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One of the single most difficult moments of my life was as I was being wheeled down the hall to an emergency c-section and I hugged my husband good-bye and we said our “I love yous.” He was able to rejoin me just as our little one entered the world, but that day and its difficulties are a painful whirlwind in my memory.
I’m so glad for that experience, especially in hindsight, but as I recounted before, that day was so difficult and there are so many things I wish I’d known to do differently.
That c-section has been good for me as a mother and as a doula. It was humbling and difficult, but it taught be so much.
A Gentle Cesarean?
As grateful as I (now) am for that experience, there are so many things I wish I could do differently for the sake of our son. I hadn’t read any of the books about c-sections because I thought I’d never have one and I wasn’t at all prepared.
Because he was early, he spent 8 days in the NICU and I didn’t get to hold him until the end of that time. I had to pump and he was fed through a bottle or a feeding tube. We didn’t get skin to skin and he definitely didn’t get any beneficial bacteria from me after birth. (As a side note, I’m smiling in that picture because of the happy drugs they gave me since the epidural didn’t work, not because I had a gentle birth!)
After my own c-section I started researching gentle c-sections and how to optimize factors in the event that a c-section is necessary. Having been through it myself, I know how difficult it is, and I wanted to find ways to help other women have a more gentle time (and an easier recovery).
I’ve now had the privilege to be a doula at several cesarean births and to help implement these ideas and I’ve seen the benefit to mom and baby. It is too late for me to have implemented this with my own son at the time of my c-section, but I hope that what I’ve learned since then might be helpful to some of you.
Obviously, natural birth is optimal whenever it is possible (and it is possible much more than the 30+% that it occurs now) but there are times where it is legitimately not possible to deliver vaginally (like my placenta previa) and there are ways that we can make the best of that situation for mom and baby.
Skin to Skin & Bonding
One important aspect that is lost in many c-section births is the vital skin to skin time with mom and baby. I didn’t get this with our son because he was having a slight trouble breathing. I really wonder if we’d had even just a minute of this, if his breathing might have improved and he would not have needed the time in the NICU (some research is showing this is a possibility).
Skin to skin contact between mom and baby helps regulate baby’s temperature and breathing patters and also helps mom hormone levels:
For example, Dr. Camann realized that by using both clear and solid sterile drapes, obstetricians could switch the solid drape for the clear one just before delivery and allow mom to see her baby being born.
“We also allow mom a free arm and place the EKG leads on her back so that she is able to hold, interact, and provide skin-to-skin contact with her baby in the moments following the birth,” said Camann, who teamed up with BWH registered nurse Kathy Trainor, to make this option available to patients and their families.Kathy Trainor notes that research has shown that techniques such as skin-to-skin contact have important benefits for a mother and her baby.
“Allowing mom and baby to bond as quickly as possible after the delivery makes for a better transition for the baby, including better temperature and heart rate regulation, increased attachment and parental bonding and more successful rates of breast feeding,” she said. (source)
Research is now showing that this skin to skin contact immediately after birth is important for culturing baby’s gut bacteria and microbiome properly.
Microbiome
Perhaps even more important for baby’s health long term is the need to properly develop the microbiome. An excellent new movie called Microbirth delves into the way a baby’s gut bacteria is cultured during the birthing process and how this affects the baby throughout his or her life and can even affect things like cancer and heart disease risk later in life.
The movie points out that a baby born via c-section has 1/3 less variety of bacteria in his or her gut than the gut of a baby born vaginally in an optimal environment. This seems especially disheartening and scary, especially to moms who have no choice but to have c-sections, but the movie also offered some unconventional advice and some hope…
One of the doctors interviewed in the documentary explained how they were able to create the same variety of healthy gut bacteria in a baby born via c-section. They inserted a sterile gauze into the mother’s birth canal for the hour or so before delivery (by c-section). In the time before birth, the mother’s body will culture trillions of bacteria in the birth canal that are passed on to baby as he or she is born. Of course, this transfer doesn’t happen in a non-vaginal birth but this offered a work-around.
The sterile gauze was removed from the mother just before the baby was born and placed in a sterile container. As soon as baby was born, the gauze was wiped in the baby’s mouth, nose, and all over the face and skin of the entire body. This exposed the baby to the mother’s beneficial bacteria first and in a five year follow-up, babies who went through this process had similar gut bacteria to babies born vaginally and had lower rates of obesity, allergies, eczema and more.
