Ep 226: Cesarean Birth – Everyone Needs to Listen to This!

Dr. Nicole (00:00): This episode is about planned and unplanned cesarean birth. Welcome to the All about Pregnancy and birth podcast. I'm Dr. Nicole Callaway, Rankins, a board certified OBGYN, who's been in practice for nearly 15 years. I've had the privilege of helping over 1000 babies into this world, and I'm here to help you be calm, confident and empowered to have a beautiful pregnancy and birth. Quick note, this podcast is for educational purposes only and is not a substitute for medical advice. Check out the full disclaimer at drnicolerankins.com/disclaimer. Now let's get to it. Hello there. Welcome to another episode of the podcast. This is episode number 226, whether you're a new listener or a returning listener. As always, I'm so glad you're spending some time with me today.

(01:05): So this episode is all about cesarean birth and you're going to learn about both planned and unplanned cesarean birth. And I wanted to talk about planned because in some ways I feel like women who are having a planned cesarean are kind of left out when it comes to talking about giving birth, and I don't think that's intentional. I think it's just that most folks have a vaginal birth and that's what gets discussed. But in this episode, I definitely want to talk about planned cesarean birth. I myself had two cesareans. The first was unplanned and the second was planned, and it's really important for you to listen to this episode so you can learn about unplanned cesarean. Honestly, most of the description of what happens is the same if you have a cesarean in labor, so it's really not a huge, huge difference. It's just that of course, with the planned cesarean, you're expecting some things more.

(01:58): Now, I know a lot of people say that if you want a vaginal birth, don't even entertain any discussion about cesarean. I completely disagree. It's important that you are prepared for the possibility of cesarean birth. As it stands right now, roughly almost 30% of folks have a cesarean. That number of course is too high, but there are instances when cesarean is the best option either for your health or your baby's health, and we can't usually predict that ahead of time. So you will feel so much better if you have some idea of what to expect if you happen to end up needing a cesarean. It's not likely. The most likely thing is that you'll have a vaginal birth, but you want to be prepared just in case. So I'm going to go over some of the reasons for a planned cesarean birth and then the timing of that planned birth based on the reason. It kind of varies, and then also just talk you through what a cesarean is like from the preparation ahead of time, and then what happens in the or the anesthesia part, and then the recovery part of a cesarean.

(03:08): Now before I get into the episode, I want to do a listener shout out. This is from Megan 1, 2 0 1 and the title of the review. She left This in Apple podcast, says so much valuable info and the review says at 27 weeks, Prego, they say, your baby recognizes mom and dad's voice. And I think it's safe to say My baby also recognizes Dr. Rankin's voice too. Oh my gosh, I love it. That warms my heart. And then she goes on to say, when I found out I was pregnant, I asked my sister-in-law if I should go into pregnancy and birth blindly or learn everything. Boy, am I glad I chose not to listen and found this podcast. Not only does Dr. Rankins give exceptional research based advice, but she also goes through others' birth stories, pointing out how differently things can go and gives her educated and informed opinion.

(04:00): This podcast is truly a wealth of knowledge and I'm so excited to do her birth course along with a few others that I found based on recommendations from other moms interviewed on her podcast. Definitely not going into my birth blindly, and I'm so excited to be able to make informed decisions based on everything I've learned thanks to all about pregnancy and birth. Oh my goodness, thank you, thank you, thank you for that lovely, lovely, lovely review and kind words. So appreciate it. And I'm so glad too that you chose not to go into it blindly. It's really important to be educated and that's why I am here now if you want to leave a review also, so appreciate it in Apple podcast. You can do that. I do look at those reviews. They do warm my heart. They do just brighten my day when they pop up.

(04:48): So if you ever want to leave a review an Apple podcast, I appreciate it. It helps the show to grow or shoot me a DMM on Instagram. I'm a Dr. Nicole Rankins or shoot me an email. You can email me or message me through my website also and just let me know what you think about the show. Okay, so let's get into the episode about cesarean birth. Now, the first thing I want to say is that if you do end up having a cesarean, it is okay to be upset. We have a tendency, and it's too often said within our culture, if you and your baby are okay, then you just should be thankful and happy that you and your baby are healthy. Like don't be upset about a cesarean. Well, you are allowed or you are. It is totally normal, I should say, to be thankful that everything went well and be upset that you had a C-section at the same time.

