Considering a Gentle C-Section? Read This First
September 21, 2017
When Jenny Robberson learned she was pregnant, she was beyond thrilled. Early on, she had a clear vision of what the momentous event of meeting baby was going to be like—and an epidural would not be welcome. This was going to be a glorious, purely natural childbirth: There would be no drugs to speak of, and a midwife would do the honors of bringing her firstborn into the world.
Then, around 33 weeks, she found out that wasn’t going to happen.
Her baby was breech and seemed stubbornly intent on staying that way, despite her efforts (including acupuncture and chiropractic care). So she scheduled herself for a c-section. Robberson was, as she puts it, “devastated,” but without missing a beat, she dove into researching how to make the best out of her situation. That’s when she hit upon the concept of a gentle c-section.
Also known as a natural cesarean, a gentle c-section is a procedure that makes a cesarean seem less like major abdominal operation and more like a vaginal delivery. “Seem” is the key word here, since the surgical aspect of the procedure is still the same: You’re numbed from the rib cage down. Your doctor makes an incision through the abdomen and uterus, and after some prodding, baby is born. The difference with a gentle c-section is what the woman and her partner can see and touch—and when.
“It’s more of an attitude change,” says William Camann, MD, who brought the method to Brigham and Women’s Hospital in Boston, where he is director emeritus of obstetric anesthesiology. With a gentle c-section, “the focus is on the mother and getting baby to her as soon as possible.”
After a traditional c-section, when the mom is left waiting (and waiting) to hold her child for as long as a half hour, her OB stitches her back up while baby gets cleaned and assessed in another part of the room. Sometimes the partner walks over to the baby-prep area, snaps a picture and walks back to show the mom. “It seemed so strange to me that the first time the mother sees her child is on her phone,” Camann says. “I wanted to find some way to humanize the experience.”
A version of Camann’s approach to a more family-centered c-section had been written about by a team of British doctors in 2008 and published in BJOG: An International Journal of Obstetrics and Gynaecology. Now a growing number of US hospitals are adopting it in some way as standard practice. Instead of an opaque surgical curtain that blocks off your view, the one used in a gentle c-section is either transparent or can be adjusted so you can watch baby emerging from the womb—which the majority of women undergoing the procedure do, according to Robyn Lamar, MD, an ob-gyn at UCSF Medical Center. Some doctors will even let baby wriggle himself out a bit before being scooped out. (Don’t worry, your bump will hide the surgical cut, which you might not want to see.)
Most important, instead of the interminable wait, after a gentle cesarean baby will be brought to you within a few minutes after birth and placed on your chest so you can breastfeed if you wish. The majority of the cleanup and assessment of your newborn is done right then and there, while the remainder of the surgery is carried out as usual, out of visual range.
“My husband cut the cord, and my doula took pictures,” Robberson says, recalling her gentle c-section. “I had asked that my baby be brought right up to me, even before she was weighed, and that’s what a nurse did. I was put in something like a tube top, and she was placed inside, skin to skin, like a kangaroo. They did the APGAR test on my chest, and she stayed there the whole time as they wheeled me out of the operating room.”
The gentle c-section was long in coming. As a 2014 Journal of the American Board of Family Medicine (JABFM) paper pointed out, “Cesarean delivery practices, including the separation of the newborn from the mother, have not changed substantially over the past 30 years.” What has pushed the gentle c-section into the forefront at many US hospitals is not fancy new medical equipment or brilliant surgical techniques. Rather, it’s pregnant women themselves.
Thanks to the power of social media, conversations between local groups of women can quickly become global ones, and news of medical findings are easily accessible to anyone willing to dig around online. Word of gentle c-sections has spread, and moms-to-be are demanding an experience that’s worthy of the birth of their child—and providers, who have grown increasingly more patient focused, are open to satisfying it.
Under normal circumstances, a vaginal birth is the safest way to deliver a child, period. But about one in three babies are delivered by c-section, and it’s the most common surgery performed in the country. A c-section is protocol under emergency circumstances (like when the baby is in distress or the placenta erupts) or if a vaginal delivery might be too risky (like if the placenta is covering the cervix, baby is breech or labor isn’t progressing). In nonemergency situations, where mother and baby are healthy, a gentle c-section can be a safe option, Camann says.
