Birth preferences for an unplanned caesarean

Most women planning a home birth write nothing about a caesarean, on the reasonable grounds that it is the opposite of what they are planning. It is also the situation in which you will have the least capacity to explain what you want. Half an hour now covers it.

What is still up to you

Theatre works to a rhythm that is mostly fixed. Within that rhythm there is a surprising amount that is up to you, and almost all of it depends on someone knowing what you wanted before the doors open.

None of what follows is a demand on a surgical team. It is a set of preferences a team can act on when the situation allows, and set aside when it does not. Preferences written that way tend to get read; a list of conditions tends to get filed.

Before and during

Who comes in with you

Say who your one support person is, and say what happens if you are put under general anaesthetic, because in most hospitals that person is asked to wait outside. Say where you want them to be and whether you want them to stay with the baby.

How much you want to be told

Some women want a running commentary. Some want the anaesthetist talking about anything else at all. Both are easy to give you if someone knows which one you are.

The screen

Many hospitals can lower the screen at the moment of birth, or use a clear drape, so you see your baby being born. Some cannot, and it depends on the theatre and the team. Asking in advance is the only way to find out whether it is available where you would be going.

Your arms

Arms are often positioned out to the sides. If you want a hand free to touch your baby, ask, and ask early enough that the leads and cuff can be arranged around it.

An unhurried birth, when there is time

A slower, gentler lift, letting the baby's chest be squeezed on the way out, is a real request that some teams will accommodate for a caesarean that is not urgent. Write it with its condition attached: you want it if there is time, and you do not want anything delayed when your baby needs to be born quickly. Without that condition it is a request nobody can safely agree to.

The first minutes

Spend your words here. These minutes are decided fastest and remembered longest.

• whether you want the baby brought to your chest in theatre, and who helps hold them there
• whether you want the cord left alone for a while, if your bleeding and your baby both allow it
• who goes with the baby if the baby has to leave the room, and whether you want photographs
• who cuts the cord
• whether you want the baby's sex announced by someone else or discovered by you
• vitamin K, the first feed, and whether anything is given without asking your partner first

If skin to skin in theatre is not possible, say what you want instead, so the answer is not simply that it did not happen.

Afterwards

Recovery, feeding help, whether your partner can stay overnight, and a debrief. A caesarean after a planned home birth is a long way from the birth you were preparing for, and a lot of women want to go through what happened with someone who was there. Ask for that before you leave, while it is easy to arrange.

A note on the word

Caesarean and cesarean are the same operation, spelled the way your country spells it. Birth Bridge prints whichever one matches where you are giving birth, along with the local drug names, so the document does not read as foreign to the people receiving it.