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A birth plan is a playbook authored by a pregnant woman who documents her labor and delivery preferences well in advance. These notes include the choice of birth setting (hospital, birthing center, water, home), people she wants in the room with her (partner, mom, if you’re a Kardashian—all of your sisters), the option to use a doula, and methods of pain relief (oh, and a playlist, too). For some, like me, a birth plan is a scheduled Cesarean section (C-section) in an operating room.
In fact, it’s not uncommon. On February 9, 2021, Princess Eugenie welcomed her first child, August Philip Hawke Brooksbank, via a planned C-section. Her Cesarean was deemed a medical necessity due to her previous Scoliosis diagnosis and subsequent complete spinal fusion surgery when she was a teen. This is very familiar to me—I was also diagnosed with Scoliosis and had the same surgery as a teen. According to Mayo Clinic, "Scoliosis is a sideways curvature of the spine that occurs most often during the growth spurt just before puberty."
During my 10-hour spinal fusion surgery, permanent hardware (titanium rods and screws) were attached to my spine to straighten it out. I recovered with great posture, symmetrical hips and shoulders—and a permanent badass scar down my entire back. I lost the ability to do a proper sit-up and some flexibility, but I can’t complain.
Eleven years later, when I was 26 and pregnant, my OBGYN determined that I would require a planned C-section to avoid back labor. Plus, I had limited mobility and wouldn’t be able to flex during vaginal birth. I was scheduled for a C-section nine days before my due date. On August 30, 2007, I arrived on the maternity floor at 6 a.m., on an empty stomach, with a perfectly packed overnight bag—and changed into a hospital gown and goofy puffy cap. It was kind of surreal since I wasn’t even having contractions. Ahead, everything that occurred during my planned C-section.
What Happens During Pre-Operation?
The nurse started a peripheral IV and the anesthesiologist (who I had a consultation with a few weeks prior) came in to say hello and give me a pre-birth pep talk.
After reviewing the X-Ray of my spine, he was 99 percent certain he could safely and efficiently administer a spinal needle to numb me from waist to feet. "A spinal is also known as a subarachnoid block. The anesthesiologist injects pain medication, typically a combination of an opiate and a local anesthetic, through the lower back into the spinal fluid, bathing the spinal cord," cites YaleMedicine.org.
I have to admit; I was extremely anxious about getting the spinal needle for two reasons. First, it’s a big needle (I was in my head, though). Second, even though my anesthesiologist felt confident he could administer the subarachnoid block (despite the permanent hardware and scar tissue attached to my spine), if he couldn’t, it meant he’d have to put me under. I’d miss my son’s birth completely. Luckily, that did not happen.
In the bright operating room, I sat on the table and crouched over the best I could so he could administer the spinal. My OBGYN was easing my shoulders forward, telling me to breathe. First, I felt a quick, warm bee sting—that was the local anesthetic. I did not feel pain when the spinal was administered—all I felt was moderate pressure. See, that big needle was not so bad.
Next, the nurse laid me down and pulled a screen up, shielding my eyes from the surgical site. My legs flushed with heat. The doctor started asking me if I could feel this or that. I didn’t feel anything, but he was pinching me with a clamp. The spinal worked. I was numb.
What Happens During Surgery?
"At this point, a partner is permitted to enter the OR, and the surgeon is given a scalpel to make a horizontal incision (in most cases) on the lower abdomen," double board-certified OBGYN and maternal-fetal medicine doctor Kecia Gaither says. To me, this felt weird, like my bikini line was being slowly unzipped, but it didn’t hurt.
"The fascia (connective tissue) and musculature (the muscles in the abdominal wall) are divided to expose the peritoneal cavity," Dr. Gaither says. "Next, the surgeon will enter the peritoneal cavity with their hands to visualize the uterus. A bladder blade (a surgical instrument used to protect the bladder during an operative delivery) is placed on the bladder."
As a note, if you're scheduled for a planned C-section your water will likely not break on its own. There will be no ceremonious gush like in the movies. "The amniotic sac can be entered via the surgeon's hands or using a blunt operative instrument," notes Dr. Gaither.
My son was swiftly removed by my OBGYN and handed to a labor and delivery nurse, who he promptly peed on. "He’s peeing on me," she said. Everyone laughed. I heard him cry, and the next thing I knew, his tiny, flushed face, was next to mine. Pitocin, the synthetic form of oxytocin is administered via IV to help manage excessive blood loss. While this was going on my placenta was removed and discarded because I didn’t turn it into pills and ingest it. But I respect the mamas who do.
At this point, I felt a mix of intense pressure (not pain) on my chest, excitement, fear, anxiety, and joy.
Next, Dr. Gaither explains that the surgeon makes a uterine incision determined by multiple factors, including fetal age, position, scar tissue, and presence of uterine tumors. "Finally, the infant is removed from the uterus and may be placed on the mom’s chest for a short period of time, then handed to the nurses/pediatricians—this depends on the stability of both the infant and the mother," she adds.
My son was swiftly removed by my OBGYN and handed to a labor and delivery nurse, who he promptly peed on. "He’s peeing on me," she said. Everyone laughed. I heard him cry, and the next thing I knew, his tiny, flushed face, was next to mine. While this was going on my placenta was removed and discarded because I didn’t turn it into pills and ingest it. But I respect the mamas who do.
"The uterus is sewn back up in one or two layers," Dr. Gaither says. "Peritoneal layers and musculature are approximated. The fascia is sewn, skin is sewn or stapled, and lastly, a sterile bandage is placed over the wound."
What Happens During Post-Operation?
After what I consider too brief a moment with my newborn, I was brought to the Recovery Ward and he was brought to the nursery. "Mom is administered IV pain medications," notes Dr. Gaither. Next, I was transferred to a maternity suite that reminded me of a hotel room. My son stayed at my side in a little plastic bassinet, or more accurately laid on my chest.
Pack high-waisted underwear. You won’t want to wear bikini-cut undies because they fall on the surgical site. While the hospital will give you pads, you might feel more comfortable packing your preferred brand—I did.
"Mom is advised to ambulate early. She is offered a clear liquid diet the first day post-op, and advanced complete bloodwork is ordered to assess blood count," Dr. Gaither says. "The bandage is removed on post-op day 3, and if the patient is stable, she is discharged home."
What To Expect At Home
I have a pretty high threshold for pain, so it wasn’t too bad. Plus, you’re discharged with oral pain medication. I felt a burning sensation (totally normal) when I stood up or sat down. I was told the only thing I could lift for the first couple of weeks was my seven-pound baby, which was absolutely fine by me.
Hold a pillow over the incision area when you need to cough, sneeze, or are laughing, if possible. Walk every day to prevent blood clots (yes, shorts walks are acceptable).
It’s also essential to keep your C-section wound clean and dry. I was advised to shower normally and use warm, mild, soapy water to cleanse my wound—and gently pat the area dry with a soft cotton washcloth.
I was also told to let the tape strips fall off on their own, and my stitches dissolved within 7-10 days. Remember, a C-section is major surgery, so taking care of yourself is just as important as taking care of your newborn. Rest when the baby is sleeping and ask for help. I did.
Drink lots of water and eat a well-balanced diet (you’ll probably want sushi, soft cheeses, and a giant Italian sub sandwich since those items were on the “don’t eat” list while you were pregnant—go for it). Pop a fiber supplement or stool softener every night to keep things moving along (it’s not fun to be, ahem, constipated while recovering from a C-section).
My post-op appointment with my OBGYN was uneventful (meaning good). I started exercising about six weeks after my C-section. Thirteen years later, my scar has faded, and my son is taller than me.