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C-section preparation 101

Shieva Ghofrany: [00:00:00] All right girls. I'm gonna do a quick, quick video about preparing for a C-section in case you are having a scheduled C-section. I realize that people ask all the time, since I had two scheduled C-sections, after I had one vaginal delivery, which is a whole discussion for another time, and again, you hear me say this a lot. 

Pros and cons to both. Nothing is ever only. Everything is always, and what do I mean by that? Meaning nothing is ever only good or only bad. Everything has good and bad, right? Duality, yin yang, whatever you wanna call. Grass is greener, as I joke. Grass is not greener. Grass is actually equally green and equally shitty brown, just depending on what parts you're looking at. 

So about C-sections. Cause I do think if you're going to have a C-section, there are some aspects of it that can really help the experience feel, um, calmer, feel physically better, and actually just be more emotionally connected. Because many people walk into the C-section kind of. I'm so glad I'm having a [00:01:00] C-section now. 

I don't have anxiety. That was my feeling. I had a lot of anxiety about having another vaginal delivery because mine was pretty untoward. Um, so I felt very relieved to have a c-section. Some people don't feel that way. Some people obviously feel very sad and they mourn the loss of a vaginal delivery, and I totally get it. 

Well, I don't totally get it cuz again, I had a vaginal delivery that was terrible. But they're mourning the loss of their perception of a wonderful vaginal delivery, which I do get. And so I think that we can still make C-sections really emotionally as connected as they need to be. Right. Like having a baby. 

Is a miraculous, crazy, unbelievable ordeal. And while I don't think we should put so much pressure on women to kind of make it feel like the most, um, like the most unbelievable experience, and if you don't relish every single aspect of it, then you've lost out on life. Because again, some of us feel differently. 

We look at it a little bit more as a means to an end. I reli. Deliveries. I have to say, when a baby comes out [00:02:00] every day for 21 years, I'm still like, how did the baby come out? And I always joke like we couldn't put it back in if we tried. Like how did it fit? It's crazy whether we're pulling it out or it's coming out vaginally. 

It's crazy. That said, when I had my own C-section, my second delivery, I was, um, excited to have it, excited for the baby to come out. All the things I'm about to tell you that we do nowadays, we didn't do, cause that was 12 years ago. And as soon as the baby came out, my anesthesiologist said, do you think you want something to help you relax? 

And I was like, bring it on. And I was, Very happy and did not feel angst guilt over kind of not being completely alert to the whole experience of having my C-section. That was what was right for me. That's not right for everybody. But again, I invite you guys to remind yourselves that you get to pick and choose what parts you're excited about. 

Don't let society or the internet or other women or women in groups or anything, nursing classes, whatever it is that you're part of, make you feel. You need to kind of be alert and emotionally engaged and do everything during that C-section if you wanna be. That's amazing. And [00:03:00] our job as your doctor is not only to keep you safe and perform the surgery as safely as we can, but also ideally to help you feel as comfortable as you need. 

As comfortable as you need might be you again, getting to do some of the things we're gonna talk about to make it feel a little bit more. For lack of a better word, I'm gonna say natural, like more of what would happen in a vaginal delivery. But maybe what you need is for us to say, it's okay. Do you want medication after the baby comes out to help you feel kind of a little bit out of it and sleepy so that you don't have to be as alert while you're being operated on, right? 

So I think it really depends. There's no one right answer. Please do not let anyone else dictate to you how you should feel or how you should experience it, and really like dig into your own intuition and figure out what aspect of this is what's most important to you. Is it most important to you that you just have a child? 

In which case, don't belabor these little details. On the flip side, if you feel like, you know what, I really want the experience to be. As close to what would mimic a vaginal delivery as is possible, then by [00:04:00] all means be as alert, um, and engaged in the process as you can. What do I mean by that? Okay, first and foremost, and by the way, I am not your doctor, so ask your doctor any of these questions. 

That's my cya, but this is what I tell my patients the day before you're having a scheduled C-section. . This also actually would work for if you're being induced. Um, we often just say the night before, any surgery, N P O, which stands for nothing per us in Latin. Nothing in your mouth. Um, bef after midnight, so right, you're having surgery sometime tomorrow. 

We say nothing to eat or drink after midnight, unless you take medication in the morning. You take it with a small sip that. The reason we say that is because for safety, your stomach, not your abdomen, your actual stomach, the contents need to be gone so that in case you need general anesthesia where the tube goes down your airway, you don't. 

Vomit [00:05:00] food and then aspirate it into your airway. Okay. So it's specifically because of general anesthesia or any type of anesthesia where you have to be asleep. So it's not as much the case with a spinal, which is what you typically get for a scheduled C-section, but you don't know what's gonna happen every now and then. 

