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Cesarean Practices

I’m going to try to write this post without sounding like I’m on a rant.  Deep breath and…

I want to talk about the immediate postpartum of a cesarean birth.  First, let me mention, that I’ve only attended cesareans at Greenville Memorial.  My experience is limited and what I’ve heard of other local hospitals is just that–hearsay. 

What bothers me the most about preparing my clients for cesarean birth is the inconsistency of practices.  I honestly don’t know what to tell them to expect anymore.  Examples: 

1)  Sometimes I’m permitted in the operating room.  If the doctor says I can attend, then the anesthesiologist must ok it.  I receive that answer second-hand from a nurse.  Sometimes after I’m already dressed in scrubs, I’m told “the anesthesiologist said ‘no’.”

2)  In that case, I’m taken to the mom’s recovery room to await her arrival.  Since Greenville Memorial doesn’t permit recovery room “rooming-in,” I stay with mom while dad goes with baby.  Recently, however, I was not allowed in recovery at all.  Like the anesthesiologist decision, it was at the say-so of one person–the recovery room nurse.  In that situation, the mom was left alone in recovery while dad stayed with baby.  I learned that if I was her immediate family, the nurse would let me in.  I’ve never heard that one before.  I wonder if it is written down anywhere?  

3)  If baby is healthy, he is taken to the nursery where inane people smile at the babies lying alone in isolettes behind the glass.  I have so much trouble with this scene.  The babies are alone.  These newborns are not skin-to-skin with a parent, are lying on their back under bright lights, and are surrounded by unfamiliar open space and smells. Why are people smiling at this?  But I digress.  The inconsistency is how quickly and easily the dad is able to bust his newborn out of the nursery.  Sometimes, it is no big deal.  Dad walks over to the nursery door and requests his baby.  Sometimes, he is told that the baby must be observed for an hour.  Sometimes 2 hours.  Sometimes he is told the baby must have a bath first.  I’ve actually started suggesting my clients flirt or fib to get their baby.  I watched one dad do both!  Tip:  go to the Mom/Baby info desk, ask for the room number of your wife, then go tell the nursery that you have been assigned a room and need to take your baby to his room. 

What logic suggests it is best practice to keep baby alone in an isolette immediately after birth?  When every medical journal is promoting immediate skin-to-skin and early initiation of breastfeeding, why this practice?  Babies do best in arms.  Why do newborn nurseries still exist?  Now I’m sure Greenville Memorial has a logistical reason for this practice but I doubt it is based on logic.

What my issue boils down to is this:  how your baby is handled after a cesarean birth is often determined by one person’s whim or mood. 

Another example:  one of my clients wanted the baby to be placed skin-to-skin on her chest following her cesarean.  She and her doctor discussed how that would work.  Everyone agreed.  Doctor exited.  OR nurse entered.  She said “absolutely not.  the OR is too cold for skin-to-skin.”  And so ensued a tense discussion that ended with a sour OR nurse influencing much of what subsequently occurred in the OR and in recovery. 

In some hospitals (even St. Francis), families remain in recovery together.  In some hospitals, babies are routinely placed skin-to-skin on mom immediately and in a few hospitals, permitted to nurse in the operating room.  I’ve heard of one Australian doctor who encourages the mother to “birth” her own baby during cesareans.  He delivers the head and then guides the mom to pull the baby to her chest, cord still uncut.  I’m not sure how the whole sterile field issue is handled in that situation.  The point is that there are ways to make a cesarean birth feel more like, well, birth.

Step 4 of the Mother-Baby Friendly Hospital Initiative is to initiate breastfeeding within one hour of birth.  And while I’ve had one client who nursed her baby immediately after leaving the OR (before baby was removed to the nursery), this is not the norm.  On average, for the cesareans I’ve attended, the delay has been more like 2-4 hours.     

And in case you’re wondering why breastfeeding within the first hour of birth is so important, here are a few reasons:

1)  Mom’s body regulates the baby’s body temperature. 

2)  Baby is less stressed, calmer, and has steadier breathing and heart rates.