(05:41): Now, the issue where that comes into play is if being upset about having a C-section interferes with you being a new mother. Now if that's the case, then you need to ask her some help because you don't want to let that experience detract from having this beautiful new baby in front of you. And then the other thing I want you to hear right up front is that if you have a cesarean, you are not a failure. You still gave birth. You cannot be a failure when you grew a whole entire human being in your body. There is absolutely nothing about that. That is a failure. The way that your baby arrives is not a reflection of your worth, not a reflection of your success or failure. It's just a reflection of how the baby came into the world. So if you had a cesarean, it's okay to be upset if you had a cesarean, you are not a failure, you still gave birth.

(06:32): Okay, all right, so let's hop into cesarean birth. So let's start off talking about planned cesarean and I'm going to talk about the most common reasons for planned cesarean birth and when those cesarean births happen. All right, so the first one is going to be an elective repeat C-section, meaning that if you've had a prior C-section and you choose to have another C-section for your next birth, which is totally obviously within your right, that is going to be done around 39 weeks, somewhere between 39 and 40 weeks. We do that so that you don't go into labor. So the idea is to do it when we know that the baby is full term and ready and 39 weeks is when studies show that babies are pretty ready. So 39 weeks between 39 and 40 weeks. So we want to do it when the baby's ready but not before labor has started.

(07:21): If you go into labor before, then it would just happen before then, and that can really be one or two prior C-sections. I'm going to put the category of forced elective repeat C-sections also happened around this time, and I say forced elective repeat, and that happens in two circumstances. One is when a hospital doesn't support vaginal birth after cesarean or vbac, when a hospital doesn't support that, that ends up being a forced repeat C-section. Or if you've had two prior cesareans, ACOG is actually clear that as long as they were the right type of incision on the uterus and that's a low transverse incision, that's an incision that goes sideways on the uterus, then it is entirely appropriate to try for a vaginal birth having two prior C-sections. But a lot of physicians don't necessarily support that. So if you are forced essentially into a p c-section, that's going to be between 39 to 40 weeks also.

(08:20): Okay, the next most common reason for a c-section is a breach birth, or I should say breach presentation Breach is when the baby is upside down essentially instead of the head being first. Either the feet or the butt are first. And I talk all about breach presentation in episode one at 53 of the podcast, episode 1 53. That's dr nicole rankins.com/episode 1 5 3. Those are typically going to be done also between 39 to 40 weeks. So what 39 weeks when we know the baby's ready before labor starts. Okay, now for multiples, and this is typically going to be twins, triplets are almost always going to be born early, but for twins it's generally going to be no later than 38 weeks. If you have a cesarean for your twins, you don't necessarily have to have a cesarean for your twins. If both of the heads are down, you should at least be offered the opportunity to have a vaginal birth.

(09:21): If one of the heads is down and the second one is not, then some doctors will offer or vaginal birth, depending on the position of the baby, some won't. If both of the babies are breached, then pretty much all doctors are going to recommend a cesarean birth as the safest mode of delivery. In episode 2 0 1 of the podcast and then also episode 92, you can learn about twins and the different modes of delivery there, but generally if you have twins, it's going to be no later than 38 weeks. Twins almost never make it to full term. The placenta's age a bit more with twins. So 38 weeks is really considered full term for twins. So you can expect your plan cesarean birth for twins no later than 38 weeks. Okay, next reason for a planned cesarean birth is an indicated repeat cesarean, meaning that because of your prior history, then having a cesarean is appropriate.

(10:27): So that would be if you had three or more prior C-sections. Okay? Then pretty much no one is going to offer a trial of labor after cesarian because the risk of uterine rupture is considered unacceptably high. So that is also going to be between 39 and 40 weeks. Another indicated repeat cesarean is if you had a prior uterine rupture that is going to be done between 36 and 37 weeks if you had a prior uterine rupture because we really don't want you to have any contractions at all if you had a prior uterine rupture. So that old incision does not get stressed. And if you've had a prior classical incision, that's an up and down incision in your uterus, not the one on your skin, but inside on your uterus, you can't see it. We have to look at it in your operative report. If you've had a prior classical C-section, then we recommend that all of your future births will be by cesarean.

