A caesarean birth plan

 
The following is an example of a caesarean birth plan. Caesarean Sections are major surgery and are performed in very clinical settings and many protocols such as sending newborns to special care nurseries are often done for the convenience of the hospital staff and not for the benefit of the mother. But the good news is that you can have a say in how your baby's birth and the immediate post-operative period is conducted.
 
There are many things parents and carers can do to enhance the experience of a cesarean birth for both mother and baby. This plan gives some insight into what one mother felt was important for the birth of her baby, which was by medically indicated elective caesarean. These aspects may not be important to you but they are a guide to spark some thoughts about what is important to you for the birth of your baby.
 
My Caesarean Birth Plan
This plan has been thoroughly researched and carefully thought out so I ask that you familiarise yourself with it so that you can ensure my wishes for this birth are honoured and respected.

• Since I had a very traumatic and disempowering birth experience for the birth of my first child, I would appreciate it if you could focus on being sensitive, positive, encouraging and supportive during my time at the hospital.
• My husband and our Professional Birth Support Person (who is a registered nurse and a student midwife) will be providing support for the birth of our baby.
• We believe our baby is a boy based on the 20 week scan and his name is [Name withheld]. Please make sure his name is noted on his ID tags once sex is confirmed.
• As the epidural I was given for my last caesarean was spotty and I felt pain during the operation, I would prefer a spinal block for anaesthetic so I can remain conscious during the “birth”, see my baby taken out and be able to bond with him as soon as possible after the birth.
• Our Birth Support Person is to remain with me at all times and assist with me and the baby during the operation. As discussed with Dr [Name witheld], my husband is happy to remain present sitting on a chair away from the table so that the anaesthetist can have ample space to move. I know that hospital policy generally allows only one support person in the room during a Caesarean but it is especially important to me to have my Professional Support Person and husband present as my previous Caesarean was very traumatic and this is not just an operation but an important life event for both my husband and me.
• We will want to take digital photographs and footage of the baby’s first moments (minus the suctioning), his meeting his Mum etc but these will be done without a flash so as not to distract anyone or cause alarm to the baby.
• If general anaesthetic is required at any stage during the operation then we wish for the baby to be given to my husband straight after birth and held by him until I am awake and can be told of the baby's sex and well-being (by my husband). If this happens, I would like to be given my baby in recovery as soon as possible so that I can put him to breast and have skin to skin contact. Please do not wash him. It is very important for me to meet my baby in his naked newborn state. So long as he is kept warm with a blanket, Wayne and our Birth Support Person can wash him afterwards.
• As we have a 3-year-old son who has never spent a night apart from his mother and father we would appreciate preoperative blood work and tests to be done on an out-patient basis, and hospital admission on the day of the birth (not the night before).
• Both my husband and I would both like the option of viewing the birth, either by lowering the screen or by positioning a mirror. I have had a previous caesarean and it is still a bit unreal, as I have never actually seen a baby leave my body - they tend to just appear from behind the green screen and be held up for a quick look before they disappear to be wrapped up and tested. In my case, I was put under General Anaesthetic and didn’t see the baby until at least an hour after the birth.
• I would appreciate a verbal description of the birth as it occurs. I felt left out of my previous caesarean as my body and labour were discussed as though I wasn't there and my requests for information and experience of the operation were virtually ignored.
• Please ensure there is a quiet and intimate environment at birth with no extraneous noise or talking when the baby is taken out. Please try not to blind my baby with bright lights upon being taken out of my body.
• It is very important to me that I meet my baby in his unclothed, naked newborn state (ie. as soon as possible after delivery and gooey). I would like the baby placed on my chest with a warm blanket over us both. I would like my gown to be covering me but will keep my arms uncovered so that I can hold my baby skin to skin straight away. It would do a lot to make this surgical delivery a bit more natural for us all. It will help me bond with my baby and it may even resolve a few inner conflicts that are faced after the birth.
• If at all possible I would like to hold/feed my baby while I am being sutured, if I feel up to it, and we would like the baby to stay with us throughout the rest of surgery and recovery. At no time is my baby to be taken away or out of sight of either myself or my husband. My husband or my birth support person would be delighted to hold baby within my view throughout these procedures if this is not possible (at least I would be able to witness it this time).
• Please do not discard the placenta as I would like to take it home after the birth to plant in the garden and I never got to see my placenta last time. Please do not just discard a part of me that I have carried for nine months as insignificant. My birth support person can take care of the placenta on my behalf.
• Please stitch me up very carefully as I am considering having another baby in a couple of years time and would still like to try for a vaginal birth after caesarean. I know women who have had two caesareans and then a natural normal birth.
• On that note, think very carefully before making comments about the baby or my body that may in your mind justify the decision to take the baby out surgically (ie. big baby, overcooked, cord around neck or shoulder etc). I believe every pregnancy and birth is different and believe in my body’s ability to birth regardless of the outcome of this particular birth.
• Please do not chat to each other about non-essential things during the operation unless you are talking to me. There is nothing more demeaning than having people talk over you as if you weren’t there, especially during an important life event. Please remember this is not just an operation but a birth.
• I would like my husband and my birth support person to give the baby his first bath after I have had the opportunity to meet and bond with my baby.
• If there is a problem with the baby upon birth and he needs to be placed in intensive or special care nursery, either myself (if I am able) or my husband is to stay with baby at all times.
• I will be breast-feeding my baby as I did my last and under no circumstances is my baby to be given formula without my express consent. I am producing good quantities of colostrum already and will express milk if I cannot feed immediately upon birth.
• Please perform all physical examinations and procedures in view of myself and/or my husband. These are not to be done until I have the opportunity to meet and bond with my baby.
• No Hep B vaccine at birth. I have strong reservations about immunising a newborn right after birth.
• I would prefer the Vitamin K injection not to be administered directly after birth but later that day or the next day.

 
Post-operative requests

• Please ensure that my 3-year-old son has the opportunity to meet and bond with his new baby brother as soon as possible after the operation (pref. in recovery if operation is in the morning).
• Please inform me of pain relief options (pros and cons for each) and encourage me to use the least harmful to myself and the baby.
• Please help me get out of bed as soon as possible after the operation and make a physiotherapist available as soon as possible after the birth to help me regain my mobility.
• Please allow my support people to remain with me for a little while after the birth and allow my Professional Birth Support person to come and go at any time as I may need her assistance and encouragement in the days after the birth.
• Please make available the ABA breastfeeding video as soon as possible after the birth so I can refresh my breast feeding skills.
• Please do not make comments like “at least you have a healthy baby” if I appear sad or disappointed about my birth experience. I will need time to grieve and comments like that only add salt to wounds.