How to prepare for a mindful cesarean birth

C-section. Cesarean Birth. These words can ignite strong opinions and emotions. Often lost in the current debate about cesareans is the individual pregnant person, who prepares to give birth in a culture that alternately glorifies and vilifies both medical technology AND individual power and choice. How can pregnant people, their partners, and those who love and care for them, truly and deeply get ready for birth in our culture, where the cesarean rate is about 30%? I think there are many ways. One such way is to tell the truth about cesareans, offering unbiased information and support, which helps them prepare for a mindful cesarean birth. Complete, compassionate preparation for the surprises and intensity of the childbearing year helps decrease the risk of disappointing or traumatic birth. As a long-time childbirth educator and doula, I’ve learned to intermingle phrases such as “major surgery” and “difficult” with “birth of your baby,” “resilience,” and “rite of passage.”

I’ve learned about cesareans by witnessing them, by reading about them and talking with nurses and obstetricians, and, most importantly, by listening to hundreds of parents who have first-hand experience. They share with me what they wished they’d known before entering the operating room (O.R.) and what was most helpful to them throughout the experience. I’d like to pass on to you what I’ve learned, so that you can envision a mindful cesarean birth experience. If you or someone you know had a difficult or traumatic birth (whether c-section, home-birth, or anything in between), please be in touch, as I offer support in overcoming negative birth experiences.

The birth of a baby is also the birth of a parent.

Because the parents go through their own journey of transformation during the childbearing year, they need love, support, respect, and compassion, no matter what that journey looks or feels like. Some people know in advance that they’ll birth by cesarean (for medical or other reasons), so they have some time to prepare practically, mentally, emotionally, even spiritually. For others, it comes as a surprise, with little time to adjust to the reality of major surgery AND the simultaneous birth of their child.

No matter what kind of birth is planned, no matter what ideas expectant parents may hold about birthing, an essential part of their preparation is to learn about cesareans.

This does not mean they only learn about how to be a patient or how to prevent things from “going wrong.” They also learn how to open to all the possibilities of birth, and how to be present, loving, courageous, and resourceful as birth is unfolding. To leave parents in the dark about cesareans (usually out of either fear or naïve optimism) is not compassionate or helpful. When they know not only how to reduce their risk of an unwanted cesarean, but also how to navigate the experience the best they can (should it happen), then they are on the path to confidence and empowerment.

Comprehensive, compassionate childbirth education helps parents understand what to expect so that they can better prepare themselves to cope if a cesarean occurs. The focus should be not only the medical part of the event (or how to avoid one), but also the emotional, social, cultural, and spiritual aspects, as well as long-term physical and psychological impacts. Inclusive preparation addresses the needs and experiences of the birthing person as well as their partner(s). If parents have fears, anxiety, or past trauma that affect how they prepare for birth and parenting, they may need additional support through a private session with Virginia or from a licensed therapist specializing in perinatal mental health.

If baby will be born by cesarean, particularly if it is unexpected, sudden or unwanted, the parents may feel afraid, confused, and/or relieved. Perhaps there is concern about the well-being of the baby or pregnant person, or labor has been long and exhausting. Maybe this is the last thing anyone wanted. Expecting and accepting a range of emotional responses is one more way to prepare for a mindful cesarean birth. Along with joy at the imminent arrival of baby may be disappointment, anger, confusion, or fear. Ride the waves of emotion using your breath as it goes in and out.

To ready for the cesarean surgery, the birthing person is taken to the O.R., and the partner(s) stays behind. In most circumstances, one support person (and possibly the doula as well) can come into the O.R. after about 20-30 minutes, just in time to see the baby’s birth. As the pregnant person crosses the threshold into O.R. and is prepared for surgery, they may want to close their eyes, focus on their breath, and connect emotionally with the baby. Focusing on the present moment, allowing sensations and emotions to come and go can be helpful and calming. It gives the parent something to DO, which can reduce fear and trauma. It may be comforting to remind themselves that they have been doing the best they can and that soon they will greet their baby.