(11:26): So that would be an indicated repeat cesarean, and that's going to be between 36 to 37 weeks also. And then there are a couple other conditions when planned cesarean is appropriate. One is placenta previa. Placenta previa is when the placenta covers the opening to the cervix, it can cause extreme bleeding and life-threatening bleeding, especially for the baby. The placenta is where all of the oxygen and nutrients and things are for the blood flow between you and your baby. And if your cervix opens and that placenta is sitting right there, a lot of blood can come out pretty quickly and it doesn't take that much blood to be lost for your baby to get anemic pretty quickly. So placenta previa is another situation where if you have a placenta previa, then we definitely want to do that indicated C-section early, and that's going to be between 36 to 37 weeks because we don't want you to dilate, don't want you to have contractions at all.

(12:25): And then the final indicated reason for a planned cesarean is that you had a prior myomectomy, which is fibroids being removed from your uterus. And depending on where the fibroids are, if the fibroids were in what's called the contractile portion of the uterus, the part of the uterus that does the squeezing, if the fibroids were removed from that part of the uterus, then we recommend a cesarean because those old incisions, the scars where we took the fibroids out and then put the uterus back together, we put it back together, but it's never as strong as it was. And there's an increased risk with the stress of contractions that those old scars from where the fibroids were removed can open up and increase the risk of uterine rupture. So it's appropriate depending on the type of fibroids you have removed in order to have a cesarean, and that can be done between 37, 38 weeks, 39, it really kind of depends on how many fibroids were removed, that kind of thing.

(13:25): All right, and then the final reason for a planned cesarean, this one is not actually this one, I'll say it is indicated. It actually is indicated because it's really, if you choose to have a cesarean, there's a small subset of women who choose to have a cesarean birth. They don't want to go through labor at all, and that will be done what's called an elective primary C-section between 39 and 40 weeks. So similar to other term, and I have to admit, I used to be kind of not supportive of this really because I really couldn't understand why would you choose to have a surgery when you know that vaginal birth is safer and is it really appropriate? But as long as people have the information, as long as you are informed about the risk, the benefits, because actually vaginal birth is not without risk. Both of them have risk.

(14:19): It's just that vaginal birth is safer for moms and babies actually. But that doesn't mean vaginal birth is completely without risk. So as long as you know the risk and the benefits of both approaches, if you choose to have a cesarean, then that is your choice, okay? That is your choice and you should be supported in doing that. Alright, now, so those are the reasons for cesarean where we know that it's going to be planned elective, repeat, you've had one or two prior C-sections or forced elective, repeat breach birth multiples indicated repeat where you had three or more C-sections, a prior classical, a prior uterine rupture, a history of fibroids, placenta previa, or you just want to have it done. Alright? Now one thing I want you to keep in mind that duper important for you to know is that with a planned cesarean, it may not happen exactly when planned.

(15:20): I have seen people get a little bit thrown off by this. Now, most of the time it does, but it is certainly possible that your planned cesarean may not happen when planned. Okay? Your water may break, you may go into labor early, and in that case, the cesarean is going to be done in that moment. So it may not exactly be your doctor, it may be the doctor who's on call. So just keep that little nugget in the back of your mind that your planned cesarean may not happen exactly when planned because just like with all of birth, the only thing that's predictable is that it's unpredictable and occasionally things happen where that planned cesarean doesn't happen as planned. Okay, so let's talk about what to expect with an actual cesarean birth. I'm going to talk you through the whole procedure. Alright, so now when it's planned and we know it's going to happen, then we do something called pre-admission testing.

(16:13): And what happens with that is that you meet a nurse, you get blood work done to make sure you're not anemic. We get your blood type done so that if you need a blood transfusion and surgery, although that's not likely, we can get that ready if need be. We do some preoperative what's called a body wash where you get a special soap to wash your body before the surgery. That helps to reduce the risk of infection. And you may meet with the anesthesiologist if there's some concern about your anatomy that's going to make it difficult for the anesthesia. But in general, you don't have to meet with the anesthesiologist, but for pre-admission testing, you're going to meet with a nurse, you're going to get blood work done, you're going to get the body wash, and we're starting to do something where we carload. It helps to with recovery.

