Friday, October 10, 2014

So, you want a Family Centered/Natural Cesarean, too??

So, you've heard about this thing called a Family Centered Cesarean or a Natural Cesarean and you want to know how to go about convincing your OB that its totally doable. Well, here I will offer a few tips about how to go about introducing the idea to your physician.

A Few Things to Keep In Mind

As you read and plan for your own c-section, please remember the following: 

1) Every woman's situation is different. There are a host of reasons why such a C-section may not be appropriate for some women. If your physician hesitates, or feels it isn't right for you ask why and try to understand. Don't assume they aren't being open minded.

2) Planning for what might be a very new idea for your practice and your delivery hospital takes time. Introduce the idea as early in your pregnancy as possible. The more time there is to plan, the better.

3) Have an open mind. Babies are unpredictable. Things happen during pregnancy and child birth that are unexpected. Not everything can be planned for. If you plan and hope to have a Family Centered C-section but it doesn't work out, trust that things happened the way they did to keep you and your baby as safe as possible. Try not to be too disappointed.

So, Where to Begin?

As I mentioned above, introduce the idea as early as possible. Talk to your OB about why such a c-section would be meaningful to you and your partner. Offer some resources to your OB as they may not be familiar with the concept. I e-mailed my OB this video:

And this article: 

The article is particularly key as it shows that this is becoming "routine" in some hospitals in the United States. A lot of people seem to think it is a "UK thing" and not something being done here in the US. Well, it is, and that article is proof. 

So, your OB is on board? What then?

If this type of c-section has been done before at your delivery hospital, and your practice is comfortable with it then you don't have too much else to do. There should be some type of "protocol" in place and the necessary staff should be aware of that. But I would type up a "Clarifying Expectations Document" and review it with your OB well in advance. (More details about this below). 

If you're the first, or one of the first people to have this type of surgery either at your delivery hospital or within your practice, then you have a little more work cut out for you. 

Talk to your OB about who the "key players" are in the hospital who will need to be on board with this idea. Request a meeting with your OB and those key players. Generally you would want someone from Nursing (perhaps the Labor/Delivery Nurse Manager), someone from Anesthesiology (the anesthesia team is key to have on board) and perhaps someone from the NICU; Though, they could probably be updated later. 

I was lucky that the Nurse Manager at my hospital brought in the Chair of Women & Children's Services, the Nurse who would be in the OR the day of my c-section, the head of nursing from the NICU, my OB (of course) and a representative from Anesthesiology (who unfortunately couldn't come at the last minute but was updated personally by the Chair of Women & Children's Services). My husband and I cannot say enough about each of the people who attended this meeting and the work they put into making our son's birth the truly magical experience it was. 

In this meeting I introduced what I will call a "Clarifying Expectations Document." This document was a list of particular details of what my husband and I expected the Family Centered C-Section would be like. As a group, we discussed each of these points one by one. I made it clear that I was not demanding or requiring any of these details (i.e., IV in non-dominant hand, delayed chord clamping, allowing my husband to clamp the chord, how long the baby would stay with me, etc.) but rather just making sure we were all on the same page as far as what the c-section would look like, so my husband and I knew what to expect on this very special day. 

I also made it  extremely clear that if at any point my son's health or my health was in the slightest danger that all "special circumstances" were to be aborted and the team was to do whatever they needed to ensure the safety and health of the two of us. I think it is imperative that any mom hoping for this type of C-section make this clear, so as to assure everyone involved that your priority is a healthy baby. Having a more natural birth experience is truly and honestly a bonus. Its not a guarantee (See item #3 at the beginning of this post). 

After the meeting, in which expectations were clarified, send a follow-up e-mail to those involved summarizing the meeting as you and your partner understood things. This once again ensures that everyone is on the same page. Allow the team to make "corrections" as necessary (if there are any).

Once its clear everyone is on the same page type up a final document summarizing all the details you discussed. Make this summary as succinct as possible, and give it to anyone you meet the day of your c-section who hasn't yet seen this document: Your OR nurse (if you haven't already met her), the Anesthesiologist, the assisting OB, etc.  In my case I was lucky that all of these people had already been e-mailed my list and had viewed the video I linked to above. It was so reassuring and calming to know that everyone involved was on board. But, you may not be so lucky. So, don't hesitate to give that Summary Document to everyone you meet the day of your c-section. 

Then, once you've done all this planning, sit back and hope baby waits to arrive on the day of your scheduled c-section. Be sure to discuss ahead of time with your OB what you can expect if the baby comes a bit early (I am talking days to a week, not many weeks early, in which case things would be very different). Since not all the "key players" may be there, your expectations may need to shift a bit if your little one comes a bit early. Your delivery team may still be able to accommodate the Family Centered Cesarean (ours said they probably would be able to), but if not, that's OK. You will have done everything you can and your team will have too. Some things are just out of our control. 

Try to relax the day of your c-section. Be in the moment, absorb everything, and know that no matter what happens, if the end result is a healthy baby, and a healthy Mom, then there is nothing more you could ask for. 

If you have any specific questions please don't hesitate to e-mail me at kris10camfam(at) gmail (dot) com. I am happy to be of assistance to any woman hoping have the same amazing experience I had. 

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