A birth plan is still useful even if you are having a caesarean
1) What pain relief can I use in water?
Q. Does a water birth rule out other pain relief?
A. Not at all. Water is widely reported to be the next most effective form of pain relief after an epidural, but if you feel you need something else, then it’s fine to use gas and air. This can be piped into the room through tubing, which then has a mouthpiece, or your midwife will have a portable canister for you to use.
If you felt you needed something stronger, such as an epidural, then you’d need to get out of the pool. While in the pool, it can be comforting to have warm water poured over your back, and to keep changing positions. Many women choose to give birth in the pool, as the warm water provides buoyancy, and enables them to relax and labour to progress.
2) Can I have a natural birth if I’ve had a caesarean before?
Q. My first baby was born by caesarean after showing signs of distress during labour. I’m pregnant again, but will I be allowed to try for a vaginal birth?
A. The majority of women who have had a caesarean section should still be able to give birth vaginally. The main risk of VBAC (vaginal birth after caesarean) is the very rare breaking down of the scar. This causes a weakness in the muscle, which could tear during contractions. You’d then need another caesarean – and quickly. However, this happens in only 0.3% of all VBAC labours.
My advice would be to ask your doctor and midwife for their opinion and explain the reasons for your first caesarean. You can always ask for a second opinion from another doctor or midwife. Ultimately, how you give birth is going to be your decision.
3) Do I still need a birth plan?
Q. My baby’s breech so I may need a c-section. Is there any point in still writing a birth plan?
A. Absolutely! This is still your birth and it’s important to focus on how you’d like it to be. There’s still plenty to plan such as the music you might want playing (the operating theatre is likely to have a CD player) and whether you’d like the screen lowered at the time of the birth. Would you like to have skin-to-skin contact with your baby in the operating theatre, while the doctor finishes the surgery? And who would you like to be there?
If you do a birth plan, it’s worth giving a copy to the midwife, anaesthetist and obstetrician, as they may all have a part to play in helping to facilitate the type of experience of birth that you would like.
4) Caesarean know-how
Q. I’m pregnant for the first time and I’ve been advised to have a c-section. Can you tell me more about the scar and healing?
A. The incision for a c-section is approximately 13cm long, and you’ll be asked to shave the top of your pubic hairline, where it’s made, the night before you have the procedure. Although you’ll feel uncomfortable for the first couple of weeks, some women find that the scar itself feels quite numb in the days after the birth. You’ll be encouraged to expose it to the air quite quickly and to start gently moving around within hours of the operation, but don’t panic, there’ll also be some hefty painkillers available if you need them.
High-waisted ‘big’ knickers are essential after a c-section as bikini-style ones will dig into the wound. You’ll still bleed afterwards, in the same way as you would after a vaginal birth, so stock up on plenty of proper maternity towels and a few pairs of big disposable pants. Make sure you avoid driving, lifting and housework for at least a month after the birth. Don’t worry, the scar won’t be very noticeable once it heals. Instead it often looks more like a crease in the skin.
5) Once induced, always induced?
Q. My first baby was induced at 37 weeks because he wasn’t growing properly. Now I’m pregnant for the second time, can I stop it happening again?
A. Sometimes a baby can stop growing in pregnancy due to the placenta not working as well as it should do. It’s often referred to as placental insufficiency. This is more common in women with high blood pressure, as it can affect the blood flow through the placenta. But sometimes a baby’s growth is restricted for no apparent reason – it’s just ‘one of those things’. Because of the problems last time, your midwife will be keeping a close eye on you and will refer you to the obstetrician if she has any concerns.
6) Do I have to be induced?
Q: I’m approaching my due date with no sign of my baby. Can I refuse induction and, if so, what are the other options?
A: Induction sounds very unnatural, but most women who are recommended to have it feel more than ready to meet their baby. So, what’s the deadline? Women should be offered induction from 41 weeks, as the risk of stillbirth increases significantly after 42 weeks. Many maternity units advise that women be induced 10-12 days past their due date, as the process can take a few days.
If women do refuse, they’re advised to have a scan to make sure there’s still enough fluid around the baby and the heartbeat is monitored twice a week. You can ask for a stretch and sweep, which is where your midwife places her finger just inside your cervix and makes a gentle, circular movement, which releases hormones and can bring on labour. In the meantime you could try walking, stimulating your nipples, or even having sex – all thought to help kickstart labour.