(17:01): It's something called enhanced recovery after surgery. And there's some things you can do beforehand to enhance your recovery after surgery, and one of those is carb bloating with Gatorade actually. So some hospitals may do that. Now, on the day of the C-section, you're going to be asked to arrive a couple hours in advance. You'll get an iv. You may be asked on that day to do special wipes. Again, if you didn't meet with the anesthesiologist before, you're going to meet with them that day or you'll meet with them again that day, they'll go over the risk of the anesthesia. Now, most often we want you to be awake during the surgery with spinal anesthesia because that's the safest anesthesia and we want you to be awake for the birth of your baby and it could be general anesthesia, that's unlikely. I'm going to talk about that in a moment.

(17:50): But most often they're going to talk to you about spinal anesthesia and I'll talk to you about what that's like in a moment. So once everything is ready, you've got the blood work, the iv, all of that's done. Oh, of course you'll meet the surgeon beforehand, like your doctor will come and talk to you. You'll also sign consent forms. You'll go back to the operating room and most of the time you're going to go by yourself initially into the operating room. Your partner doesn't come back with you until later. If your partner does come back with you, then usually they're asked to wait outside until the spinal is placed. Once the spinal is placed, and I'm going to talk about how that goes in just a second, then your partner will be able to come into the or and usually it is one person who can be in the OR with you, but sometimes it could be two, like if you have a doula, you can ask if your doula can come back too, but that really depends on the anesthesiologist.

(18:41): Now, once you get into the or, then you're going to get the spinal. The spinal is a single injection of medicine that's going to numb from a certain level of your spine down. It's different than an epidural. An epidural is a catheter that is placed in the epidural space and you can get a continuous infusion of medication through the epidural and at last during your labor. But for a C-section, a planned C-section, a spinal injection is appropriate. That single injection, it's going to last two or three hours to help you not feel the pain and it works really, really well. There's no reason to put that catheter in because we don't need to keep using it. So you're going to get a spinal for a planned a C-section, not an epidural. People get confused about these because they go in a similar space. There's both a needle in your back, but with the epidural, a catheter's left, whereas with the other one it's not.

(19:42): Now getting a spinal is not terribly painful. It's usually just a quick pinch to numb the area and it doesn't take too long. It may take longer if you have different anatomy, for example, if you have scoliosis and your spine curves, then it may take a bit longer to place a spinal. And also, I'm going to be honest, it may take a bit longer. If you carry extra weight, the anesthesiologist has to be able to feel the bones in your spine in order to know the right place to insert the needle. And if your anatomy is different or if there's a lot of extra fat tissue there, then it can be harder as you might imagine, to feel the bones. Then it can take quite a bit longer. Sometimes I've seen the spinal take 30 or 45 minutes with multiple attempts at it getting placed all.

(20:36): I'm not trying to offend anyone or upset anyone. I just want to convey a true picture of what can happen. That it really can be challenging because you have to be able to feel those bones in order to know that you're putting it in the right place. That's actually the same for an epidural. Okay? When an epidural is being placed, it can also take longer if you carry extra weight or if you have scoliosis or some issues with your spine, that can make it difficult to feel the bones. Okay? Now the rest of what I'm going to describe is what happens whether or not it's a planned cesarean or it's an unplanned cesarean, whether it's planned or unplanned, the rest of it is about the same. If it's unplanned and you already have an epidural, then what we do is you get a big dose of medication through that epidural and that's going to work during your surgery.

(21:29): Alright? If it's unplanned and you don't have an epidural, then you would get a spinal. Alright? So once you get into the OR whether it's planned and you have a spinal or it's unplanned and you have an epidural, then you get laid down on the operating table and this feels a little bit awkward because your arms are stretched out to the side. You're in a T position on the OR table and you'll start to feel the numbing medicine kick in where you know that your body's there but you can't really feel it and you can't really feel that things are happening down there. Your arms absolutely do not have to be strapped down. You just can't touch your belly because your belly's going to be washed with a surgical prep. But if they strap your arms down, ask to unstrap your arms, they really can be loose.

