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. 

Monday, October 6, 2014

A Family Centered Miracle

(Warning, some graphic (i.e. bloody) images included below. Do not read if you are squeamish.) 

This past Wednesday, October 1, 2014 at 12:17 p.m. our third son, Connor Matthew DeBoy Caminiti was born. He was born in what was our delivery hospital's first Family Centered C-Section and everything about it was perfect.

With those not familiar with a "typical c-section" I'll try to paint the picture so you understand what was so very different about this c-section.

In a typical c-section, the mom is sometimes (though not always) given the choice to watch the c-section using a mirror. With my two previous c-sections I jumped at this chance as I did not want to miss seeing my babies being born. Partners are almost always allowed in the OR, and they can take pictures. Typically, after the baby comes out of the Mom's belly they hold the baby up high, above the curtain, or more correctly, the drape, for mom to see (as you can see here with my oldest son, Ryan).

They then take the baby away, into another room, where the baby is cleaned, weighed, given shots, etc. My husband has always followed the baby, to be with him, as I knew I was well taken care of by the Anesthesiologist and the rest of the OR team. You can see pictures of this process here, with my second son, Zachary:

While all of this is going on, the mom remains in the OR where the surgery is completed. At some point, the baby is brought in for mom to get a quick peek, to give a kiss, and then the baby is returned to the warmer in the recovery room, where he remains until the mom is able to be moved from the OR to recovery. All told, I would say, typically, a mom is away from her baby during a c-section for about 30 minutes.
During my two "typical" c-sections I was lucky in that as soon as I was moved from the OR to recovery my baby was placed on my chest and I was able to begin breastfeeding. But this is not always the case. I've heard stories of moms who did not hold their perfectly healthy baby for up to two hours after a c-section.

Me with Zachary after arriving in recovery.

All things considered, my two prior c-sections were amazing, wonderful experiences and I will never, ever forget them. In fact, you can read about Zachary's here. (I wasn't blogging yet at the time of Ryan's birth, so its not documented except in a file just for him). 

And then, then I had the amazing opportunity to experience a Family Centered C-Section and well, it was just a magical, amazing experience. Let me try to paint the picture of how very different it is from what I described above. As I've done before, this section will be written as a letter to my sweet baby boy. 

Dearest Connor Matthew, 

The experience of watching you be born was one of the most raw, and amazing experiences of my life. I hope you know how much planning went into making this happen, and how thrilled and excited Daddy and I were and are that you entered the world in such a special way. 

You might be wondering what was so different or magical about your birth. Well, let me tell you. During the surgery they dropped the drape and raised the head of my bed so that I could actually see you coming out. I didn't have to strain my neck to see you using a mirror. I saw it happening directly in front of me and so did Daddy. We saw your little head pop out and immediately were in love. We marveled at your dark hair and watched in awe as they slowly pulled you out completely and then immediately transferred you to my chest where I was waiting to snuggle you. 


Then, while they sewed my belly up, Daddy and I got to revel in just being with you and snuggling. It was perfect. Daddy captured our first hug on camera and you can see the awe, love, amazement and pure joy on my face. It may be my most favorite picture ever: 

 During the next 30 minutes--which in a "normal" c-section I wouldn't have seen you at all--Daddy and I instead got to snuggle and love on you. These thirty or so minutes were some of the most peaceful and amazing of my life. The doctors were sewing up my belly, using stitches and glue, I was in an operating room, and I was having major surgery! But none of that mattered because I was with my baby boy. My brand new, perfect, beautiful boy. I was with YOU and with Daddy and it was perfect.

Soon, the doctors finished sewing me up and they prepared to transfer me from the operating table to the bed. I thought maybe they would have me hand you to Daddy at this point. But they didn't. The doctor simply said, "You just hold him tightly," which of course I did, and the next thing I knew they were transferring me to the bed, and off we went, headed to recovery.

Mommy & Dr. Penn 
Connor, I think everyone involved in your delivery thought it was a pretty magical experience. The clinicians had never done a c-section like this. I was honored to have them there. They had all taken a lot of time preparing for this delivery. My OB (the Amazing Dr. Penn) assisted by Dr. Keith, Dr. McAllister, our Anesthesiologist, Katie and Anne, our nurses (supported by Anne's student Laura), and Betsy the nursing manager who coordinated everything were all so invested. They watched videos of a similar procedure, they read articles I sent, they read e-mails, they attended meetings, they checked on us even when they didn't have to, and they put their heart and souls into making your birth the magical experience it was. I will be forever indebted to them.

Once we got to the recovery room the nurses weighed and measured you. You weighed 7 lbs 13 oz and were 19.5 inches long. This made you the shortest of the three Caminiti boys at birth, and the middle one weight-wise. They took your footprints and declared you perfect! Then they gave you back to Mommy and you immediately started to nurse. Mommy got you latched on so quickly that all the nurses were very impressed with you! You've been a champion nurser since!

During this time of waiting to make sure both you and I were stable Daddy and I enjoyed getting to know you and cuddle you.

Connor, so far in the 6 days we've been privileged to get to know you I would say you are one of the sweetest most patient babies I've ever met. You are patient and rarely fuss when trying to latch on. You cry at diaper changes but only when they take too long (which is usually your fault, if you pee while I'm changing you, thus necessitating a full outfit change), you tolerate your brothers' constant adoration, poking and prodding, and you sleep well! You are super snuggly and love to curl up in a little ball on my shoulder. I know you will not stay this way forever. But I hope at your core, you will always be patient, gentle, and love Mommy snuggles!

During the 3.5 days that we were in the hospital (with you I stayed 3 nights, and I am so glad I did, as my recovery has been so much easier!) you had many visitors: NeeNee, PopPop, Ryan, Zachary, Auntie Catharine, Julia, Caitlin, Auntie Cindy, and Uncle Chris--your Godfather. Everyone was smitten with you, especially your brothers. You can see in the pictures below how much they both already love you.

Finally, on Saturday, October 4th we headed home with you!

 Every minute with you since your birth has been amazing. I cannot wait to watch you grow and mature, though you can be certain I am going to cherish these moments with teeny, tiny, you, as I know I will never experience the joy of a our very own newborn again. Connor, you have completed our family. We never felt that anything was really missing before, but now that you are here I have a sense of peace about the fact that yes, indeed, we have met all the little people that Daddy and I will create and bring into this world. That is an amazing feeling indeed. 

Caminiti Family: Complete! 

Thank you for joining our family and for making it complete. We all love you so very much already.

Love always, 


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