40 Weeks to Forever
When It Doesn't Go As Planned
Twenty-eight percent of births in Canada are cesarean sections — a 50% increase over the last 20 years. Labour is an unpredictable process, and patients must keep the prospect of a c-section in the back of their minds. In this episode of 40 Weeks to Forever, local OBGYN Dr. Kelly Strode joins us to answer our questions on cesarean birth. Listen as she walks us through every step of the cesarean birth procedure, from preparation to recovery. Building on her years of expertise, Dr. Kelly discusses the difference between planned and emergency cesareans, the healing process, and the qualities of a good VBAC candidate. If you are considering a cesarean section or want to be ready for the possibility, this episode is for you! Here are three reasons why you should listen to this episode: 1) Find out if cesarean delivery or VBAC is an option for you. 2) Learn OBGYN-proven ways to deal with cesarean incisions. 3) Discover helpful advice as you prepare for motherhood after a cesarean section.
[01:30] Defining a Cesarean Section
- There are multiple reasons why a patient might have a cesarean section. Listen to the full episode for a comprehensive list!
- The entire cesarean birth process takes about 45 minutes to an hour; it takes less time if everything goes well and longer if complications arise.
- Preparation for a c-section includes ingesting preoperative antibiotics, establishing anesthesia, placing the catheter, and cleaning the belly through antiseptics.
- Doctors open the patient in layers; if the baby is well, the OBGYN will attempt delayed cord clamping and proceed to close the patient's skin.
- The patient will be transferred to the recovery room if no complications arise.
[07:37] Birthing Support for Cesarean Patients
- Dr. Kelly shares that their center currently allows up to two support people for the birthing patient.
- If the patient needed a general anesthetic, the partner or support person would not be allowed inside.
- In cases when the patient is uncomfortable, the standard practice is for the OBGYN or their nurse to inform the support person that they will not be allowed to enter.
- The partner or support person may enter the room once the baby has emerged.
[09:37] Emergency Vs. Planned Cesarean Sections
- Labour and delivery can be very unpredictable.
- Dr. Kelly shares that the practice is to move quickly in case of an emergency cesarean section; patients might not have the time to get comfortable with the regional anesthetic.
- The support person is also not allowed in an emergency cesarean birth.
- Delayed cord clamping is also more challenging for emergency cases.
- Skin-to-skin contact between the mother and infant during an emergency caesarian is also slightly more complicated.
[11:52] Advice for Mothers Planning to VBAC
- Patients with non-recurring indications such as a breech baby or a placenta previa are typically better candidates for VBAC.
- Patients who haven't given birth for two years or longer are also good candidates.
- Dr. Kelly emphasizes that discussing VBAC is a risk-benefit discussion.
Dr. Kelly: "Everyone is willing to tolerate different risks and make informed decisions, and then we make an informed decision and we sort of have some backup plans… It's just an informed discussion to the whole pregnancy about what they feel is best for them and what are the possible outcomes depending on if things change in labour."
[14:43] Dealing with Cesarean Section Scars
- Due to medical advancements, cesarean incisions are now only slightly larger than necessary to remove the baby's head.
- There’s little difference in the scarring whether a patient receives staples or stitches.
- Dr. Kelly recommends keeping the incision open in the air to dry it out. She advises against swimming, bathing, and sitting in a tub until the skin heals fully.
- Ointments in the incisions are also not advised except in cases of infections that may require topical antibiotics.
- Listen to our episode with pelvic health physiotherapist Aliya Dhalla for more information on the cesarean scar healing process.
Judith: “Women are very sensitive when it comes to the scar and I think everyone needs to remember: it’s just so important that your baby made it here earthside regardless of how that happened.”
[18:59] Recovery for Succeeding Cesarean Sections
- The difficulty of the second cesarean section depends on how the first one went.
- Most patients find succeeding cesarean sections easier to handle.
- According to Dr. Kelly, OBGYNs recommend vaginal birth for both the mom and baby.
[22:14] A Mother’s Journey into Parenthood
- Many people think the mother is not given much attention after giving birth. However, the mother's health is also a priority
- Dr. Kelly encourages mothers to take time away from the baby, take a break, and get enough sleep.
- Find the grace to feel what you feel and talk to people about your feelings.
- Talk to your friends or opt for counseling so you can find someone to connect with and process all changes.
Judith: "Birth can be a very empowering process, so it's important to work through any fears or disappointments you may have surrounding the process. For some even if things did go smoothly, it's still important just to chat things through."
About Dr. Kelly
Dr. Kelly Katherine Strode, MD, is an OB-GYN specializing in obstetrics and gynecology. She is currently in Guelph Obstetrics and Gynecology, a clinic in Ontario that offers preconception, prenatal, and postpartum care. She also has privileges at Guelph General Hospital, where she attends deliveries, admits patients, and performs surgeries.
Learn more about Dr. Kelly’s work at Guelph Obstetrics and Gynecology or reach her at (519) 265-7477.
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