Cesarean births

But what if mom needs a cesarean? A very common question for new birth photographers. Let’s take a look at some of the common concerns:

Should I charge less? In a word, no. Even if the cesarean is scheduled, mom may have her water break before the big day, so you are still on call. Or the birth may be rescheduled. Even if you show up at the appointed day and time, emergency surgeries may delay the scheduled ones by several hours. I have spent 10 hours shooting a “scheduled” cesarean because of multiple delays! I have had moms call me for scheduled cesareans 10 days before the day it was scheduled. You simply don’t know what will happen, and of course your editing time is unchanged!

What can I expect in the OR?
When you go, the hospital will bring you something to wear in the OR. This usually includes either a paper gown that goes over your clothes or cloth scrubs to wear instead of your clothes. Also a hair-catching hat, booties to cover your shoes and a mask to cover your face. The mask may or may not have a clear plastic splash guard to cover your eyes.

Unlike the labor room, the operating room will most likely be brightly lit, so you don’t need a high ISO and can stop down somewhat as well. Most of the time, mom is taken alone into the OR for anesthesia and to get her settled on the narrow operating table. If you do happen to be there for the prep, don’t be surprised that mom’s legs are strapped to the table to keep them from slipping off. (They are usually numb during the surgery, so she can’t control where they are, and they don’t want mom moving.) The operating table is narrow and has small offshoots for mom’s arms, which makes it look cross-like. I’ve had several dads comment on that. Mom’s arms may or may not be strapped down. In my experience, that was a lot more common 10 years ago than it is now. There will be a blue or green drape placed between mom’s face and belly so she cannot see the surgery. This drape may be placed above her arms or below her arms, I find it varies by hospital. Below the arms is a little less claustrophobic for mom, and allows her to have more freedom to move her arms.

Generally the anesthesiologist is sitting next to mom’s head, and her job is to monitor mom’s vital signs, pain levels, and take care of any needs she has during the surgery. There is usually a round stool or chair on the other side of mom’s head where her partner will be. There may or may not be a second chair for you to sit on.

How can I get into the OR? This is tricky. In some hospitals, mom can have 2 people in the OR with her and there is no problem. In others, only one person is allowed, or no photography is allowed. In this case, there is some serious negotiating to do! In my opinion, it is not the photographer’s job to lobby to get in. It is the parent’s job to lobby for what they want. Some lobbying can be done prenatally, but generally the decision to have an extra person in the operating room is left to staff members who mom doesn’t get to know prenatally. (Often the anesthesiologist or circulating nurse) This is really too bad, because if mom has the opportunity to connect with those decision makers, they might be more willing. Mom or her partner need to be prepared to step up and be a strong advocate for themselves and their wishes. I recommend showing up with the assumption that you will be allowed in and proceed as though you are coming until unless you are told otherwise.

What if I can’t get into the OR? Sometimes this happens, and it really stinks! You can attend and just shoot what you can, like I did with Oliver’s Birth, or send your camera in with dad. Set it to auto or a semi-auto mode and hope for the best.

Mom receiving anesthesia for cesareanWhat do I do once I am in the OR? A good rule of thumb is to never touch anything that is blue or green, or is resting on a blue or green cloth or paper. These colors in a hospital designate sterile fields, and you are not sterile. Ask where you are allowed to be. Ask if you may follow the baby to the warmer. Ask if you are allowed to shoot over the drape.

What if I’m too squeamish? If you’re not familiar with cesarean births, it is a possibility! Before you go back, ,eat something with complex carbs and protein (like a granola bar or some yogurt) so your blood sugar remains steady and doesn’t compound the issue. The average blood loss with a cesarean birth is twice what you’ll see with a vaginal birth, and the incision itself may be tough to see. Just shoot what you can, and focus on the technical details of shooting instead of what you’re seeing. Don’t be surprised if the doctors doing the surgery (did you know there are two? One main surgeon and an assisting surgeon. Usually a second OB, but I have seen two CNMs assist as well.) have to do a surprising amount of tugging and pulling to get the baby out of the small incision. This is very normal. Some hospitals use a scalpel that uses heat to make the incision, so there may be a smell of burning on top of the smells of blood and amniotic fluid. If smells tend to bother you, rub a little mustache of Vicks VapoRub under your nose right before you go back, and that’s all you will smell!

Got any other questions or tips? Share them in the comments!

by Andrea Lythgoe
Sharayah JoyMarch 7, 2013 - 9:48 pm

Thanks for the tips! heading into my first e-caeserean at 5 am tomorrow…a little nervous but excited! glad to hear what i should be expecting…

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