Options for a More Reverent Cesarean Birth
- Mary Haseltine
- Aug 5
- 14 min read
For some mothers, a cesarean birth becomes the preferred or a truly necessary choice for the best outcome for mother or baby. Understanding the possible options for a cesarean birth is important for the mother in this situation to feel as empowered as possible and create a personalized, dignified experience for both her and her baby. As Catholics we want to honor God's design for our physiology by recognizing what may be lost during a cesarean birth and restore what we are able to the best of our capability.
We know that the vast majority of cesarean births are iatrogenic (caused by medical interventions or errors), completely unnecessary, or the result of deskilling of medical professionals (as in breech). There are very important reasons one would want to avoid a cesarean birth and our goal as a Church must be to first unapologetically reduce the number of these unnecessary cesareans and better work toward physiological birth whenever possible. But we also absolutely recognize that for a small percentage of women, cesarean birth is absolutely medically indicated and in the best interest of mother or baby.
Regardless of the reason or necessity of the cesarean, every mother and baby deserve to have all possible options available to them during the sacred and pivotal moments of birth. The dignity of both demands that we do what we can to make the experience as personal, safe, and reverent as possible. We believe it is the duty of every hospital and provider to offer these to them and in the best interest of both for the mother to be as fully informed as possible going into surgery as to what the surgery entails as well as her options for it.
While the options we are going to discuss are possible, it's imperative that parents know that the vast majority of providers and hospitals are not going to intentionally offer these as the default or protocol. It is up to the mother and father to know about them and request or demand them. Sadly, we know that the medical system can often take years (or decades!) to recognize the validity of childbirth options or institute changes in policy, especially those that don't generate profit, are not as efficient, or that take effort to change. We also know that policies and protocols vary from OB to OB, hospital to hospital, anesthesiologist to anesthesiologist, and so on. One hospital may have absolutely no issue with a doula in the OR and baby immediately skin-to-skin, while another may deem it "impossible".
This means that these options may or may not be presented to you but that doesn't mean you don't have the right to them. It may just require significant effort, advocacy, and discomfort to push for them if they are important to you.
Types of Cesarean Births
Of important note, too, is that the circumstances surrounding a cesarean birth will inform what options are possible. A planned cesarean will have different options to a truly unplanned, emergency cesarean, though there is often much overlap. Knowing the different types of cesarean births can help you make informed choices should the need arise.
Planned Cesarean: This is when the mother knows that she will be opting for a cesarean birth. Situations like complete placenta previa, placenta accreta, conjoined twins, and others will require a known, planned cesarean for the best outcome.
Unplanned Cesarean: This occurs when a situation occurs during labor where the choice is made to proceed with a cesarean instead of a vaginal birth. The unplanned cesarean can fall into different categories - true emergency, urgent, or non-emergent but indicated by the situation at hand. There is a spectrum of how urgent an unplanned cesarean needs to be. With some you may have plenty of time to make decisions but with a truly emergency situation, you may have only minutes.
Considerations for a Cesarean Birth:
Anesthesia Options:
Discuss different types of anesthesia with your provider during pregnancy or at the time of the cesarean. Regional anesthesia under the form of an epidural or spinal block is the most common and usually the safest choice. This allows the mother to stay awake for the birth and has significantly less risk for mother and baby. However, in the case of a truly emergency cesarean where there is no time to place an epidural or spinal block or there are contraindications for either, general anesthesia may be required. This makes the woman completely unconscious for the birth. It's important to note that most hospitals will NOT allow even the father in the room for a surgery under general anesthesia. General anesthesia also travels much more quickly to the baby and can compromise their breathing instincts at birth, the biggest reason to avoid this whenever possible. It also means immediate skin-to-skin with mother is impossible and that the mother will not be awake for a while after surgery.
Allowing Labor to Begin Physiologically:
In most cases, even with a planned cesarean, it is safe and ideal to wait until natural labor has begun for the baby to be born. Induction or a pre-labor planned cesarean both mean that baby is being born before mother's and baby's bodies have initiated labor themselves. A baby who would have naturally been born at 41 or 42 weeks who is taken out at 38 or 39 is being born far earlier than they would have been and that may mean they are just not ready and may struggle. This can lead to a cascade of intervention and trauma for both baby and mother - breathing issues, NICU stay, separation, infection risk, blood sugar dysregulation, breastfeeding impossibility or challenges, and more.