(22:16): There's no reason we used to strap people's arms down on the table. It's really unnecessary if you're awake to strap people's arms down. It's just not necessary. Okay? Now once you've laid down, the nurse will shave your pubic hair if there's any near where the incision will be made that actually decreases the risk of infection. And I want you to hear me. Don't do this ahead of time because oddly enough, it can actually increase the risk of infection if you've shaved within the few days before the hospital. So don't feel like, oh, I'm going to shave or I have to shave just in case in order if I have a C-section, it actually can increase your risk of infection. And let me be clear, we're actually not shaving. We actually clip, we actually clip. So it's clippers and not shaving. Clippers can help decrease the risk of infection.

(23:09): If we shave like with a razor, that can increase the risk of infection. So the nurse will use clippers in order to clip the pubic hair and get it out of the way for where the incision is. And it's going to be what's called a low transverse incision on the skin. Almost always, that's like the bikini cut. Now, in addition to clipping, the pubic hair will put a catheter in your bladder so that your bladder can be emptied during the surgery. The bladder sits right in front of the uterus, so we want it to be empty so that we don't accidentally hit it during the course of getting the baby out because they're very, very close together. And then something called sequential compression devices are put on your calves in order to prevent deep vein thrombosis. These are little cuffs that will squeeze your legs and they do it in a sequential way and it helps prevent blood clots.

(24:00): So you get those on and you'll keep those on until you're up and walking after surgery. Again, you will not feel most of this, you will not feel the clipping, you will not feel the catheter, you will not feel the STDs being put on. If you do, then that could be a sign that your spinal or your anesthesia isn't working. Alright? Now the nurses will then scrub your belly with the surgical soap that helps prevent infection. And once the soap is dry, typically that takes about three minutes. Then we put the surgical drape up. When they are washing your belly, you will feel it. It is hard to explain what it feels like, but you know something's happening, but it's just not painful. And for example, the scrub is actually cold, but you won't feel it as cold. You'll just know that something has happened.

(24:48): Okay, a couple more things that will happen is that you'll get an antibiotic or more than one through your IV to help prevent infection and there will be a timeout. When everyone stops, we confirm who you are, why you're having the surgery done, what surgery you're having done, if you have any allergies and that you receive the antibiotics. Okay? Time marts are really routine to make sure there are no mistakes. It's going to sound crazy because we're like, can you tell us your name and your date of birth? And you're like, do y'all not know my name and date of birth? But it's so that we can match it against your name band, make sure we have all of the things correct and labeled and that you can hear that we are saying the right things that are going to be done also. Okay? Now before we get the surgery started, we test to make sure your anesthesia is working.

(25:43): And we do that with something called an Alice clamp. And Alice Clamp is a surgical tool that has very sharp edges, very sharp. So if your anesthesia is not working well, it feels like a pinch. Ask me how I know because with my first C-section, my anesthesia was not working well, they did the alice clamp test and I could feel it as a pinch. They actually went ahead and continued with the surgery. It was quite traumatic for me. That's the story. You can hear my birth stories, but we test with the ALICE clamp to make sure that you don't feel it pinching. Now what we should say is, do you feel this pinching? Sometimes people clamp and they don't say anything. They're waiting for you to react. So if they pinch and you feel something and they're not saying anything, if it feels painful, you need to speak up and say That hurt, that pinched, that felt painful so that we know that your anesthesia is not working and it shouldn't feel painful. I can't reiterate that enough. You should not be experiencing pain during your C-section. You will feel touch and you will feel pressure. And sometimes it can be quite a bit of pressure, especially as the baby's being born, but it shouldn't feel painful. It should not feel painful.

(27:09): If it feels painful, then please, please speak up. Alright, please speak up. Now we'll say the alternative. If your spinal is not working then or your epidural is not working, then the alternative may be that you have to go to sleep for the surgery. If you have to go to sleep for the surgery and that's the best option for pain management, then that's the best option for pain management. We try to avoid that. But if it's not working, then you may need to go to sleep for the surgery.