It sounds strange, especially at first, but it certainly isn’t any more strange than the way the transfer happens during a vaginal birth where baby comes fully in contact with the bacteria in the birth canal, getting it in his or her mouth and nose.
I highly recommend the movie Microbirth to any expecting parents, but especially to those who must deliver via c-section. I’m purchasing several copies to pass on to doctors I know to spread the word about this important topic. As Toni Harman explains:
As the fetus grows in the womb, it develops in a near-sterile environment relying on its mother for protection. But when the baby emerges, it is entering a world of bacteria, some of which are bad (pathogens) but some of which are good.
In the weeks and days leading up to birth, specific species of good bacteria are migrating to key locations in the mother’s body and are transferred to the baby during and immediately after birth via the birth canal, immediate skin-to-skin contact and breastfeeding. The role of these good bacteria is to train the baby’s human cells to distinguish between what is “friend” and what is “foe” so that its immune system can fight off attack from pathogens. This process kickstarts the baby’s immune system and helps to protect the infant from disease for its entire lifetime.
However, with interventions like use of synthetic oxytocin (Pitocin / Syntocinon), antibiotics, C-section and formula feeding, this microbial transfer from the mother to baby is interfered with or bypassed completely. For babies that enter the world by C-section, their first contact could be with bacteria that is resident in hospitals and from strangers, i.e. not with the special cocktail of bacteria from the mother.
The latest scientific research is now starting to indicate that if the baby is not properly seeded with the mother’s own bacteria at birth, then the baby’s microbiome, in the words of Rodney R Dietert, Professor of Immunotoxicology at Cornell University, is left “incomplete”. Consequently, that baby’s immune system may never develop to its full potential, leaving that infant with an increased risk of developing one or more serious diseases later in life.
This area of research is very much still in its infancy but as research develops, I know many families that are attempting this method of culturing baby’s gut bacteria since there is no documented downside and baby would naturally encounter these bacteria during birth anyway. Baby is usually wiped off and dried anyway, there isn’t a reason this could not happen with a gauze that had been exposed to the mother’s gut bacteria.
A Gentle Cesarean Birth Plan
When c-sections are needed and especially pre-planned, there are some factors that families can discus with their doctors and birth team to try to create a more gentle environment if circumstances allow. Things like:
- Dropping the drape or using a clear drape so that mom can actually witness the birth of her baby (especially since she won’t be able to see the incision because of its placement
- Immediate skin-to-skin once baby is born and while mom is being repaired if possible. If not, dad can have skin to skin with baby while mom is being repaired.
- Fostering of the early nursing relationship by having baby on mom’s chest during the rest of the procedure so baby can start to nurse if he/she desires
- Using a specially cultured gauze to swab the baby and expose him/her to mom’s beneficial bacteria
- Letting the dad cut the cord if circumstances allow
- Keeping mom, dad and baby together in the recovery unit to let nursing and bonding happen
- Allowing for an extra person (doula, grandparent, etc) to be there to photograph the birth so that mom and dad can both interact right away
- Have music of choice playing if possible
- Having all IVs, straps, etc on the non-dominant arm so that mom can touch and hold baby once he or she is born
- Performing all newborn tests on mom’s chest if possible
- Ensuring that all medications are approved for breastfeeding, if possible
- Letting the cord continue pulsing after birth if possible
Have you ever had a c-section? Did you try any of these things?
Thank you for this article. It made me cry. I’ve had 2 c -sections – the first was an emergency & the second elective. They were both traumatic ( although on paper everything went well) and it’s putting me off having a third baby. Ive spoken to many women and some but not all have been left feeling traumatised after & I wonder why I feel so emotional and damaged after the surgery? In retrospect I believe I was suffering from PND but everything from the spinal to recovery was terrifying to me & I couldn’t get the surgery out of my mind for a very long time. I have been advised to get hypnotherapy and to ask for anti anxiety drugs if I do decide to try for a third, just to help me through the process. Has anyone else tried these measures?
I also had 2 C-sections, 1st unplanned, 2nd planned. I went into the first not knowing a thing and never would have dreamed I would have one. I am ok with gore but I don’t know how I would feel about seeing everything going on with me. I was thankful for the white sheet. My husband said it was pretty graphic. I am going to be honest, as much as I LOVE my children and loved it when they were babies…. it was hard on me.