It can be a tremendous advantage physiologically, far more comforting to mother and baby, as well as honoring of the physiological design of God to know that God and baby have chosen the birth date rather than the OB or hospital schedule. While there are some cases where even early labor is not in the best interest of mother or baby, the vast majority of the time it is reasonable and safe to wait until the mother's body is at least giving some signs of labor being imminent or even starting. How far labor progresses before going to the operating room is subject to the individual circumstances.
Birth Environment:
Think about the atmosphere you'd like during a cesarean. Some hospitals may accommodate preferences for playing your own music or even for dim lighting. Creating a comfortable environment can ease your stress during the procedure. If they don't have the ability to play music or audio tracks in the OR, you can bring your own phone in to play next to you. You can bring in essential oils on a washcloth or something else your husband or doula holds to stabilize you and make the environment feel a bit less sterile. It's okay and reasonable to ask that there be no unnecessary conversation in the room amongst staff (MANY are the stories of women hearing the staff talk about banal topics like football games or lunch plans while their baby is literally being born!). If the gender is a surprise, you can insist that you or your husband are the ones to first see and announce the baby's gender. If you have an important sacramental or sentimental object like a rosary or scapular, you can still hold or wear it during surgery.
Prayer:
This could be considered part of "environment" but we consider it important enough to have its own point. Both the process of deciding a cesarean and the cesarean itself can happen with deep prayer and saturated in God's grace. This should be respected by the staff present (and perhaps they can even be invited into it). This environment of prayer may be through spontaneous prayer from you, your husband, or doula or it may be through the Rosary, sacramentals, audio tracks, worship music, or otherwise. This birth can be an opportunity for union with God through an act of the will and these offerings of prayer. In the surgery itself, audio tracks can be played, chant or worship music streamed, Scripture verses read, intentions prayed for, the Rosary or simply Hail Marys offered, etc.
Clear Drape or No Drape:
A vertical drape between the abdomen and head, usually placed right at chest level, is pretty standard for most cesareans, said to "protect the sterile field" of the incision site. However, some hospitals now provide clear drapes (rather than the typical opaque blue) so that a mother who desires it can see her baby immediately as he or she is born and not feel as disconnected from the process. As she is laying flat for surgery, it is still difficult for her to see the actual surgical process but at the very least she is able to see when the baby is lifted out and a bit more of what is happening. Some more progressive doctors are willing to eliminate the drape all together or immediately drop it when baby is born so that the baby can be assisted by mom or immediately given to her.
Arms Free:
A traditional cesarean involves strapping the mother's outstretched arms down in a "T" or cruciform shape. While stunningly symbolic, in most cases this is not necessary and the feeling of being strapped down is incredibly traumatic and if not necessary or desired, could even be considered abusive. More and more OBs and hospitals are recognizing it is completely safe to have the mother's arms free for her own sake but also to facilitate skin to skin after birth. Again, this may not be presented as an option but in most cases, it is absolutely reasonable and possible.
Support During the Surgery:
At most hospitals it is now standard practice to have the husband (or one other support person) present in the operating room, save for when the mother is under general anesthesia. However, many hospitals now permit a doula to also accompany the mother into surgery (meaning two support people). While this is possible at nearly every hospital, many are still balking at the idea making excuses regarding space or deferring to the anesthesiologist. (In our area, none of the hospitals allow that extra doula support but in the city near us, it is welcome and normal!) Having a calming, knowledgeable, faithful doula right at your ear can completely shift the experience. She can explain what is going on (if desired), offer prayers, help you feel safer or talk you through fear, provide essential oils to smell, take pictures, advocate for your preferences, and more.
Photographs:
You should have the option for your husband or doula to take photographs or even video during the cesarean. Again, this will vary greatly from hospital to hospital. Many forbid it due to liability concerns while others openly welcome it. If this is important to you, it is worth advocating for.
Prophylactic Antibiotics:
It is standard practice to administer strong antibiotics via IV to prevent infection due to the surgery. There are benefits and risks to all antibiotics and you have the right to know which they recommend and usually use, decide which one you are comfortable with receiving, or decline altogether.