(27:38): So who is in the room During the C-section, there's going to be at least two nurses. One is what's called the circulating nurse. She's there to grab extra things for me if I need it, count the instruments, count the sponges, make sure that everything is functioning well in the surgical team that we have the things that we need. And then there's going to be a second nurse who's there for the baby. All right? So when the baby's born, they'll be responsible for assessing the baby, taking care of the baby, getting the baby back over to mom. There will also be an anesthesiologist and or a certified registered nurse anesthetist. Oftentimes the anesthesiologist will start the case and if it's the hospital that works with CRNAs, that's a certified registered nurse anesthetist, then the anesthesiologist will leave and the CNA will continue or finish the case and they will stay with you throughout the duration of the case.

(28:36): Of course, the surgeon is there, no surgeon can operate alone. We need assistance. There's going to be someone standing across the table from me and I said me like I'm going to be the one there doing your C-section. I'm not most likely, but across from your surgeon there will be an assistant and then there will be a second person there or who hands the instruments to me or to the surgeon. And if there's a concern about your baby, then there may be a NICU team there. And that's generally going to be three people. It's going to be a neonatal nurse practitioner, a respiratory therapist, and a NICU nurse who are going to be there. Now in some places, that team is there for every single C-section, regardless if there's a concern or not. It really depends on the hospital, but I'm telling you all this to say that there may be quite a few people in the or, there may be quite a few people in the or.

(29:33): And that doesn't necessarily mean that anything is wrong, it's just that that's the people who need to be there in order to take care of all the things that need to be done. Now let me speak for a minute about what's called natural or family centered or gentle cesarian. This has started as an approach to improve the birth experience for people having uncomplicated cesarean births. And it's really trying to replicate as much as we can about a vaginal birth and make the cesarean birth more family friendly. And these are all fairly easy things to implement. Some hospitals implement this routinely at most cesarean births. For some hospitals you have to ask, okay, so some parts of a family centered or gentle cesarean. You can have music playing in the background. That can be music or should be music of your choice, music of your choice.

(30:36): We do that a lot in our hospital, whether the mom chooses it, if she doesn't have a particular choice and we have playlists and things going on, we can also dimm the lights if we can and do so safely. That's also a possibility just to make it not quite so bright. The OR lights, I will say are very bright. It's very hospital, but there are some options for dimming the lights in the room but still have the surgical lights so we can see. And then we just try to reduce extraneous noises, not so much chitchat and chatter, that kind of thing, just to make it a more calm and peaceful environment. Some hospitals will use clear drapes so that you can see the birth or so that we can pass the baby through the drape to you to do immediate skin to skin contact. Not all hospitals have those special, I should say most even don't have those special drapes for immediate skin to skin contact.

(31:33): But some may have a clear drape where you can see if you want to, where mom and dad can watch the birth or mom and partner can watch the birth that they want to. We definitely avoid using sedation so that you're awake. So anesthesiologists will avoid using sedation medications. They don't want you to be knocked out during the surgery so that you're awake. And then we also keep your hands free. You really don't have to be strapped down. As I said, you can keep your hands free so that you can hold the baby in the OR if need be. And then the final thing is we do skin-to-skin contact as soon as possible in the or. The nurse brings the baby over to do skin to skin contact in the or skin-to-skin contact in the OR can be a little bit awkward because you're laying there and it's just kind of awkward.

(32:25): I did see this really cool device where you can put it on before the surgery and we can wrap the baby in it to do skin to skin right away. I think it's called a kangaroo. I can't remember the name of it, but haven't seen it in most hospitals. So just know that skin to skin may be a little bit awkward in the OR and we can absolutely still do delayed cord clamping at the time of C-section that's recommended for at least 30 seconds. And we can also leave the cord long if dad wants to still trim the umbilical cord because dad cannot cut the umbilical cord in the surgical field because it's sterile. So we can leave the cord long and then dad can trim it. Alright,

(33:09): So definitely in the prenatal period, you should ask about what cesarean birth looks like in the hospital. You should have this as sort of a plan, your backup plan for if you have a cesarean birth, how things go that way you're prepared just in case. So you want to ask in the third trimester, can you have music? Not that you and you want to be clear, you don't want a cesarean, you just want to be prepared for the possibility. So can you have music playing if that's something that's important to you? Does the hospital have a clear drape? Do they do delayed cord clamping, skin to skin? Tell the surgeon you want to see your baby as soon as possible. Okay, that's a moment you definitely may remember. I so remember seeing both of my children the first time when the doctor held them up over the drape Sienna, my first one looked like a monster.

