Facebook page from ICAN (International Cesarean Awareness Network), listing the Top 11 Ways to Decrease Your Risk for a Cesarean. While some expectant couples opt for Cesareans, most desire to give birth vaginally, resorting to surgical birth when medically necessary for the health of the baby or mother. As the rate of Cesarean birth is on the rise, accounting for roughly 1/3 of all births in the United States, questions have arisen about the numbers and reasons for unnecessary, or preventable Cesareans. Individual physicians serving the same population, in the same hospitals, can have drastically different Cesarean rates, indicating that the attending physician is a key factor in whether a mother ends up with a Cesarean. Choice of provider (doctor or midwife) is the number one factor on ICAN's list.
If reduced risk for a Cesarean is a woman's goal, then choosing her care provider carefully is key. But looking at the bigger picture, if a positive birth experience is the goal, then choosing the right care provider is essential. A woman can end up with a Cesarean and feel happy about the outcome, and she can also give birth vaginally with no complications and feel traumatized. And vice versa.
There are three reasons for the disparity in outcomes. First of all, the care provider (or team of providers, in some cases), sets the tone for how the relationship will go. This includes whether or not:
Not all care providers will meet a couple's expectations in these areas. Some care providers are well-intentioned but act out of their own biases, or act without obtaining the consent of the patients in their care. (These areas comprise the idea of informed consent: Do I have enough information to make a decision, and do I consent to that action/decision?) And some care providers are just not a good fit, for a variety of reasons.
Second, the choice of care provider dictates where the birth will take place. If an obstetrician is hired, the birth will almost certainly be at a hospital where the OB has privileges. Depending on the midwife, and the laws in that state, the birth may be at home, at a birth center (either freestanding or attached to a hospital), or at a hospital. Each of these locations has its own restrictions, policies, and limitations, which can influence the overall birth experience.
Finally, a client's knowledge about the birthing process, and what to expect from the care providers and the birthplace, will greatly impact the birth experience. Becoming educated on the benefits and risks of medical interventions, the roles and limitation of the staff, and the physiology of birth can impact expectations about birth, or lead to making different choices in labor based on learned information.
Expecting couples can play an active role in the beginning of pregnancy, to maximize the chances for a successful end to it, by choosing a care provider that aligns with their goals and values. Sometimes clients are unsure of what they value; they haven't experienced pregnancy and labor before and so don't know what kind of provider or location they would prefer. Or they already have given birth, but are faced with new circumstances or want to avoid the negative experiences of previous births.
If they are unfamiliar with their options, consulting a doula can be a way to sort through the choices available in their area. Even those who are far along in pregnancy, who have been seeing the same provider throughout, still have options and can change to a provider that meets their needs more closely. Or they can choose to stay with their care provider, but communicate their needs and desires more effectively. There are always options.
For a quick, fun way to jumpstart thoughts on where you might want to give birth based on your personality, take this Birth Quiz from The Birth Hour podcast website. It may make you think more deeply about who you choose as your care provider!
I've worked in the forest, in the lab, and in an office cubicle. My favorite and most passionate work has been alongside clients as they reach inside to find their innermost strength, and give birth to their babies. Each birth is an honor to witness.