There is no question that cesarean birth, when used appropriately, is a life-saving operation. But there is little question that C-sections are over-used in the United States, often because it is more convenient and more expedient for the doctor and the hospital.

If you have a low-risk pregnancy and are being cared for by an experienced natural-minded birth provider, it is very unlikely you will need a C-section. In fact, over 600,000 C-sections performed in the United States each year may not be medically indicated, according to home birth obstetrician gynecologist Stuart Fischbein, M.D.

“C-section isn’t obstetrics,” Dr. Patji Alnaes-Katjavivi, an obstetrician who works at Oslo University Hospital in Oslo, Norway, explained when I interviewed him several years ago, “It is the surgery that is required when obstetrics has failed.”

Do You Really Need a C-Section?

Before you prepare for your C-section birth, be sure that you really need a C-section. Pregnant women who are told they “have no choice” and must have a surgical birth can seek the opinion of another provider. Talking to a homebirth midwife who specializes in VBAC birth can be tremendously helpful, even if you decide you don’t feel comfortable delivering at home.

Consider Aneka’s Story

Instead of going in for her scheduled C-section, Aneka decided to give birth to her fourth child at home, against her doctor’s advice. In fact, her doctor was aghast. “You’re being irresponsible,” she insisted to Aneka on the phone, “Your baby could die.” After just ten hours of labor with her firstborn, Aneka was told she was not progressing quickly enough and she needed a C-section.

Four years later, she was told she must have a second C-section because she was at higher risk of a uterine rupture and her doctor was not willing to “risk” a vaginal birth. She also had a scheduled C-section with her third child.

But when she became pregnant with her fourth baby, Aneka started doing her own research. The more she read and the more she learned about best birth practices, the more she realized that none of her previous three cesarean births had been necessary.

A Homebirth VBAC After 3 C-Sections

“I asked my doctor if I could try delivering vaginally, and she said no,” Aneka told a CNN reporter in 2010. “I called the hospital and they said they wouldn’t allow it, and I called three other hospitals and they wouldn’t let me deliver vaginally, either.”

So the pregnant mom of three took matters into her own hands. She found an experienced midwife who was not only willing to deliver Aneka’s baby at home, but who was also there to provide Aneka with the emotional support she needed. After a labor that lasted twenty hours, Aneka delivered a healthy baby boy, who weighed 9 pounds 6 ounces. Her son, Annan Ni’em, was born vaginally and at home.

Aneka’s story is similar to my friend Roanna Rosewood. Roanna’s first baby was born via C-section after a homebirth transfer. Her second child was also born in the hospital via surgical birth. But her third and last baby was born vaginally at home with the help of an experienced Oregon-based midwife named Laura Roe. Roanna describes her experience in the book, Cut, Stapled, and Mended: When One Woman Reclaimed Her Body and Gave Birth on Her Own Terms After Cesarean.

If You Need a C-Section, Here’s How to Prepare

If you are not comfortable delivering at home and cannot find a doctor who will support your desire to birth vaginally or you have a health condition that makes a cesarean birth necessary, the good news is that there are things you can do to prepare in order to have the most gentle, empowering, and positive surgical birth experience possible.

1. Find a Doctor Who Practices Family-Centered Gentle Cesarean Birth

Not all C-sections are created equal. There are providers across the country who are performing family-centered gentle cesarean births. A family-centered gentle cesarean birth usually includes allowing more than just the partner into the operating room, delaying cord-clamping, placing your newborn skin-to-skin with you just after birth (without first wiping off the beneficial vernix or cleaning up the baby), encouraging breastfeeding, and making sure not to separate the you from your baby baby for at least an hour after birth unless it’s absolutely necessary.

A gentle C-section can be a tremendously healing and beautiful process for a woman who had a previous surgical birth. If this is out of the scope of your obstetric practice, find a different surgeon (like Angelo Cumello, M.D., a physician affiliated with Northern Westchester Hospital in Mount Kisco, New York or Sarah DiGiorgi, M.D., who works at Premier Women’s Care in Southwest Florida) who supports gentle, family-centered cesarean birth.

Gentle C-sections will also include vaginal seeding to help the baby establish a beneficial microbiome. If your doctor is not familiar with this new practice, print out this article about vaginal seeding and bring it to your next appointment. If vaginal seeding goes against hospital policy, plan to do it yourself anyway.

2. Move Throughout the Day

It’s very important to stay active during your pregnancy. Whether you are having a vaginal birth or you need a C-section, moving throughout the day helps improve your mood, oxygenate your blood, and make your pregnancy more enjoyable.

One review article published in the Journal of Perinatal Education found that the benefits of regular exercise during pregnancy include, among other things:

  • Less lower back pain
  • Fewer pregnancy discomforts
  • Healthier weight gain
  • Less likelihood of gestational diabetes
  • Stress reduction

It’s not just about going to the gym, taking a weekly prenatal yoga class, or a nightly after-dinner stroll (all wonderful activities), it’s also about not being sedentary throughout the day.

You can make movement a habit by taking the stairs instead of the elevator (it’s okay if you climb them s-l-o-w-l-y); biking or walking instead of driving; parking your car two or three blocks away from your destination and walking the rest of the way; getting up from your desk every twenty minutes to talk a walk around the office or to go outside and stretch for a few minutes.

Being in good physical shape during your pregnancy will help your pregnancy be more enjoyable and also help your body recover from the surgical birth.

3. To Prepare for a C-Section: Eat Right

The single most important thing you can do for your health during your pregnancy and to prepare for your cesarean birth is to eat real food. The nutrients in the food we eat give our cells the fuel they need to grow a healthy baby.