Someone's gonna need general, so we say nothing to eat or drink after midnight. I kind of go one step further with my patients cuz I learned the hard way actually before my induction with my first, and I ate a big fat plate of spaghetti carbonara that my best friend Sarah Marzi made me. And damn it was good, but dang it, two days later when I was like, you know, 30 hours into my induction and three hours into pushing and then delivered a baby and then I had. 

Pooped. So people, if you kind of do the celebratory like, Hey, I'm going to eat like a huge meal at 7:00 PM with my family, and then I'm not gonna eat after midnight, and then I'm gonna have surgery tomorrow. I'm telling you what's gonna happen. You're gonna be f os full of shit. You're gonna literally be constipated. 

You're not gonna cause any danger because again, for safety, [00:06:00] Your stomach needs to be empty, but I am telling you that for comfort, your bowels should be empty, and we'll talk about how in a second. So make sure your bowels are as empty as possible because between the narcotics and all your bowels just being sluggish from being kind of manipulated during surgery. 

You will be constipated. And it's so uncomfortable. And in fact, I tell patients this even before they're gonna have surgeries that I don't perform like breast surgery, things like that. I kind of say to them, listen, it's not like you have to do this. It's not for safety, but I'm telling you for comfort, because typically you get narcotics, you'll be constipated. 

Please, please, please go ahead and make sure that you have, um, something. That helps you poop. So, God, I'm so hot. I'm dying in my car right now. I'm actually waiting to pick up my son while I'm doing this video. So here's what my something is. So I tell patients to actually let me get the sun outta my face. 

So I tell patients that what they should do is wake up in the morning, eat a big meal the day before their surgery, eat whatever they want, really till about 12:00 PM after 12:00 PM I encourage them to. [00:07:00] Copious amounts of liquids of all types, not just clear liquids, cuz you're not doing a colonoscopy. 

You don't need to be cleansed completely, but thick liquids like soups and smoothies and shakes, load up on that so that you're not starving so that your sugar doesn't drop. And then sometime in the afternoon, Have either a stool softener or a laxative, it's okay because you're not gonna be causing so much diarrhea that you get dehydrated. 

Again, ask your doctor, I'm not your doctor. Um, but this is what I tell my patients. So have somebody that's gonna help you poop because you want whatever you ate the night, night before and the morning before your surgery. You wanna poop that out by the evening before your surgery, ideally, because you wanna go in the next day. 

No food or water after midnight, right? But you wanna go in the next day with not just your stomach being empty, your stomach for safety, but your bowels being empty for comfort. Okay? So tip number one, I tell my patients, eat whatever you want in the morning. Tons of thick liquids, tons of clear liquids. Be really hydrated. 

Take something and help you poop, and then [00:08:00] no food or water after midnight. Okay. That's just my tip. I also kind of encourage my patients if they think they're gonna be particularly anxious to maybe take a small medication that decreases anxiety again, if their doctor is willing to prescribe it, which I am for most of my patients because I find that it helps them feel calmer. 

When they're calmer. Their stress hormones are less. They will sleep the night before their surgery. Sleep helps us heal, so I let my patient. A little pill. I will not name the name of it, but is a small pill that helps you relax that is controlled substance. So I don't give them that many. I give them just a couple for the night before the surgery and even sometimes a half of one the morning of with a teeny sip of water. 

Okay, let's get to the gentle part cuz some of you guys have come to me and said, I've heard this term gentle. C-section. I find it to be a bizarre name because anyone who has either had a C-section or done a C-section or seen a C-section knows it is anything but gentle. I mean, it is not for the faint of heart because I think everyone's belief is that we like make [00:09:00] an incision and the baby just kept popping out. 

But unfortunately, as you can guess, we have to really kind of like push and pull. And I always say right before I'm getting a baby out, okay, you're gonna feel a lot of pulling and tugging and you're gonna hear grunting and groaning and. You might hear me and my partner's yelling at each other, like, pull here. 

No push there. None of this is gonna be painful because again, if you're going in for a scheduled C-section, you have a spinal anesthesia where the doctor gives you a quick shot. Um, and I'm just gonna go through like the details of what happens when you go in, um, and then. You don't feel pain, but you do feel pulling and tugging. 

And I'd rather patients know that because I don't want them to think that feeling pulling or tugging is going to make them is gonna mean pain. It's not. The other thing I tell patients that I learned my own hard way, cuz we say all the time is the doctor's like, okay, take a deep breath. And what I learned from my spinal is when you try to take a deep breath, when everything has been so, You often can't, um, feel your muscles inhaling. 