(34:06): She just looked like a monster. That's all I can. She's like a monster. And then the second one was very, very loud and she was so pale. Obviously I'm black, but I swear she looked like almost white and she had a head full of dark, dark, dark, dark black hair, jet black hair, which she still has. So those are moments that you will definitely remember. And then also ask who can be in the room with you? Especially if you plan to have a doula with you. Ask, can your doula come back during a C-section or how that works in the hospital? And then during the C-section after your baby's born and you haven't seen your baby for a minute or they haven't brought the baby over, don't be afraid to say, when will I see my baby? I'd like to see my baby as soon as possible.

(34:53): Or have your partner ask because sometimes they get caught up in like, oh, we got to wrap up the baby. Oh, we got to do this and that. And I don't think it's intentional that people don't bring the baby over. We just don't necessarily realize the importance of prioritizing and doing that as soon as possible. Now the C-section itself on a minimum takes about 30 minutes. That's a very quick straightforward. And then to an hour or longer, depending on if there's scar tissue, if there's bleeding that needs to be fixed, I would say plan for an hour about on average. Now, every now and again I have someone ask me how much longer is it going to take? How much longer is it going to take? And I have to be honest, that question really used to annoy me. It takes as long as it takes to close your body back up the right way and take my time and do so.

(35:49): I'm not dilly dallying, I'm like operating and you don't want me to rush it. But then I had somebody reach out to me and say that she asked that and it wasn't because she was wondering how long or what the surgeon was doing or that kind of thing. It was because she was so anxious about it and it helped her cope to be able to know how much more time it was going to take. So it wasn't that it was a problem or that she was worried, it was just that it was more, it helped her to understand what to anticipate. So that is something that I learned. It was actually a listener because this, I've done this episode before. This is an updated episode about cesarean birth and after she listened to it, she explained. So that helped me to understand. So you can tell your doctor, Hey, how much longer does it take?

(36:43): I just have a little anxiety and it just helps me to understand a little bit better what to expect if I know about how much longer it can take, that kind of thing. Okay, so let's talk about recovery. After the surgery is done, all of the drapes are removed. The nurses and the OR staff will move you to the bed. The surgeon we leave right when we're done with our part and then the nurses and the staff do the moving and that kind of thing. You won't be able to move yourself because your legs are still going to be numb. You'll go back to the recovery room. The recovery room may be a separate recovery area or it may be your labor room. It just depends on the hospital. And you'll stay there for about two hours afterwards that you're in recovery. We wait for the numbing medicine to wear off and your baby should be with you during that time. 1000% baby should absolutely be with you. And then after those couple of hours, you will be moved to a regular postpartum room. Okay, regular postpartum room.

(37:42): These days, more and more hospitals are doing enhanced recovery after surgery. I talked about a few things that are done beforehand and there's some things that are done afterwards in order to speed up recovery, make recovery a better experience for people. So some things that can happen or that happened with eras that should happen. You get along acting anesthetic medicine through your spinal or through your epidural. It's called dorm morph and it lasts for about 24 hours. So it helps for those first 24 hours with your pain control. We also can give IV Tylenol. We can give IV NSAIDs like IV versions of ibuprofen, which can help with pain relief. And then once you're on oral pain medication, we do scheduled ibuprofen and acetaminophen. That's Motrin and Tylenol so scheduled. So you should be getting those on anywhere from four to six to eight hours depending on the doses.

