Ep. 96 - Tips for a Gentle Cesarean Birth with Debra Pascali-Bonaro

Debra Pascali-Bonaro: I always say that every birth can have an orgasmic nature. I know that many of you ask, but what about when birth takes a different path than what we envisioned? I know that some births do need and benefit from technology support, and a cesarean birth can be life saving for a mother or a baby. I do believe it’s important to prepare to bring love and pleasure to whatever birth asks of you, and that’s why I encourage my clients to write their preferences ahead for a Positive Cesarean Birth. Preparing ahead is important as birth trauma often happens when the unexpected happens, and your voice and choice is not heard or honored. So having a list of preferences to discuss with your care team ahead to ensure that whatever birth requires, you’re ready to include your desires, wishes, and that they can honor your voice and choice so that you can give birth with love and simple pleasures in any situation in any setting. I know that we can ensure that every birth is powerful and joyful. So I hope you can take time as you listen today to write down your own gentle Cesarean birth preferences. And if you’d like more support, I offer my pleasurable birth essentials online childbirth class, and go at your own virtual course. But I also have a class on positively preparing for a cesarean birth or a VBAC, a Vaginal Birth After Cesarean, and you can find all of these on orgasmicbirth.com. For parents, if you go to the homepage, you’ll see a tab for parents or one for doulas. 

Hi, I’m Debra Pascali-Bonaro, Founder and Director of Orgasmic Birth, and host of the Orgasmic Birth Podcast. And today, I want to talk about all things of how to have a gentle pleasurable cesarean birth. So number one, and I have several tips for you. One is to prepare for any birth with pleasure practice. You’ve heard me say this again and again in past episodes. But during pregnancy, make sure you have three to five pleasures a day. And then out of your list, which I hope eventually that you have 20, 30, 40 things on it and you break it into simple pleasures, one to three minutes, maybe 5 to 10 minutes once. And of course, we all love when we have the time, those longer expansive pleasures. But find two to three that you could bring with you, even if you needed a cesarean birth. So an example is partners, some words of love, together singing a special song. From the time that you begin to have a cesarean birth, it’s often only six or seven minutes to a baby’s birth, and how beautiful it is. And it transforms the whole feeling in the room. When you sing your baby a song of welcome, kisses, touch prayer, affirmations, visualization, there are so many ways you can stay in love versus fear as you prepare for your birth. 

Tip two is sensuality. I say this for every birth. It’s really important what you hear, smell, taste, touch, feel. And so even if necessary and you can feel in your head, your shoulders, your arm, a gentle reassuring touch can really make a difference. Anything above the sterile field. Playing music, what you hear if you’re in a room that’s literally cold and bright, and we can’t change that because we want everyone to see well. Music can really shift it. So asking for your playlist, as I said, singing your baby into the world. Or if you don’t want to sing, put on your favorite song that you’d like to welcome your baby to, and you’ll always know the song that they were born to. So it’s really important to think about how you can change anything in the room, and some of that is smell. If you’ve ever been in a hospital room, it really has that sterile smell. And if you’ve been laboring and you’ve brought whatever your favorite aroma is, I often am with people, and it’s lavender, jasmine Yang Ling, camomile, you can’t bring a diffuser because of sterile things. But for partners that are wearing masks, you can put a drop of your favorite scent. It’s my favorite doula tip, and it really served me during the pandemic. I always put a drop of essential oil before I put a mask on so I’m staying in my comfort and peace. For those of you that are birthing, you don’t always wear a mask. But depending on skin sensitivity, sometimes you can put a drop of an oil that’s blended in a base. Your favorite cream, or lotion, or oil and dab it here. So that’s what you smell. But if that’s too much for your skin, sometimes dualism partners, I’ll put it on my wrist and then I can keep kind of moving it by. So think about your senses. Think about sensuality? How can you keep every sense in calm comfort and love? 

My next tip is to ask for clear drapes. Part of a gentle cesarean is being able to see your baby come into the world. So many cesareans have a sterile drape up. I hear from so many people that not seeing their baby’s birth is part of a real disconnect from them. So we are seeing that just a simple ask, lower the drape when the baby’s about to be born. This can really make a difference. I have to say Lonnie Morris, my midwife, and she also caught my grandchildren. I love it that when that baby’s about to be born, she always says to that mom, push your baby out. And even though you’re completely numb, hearing those words, having everyone in the room pause and honor your baby, your birth, I always have tears. It kind of brings us all into no matter how birth happens, it’s sacred. 

Number four, have your hands free. Amazing that this has existed around the world too often. They tie that person’s hands down, and it was this thought that they don’t want you moving your hands into the sterile field. But I think how silly I think everyone understands sterility for your own health and well being for your babies so you can lay your hands out, have people hold your hands. But having free hands is going to be important for many people. If you are a survivor of different traumas, sometimes that can trigger it and lead to a really traumatic experience rather than a joyful birth. So be clear with your providers ahead of time. How you feel about that even one hand that’s free. So as soon as your baby’s born, it can be placed skin to skin. 

