One of the most memorable and moving experiences I had years ago was providing labor support for a mother who ultimately needed to have a cesarean section. What Joanne mourned the most while preparations were being made for her surgery was not being able to hold her newborn in her arms. As we all understood, cesarean born babies were taken immediately by the staff, assessed to make sure they were stable and then put under a warming light in their bassinet. Hospital protocols required that cesarean born babies were observed for the first four hours in the nursery. That meant that Joanne would not embrace, talk to, or breastfeed her baby during that “golden hour” immediately after birth.
Joanne’s deep sense of loss seemed to me so distressing, and ultimately so unnecessary, that I told her and her husband that I would do something unusual once we were settled in the operating room. I would ask her physician if she could have her baby placed on her chest and one of her arms freed so that she could hold, touch, and speak with her newborn. When the epidural had taken effect and Dad was seated next to his partner, I softly asked, “Dr. Smith, if everything goes well and Joanne’s baby is in good health, can she have her newborn placed on her chest and given a minute or two to welcome her baby? It would mean so much to her.”
Dr. Smith and the operating room staff had never done this before, but they were willing to accommodate Joanne’s request if circumstances allowed it.
At birth, Joanne’s baby had a good Apgar score. Joanne and her husband watched intently as the staff cared for their newborn. The nurse assured them both that as soon as he was wrapped in a warm blanket, and a knitted cap was placed on his head to keep off the chill of the operating room, their son would be ready to meet them.
Nothing can compare with the happiness and joy I witnessed that day. The nurse brought Joanne’s baby over to the operating table and placed her son tummy-down on her chest. Another nurse released one of her arms. Both parents were able to caress their newborn son, speak softly in his ear, and reassure him that everything was going to be alright. They would be reunited very soon after a short stay in the newborn nursery. Given the chance to hold, caress, and greet her son after her cesarean gave Joanne the confidence, patience, and readiness to better understand her baby’s needs.
Birth by cesarean affects mothers as well as their babies. A long labor preceding a cesarean, pain from the surgery, or complications such as developing a fever, an infection or a reaction to medications, may make it difficult for a mother to be with her baby right after birth.
Holding, feeding, and soothing her baby may be more painful than she anticipated. Mom and baby will benefit from skin-to-skin contact and rooming in (having the baby in mom’s room as opposed to the nursery) as soon as possible. But, mothers should also take the time they need to feel ready to welcome their baby.
In my childbirth classes, this is what I suggest to expectant mothers who may need to have a cesarean 1. Ask to have an epidural or spinal anesthesia instead of general anesthesia. Regional anesthesia has fewer side effects and gives you both a chance to be together sooner after birth. 2. In the operating room, after your baby has been born and if you are feeling well, ask that one of your arms be released and that your baby be placed belly-down on your chest as soon as it is safe. You can also ask that the baby be placed skin-to-skin with your partner as soon as it is safe. Your baby will be less fussy and more ready to breastfeed. 3. Ask that a lactation specialist help you to recognize your baby’s hunger signs, to position your baby to latch on correctly at your breast, to support you to continue to breastfeed while in the hospital, and to provide you with a list of community resources that you can access once you are home. 4. Your health insurance may reimburse you for the services of a lactation consultant once you are home and for the rental of a breast pump, if you need one. 5. You may want to draft a birth plan to communicate your needs and wishes for staff support with breastfeeding. 6. You will be in pain after the initial anesthetic wears off. Ask about the safest pain medication available for breastfeeding. 7. Ask for your partner, friend, or doula to stay with you in the room to help you lift your baby, change positions in bed, change the baby’s diapers, and help you get out of bed.
Over the years, I have found that mothers who are prepared for the possibility of a cesarean, and who take time to speak to their care providers about what is important to them, are better ready to “HUG” their babies soon after they are born!