Type of Suturing/Incision Closure:
Double layer suturing of the womb is usually standard practice at this point but it is worth making sure that is what the OB will be utilizing to ensure a stronger incision site and healing for its own sake but also very important for the health of future babies and births. This is especially important if you are hoping for a future VBAC. For the final closure of the outer layer of skin, OBs will use sutures (stitches) or staples. Sutures will usually fall out on their own some time post surgery while staples usually require an extra trip to the doctor's office to be removed by the OB. It will depend on the OB's personal skill and custom what they will do by default but it is absolutely your right to ask and talk with them about the differences and reasons for using one or the other and which you would prefer.
"Mother-Led" Cesarean:
Some very rare OBs are now offering what has been coined "mother-led" or "maternal assisted" cesarean where the mother takes an active role in the actual surgery, drawing the baby (with the help of the OB) from the womb right to their chest. You can see examples of this and more information at the links below:
Optimal Cord Clamping:
Every baby deserves to receive all their blood and we talk extensively about the benefits and the baby's right to optimal cord clamping. The baby should receive all his or her blood before the cord is clamped and separated. You can read more about this here. This is absolutely still possible with a cesarean as well. The problem is that it takes more time and a tiny bit more effort for the OB and staff to have patience for the few minutes it usually takes for this to happen. Many OBs (and midwives) will state they practice "delayed" cord clamping but for most, it only means leaving the cord for 30 seconds to a minute, which can hardly be called delayed or optimal. Rather than an arbitrary number, we want the cord to be completely white, limp, and empty, which means the baby got everything they were supposed to have, and the amount of time that takes can vary from baby to baby. In the case of a baby that needs more help with breathing at birth and who has already been physiologically compromised due to cesarean birth, this optimal cord clamping is ESPECIALLY important. In our experience, this is something you will likely have to FIGHT for and be alert to remember at the moment of birth, but it is worth ruffling feathers and feeling uncomfortable for the longterm benefits to your child. There does not need to be a rush to clamp the cord after the baby is born but it will usually take a husband or the mother herself saying a vehement "no" or "I do not consent" at the time of birth to ensure that the cord is not clamped prematurely.
Immediate Skin-to-Skin with Your Baby:
Many mothers want immediate skin-to-skin contact with their newborn after surgery. It's essential to ask your healthcare team whether this is feasible and how they can facilitate these important moments. In most cases, it is possible to place your baby directly on your bare chest right from the womb, though it means that the staff has to be completely supportive and on board to help that. We know without doubt that this practice of skin-to-skin in the hours and days post-birth can enhance emotional connection, stabilize baby, promote breastfeeding, and reduce trauma.
Vaginal Seeding:
Vaginal seeding seeks to mimic the very important microbial transfer and colonization, AKA "seeding", that babies are supposed to receive in the birth canal. This is the foundation to their future microbiome which influences every process of the body and their lifelong health. The process takes fluids from the vagina and, using a swab or cloth, rubs them onto the face, mouth, and entire body. This option would be contraindicated in the case of a known maternal infection (either acute or known sexually transmitted infection) or heavy GBS colonization.
You can read more about this important option HERE.
No Bathing or Wiping of Baby:
This is important no matter the type of birth but you can decide and clearly state that you do not want the baby wiped or bathed immediately or at all. Not only does it delay the mother receiving the baby, but the vernix on their skin is protective and important to their microbiome health. Bathing also lowers the temperature of babies and even raises their risk of infection. It can also interfere with the mother's olfactory response to the baby that helps with oxytocin release, bonding, breastfeeding, controlling bleeding, and more
Immediate Postoperative Care
Inquire about the hospital's policies on postoperative care related to pain management, mobility, and recovery time. Knowing what to expect can significantly improve your overall experience and healing process. You should have options for different pain medications. You should still have access to robust breastfeeding support. You should receive detailed instructions for healing and signs of complications.