Number five is delayed cord clamping and cutting. And we are seeing this done more. We know that just one to three minutes of allowing the blood to settle between baby and placenta, it’s their blood in the cord. It’s not kind of neutral blood. And if that cord is cut too quickly, babies can lose up to a third of their blood volume. And so there’s no different technique or risk to anyone to just slow it down. Have them hold the baby. Again, the drape down or clear drape so you can be already singing, talking, really interacting with your baby, but making sure that they get all of their blood with that delayed cord clamping and cutting. Next, you could invite your partner to cut the cord. Some providers let the partners come down and do that. But what other people do is the providers cut the cord super low so when the baby comes up, and now they put the drapes up to do the repair. You and your partner, or whoever you designate is there with you, your baby’s skin to skin, and you can re-cut the cord as a part of the ceremony that you anticipated doing. 

Number seven, skin to skin. The research we have demonstrates that both immediate and very early skin to skin care after a cesarean is safe and beneficial, including skin tone, skincare that started in the operating room. So for parents that are interested in any form of breastfeeding, body feeding from nursing to pumping skin to skin care after a cesarean birth can help support that plan. And so definitely visit evidencebasebirth.com. It has a really good article on skin to skin care after a cesarean. Really important no matter how you’re feeding. Babies born by cesarean don’t pass through to get all the microbiome, the flora, the bacteria through the vagina that helps them to colonize their own immune system, their own gut microbiome. Skin to skin is really important, so much better. They get your microbiome skin to skin, and get put over on a hospital incubator as their first flora that they’re in contact with. And all care can be done right on you. 

Number eight, support, support, support. A doula can be there to support you for both your birth and in the days and weeks postpartum. And even for people that for whatever reason know that they’re planning a cesarean, having extra support for any birth is really important. I’m really proud here in New Jersey, doulas are really part of the team. We were essential workers during the pandemic. And just recently, there is a bill that has passed that states that every facility must post in every room, there is a doula policy that doulas are accepted and welcome. There needs to be a liaison at every hospital that interfaces between patients and doulas for any concerns, or hopefully joys that come up that want to be shared. And we’re really looking at ways of ensuring that a doula is a part of the team if you invite them in. And that means to invite them no matter what birth, as many doulas, myself included, are often there in the or along with partners and every family member not taking their place. But you deserve support in whatever you choose, or are asked to give birth for safety. 

My next tip is love adding love and connection talking to your baby. When you think about it as if you’ve been in labor, still the babies working their way down, they are active participants. We know that babies are doing certain reflexes by dropping their shoulders. You can feel them wiggling into place, their hormones that baby and birthing parents are producing. There’s so much happening. And so when all of a sudden they’re going to be born in six minutes, it can be a little bit of a shock. Especially if it’s a non labor, that there is a reason. I have a guest coming on in a couple of weeks. Stay tuned, Nicole is going to share her story of planning a cesarean knowing that, how she’s integrating all these choices, talking to her care team and preparing for it. So definitely, you want to really have, how are you going to explain to your baby that you’re about to be born in a little bit. Think about yourself. Don’t you like to know what’s coming, especially if there’s going to be a very abrupt change from one environment to the other? So when I say adding love, it’s not only love between you and the baby, you and a partner, partner and you, partner and baby, whoever is there. But definitely, making sure that you’re really including your baby in the conversation. They are listening. They’re hearing. They are feeling. And it’s their birth as well. 

My next one is delayed newborn interventions. Vitamin K, and erythromycin, all these things can be delayed until after first feeding or up to two hours. So often people are in a rush as soon as the baby’s born. They go over to that isolette, they get goop in their eyes, they get a shot. They’re just being welcomed to the world and happened a little more abruptly than they might have been ready, and we can take the time to just slow it down. Give them those cuddles, give them skin to skin, give them time to nozzle the breast and to feed. And we still can get it to them in a safe way at the end of the end of those two hours. Next, if any additional care is needed. Let it be done skin to skin, or at least right next to you so you can be talking. The baby can hear your voice. You can see them. Your voice is so important. Newborns will always turn to their mother’s voice before strangers. They’re really listening to it. They’ve heard you inside this bag of water for nine months, and so they want to turn and hear you. And as parents, you want to see your baby. You don’t want to know that they need extra care, and they’re out of sight and you don’t know what’s happening. So you always can request that care is either done right on you, which is you’re the best incubator. We know that your body will help the baby to come to their right temperature. The birthing body will raise up to two degrees to warm a baby, or one degree down to cool a baby. 

