Because scheduling a cesarean is absolutely something women do and will continue doing, whether by need or desire, I offer some ideas that make the experience more tender and with a small amount of control. These ideas have helped many women choreograph their own cesareans and have been adopted for the cesarean portion of many a birth plan.
One of the most difficult aspects of a cesarean is the total loss of control over the experience. Finding even very small places where women can know what might be coming down the pike helps keep them in a much calmer place and gives the birth an aura of partnership instead of being acted upon.
Each woman will have her own needs and desires. One woman might despise having her arms tied down while another might feel suffocated by the oxygen mask. I encourage women to pick their battles and negotiate with the doctor to remedy what is most important to them.
The doctor who leads the way in the Operating Room (OR) is the anesthesiologist. All visitors, changes, needs... all are directed by the anesthesiologist. S/he is responsible for your life - that one person deserves to be amused and taken care of. And respected.
An easy request tends to be the choice of music playing during the surgery. All ORs have cd players and can accomodate your music during your baby's birth. I haven't ever known this request to be turned down. (Doesn't mean it couldn't be!)
Because many women feel claustrophic with being strapped down during surgery, asking if you might have one or both arms free might be able to be negotiated. I explain it to women that the anesthesiologist cannot risk your touching the areas that are in the sterile field. Your OB would have a fit if you did - and your subsequent infection might make your family a tad distressed, too. If you want to talk about your arms being free, you might have to PROMISE not to touch anything but your partner and your baby. I've also found it helps to say, "If I move somewhere you don't want me to, you are free to put the straps on then." This discussion might help, but the anesthesiologist (or nurse-anesthetist) has the final say and it might seem cruel, but it is the interest of your safety.
The other claustrophobic area is the oxygen mask and depending on how your baby is faring depends on whether you are able to negotiate having the nasal canula instead of the mask. If the baby is having any sort of an issue, it really might be a better idea to forego asking about the mask until after the child is born, then perhaps asking for it to be removed. Some women do better with the mask, knowing they are getting a lively dose of oxygen to supplement their own breathing... and for women who feel like they are so nervous they are hyperventilating, the mask acts like the "paper bag" into which you breath to slow down and find your head again.
A blog reader reminded me to ask everyone to not have extraneous conversation during the birth. There is nothing more disconcerting than having people talk about football scores or where they are going for dinner while you are in the middle of having a baby.
The other request is to not state the baby's gender. This is habit for them, so will be the most challenging request if it is seriously important to you. As they say the baby is coming out, your partner/doula can remind them you or your partner wish to state the gender of the baby. The sound of "It's a boy!" and "It's a girl!" resonates in our minds forever.
More and more, I am hearing about fathers or partners cutting the umbilical cords right as the baby is born. I haven't ever seen this - mostly what I've seen is the dad re-cutting the cord in the warmer. This might be something to ask about, but don't be surprised if you get a funny look from your OB.
I know how many of you all want to see your babies naked and smell them right out of your body, but for a variety of reasons, including the comfort of the surgical team, the OR is kept so cold, your babies could have some serious distress if they were naked in that temperature. In these cases, ask them NOT to bathe your baby at all... no rubbing off of anything (but meconium)... and then have someone unwrap your baby in the Recovery Room so you can replay the moments of seeing your naked child and smell him or her in all his/her glory.
Babies are bathed because nurses have to wear gloves with un-bathed babies (they are considered "dirty" or "contaminated"), but they can just wear gloves until your baby is ready to be bathed by you or your family - or if you want them to do it.
Anesthesiologists are able to put medication into the epidural or spinal that can significantly lower the first couple of days' pain. Duramorph is but one of the options for them to use.
Pre-op, making sure you and your baby will be back together the moment it is feasible is vital for most women. Most scheduled cesarean moms aren't as exhausted as post-labor unscheduled moms, so they tend to be talkative and wide awake, delighted to interact with their newborn. If your baby isn't ill, it shouldn't be difficult to have you both together, even nursing if that is your desire. All that is necessary is someone to help you with the baby... holding the baby to your breast, adjusting the pillows to protect your belly and holding the baby when you are tired. Letting your pre-op team know you will have support post-op can go a long way towards getting you your baby sooner.
For all cesarean mamas, I highly encourage women to do this exercise as soon as you think about doing it:
Pull your abdomen in as far as you can - towards your spine - and then relax. Do this 5-7 times at first, and then up to about 10 times in a few minutes' time. No need to do a belly dancing fast back and forth movement, just pull in, relax... pull in... relax.
This exercise "massages" the intestines and helps get them moving faster. You know, farting so you can entertain the nurses and fellow patients. Intestines being active is a great sign of inner healing. Any help you can offer is great. I've also seen women walk sooner and be more comfortable doing this exercise. It might not feel fantastic the first few times - only pull in to comfort! - but just keep at it. Your body will thank you.
Getting up and walking is a distinct challenge after a cesarean. Do it anyway! I had an abdominal surgery that opened my belly from hip to hip and refused to get out of bed for two days. The nurse came in and took the IV and catheter out threatening me with putting them back in if I didn't get up. It was horrible! I passed out the first two tries. Years later, with another 13 inch abdominal incision, I was up 4 hours post-op and made myself pace the halls with all that I was worth. It made a world of difference even though I was 100 pounds more the second time. MOVE! Your body will thank you. (It also can save your life as you minimize the possibility of a DVT.)
For some women, the choice of hat is very important - bring a selection of washed and soft baby caps and give ONE to the pre-op nurse to put on the baby in the OR.
Bring your own pillow to lay on during your pre-op and then post-op healing time. Just make sure there isn't a white pillowcase on it or it can end up in someone else's room or the pillowcase taken down to laundry when your bed is changed.
When I had my abdominal surgeries, I had a small "woobie" pillow made for me. My woobies were half the size of a regular pillow and had a cover that could be removed and washed. The woobie was a lifesaver when I needed to cough or sneeze or when my crazy family made me laugh at terrible jokes about how funky my hair looked.
Laughing, coughing and sneezing are great physically, by the way. Coughing is a requirement, often with an "Incentive" Spirometer to help the lungs clear and cough measurements calculated.
Those are my most common recommendations... any other providers or post-cesarean mamas have ideas? Please share them!