Our Bodies, Ourselves (91 page)

Writing to her child, one woman recalls:

You were perfect, of course. Sue caught you and placed your warm, wet body on my chest. You immediately gave out a healthy, albeit short, cry and then just looked around and took it all in. The three of us just sat there getting to know each other. We were so in awe and in love with you that we forgot to check to see whether you were a boy or girl!

You may approach labor and birth with a vision of how you will react when you first meet your baby. It is common to have a reaction that does not match up with a vision of instantaneous
bonding. Often disbelief, shock, wonder, or an overwhelming sense of pride are the first emotions. As you spend quiet moments with your baby over the next hours and days, the bonding process will intensify.

Delivering the placenta completes the birthing process. After five to thirty minutes or so, the umbilical cord lengthens, a contraction occurs, and the placenta is expelled, often with a gush of blood. Breastfeeding or simple skin-to-skin contact in a quiet and undisturbed environment stimulates this process. It's important that your providers not pull on the placenta before it has separated from the uterine wall. It is very important that no fragments of the placenta remain in your uterus, as these fragments may allow blood vessels to remain open, causing hemorrhage. Retained fragments can also put you at risk for infection in the uterus. Your care provider will inspect your placenta carefully to make sure it is complete and intact.

Once the placenta comes out, blood vessels close off. Your uterus contracts and begins to shrink. After the placenta is out, your baby's suckling helps keep your uterus firm and contracted.

Some view the placenta as a beautiful organ, with its pattern of blood vessels resembling a tree of life. Many cultures have rituals surrounding the afterbirth, including planting trees or flowering bushes above it. Let the staff know if you want to see and/or keep the placenta.

© Eric Silverberg

The first few hours of a baby's life are a time of heightened alertness. Breastfeeding will be easier to establish if your baby nurses at least briefly
within the first hour or two after birth. Babies have an instinctive sucking reflex but show varying degrees of interest and take different amounts of time to nurse. Some latch on to the breast immediately; others learn to do so more gradually. Smelling, licking, and exploring your breasts are part of the process. Allowing your baby to suckle, even if you don't plan to breast-feed, will give her or him the benefit of antibodies and nutrients from colostrum, the first milk. After a few hours, your baby will fall asleep, and when he or she wakes up the next time, breast-feeding may not be as easy as it was the first time. Over the first twenty-four to seventy-two hours, your baby will learn all the coordinated moves used to latch on to your breast and nurse effectively. If she or he was able to nurse initially right after birth, the learning process will be a little faster and can set you on the path of a long, fulfilling breastfeeding relationship.

You might want to ask your midwife or doctor in advance to help you start breastfeeding by placing your baby onto your belly or chest, skin to skin, right after birth. Also, if you are planning to breastfeed, it is important to insist that the baby not be given any water or formula without a clear medical need.

At home and in birthing centers, it is usually easy for you both to be together, sleeping and waking together, getting to know each other, the baby nursing whenever she or he desires. In the hospital, specifically request that your baby remain with you. If a practitioner thinks that separation is needed, ask for an explanation and remind hospital staff that you want your baby to remain with you. Even if medical observation or treatment becomes necessary, it is usually possible for you or your partner to stay with your baby.

My first baby was a face presentation, mentum posterior, and there was no way he would have made it out alive vaginally; that position wedges the baby's face between the sacrum and the pubic bone, with no room to descend. I had a C-section in a small local hospital. The OR [operating room] was actually warm. . . . My midwife and my partner were with me, right in the OR! It was a good way for this skeptic to learn that yes, a surgical birth can be a positive event. I had minimal anesthesia and had the baby back with me within an hour or so of his birth
.

In certain circumstances, cesarean sections are clearly needed for the safety of the mother and/or the baby. In other circumstances, it can be difficult to determine whether or not the surgery is medically necessary and a different care path might have resulted in healthy vaginal birth. The risks and benefits of a cesarean vary according to your specific situation. Ideally, you will discuss during prenatal visits the possibility of having a cesarean section, although many of the circumstances that require birth by cesarean section emerge only during labor.

I'd always dreamed of having a home birth and, if that wasn't possible, to give birth in a birth center with a midwife. At thirty-two weeks, I had some bright red spotting. My midwife came to the hospital with me for an ultrasound, which showed that my placenta was partially covering my cervical opening. The obstetrician held out the possibility that the placenta might still move away from the cervix, although he was doubtful. I returned home with directions to call
immediately if there was any more bleeding. At thirty-five weeks, I woke to find blood pouring. With a towel between my legs, I called my midwife, jumped in the car, and headed to the hospital, where my lovely five-pound daughter, Chiara, was delivered by cesarean section
.