The O.R. is cold, brightly lit, and usually filled with noises, such as beeping machines, clattering instruments, and people talking. There are about six birth attendants in the room, dressed in special gowns, hats, and masks. A surgical drape is hung between the parent’s shoulders and belly, to create a sterile field for the surgery. The pregnant parent receives an intravenous drip (I.V.) to provide fluids, and other medications as necessary. An anesthesiologist, who sits close by, administers spinal or epidural anesthesia via the back, so the parent will be awake for the birth (except in rare cases when general anesthesia is needed) and won’t feel pain . This doctor sits behind the parents and closely monitors their health and comfort.

As the surgery begins and the birthing parent awaits the birth of the baby, they may notice bright lights shining down, and beeps, buzzes, and chatter around them. Some might chit-chat with staff, while others are very quiet. Some shake uncontrollably; some cry; some space out and imagine being somewhere else; some even feel nauseous, disoriented, or throw up. All of these reactions are a normal part of any birth–cesarean or vaginal.

When the birth is imminent, the birth partner is brought in, wearing special clothes (“scrubs”) over their regular clothes. They’ll wear a cap and a mask over their nose and mouth. They sit next to the birthing parent and can hold hands, talk, and even slide their mask down briefly to give them a kiss. The birthing parent may look “out of it” but appreciates focused attention and reassuring words of affection and affirmation, as well as eye contact, loving touch, and stroking. Parents do whatever is possible to connect and get ready for their baby’s birth.

A few minutes after the partner gets settled (about ten minutes after the start of the surgery), the baby is born. The birthing parent may feel their body rocked or tugged just before and as the baby emerges. Since they cannot physically push the baby out, they can find power and connection in bringing their baby into the world with internal love, intention, and strength. Often the doctor holds the newborn baby up, so the parents can see their baby over the surgical drape. Parents can pause, holding this moment in their heart and memory, connecting with and “drinking in” their little one. They can carry the sensory imprint of their baby with them until baby is snuggled in their arms. Often parents can ask for and receive a moment of silence, song, or prayer just after the birth.

Immediately after birth, a nurse dries off and assesses the baby—either near the parents or on a warming unit in the room. After birth, parents deeply need to connect to their baby. If they’re physically separated, partners can support the physical connection, mindfully talking with and moving between the two of them, describing what they see and hear. Planning ahead for the time after birth is one way to prepare for a mindful cesarean birth.

As the doctors continue the surgery, remove the placenta, and begin to close the body again, the birthing parent can remind themselves that their body is already healing. Strong muscles that cradled their baby for months are now mending. Tiny blood vessels and nerves forge new connections with each other, without guidance or direction from anyone. About an hour after beginning, the doctors finish their work. The parent(s) are brought to a different area to recover from surgery. Sometimes there’s no separation of the baby from its parent. Sometimes, separation is routine or medically necessary.

Practices vary greatly at different hospitals (before, during, and after surgery), so parents should ask their care-provider in advance about policies and common practices. Some hospitals allow a second support person or doula to be present throughout. Other possibilities are: taking photos/videos, music, or dimming some of the lights. Delayed cord-clamping, parental cord-cutting, and saving the placenta may also be possible. Skin-to-skin contact between the parents and newborn is wonderful for all sorts of scientific, spiritual, and emotional reasons. Often skin-to-skin can be done immediately after birth; sometimes it will be delayed for a bit. Making a cesarean birth plan can help guide conversations between the parents, as well as open up dialog about their preferences and decisions with their care provider at prenatal appointments. If parents need help preparing for the possibility of a cesarean, contact me for a private session.

The essence of birth preparation is seeing, hearing, and feeling how you’ll cope with the intensity that birth (and parenting!) bring. When you prepare for a mindful cesarean birth, you are increasing your knowledge and confidence. Setting an intention to be present, loving, and connected, doing your best at each moment no matter how YOUR birth happens, is what a positive birth experience is all about.

Virginia Bobro is the mother of three grown children, and a Certified ‘Birthing From Within’ Childbirth Educator and Doula, and a Certified “StillBirthDay” Doula. She offers international & online trainings, retreats, and individual sessions for birth professionals, parents, and women in transition.