“Gentle” C-Section: Small Changes Deliver Big Results

Cesarean-section (C-section) deliveries are the most common surgical procedure in the world. In the US and many developed nations, one in three babies is delivered by C-section. In many cases, the procedure occurs in response to medical emergencies, leaving little choice for vaginal delivery. In other cases, C-section delivery is only matter of choice.

Many mothers who undergo C-section deliveries aren’t always satisfied with the experience, as evidenced by a recent story on NPR’s Morning Edition. One mother describes feeling as if she “missed out on a pivotal moment in her pregnancy” after undergoing an emergency C-section delivery.

Other undesirable outcomes of a C-section include:

• Increased risk for postpartum depression.
• Breastfeeding is more likely to be difficult or impossible.
• Bonding issues sometimes arise when a mother and child aren’t allowed skin-to-skin contact immediately following delivery.

Some obstetrical centers are working to improve the experience by using what is described as a “gentle” C-section delivery. Some centers refer to the new technique as natural caesarean, woman-friendly, family-friendly, or baby-friendly C-sections.

A 2008 article in the BJOG (International Journal of Obstetrics and Gynaecology) describes in detail the natural C-section procedure as it’s done at Queen Charlotte’s and Chelsea Hospital in London. At the time the article was published, more than 100 natural cesareans had been performed with no adverse comment about any of them.

The BJOG article includes a link to comments from women who had the natural procedure. They describe the experience as “excruciatingly exciting,” “the most fascinating connecting feeling,” “immediate bonding,” and “an amazing family experience.” One mother in the NPR piece said “It was awesome” and “the most amazing and grace-filled experience.” This mother had had two traditional C-sections and asked for the gentle procedure for her third.

The gentle C-section is a slightly slower process than the traditional procedure although it is kept within the 3-minute timeline considered medically safe for the baby. The baby is allowed to gently emerge from the womb, just as it would during vaginal birth. Both parents are allowed to watch the birth, just as they would during a vaginal delivery. The surgical incision is only large enough to allow the baby’s head to emerge; this minimizes bleeding, risk of infection, and doesn’t give the parents a gory glimpse of things they’d rather not see. The baby is placed immediately on the mother’s chest, where it stays while her abdomen is closed and suckling is encouraged as soon as possible. The other parent is even allowed to cut the umbilical cord.

Dr. William Camann, director of obstetric anesthesiology at Brigham and Women’s Hospital in Boston, says, “No one is trying to advocate for C-sections...we just want to make it better for those who have to have it.”

The procedure is “slow to catch on” in the US, according to the NPR story, mostly because there are no clinical studies that address issues of outcomes and infection control. The medical community in general can be “wary of changing their routines,” too.

The procedure is being done at Anne Arundel Medical Center in Annapolis, Maryland, according to Betsey Snow, who is head of the hospital’s Family and Child Services department. She said “the family-centered C-section represents a cultural shift” and is the first time in years that something creative and innovative has been done for C-section deliveries.


Sources:

1. Schmidt, Jennifer. "The Gentle Cesarean: More Like A Birth Than An Operation." NPR / Shots. NPR, 9 Mar. 2015. Web. 17 Mar. 2015.
2. Smith, J., F. Plaat, and N. M. Fisk. "The natural caesarean: a woman-centred technique." PMC / BJOG. National Institutes of Health, July 2008. US National Library of Medicine. Web. 17 Mar. 2015.