If you are giving birth by cesarean section, whether planned or not, the process will start in an operating room, where you will usually receive spinal or epidural anesthesia to make you completely numb below the level of your ribs. Your partner or support person may be asked to wait outside the operating room while the spinal or epidural is being set up, but in most instances he or she can return to the room to support you during the surgery. If an epidural catheter (tube) is already in place when the decision for surgery is made, the level of anesthesia will be increased so that you are completely numb.

In the rare instance when a cesarean section needs to be performed very quickly, you may be given general anesthesia (which makes you unconscious), because it is faster than making you numb with a spinal or epidural. General anesthesia is also used in the rare instances when an adequate level of anesthesia is not obtained with a spinal or epidural.

For most cesarean sections, your belly will be scrubbed and you will be given a dose of antibiotics before or during the procedure to reduce the risk of infection. In addition, a small tube (catheter) will be placed in your bladder to keep it empty during the procedure. A drape will be placed between your chest and the lower part of your body to create a sterile area for the operation. The drape also prevents you from seeing the surgery as it happens, although you can ask to have it lowered enough to see the baby emerge, if you prefer. Sometimes the drape is close to your neck, but you can turn your head to the side if it makes you feel claustrophobic.
Orgasmic Birth
authors Elizabeth Davis and Debra Pascali-Bonaro also suggest:

You may be able to have music in the room, aromatherapy on a tissue at your nose, touch support from your partner or doula, the opportunity to see the baby emerge by watching in a mirror, and photos (taken by your partner or doula) of your first few moments with your baby
.
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Your arms may be strapped down at either side to keep you from inadvertently touching the sterile field, although some hospitals are doing away with this requirement because it makes some women feel vulnerable and helpless. If you prefer to have one or both arms free, say so. Operating room staff will attach a sticky patch to your skin and place a small clip over one of your fingers that monitors your vital signs. In most hospitals, if you do not have general anesthesia, a support person or partner as well as a doula or midwife can be present during the surgery. He or she will likely stay at the head of the bed, next to your head, behind the drape.

After the anesthesia has taken effect, the surgeon will usually make a horizontal incision in your skin, low down near the pubic bone—the so-called bikini cut. The surgeon will then open up the layers inside your abdomen and cut through the uterine muscle to lift your baby out.

I looked up at my husband. There he was, looking quite ridiculous in his blue scrubs and hairnet. He was standing slightly, just enough to see over the draped curtain. His eyes [were] intently staring. I can't even be certain he blinked. When the doctor announced the birth of our daughter, there was no need for him to say it. I saw it on my husband's face, the birth of his daughter. His eyes widened at first, almost as if someone had stomped on his toe, then he began to cry. The look
on his face was amazement, pride, love. I saw the birth of our daughter that day, too . . . through the eyes of my husband. It was beautiful
.

© Can Stock Photo Inc. / M. Valigursky

The surgeon will clamp and cut the umbilical cord and hand your baby to a nurse or other attendant, who will suction your baby's nose and mouth if needed and assess the baby's breathing. Once the baby is breathing normally and has been bundled into a warm blanket, your partner and you can hold your baby next to you cheek to cheek and you can welcome your child even as the doctor removes the placenta, sews up the incision, and closes the skin with sutures or staples. The entire procedure usually takes about an hour.

Following your surgery, you will be cleaned up in the operating room and taken to a recovery room, where you can focus on getting to know your baby. This is an important time to start breastfeeding. The baby is usually alert for the first hour or two after birth. Ask for help if you feel that you cannot start breastfeeding on your own. The surgery and recovery pose extra challenges for getting breastfeeding off the ground, and good support and your determination can make all the difference. During this time, if you have had a spinal or epidural, the anesthesia will gradually wear off. If you received a long-acting medication in the spinal/epidural catheter, you shouldn't have much pain the first twenty-four hours. If you did not have the long-acting medicine, you will be given IV pain medication as needed. Usually, after a few hours you are ready to go to your postpartum room.

Women who have complicated labor and obstetric emergencies understand the necessity of a cesarean section. Some experience a cesarean section as a relief, even while wondering whether or not it was truly necessary. Some fault themselves, feeling guilty or defensive that they
didn't do “everything possible” to have a vaginal birth even though they did the best they could, given their physical circumstances and the information and support available. It's normal for women to have a wide variety of emotional responses to a cesarean. Honor your feelings, whatever they are. If you feel you need additional support after a cesarean, visit the website of the International Cesarean Awareness Network (ican-online.org).

A midwife says:

I tell women who begin labor at home and end up in a hospital, “Who you are never changes. Your planning, ideals, beliefs, and principles never change just because you end up with a cesarean. You are stronger than you would have been, because you've gone through all these decisions and made the choices you did.”