Leaving the Hospital:
Most hospitals have the mother and baby stay 3-4 days after a cesarean for healing and observation. However, you can leave whenever you feel ready, whether or not it is standard practice. Contrary to popular belief, you don't need permission to leave the hospital, nor do you even need to sign anything "AMA" (against medical advice). Those papers are for the hospital's protection, not necessarily yours. Staying at the hospital may be important for healing for many but many mothers find much more rest, better nutrition and support, and therefore more healing, at home in their own bed. While an adult has the right to leave the hospital whenever they want to, the hospital must clear the baby to leave with mom or she risks a report of medical neglect to CPS. If you'd like to leave the hospital earlier than is standard, you can push to have the baby cleared to go and push for discharge asap.
Preparing for Recovery
Preparing for recovery after a C-section is vital. Although every woman’s healing journey is unique, consider these tips:
Learn about cesarean recovery: Many women will need significant help managing pain, lifting their baby, breastfeeding, diaper changes, and basic needs like using the toilet or getting up out of bed for the first few days after surgery. Often this is NOT provided by the hospital, at least in a timely manner, and it is imperative you have your husband or someone with you throughout your stay. It will usually take a few weeks to be capable of safely lifting anything heavier than your baby or driving. Be sure you understand how to assess the health of your incision and how to care for it in the weeks following surgery, keeping it clean and dry.
Build a support network: Surround yourself with friends, family, or postpartum doulas who can assist you during recovery. This support can make a world of difference in ensuring you have the help you need.
Scar Massage: Once the incision site is healed enough, consider learning and utilizing scar massage to help keep the cesarean scar, both interior and exterior, as flexible and elastic as possible, reducing the amount of scar tissue as much as possible. You can learn more about scar massage techniques here.
Pelvic Floor Therapy: Pelvic floor therapy is NOT just for vaginal birth. The pregnancy itself and the cesarean surgery can greatly compromise the pelvic floor and lead to issues like incontinence, sexual dysfunction, hip and back pain, pelvic heaviness, and an abdominal "shelf" due to abdominal separation/diastasis recti and muscular core dysfunction. If you are experiencing any of these post-cesarean, a pelvic floor consult may be of significant benefit. Even if not experiencing significant issues, a consult may be a good idea for EVERY mother several weeks or months out from birth.
Birth Processing: Processing the birth mentally, emotionally, and spiritually is important regardless of the type and how it occured. However, it is often even more critical for cesarean mothers to process the experience, most especially if it was unplanned and, as is often the case, far from what the mother wanted for her and her baby. Finding a trusted therapist, friend, doula, or community where you can safely share your experience and complicated feelings surrounding it without fear, shame, "but at leasts", or trivializing what you went through is extremely healing and helpful. Processing the story of your baby's birth and understanding what happened from a clinical perspective and how objectively necessary it actually was, or what led to that outcome, is also important.
Reverencing Your Birth Experience
Knowing the options for a cesarean birth is a powerful step in asserting some degree of autonomy, health, and safety over your birthing experience, should that end up as part of your story. A virtuous surrender in pregnancy and birth does not mean acquiescing all control of your body and baby to a system that does not always have your best interest at heart or even respect evidence-based practices or our faith. The Lord asks us to do what we are able to serve the genuine physiological, emotional, spiritual needs of both us and our babies. Those are our primary responsibility and they are worth fighting for. He asks that we honor His design for our bodies but also acknowledge that in our fallen world, cesarean may sometimes be necessary or feel like our only option. We can be profoundly grateful for the life of our baby, the tools we have for intervening when necessary, and the skills of physicians and nurses when used well. We can accept the need for a cesarean while still doing what we are able to recognize what may be lost in the process and restoring, to some extent, what we are able.
The emotions you feel around a cesarean birth may be incredibly complicated and that is normal and valid. Even if it was not the plan and far from what you hoped for, know that God is still present and with you during a cesarean birth. He rejoices with you in the life of your baby but also grieves with you at what may have been lost. It can still be a profound spiritual experience. It can still be a heroic act of faith. It can still be an immense act of worship and prayer. It can still bear beautiful fruit for you and your family. Your body is incredible and powerful. Regardless of how your baby comes into this world, it can be a beautiful and poignant offering of self that powerfully reflects the Paschal Mystery, a gift to your baby and to the world. With our fiat, the offering of a cesarean birth can be a tremendous opportunity for grace and still be the transformative feminine rite of passage birth was designed to be.
