C-sections in Awareness: Gentle, Spiritual Belly Births

Gentle, Spiritual Belly Births by Bernice Rivkin CCE(BFW). CD(DONA). And CHBCHD

We recently had some guests over for dinner and we got into this interesting discussion about the following scenario: A pregnant woman’s health care provider recommended that she be scheduled for a c-section.   What happens next?  We all agree that sometimes there are evidence based, valid reasons for this to be the preferred option for the way that some children need to come into this world.   We pray that all should go well, and our challenges should not be difficult ones, i.e. that all of our new moms should have natural, uncomplicated births.  On the other hand, we are fortunate to live in a time and environment that allows for the cesarean option that protects moms and babies in this way when there is no other safe way to give birth.  It is helpful for all expectant parents to prepare for and educate themselves about cesarean (or belly birth) birth as a possibility even if they have hired the most natural, non-interventionist doctor or midwife, even if they are planning a home birth.  Birth is unpredictable, occasionally even for low risk women.  G-d is holding the keys to this miracle and how it will unfold.

 Yes, there are many c-sections being done out there.  Cesarean statistical rates vary by geographical area and even from hospital to hospital.  I just heard of one hospital in southern Florida that has a rate hovering at around 70%.  At the other end of the spectrum, in some parts of the world, hospitals don’t have the resources to perform enough necessary cesareans and women’s and babies’ lives are compromised.  The national percentage is now around 33%, and that is pretty much the story worldwide.  According to most experts, that is too many.   The World Health Organization is advising us that the rate should be around 10 to 15%.

 Since I am a doula, the next question at our dinner was: “Would you hire a doula?”  One of our guests asked: “Why in the world would you hire a doula if you know that you are having a cesarean??? Doesn’t a doula support you through labor?  With a c-section, there is no labor.”  My initial response at that time was, “Yes, a c-section is major abdominal surgery but it is also a rite of passage.  It is a couple’s transitional journey to becoming parents.  It is a very special moment that needs to be cherished.”  Many parents-to-be have lots of fears as they cross this threshold, and the potential for this being a traumatic experience for them is very real.  A doula can support not only the new mom, but also the new dad as they enter many unknowns together, and dad may have questions of his own, and may also want to explore some of his fears and feelings.  A doula can help support his journey too, and often help them connect and communicate with each other. 

 Let’s assume that our hypothetical family that we discussed at our festive meal has determined that the reason for their c-section falls into the 15% that is lifesaving, and the benefits outweigh the risks.  What next?  What services can a doula provide to help make this birth a memory that these parents will cherish?   How can a childbirth class prepare this couple for this experience? How can we address their fears and minimize the potential for trauma?

So much is not in our control, but we can still dream of the possible and we can choose to focus on the choices that are possible.  One of my favorite stories is told by Penny Simkin, one of the founders of DONA International: She was hired to attend a c-section birth as a doula.  When this couple learned that they were carrying a son, they wanted to welcome him by singing their favorite song to him, the Beatles old song: “Here comes the sun”.  When the obstetrician held up their baby from behind the sterile drapes, they burst into song.  Penny said that everyone in the room felt that joyful moment.  This mom and dad may not have had the vaginal birth that they hoped for, but they did welcome their baby in a way that speaks of love and connection.

Before the birth, how can childbirth classes or doula prenatal visits help the mom and dad prepare for a belly birth? For sure, all pregnant couples should learn as much as possible about surgical births, i.e. what are clinical indications and what questions to ask if a c-section is recommended and what to expect after the decision is made. This preparation helps parents embrace a broader range of possibilities for their child’s birth.  This component becomes more imperative when a c-section is scheduled ahead of time.   It also opens the door to ask whatever questions they may have about the procedure and the experience.  Beyond that, it takes away the element of surprise and shock taking it from the unknown to the more familiar, minimizing the possibility of a traumatic response.

 Childbirth educators and doulas can also help the parents-to-be incorporate calming stress-relief techniques before, during, and after the birth, such as deep relaxation, affirmations, visualizations, and mindful breathing to help them make their cesarean birth a joyful Birth Day.

A hospital may be a rushed place, focusing on medical crises and emergencies.  However, unless it is a true dire emergency which is relatively rare, there is usually time for mom and dad to make decisions that are within their control, and listen to their inner voices and intuition as to what is right for their baby.  After all, a birth is always a shift in dynamics for this family, a deeply spiritual event, an opportunity to connect to the miracle that they are witnessing no matter how they give birth to their baby.  Preparation and having a doula on board can help create this conscious dimension.