I was in pain. I was exhausted and I was scared. The post-partum care is sketchy for the first timer. For me, all the stuff with the babies came pretty natural and my kids are older now, so it seems like a memory. What I didn’t forget was how scared I was and how I was in pain trying to roll myself up at 2 am and get to the baby. I couldn’t move fast when chasing after my other son (he was still little when the 2nd baby was born). I just think there is more to tell. I wish I had better advice on how to care for myself during post partum and not feel guilty that I was also worrying about me. I mean, it’s a serious mental roller coaster…. Maybe your follow up can be post partum care and it’s ok to take care of yourself with a newborn, because it is. 🙂
Hey Katie,
Great Article! Thank you for sharing this 🙂 I have a question (not sure if you’ll be able to answer), but in the example you used of placing the gauze in the mother’s birth canal to pick up bacteria to then transfer to baby… I’m curious how soon these bacteria migrate to the birth canal, or are they just kind of always there through pregnancy? I had to have a c-sect 6 weeks early, and am curious if this process would have been beneficial (I can’t imagine that it could have hurt!) but was wondering if the process of labor (which I never experienced) sort of signals this bacterial migration, or what. Just curious if you know anymore about this!
Thanks again for your insight and sharing your experience with us 🙂
~Sarah
They are present throughout pregnancy. They do amp up during labor, but the benefits were still seen even with scheduled c-section moms 🙂
6 months ago I had my 4th Cesarean. I am happy to say that the hospital I used did in fact do several of the things you have listed without me asking for it! Now that I know that there are more options the next time I will talk to my doctor and plan for them as well.
One thing I wish they would change – they used three different adhesives on my during surgery. I developed an allergic reaction to all three. This made my fist two and a half weeks after birth uncomfortable and stressful due to the fact the only meds they could give me to get rid of the rashes is the kind that can potentially dry up your milk. I wish that there was an alternative to using any adhesive during surgery.
Thank you so much for this post and for talking about your own Cesarean delivery.
I had a planned csection a few months ago due to breech baby. Because I knew it was coming I did some research and was able to implement many of the things you mentioned. I soaked the gauze in saline and wore it overnight like a tampon. Then I removed it and swabbed myself with several qtips right before delivery. We put all of that in a ziplock bag and “seeded” our baby in the recovery room, by swabbing his mouth, nose, palms, etc. With gauZe and qtips. I Hope it worked!!!! Oh I also rubbed some vaginal fluid on my chest and nipples before surgery, so when he was immediately put on my chest and nursing he would come in contact with it. Not sure how long the bacteria stays alive after it leaves the body though. My surgery team would not delay antibiotics until the cord was cut, they brought up medical “laws” which I couldn’t argue wit, but after much pleading they agreed to wait until the moment before the incision to administer the antibiotics. Since the baby was out so quickly once they began, I hope he didn’t get any of it!
Thank you so much for this post!!! I am someone who has to have a c-section (due to a previous surgery on my cervix) and I want to make it as natural and gentle as possible. One question, do you think it would be possible to delay anti-biotics until after the baby is born? I mean, I’d rather have no anti-biotics, ever, but being cut open seems like an appropriate use for them. I’d much rather the baby not get them intravenously, so I’m hoping they will agree to not start the anti-biotics until after the cord is cut. I know some will go through the breast milk, but surely less than in the blood stream. I haven’t asked my specialist about this yet, but I’m hoping he agrees. What do you think?
I would insist on it again if I ever had another c-section.
Hi Katie! My first two were born naturally but my third was born via C-section. I was at the hospital, in the pushing stage of labor when the doctor or nurse realized my baby was breech. I kinda knew something wasn’t right about his labor compared to the two previous babies. The doctor gave me the choice of either a C-section or to continue a vaginal birth with a breech baby. I chose a C-section because in my heart I knew that was the best choice (in this situation) for a healthy baby and healthy mother. Unfortunately, since I was so far along in the labor process, I had to be put completely under and did not get that immediate skin-to-skin contact after birth. I did, however, get to give him his first meal (breastmilk) so I was happy about that. Come to find out later that not only was he breech, he was also turned sideways. Not sure if that is common or what would have happened if I chose to deliver him naturally. But in the end, everyone was healthy and happy. Even though he is my third baby, I was not truly educated on C-sections and what happens afterwards with me and the baby. I am so grateful for you and your website as I am learning so much towards a healthier lifestyle for me and my family. Thank you!