You're breathing, the doctors are watching your oxygen, you're fine, but you feel like you can't take a deep breath and then it makes you feel anxious [00:10:00] and then you get really, like, then you start to spiral. So instead, I kind of say to my patients, okay, just take shallow breaths. If I, in other words, if we see that they're starting to get anxious, I don't say take deep breaths. 

I say, okay, take. Just take some slow, shallow breaths. Okay. Now the gentle C-section part, what does it mean? Well, in an effort to make the C-section again, kind of more, um, emotionally connected. I don't know who came up with this, but in my practice, Dr. Antonio's, my partner, actually got the hospital to get these drapes. 

There are these special drapes, a clear drape meaning when you've had a C-section, you might know that you have a drape I surgery actually, that goes between your abdo. Up between you, the the surgeons and the anesthesiologists, and that's to create a sterile field so that we on the side of the incision are sterile. 

They are not. There is a clear drape where you can pull down the blue part and then there's a clear part. I don't personally like the clear drape because like I say, it looks like a dirty windshield. I would rather, right when I pull the baby bbl, hold the baby up. Your partner to see, take some pictures if they want, and then hold the baby over the drape because the anesthesiologist [00:11:00] asks your anesthesiologist, ask your doctor, I'm not, your doctor can kind of pull down the drape just enough without breaking the sterile field so that mom can really see the baby over the drape. 

So I find that to be better than the clear drape. But again, it's up to you and your doctor and some of you don't even wanna see it and that's okay cuz the baby's coming out kind of, you know, slimy. Um, okay. Right When the baby comes out, whether it's vaginal or C-section, many hospitals are hospital, but many hospitals throughout the country do delayed cord clamping. 

So 45 seconds at least, of not clamping the cord. Um, because it does seems to improve the, um, iron of the baby later on and. So we do that as long as the baby seems like the baby's vigorous and crying. If the baby is floppy or seeming not vigorous, then we have to clamp the cord and send the baby to the pediatrician immediately who's in the room with us? 

Then the baby not only just goes to the pediatrician for some suction quickly. But then goes to, um, goes back over and then either your partner or you can snuggle with the baby like on your [00:12:00] shoulder, maybe do skin to skin, depending on if there's enough nurses to kind of make sure that's safe. It's a little awkward because there's a drape up to here. 

So I find that just your partner holding the baby right up by your shoulder and like, maybe I'm snapping your, your gown if you want. I think more than enough, at least how I feel, again, personal. And then the baby gets a delayed bath. So 24 hours of no bath. So the verex, that cheesy stuff, which is actually all the skin and sebum, that's s sloughed off the baby, the verex stays on the baby and that helps the baby's microbiome. 

Um, I'm running outta time, so I just wanna say again, you can see the baby. Your doctor can hold the baby over the drape if you ask them or clear. You can do delayed cord clamping and you can do the delayed bath. And those three things really help. And the minute you get into the recovery room, if not in the operating room, you can do skin to skin. 

And that alone helps with your pain, but also with bonding with the baby and helping your brain figure out the right hormones to start to stimulate your milk. So all those things make it to me as homey as it can be [00:13:00] for a procedure where, Pulling a baby out of your belly. Um, I wanted to say one more thing. 

When we talked about, oh, vaginal seeding. I'm just gonna say this quickly. There's something called vaginal seeding with the idea that when the baby does not get pushed out of the vagina, the baby does not get exposed to the microbiome, which is all of your bacteria. And so vaginal seeding is a situation where someone takes a. 

Puts it into their vagina before the surgery, and then after the surgery, they either wipe it across the baby's face, put it in the baby's mouth, so that the vaginal microbiome can then get into the baby after a C-section much like it would've in a vaginal delivery. I am just gonna say this. The data, from what I know so far is still spotty. 

I personally have told patients like, if they wanna do it, it's fine, but this is where I have to play the CYA card and say like, I can't actually do it. I'm not gonna put it in your vagina and then rub it all over the baby. But I'll. Or maybe I'll put it in their vagina if they want, but they'll do, they have to do it. 

I think it's probably not harmful though. There have been [00:14:00] a couple of um, case reports of babies who did actually get sepsis and they think it might have been from mom's vaginal bacteria. I don't know, but just a word out there about it. It's called vaginal seating. I'm not endorsing it. I don't really think, I don't know. 

I don't know what to say about it. All right. I hope that has, My parting words, as I say, often are whether or not you deliver vaginally or C-section or adopt or have stepchildren. If your goal is to be a mother, there are millions of ways of being a mother. Please do not be labor, no pun intended, the root. 

If you need a C-section, it is okay. If you need a vaginal delivery, it is okay as long as they're both safe. That's the most important, and I say that I joke hair club member. A hair club president. I've had a vaginal delivery. I've had two C-sections. Okay? Piece out.