But most women who think they are eating a healthy diet are not. And many nutritionists, unfortunately, give women bad advice. Packaged food, even if it is organic, is not healthy. If you want food in a “package,” choose organic bananas and unshelled nuts as your snacks, not potato chips or even granola bars.

To eat right during pregnancy is also not about following a strict dietary regime or the latest diet fad. It is about paying close attention to the foods that make you feel good.

Pile your plate — breakfast, lunch, and dinner — with colorful vegetables and fruits. Eat high quality, pasture-raised meats and wild caught fish that is low on the food chain (so it is not high in mercury).

Every pregnant woman is different and you may find that you have different cravings with every pregnancy. I have four children. I found that when I was pregnant and I “snacked” throughout the day on sugar snap peas, green beans, carrots, celery, fresh pineapple, blueberries, oranges, kumquats, and other colorful vegetables and fruits (even raw broccoli!), my mood and my energy levels increased and my nausea decreased.

It’s also very important to avoid eating refined sugar, food-dye laden food, and highly processed, edible food-like substances. Two excellent books that can help you eat right during pregnancy and also help your family enjoy lifelong good eating habits are obstetrician Jennifer Lang, M.D.’s The Whole 9 Months and Ruth Yaron’s Super Baby Food.

When you eat healthy, fresh, health-giving foods during pregnancy you help your body grow a healthy baby and you gain an optimal amount of weight. This helps you have a positive birth experience and a shorter post-surgery recovery time.

4. Practice Positive Birth Affirmations

Mental health matters. Which means that your state of mind going into the C-section you need is as important as your physical health. Prepare for your C-section birth by learning to meditate, taking a hypno-birthing class, or practicing positive birth affirmations.

In her book, Unassisted Childbirth, Laura Shanley gives many helpful examples of positive birth affirmations. These are inspiring phrases that you repeat to yourself. You can also say them out loud, ask your birth support team to remind you of them, and write, paint, or draw them on paper that you put around your house, office, and car.

Some positive birth affirmations to help you through the cesarean:

My body is healthy. My body is strong.

My baby is healthy. My baby is strong.

My body knows how to heal itself.

My baby will be born healthy.

I come from a long line of healthy, strong women and I will birth a healthy baby.

I embrace my birth and my baby. 

I wear my birth scars proudly.

I love myself, I love my baby, I love my birth.

I am strong and unafraid.

I look forward to being a mother to my baby.

I am open and willing to have a wonderful, safe, healthy birth.

5. Make Sure You Have an After Birth Support System in Place

When friends and family ask what they can do to help you, ask the person you trust the most to set up a meal train for after the baby is born. Let them know that you would like organic healthy whole-food meals delivered to your home or apartment once every two days. That way you will be able to concentrate on loving your baby and recovering from the birth without worrying about food.

You may feel shy about doing this. But remember that people genuinely want to help. You are giving them a gift by allowing them to bring you food. And when you have recovered from the cesarean and your kids are older (say, in five or ten years), you will be in a position to pay it forward.

Be specific about what foods you and your family enjoy most, how many people are eating, and what time you would like the meals delivered. Make sure to specify if anyone in the family has food allergies. And remember to request fruits or healthy treats instead of sugar-laden desserts.

You may welcome visitors or you may want to be alone with your new family for the first four to six weeks after you bring your baby home. Put a cooler on the porch or outside the door to your apartment where friends can leave meals without waking you or the baby up.

6. Keep a Birth Journal

Even if you’ve never put pen to paper in your life, now is the time to start journaling. You can write the journal to the baby (we called our first birth journal “Dear Chickpea” because the baby used to be that small) or simply to yourself. Or you can start a family journal that your family members (including older siblings), house guests, and other loved ones contribute to. If you’re more of a visual person, or have very young children at home, buy a larger sized blank book and add drawings, photographs, ticket stubs, and other visuals to the journal in addition to writing in it.

It may feel like every day is lasting forever as you are growing this small human being inside your body, but the nine months will go by more quickly than you think. A journal is not only a wonderful keepsake, something to re-read in years to come, it turns out keeping a journal is also beneficial for both your mental and physical health.

Psychologists and self-help experts say that journaling will improve your feelings of well-being, lessen your stress levels, and help you think through thorny issues. As you prepare for a C-section, use the journal to express your hopes and dreams and to confront your fears.

As simple as this sounds, it seems to work. When researchers at the University of Texas in Austin asked students to journal about difficult or traumatic events, they found that study participants who wrote about stressful events saw improvements in their health. According to the American Psychological Association, journaling can even help you reduce visits to the doctor and get sick less often.

7. Give Yourself Grace

Having a baby, either vaginally or via C-section, is a huge undertaking. Whether this is your first child or your fifth, your body is undergoing massive changes, your family dynamics are going to shift, and you will need time to recover and adjust. It’s easy for women to take care of other people but much harder for many of us to be kind to ourselves.

Accept that you may be moodier and more emotional than usual in the days leading up to your baby’s birth. Allow yourself to stare into space and sit and do nothing. Allow yourself to lose your keys and forget your train of thought. Tell yourself it’s okay if all you manage to accomplish is taking a shower. Give yourself grace. Be patient and kind to yourself and you would be a friend. Soon you will be holding a warm, delicious bundle of baby in your arms, a person you’ve never met before but have somehow known your entire life.

Jennifer Margulis, Ph.D., is a science journalist based in Oregon and the author of Your Baby, Your Way: Taking Charge of Your Pregnancy, Childbirth, and Parenting Decisions for a Happier, Healthier Family (Scribner, 2015), which contains a chapter on cesarean birth. Sign up for her free weekly email and learn more about her work at www.JenniferMargulis.net.

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