Advocate

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Surgical Birth (C-Section)

Posted by matt on June 4, 2014
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(This post is lightly edited from the “Surgical Birth – C-Section” chapter of the Field Guide to Being an Awesome Birth Partner.)

According to the Centers for Disease Control and Prevention, almost 33% of the births in the U.S. in 2012 were c-section deliveries.  You may not ever experience being a birth partner through a c-section delivery, but you should be prepared for the possibility.

A c-section is major abdominal surgery.  The doctor makes an incision in the mother’s abdomen and pulls the baby out through the incision.  Typically, the mother is awake during the procedure, with only regional anesthesia to block pain sensation.  Occasionally, general anesthesia (the “knock you out” kind) may be used for specific reasons.

To review:  in a c-section, a doctor will cut open your wife’s (or girlfriends, or…) belly, and pull out a baby while she is awake.

Usually, you will be able to stay with her during a c-section.  In some emergency situations, it might not be possible.  But usually, you will be allowed to dress in scrubs and take a seat by her head.  The surgical team will place a screen around the mother’s belly for two reasons:  to avoid infection and to keep the “audience” (you and her) from seeing too much of the cutting.

During this whole process, the mother  may need extra support and reassurance.  All her feelings of control over teh process are gone.  If the c-section is due to a problem with labor (maybe dilation stalled too early), she may have feelings of failure or inadequacy.  She might be tired.  So just like the pushing stage of labor, you need to be the voice she listens to and her encourager.  Tell her how well she did, or how close she is to holding her baby, or how much you love her, or how proud you are of her, or any other encouraging, loving words you can to help her.

In between all those words of reassurance, encouragement, and love, make sure to distract her.  Talk about something that interests her and that will draw her into a conversation.  As soon as you find out a c-section will be necessary, start thinking of distracting topics.  The anesthesia will keep her from feeling pain, but she will still be able to feel pushing, prodding, tugging, and other sensations inside her belly.  The distractions might be necessary to keep her from fixating on what is happening or freaking out.

As you support, encourage, and distract the mother, make sure to observe how she’s doing.  If something seems wrong, bring it to the attention of the medical staff.  If it seems like she is emotionally losing control, physically having trouble, becoming unusually anxious, etc, make sure the medical staff knows.  This is part of being her advocate.

Depending on the circumstances, the surgical team may lower the screen so you can witness the moment of birth.  While the obstetrician delivers the placenta and begins stitching (and/or stapling) the incision (the closing-up process can take quite a while, as there are several layers that need closing), another member of the medical staff will examine your baby.  If you can, take a couple of pictures of your new baby and show them to Baby’s mom while the examination is still going on.  If everything is okay with Baby, the medical staff will hand the baby to you–not to the mother.  Hold Baby close to mom.  She’ll want to see, kiss, and touch Baby, even if she’s not allowed to hold him/her yet.

Now, if there’s something that concerns the medical staff, Baby may need extra attention.  If that happens, someone will tell you what is happening.  If the baby needs to leave the operating room and it is possible for you to go with, quickly ask your wife (girlfriend, etc) whether she would prefer for you to stay with her or with your baby, then decide–very quickly–what you will do.

After everything surgical is finished, the recovery process will begin.  The medical staff will keep a close eye on the mother for a few hours.  At some point, they will give the okay for her to hold Baby and to try breastfeeding.  The timelines depend on how mother and baby are doing–feel free to ask the medical staff, once any emergency situations have passed.

After a c-section, which as a reminder is major abdominal surgery, your wife (girlfriend, etc) will have some serious restrictions on physical activity.  Your task will be to do the things that she can’t, cheerfully and lovingly.  If you do your task well, with a good attitude, it will help your relationship with both your baby and your wife (or girlfriend, but at this point, you get the idea).

Being an “Advocate”

Posted by matt on March 12, 2014
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One of your roles as a birth partner is to act as an “advocate”.  That’s not a common word these days, so it’s natural to have questions about what an advocate should do.

An advocate is a person that promotes the best interests of another.  Simply put, as an advocate, you promote someone else’s best interests and do what you can to help them through their situation.

That’s pretty abstract, so let’s get a bit more specific.  In the birthing room, there’s a woman busy trying to have a baby.  That’s generally considered a difficult task that can take some effort.  So she would benefit from not having to deal with extra details.

Think of it like she’s a professional athlete, and you’re her agent.  Her job is to play her sport.  She doesn’t need to worry about the details of negotiating a new contract, or calling UnderArmour back about that endorsement deal, or arranging plane tickets to get to that charity event.  That’s your job.  You take care of those details so she can do her job better.

And now, back to the birthing room.  You can be a good advocate or a bad advocate.  I’m going to suggest being a good advocate.  That means understanding what she needs (asking can be helpful), making things that you can make happen happen (say, getting her a drink of water), and making sure her concerns and needs are addressed by the medical staff (“excuse me, nurse, she says something doesn’t feel right”).

Remember that your interactions with the medical staff can have a big impact on the tone in the birthing room.  Be assertive.  That means making sure your (her) concerns are heard and understood, without being aggressive or a jerk.

You’re looking out for her best interests.  That means making sure she’s taken care of, and it also means that her entire support team (you, the medical staff, anyone else in the birthing room with you, people texting or Facebooking) is doing their best to make sure her needs are met and to act supportively.

[There is more about being an advocate, including scripts for being a good (or bad) advocate through requesting a replacement nurse, in the Field Guide to Being an Awesome Birth Partner.]