 Some sample questions: Will their doula be allowed to be in the operating room? May they play music?   If the baby needs to go to the nursery after his/her birth, can the dad go with the baby and the doula stay to support the mom while they sew up her incision?  More and more hospitals are aware of the benefits of skin to skin contact.  However, sometimes after a c-section the hospital may be focused on other priorities since it has now become a surgical procedure.  If baby is healthy, does this hospital encourage skin to skin contact after birth?  If not, are they open to it if you request it?  How soon after birth will it be possible to initiate breastfeeding?  Can mom have on-demand nursing while she is in the hospital? Is there a lactation consultant  available on the hospital staff who can help mom with that first latch, and positioning the baby so that the abdominal scar is not pressed or retraumatized?  Is the Lactation consultant available 24/7?  If not, are there knowledgeable nurses who have experience helping cesarean moms start breastfeeding?  Doulas can also help mom initiate breastfeeding.  If it is not feasible in the operating room, they can help mom get started in the recovery room.

However, besides the medical and concrete informational perspective, there are other dimensions to childbirth preparation.

  As a Birthing From Within mentor, I spend a considerable amount of time in my childbirth classes and prenatal meetings with my doula clients talking about birth as a natural process that our bodies were designed to accomplish and is an astounding miracle.  We talk about the range of possibilities for natural childbirths.  I share statistics and information about our anatomy.  We also talk about common interventions and their medical indications.  I include a section about breastfeeding.  We also consider the many proven ways that prevent many unnecessary cesarean sections.  However, I don’t think that we want to stop there because we are not just talking about a medical event.

 There is another way of knowing that is not linear; it is an inner knowing deep in our souls and psyche.  Some call this mindfulness or conscious birthing.  As a Birthing from Within mentor, we do birth art together, and I love to tell stories, and we draw labyrinths together to find our way into that world of our brains that may be hidden at first glance. To paraphrase something that Nikki Shaheed of Birthing from Within said: We want to feel empowered no matter how your birth story unfolds.

 When Mom and Dad feel that their voices have been heard, that opens the door to becoming mindful and empowered parents who are aware of their choices.  Parents whose voices are heard, and feel supported before birth are at less risk of postpartum depression too.  Here is a 2013 study done at UCLA about the value of support for pregnant moms:

 http://newsroom.ucla.edu/releases/stress-hormone-foreshadows-postpartum-243844.

 This paves the way to make the operating room a spiritual, sacred space where Mom and Dad will welcome their child into this world with love. Robin Lim, a well known midwife from Bali and Indonesia, calls C-sections “Belly births”.  Baby is entering this world through a different doorway, but it is still a miracle.  We are grateful for modern medicine that makes this safe passage possible when the natural doorways are not working out the way that we expect them to work.

 What about those rare circumstances when birth does turn into a dire emergency where seconds and minutes count?  Can a doula be helpful there?  She can still support the dad while mom is being whisked away to the operating room, and may support the extended family.   At those times, doctors and nurses are busy keeping mom and baby safe and don’t have time to offer comfort measures for the worried loved ones.  They may not have time to hear their questions and concerns.  Just not having to go through this alone can help them stay calm and able to support the new mom after the birth. Her doula can then join mom in the recovery room after the emergency surgical birth and continue supporting her there.

 No matter how mom gives birth, this is an experience that mom and dad will never forget, they will tell and retell their stories for many, many years to come.   It makes sense to do whatever we can to make this a story that mom and dad will want to share and retell again and again.

 And then after the birth, postpartum doulas can be invaluable resources as the couple continues to become a family, and mom recovers from the surgical birth.  When new mom comes home from the hospital, her postpartum doula can “mother the mother” and help her adjust to her new reality.  She might make delicious soup one day, help her with breastfeeding another day, she may listen to her birth story and provide information about newborn care another day as mom gets acquainted with new role.  As a matter of fact, many birth doulas include some postpartum doula sessions as part of their package for their clients who enter parenthood through belly births/cesarean births. 

I want to thank our dinner guests for sparking this dialogue in my thoughts.  As doulas, we love to try to  diminish fears, provide loving support, smooth the transition from couples to families, and make this crossing the threshold into parenting a time to celebrate the miracle of bringing a new soul into our world and family no matter what doorway Baby enters our lives.  When there are expected and unexpected bumps and hills and valleys on that road, we want to help support that journey too.

Bernice Rivkin is a Certified Hypnobabies Childbirth Doula, a DONA International Certified Doula, and a Birthing from Within Certified Childbirth Educator.  She has also taken DONA postpartum doula training and practices as a postpartum doula, and is a Birthing from Within Birth Story Listener to help those with difficult births heal from their experiences.  In addition, she has taken advanced courses in Storytelling and Birth Art.  For further information, please PM her via this page or contact her at bernicerivkin@gmail.com or call her at 773-965-5221.