Plus the benefits of skin to skin, I mentioned microbiome, but there’s also hormones. Babies that are separated to have a response called protest. And if they protest for a law, that’s crying, they go into despair, they’re too tired to carry on. Babies in protest. Despair has very elevated stress hormones, which actually lowers their body temperature, it can make their heart and breathing rates more irregular. Skin to skin stabilizes them, keeps them in oxytocin. The love hormone regulates their temperature, helps regulate their breathing and heart. So even if there is extra care, the best place to do it is right on that birthing chest. 

My next thing is all about after the birth. So that’s postpartum reflection. I think it’s really important if birth takes a different path. And whatever birth asks of you, we never know what birth will be like for any birth that you take time to really process it both for yourself and also with your care team. I know as doulas, we call it processing the birth experience. We always do that with our clients after to really say, how was this? How was it different from what you expected? Were there things that supported you? Were there things that didn’t that you wished were different? All of healing is feeling, and that means on every level. So we used to just say, safely give birth. Safety is important, but we now know that it must be safe emotionally too. I mentioned birth trauma, and too many people that have been more medicalized including cesarean birth often have more trauma, and that can also lead to increased levels of postpartum, mood and anxiety disorders. 

But if you follow these steps, if you really talk to your team ahead of time so that they hear if this should happen, what do you want? What are the things that you can still bring in to have more love, joy, connection and birth? How can your voice and choice be honored? And then after to take this time to reflect, how did that go? I know as a postpartum doula, I also even say to people when the time is right to create a healing ceremony, recreate the birth that you wished. I’ve had people when they felt ready and were cleared by a medical team who maybe wanted a water birth or just felt like this would be a good place to recreate. They’ve taken a warm bath, and then they put candles on the music, their favorite aromatherapy, everything that they had prepared to welcome their baby. And first, that mother gets in the tub. And next, the baby is handed in by maybe a partner, a doula or a friend. And that mother, that birthing person shares the story of what she desired with her baby. Explains why, what happened differently, and invites the baby to share their feelings, and invites them now. You can kind of put the baby a little bit lower. Of course, make sure the water level is keeping the baby’s head out of the water, and invite them to kind of crawl, let’s mimic that minute or two before birth that we would have had where you also would move and ease your way into the world. 

Some of you may know this, it’s called the breast crawl where babies literally crawl, bob and find the nipple on their own. And so this kind of acknowledgment, I’ve seen babies when you say to them, how was it for you? And this was different than I was expecting, and I want to just take this time to honor your feelings and my feelings to little newborns, a few weeks old. Just look and you can see them start to make sounds. They truly are acknowledging they too want to be seen and heard. So I’ve seen it as an incredibly beautiful ceremony to just say, this is what birth was. Let’s really process it together. These can be magical moments for you all to release and heal any birth challenges that came up. Now, this certainly doesn’t replace any professional help that can be beneficial if you do feel your birth was traumatic, but it is something that might be part of a healing ceremony that I’ve seen really be a beautiful ceremony for many families that I’ve supported. I truly hope that you will take time. I hope this spurred you to think about if cesarean birth were needed. 

What would be my preferences? I would encourage you to write it in the positive, like any birth preferences, have it just be one page, short and simple, bullet your points out that you’d like, and make sure you call ahead to your next visit. As it comes closer to your birth to a visit, ask the manager of the office to schedule you for an extra 5 or 10 minutes so your providers are not rushed, and let them know you’d like to discuss what birth requires any additional assistance and become a cesarean. You’d like to go over your cesarean preferences with them. And this is really key to helping your provider know what you desire. And also finding out is your provider doing gentle cesareans. And if not, you might be planting that seed. There are so many wonderful videos. Google them online. I’ll add one or two to the show notes of Beautiful Gentle Cesarean Births that you might take a look at, maybe even offer you more tips and points that you want to include. 

I also would encourage you, and I’ve mentioned this in other podcasts, to know your provider’s rate of cesarean birth because that’s yours. So if you do have a provider that says their rate is 30, 40, 50%, then having this plan in place is super important. I work with a lot of clients birthing at home or in a birth center where often their kind of the practice rate of cesarean birth is less than 5%. I still say it’s worth doing it. Put it away, you know you have it. Of course, we all hope we don’t need it. But when we do need it, as I said, it can be life saving. So having it there so that every birth can be positive and pleasurable. And as I hope you did listening to an earlier podcast, writing your definition of orgasmic birth can encompass all of this in any setting in any situation. So thank you for taking time today to let me share with you how to create a positive preference for a gentle cesarean birth.

And truly, stay tuned and look forward to Nicole’s Podcast coming in. I think in two or three weeks she is going to share with you her own planning. Nicole is another doula trainer. She is someone that I’ve really worked with over the years, and you’ll understand how her path is taking her to planning a gentle positive cesarean birth. 

So wishing you a good day, please tag me with your favorite takeaway. I really appreciate you taking time to rate and review our podcast. It truly helps us reach more people so that more people are hearing how they can positively prepare for a pleasurable orgasmic birth. Thank you.