(38:44): But they should be scheduled, meaning that you get it whether or not you're hurting or not. For the first 48 hours, you get the scheduled ibuprofen and Tylenol and then narcotics if need be for the breakthrough pain. There's actually some synergy between Motrin and Tylenol that they work really well together. And when you do it on a schedule basis, it really helps with recovery. And then we limit the use of narcotics if needed so that it reduces the risk of addiction. It reduces the risk of you being sleepy. It reduces the amount in your breast milk. So of course we want to limit the use of narcotics. We also want to get you up and moving around as soon as possible. Generally within 12 hours afterwards you're going to get up. We start trying to disconnect you from things. By disconnect, I mean we remove the catheter, we remove the IV so that you're up and moving around because motion is going to help with the recovery.

(39:41): You can generally eat right away after surgery. You don't have to be on liquids or anything like that. You just use common sense. You're not going to scarf down a bunch of food, eat a little bit, try a little bit more, try a little bit more, but you can eat right away. And then depending on how your skin is closed, you may have sutures which don't need to come out. They just absorb on their own. You may have absorbable staples which absorb on their own or if you have metal staples, then they will be removed prior to you going home. Most people will have that low transverse incision both on the skin and on the uterus. That's the bikini cut. Again, you can't tell about the one on the uterus without asking, but most will have a bikini cut incision. You can shower pretty quickly afterwards.

(40:29): Once you're up and moving around, you can shower. And we really just want you to try to get back as close to your normal self as you can. Now, recovery for everyone really varies. Some people have a hard time recovering from C-section. I'll be honest, it can be challenging for some people to recover. Some people pop up and bounce back very quickly where they feel close to themselves. They're not needing narcotics after two or three days and they feel like themselves. It really is going to depend. I can't say that there's anything that necessarily predicts how you will recover. You're just going to have to see how it goes. And then when you're at home, you generally want to limit lifting to nothing that's any heavier than the baby for about six weeks as best you can. That can be hard. If you have other children, then you can ask the children to come and sit down with you.

(41:20): You don't necessarily pick them up, have other people pick up the kids for the first six weeks or so, but do the best you can with that. And then you can drive. When you can turn and look over your shoulder comfortably, you can slam on the brakes in an emergency and when you're off of narcotic medicine. Okay, so that's what to expect for recovery after a C-section. And that is it for the episode on cesarean birth. So just to recap, the reasons for a cesarean. A planned cesarean may be that elective repeat cesarean, a forced elective, repeat cesarean breach, birth multiples, an indicated repeat, whether you have a prior classical cesarean, a prior uterine rupture, history of fibroids being removed, placenta previa or that elective primary C-section. And those can happen anywhere. Most of the time it's going to be around 39 to 40 weeks, but they can happen a little bit earlier.

(42:15): Ask for the procedure itself. Definitely ask during the prenatal period about how cesarean is approached at that hospital and things that you want that may be important to you, like music, who can be there, do they have a clear drape? Those kinds of things. The recovery is going to vary once you have a C-section. Most women do absolutely fine. I think a lot of folks worry about the recovery, but most people do absolutely fine. After cesarean birth, I anticipate that it shouldn't be too difficult to recover. And then one other thing I didn't talk about is things to look out for once you get home. I actually have a free one page guide called warning Signs to look out for after birth. And this is actually for vaginal and cesarean section. So if you look at drnicolerankins.com/warningsigns , then you can grab just that one page document.

(43:08): It's important for you to know some of the things to be on the lookout for. And of course the hospital will tell you things to be on the lookout for as well. After discharge, you'll get discharge instructions and all that. Good, great stuff. Alright, so there you have it. Do me a solid share. This podcast with a friend sharing is caring. It helps me to reach and serve more people. And also if you listen to this or after you listened to this and you had a planned cesarean birth, then go ahead and submit your birth story. I would love to hear some birth stories of planned cesarean birth so people can hear what that is like. You can submit your birth story drnicolerankins.com/birthstory and also subscribe to the podcast wherever you're listening to me right now, whether that's Apple Podcast or elsewhere. Be sure to leave me a review, an Apple podcast. I read all those. I read them out on the show sometimes. So do that for me as well. And last thing, come follow me on Instagram. You can get great information there. That's a great place for us to connect outside of the show. I'm on Instagram @Drnicolerankins. Okay, so that's it for this episode. Do come on back next week and remember that you deserve a beautiful pregnancy and birth.