3)  Baby is exposed to bacteria from the mother which are mostly harmless, or against which the mother’s milk contains protective factors.  Mom’s bacteria colonizes the baby’s gut and skin.  These compete with more harmful bacteria from health providers and the environment, and so prevent them from causing infection.

4)  Baby receives colostrum which, among many other protective factors, stimulates the baby to have bowel movements so that meconium is cleared quick.  This helps get rid of the substances in the baby’s body that produce jaundice and may help reduce it.

5)  Touching, mouthing, and sucking at the breast stimulates oxytocin to release in the mom.  Oxytocin causes the uterus to contract which may reduce maternal bleeding.  It stimulates other hormones which cause a mom to feel calm, relaxed, and “in love” with her baby.  And finally, it stimulates the flow of milk from the breast.

6)  Mom experiences joy.  The process of bonding is strengthened.

If you had a cesarean birth or attend cesareans, what has been your experience?  What are the practices like at other hospitals? 

 

 

 

 

 

 

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9 responses »

  1. can’t even begin to speak. it’s amazing the difference in “care”. Whim is exactly the word I would use; one person thinks there “must” be this much of something, but the guy standing next to him has a full different idea.
    😦 as you have said in previous posts, thank goodness you (or another doula) are there in the preventative state to prepare parents and to support them.

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  2. It does amaze and sadden me how much power these strangers have over something so intimate and personal like birth, and how much they simply don’t care. It may just be another baby and another day on the job, but for these parents and infants they are sacred moments with powerful emotions. It’s a great privilege and responsibility to be allowed to witness these times, and they let all that go to waste without a fleeting thought. I hope like you, I will never lose my sense of wonder and amazement when it comes to birth.

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  3. Some nurses are so domineering. (Not all of them, of course–several of mine with Suzi were really helpful.) I felt more like a prisoner than a patient at times during labor and delivery, and I can’t imagine having my baby AND support people kept from me like that after a c-section! I can see they might have concerns about the baby, but what is the point of keeping a doula from her client when she needs her most? I hope I never have to go back to the hospital.

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  4. Hey…I read your blog a lot but rarely comment 🙂 I think I might be able to shed a little bit of light here. I am a nurse…and I do agree with you about how things are handled. With that said…a lot of things are done the way they are now because of the “sue-happy” society that we live in now. I believe an OB-GYN’s malpractice insurance is 2nd highest (only to the anesthesiologist) because if something is wrong with a baby…a lot of people want someone to blame (regardless of whether it was their fault or not)…so hospitals and doctors have become overly cautious with a lot of their rules and regulations. It’s sad that it is that way. (and not everything is policy…there are some people that work in hospitals that are just power hungry and take it any way that they can get it) Does that help any? I don’t agree with it but in my experience, that’s why it is what it is. (Sorry Jenny….my grammar and English is terrible when I type!)

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  5. I’d say that you are pretty accurate with saying that the answer is subject to the nurse’s whim.
    I’ve worked at a lot of different facilities as a Labor and Delivery nurse (I was a travel nurse for a short period of time before I became a midwife) and I will tell you that the scenario does not vary much from what you describe. The most baby friendly hospital I worked at was in Northern California. Babies were bathed right in the room with mom on the postpartum unit. Their staffing ratios were also excellent (this makes a huge difference in the care you receive, in general). I can appreciate both sides of the coin here. I totally agree with what your saying about breastfeeding after c-section and mother-baby contact. But, I can also appreciate the reasons why it doesn’t happen right away. There is a vast array of paperwork associated with being a nurse. Most nurses have a routine they’ve developed in order to accomplish it all. Most times that means that the baby’s assessment, bath, blood sugars and whatever else gets done right after the birth. This is especially true of cesarean birth because mom is usually busy trying to recover a little bit from the anesthesia and surgery so it seems like a good time to do these things.

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  6. Thanks for commenting Beth! We met at babywearing, yes? Wow Sharon, you worked in Northern Cali too?