I had a client that this exact scenario happened. Third baby that flipped breech sometime before she was complete, cesarean and general anesthesia. That is so awesome that your provider gave you the option to go about a vaginal breech or cesarean and that they had the confidence in their skills to assist in that. On the other hand, it is pretty neat that you and your baby’s intuition told you both that cesarean was that way for him to come into the world.
Thank you so much for this post. It really hit home. My son was born via cesarean a little over two years ago. I was induced at 41.5w and things went downhill from there. After two hours of pushing i got a high fever and my sons heartrate went over 200 so they said we needed to get him out. They thought I had some sort of uterine infection so he was taken to the NICU and we were both administered two full days of a really strong antibiotic. I nursed him but the nurses convinced me I wasn’t doing a good enough job so they said i had to supplement in order to get him out of the NICU. I stopped that after i convinced myself that i could do it. I nursed him for over a year. He started gettting eczema around two months (could have been sooner). His digestion has always been poor. I supplemented with probiotics for him but not nearly enough and probably not a great kind.
Well he’s two now and since his eczema started getting worse we decided to do something to fix it. We started the GAPS diet and that was nothing short of a failure. He reacted very poorly to the diet. His digestion never improved, he started getting hives and his eczema got significantly worse. We quit the diet after two months because he was literally getting worse and worse by the day.
Now I’m just not sure what to do about the damage I caused both at delivery and from the GAPS diet. Do you or anyone have any suggestions on whom we should talk to or the next step we should take to help my son? Hopefully someone does because I am feeling at a complete loss on what to do for him.
Have you ever looked in to histamine intolerance.
Try homeopathy my child was born by c-section and has had bad eczema since about 1. She is 3 now and the last time it got really bad i took her to a homeopathy. It is brilliant now. I highly recommend going.
IgG allergy testing: this helps to eliminate food allergens. Once these are identified removing them from the child’s diet for at least 4 months. While doing the elimination diet also out the child through a gentle detox. For my daughter we used a company called Bioray. The three products I suggest are Liver Life , Cytoflora and NDF+. Follow there protocol. My daughter developed allergies after our c-section around 9 months old . We did all the above testing and detox and now she no longer suffers from any of the allergies or skin issues. She is a healthy vibrant little girl and is able to eat whatever she wants. I have placed several PT’s on this protocol and they are Seeing great results. The body will heal you just have to remove the interference ..
Thank you for this timely article. We are currently pregnant with identical twins who share a placenta. Apart from the fear of TTTS, a c-section is a huge fear. I have had 5 previous vaginal deliveries, and I never thought about needing a c-section. However, this time it is a very real possibility. I really appreciate sharing your wisdom!
Where can I find the Microbirth movie?
I added the link
Hi Katie,
I had two C Sections, first was an emergency, and second happened because I got pregnant only one year after the first one so doctors strongly recommended second surgery. I recovered easier after the first one, because I wasn’t aware of almost anything, adrenaline and first born helped a lot. I had time to prepare for the sedond surgery, had everything under control, but pain afterwards was more intensive. Although, I started to nurse immediately. There is nothing I would love more than giving natural birth but it is obviously impossible. I agree that there should be skin to skin contact and all this things you wrote, but they didn’t let me unfortunately. I was just given chance to breastfeed every couple of hours.
I think every pregnant woman should prepare herself for the possible C section and inform herself about it, I wrote an article on this subject on my blog Countryside Mom.
matea ,
I just wanted to encourage you…. though I know every situation is different, I had two c-sections and then was able to find a doctor who would work with me to try a v-bac. I have gone on to have three successful v-bac deliveries, and have been so glad I was able to go that route.
Just wanted to offer some additional encouragement, that VBAC (even after multiple c-sections) is entirely possible, and safe. There is typically only a slightly increased risk of of uterine rupture (around 1%) and this can be mitigated with good monitoring. There are more and more VBAC friendly providers. To find one, please contact your nearest ICAN (International Cesarean Awareness Network) group. You will find tons of support there.