    I wanted to add that I’ve heard some folks at Greenville Memorial want to implement mom/baby recovery rooming in for cesareans. But there is some resistence from recovery room staff about the idea. Hopefully, the administration will be able to work together to change the process.

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  7. I am so thankful that I had a good recovery experience at our hospital after my emergency C-section. Unfortunately I wasn’t able to nurse right away bc of convulsions from shock but after my body calmed down, I was able to. The nurses even felt bad and I could really feel their sympathy. Until then, Stephen held Jubal in the recovery room where I was and I was able to see them the whole time. All of the nurses strongly encouraged Jubal not go to the nursery. They really wanted him in our room. I loved that. Every time I go to the hospital to see friends now, I never see babies in the nursery. That’s nice to see.
    Even though my c-section was not at all ideal or expected, the nurses were awesome and let me have a voice in what I wanted. I really appreciated that. My midwife was also the best. We did everything we could to try to avoid the surgery which helped with my disouragement afterwards.
    My doula was not allowed in the OR which was a bummer since we had already been through so much with her during labor. I never quite understood why either. At least Stephen and my midwife were there for me and Jubal. The surgeon let my midwife hold me and coach me through all the prep work. I couldn’t have done it without her.

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  8. We had Max via emegency C at Sacred Heart in Pensacola, Florida. Thankfully, my doctor insisted the baby stay with me the whole time and so did she (my doc.) She sat in the back of the recovery room drinking tea for an hour just making sure no one interrupted us. It was pretty cool. I could hear her actually telling the nurses, “Leave them alone. They are fine. Don’t you have anything else to do?” She used to be a Navy doctor and could really scare people into doing what she wanted. Max nursed imediately and two years later is still nursing. It was a really positive experience for us (as much as a C can be.) We wanted him to be delivered naturally, but he was transverse breech. My ob tried to do an external version to get him moved around, but his cord looped his neck and his heart stopped. Wonder woman that she is, she got him out in 4 minutes. He is fine…some might say gifted.

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  9. I know this posting is old but I just had to respond. I just refused to have my csection changed from Greer Memorial to Greenville Memorial yesterday. My doctor says his partners and the hospital are “nervous” as this is my 7th csection. I won’t go to Greenville for the same reasons you mentioned. Greer is extremely mother/baby friendly. My baby will be taken care of in my room until I am done in the OR and only after I have both seen and touched him. He will be my 4 th delivery with this practice and hospital.

    My first emergency cs, was a nightmare! I was never shown my baby, didn’t get to touch him, he and my husband were whisked away despite no issues with baby for over 7 hours. At 8 hours I disconnected my if, got out of bed, and horrified the nurses by walking directly into the nursery and demanding my baby! that was in a small GA hospital

    With emergency CS 2 I was in a small NC hospital and my midwife was there. I saw her for a second at delivery and was brought her back a few minutes later in recovery. It was such a relief I was devastated already thinking I wouldn’t be allowed to have her back for hours.

    CS 3 was scheduled. Different hospital and Dr’s. I saw him for about 10 minutes in recovery and not again for over 4 hours!

    4,5,6 were all at Allen Bennett/ Greer Memorial (last one was 1 day after they moved lol! Talk about chaos :D). I cannot say enough greatthings about the staff! Our last baby breathed a lot of fluid at birth. We were informed by out pediatrician that at memorial he would have been in the nicu for a day or two. At Greer they did everything possible not to transfer him. He was on oxygen with a respiratory therapist and a pediatrician in the room at all times for 18 hours. I was still able to hold and nurse him within 2 hours and he was kept where I could see him the entire time. It made all the difference in the world.

    I’ve been informed I shoild tie my tubes since I’ll be “fired” lol from the practice if I have another baby. This despite the fact I’ve had 0issues, always heal well, and don’t have massive adhesion issue etc. Sorry, but it’s my body. Not happening. We wanted a large family, and despite a very bad car crash that left my pelvis inflexible, God has seen fit to give us one. I believe that decision should be between myself, my husband, and God and not up to a medical doctor who admits it is only because it makes he and his partners nervous.

    Reply

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