A gentle c-section doesn’t take much longer (less than five minutes longer, according to one study) than a traditional c-section and doesn’t cost more. Camann uses a transparent drape—which had always been available in the operating room but was typically used in open-heart and orthopedic surgeries—to keep the surgical field clear and still let the medical team communicate with one another. The equipment for a gentle c-section is the same—it’s just that it may be moved to slightly different positions so there’s more room for the medical team to monitor baby and mom. The IV catheter, oximeter and blood pressure cuff are placed on the mom’s nondominant arm, and the electrocardiographic leads are placed in the back so her chest is cleared for the baby. “It’s the small, subtle things that make a big difference,” Camann says. In his hospital, patients are also given the option of selecting calming music during the procedure, the medical team takes care not to slip into unrelated conversation, and a doula or midwife (some specialize in c-sections) is also allowed join mom and her partner while the gentle c-section takes place.
A gentle c-section doesn’t just transform a cold, sterile procedure into something warm and meaningful. New reports suggest that it’s not only safe but also healthy for both mother and child. Last year, Dutch researchers analyzed 365 conventional and 285 natural cesarean cases. They found no difference in the rate of infection at the surgical site, and infants born via gentle c-section were less likely to end up with an infection or in the NICU.
What’s more, moms who had a gentle c-section had shorter stays in the hospital and reported (along with their partners) greater satisfaction with the whole experience. Fueling the positive outcomes in large part is the early skin-to-skin contact between mom and baby, something that’s typically a given after a vaginal birth. A 2014 review study of immediate or early skin-to-skin contact after a c-section, published in the journal Maternal & Child Nutrition, reports that it may promote bonding and breastfeeding, reduces newborn stress and stabilizes baby’s body temperature. It also suggests that bonding with baby provides a distraction for mom that reduces perceived pain.
Another paper, published last year by doctors at Charité Hospital in Berlin, reports higher rates of breastfeeding with a cesarean that incorporates early skin-to-skin contact, like a gentle c-section, and no difference in APGAR scores between babies born with a conventional c-section and those given early skin-to-skin contact.
Doctors say it’s hard to know exactly how prevalent a gentle c-section is. “It’s dynamic and always changing,” Camann says. And while early skin-to-skin contact is at the core of all these procedures, the protocol isn’t the same everywhere, and patients might want certain aspects of the protocol but not others. Some physicians are happy to accommodate a patient’s request as much as possible, even if a gentle c-section isn’t standard at their hospital, while others prefer to stick with protocol. “Change is very hard in medicine,” Lamar says. “There’s comfort in routine, and certain powers become attributed to it.”
We get it. For the most part, conventional c-sections are performed without a hitch, so why fix something that isn’t broken? And while the recent papers trickling in about the benefits of a gentle c-section are convincing, larger-scale studies still need to be done to justify an overhaul of the procedure on a large scale.
As Susanna Magee, MD, lead author of the JABFM article, which recounts how her hospital implemented a new c-section protocol, explains: It “required a systematic process of input and revision” from every team member involved—and it’s a pretty big team, including nurses, the doctor delivering baby, the pediatrician and the anesthesiologist. A new checklist needed to be meticulously drawn up so the operating room was properly equipped. Every delivery scenario needed to be simulated to address any incident that might come up. In short, it took some time and careful consideration.
Whatever your hospital’s setup, talk to your doctor about how you envision your c-section, just as you would if you were to have a vaginal delivery. Find out what can be safely accommodated given your particular circumstances (remember, a gentle c-section is for planned, nonemergency procedures only) and whether the doctor and hospital have experience in offering it. If you don’t like what you hear, don’t be afraid to look for a provider who understands your wishes and concerns—which is exactly what Robberson did at 39 weeks.
For her, it was worth the effort. “I’m never going to be happy that I had a c-section,” she says. “But I’m happy I advocated for myself and made sure to find someone who could provide the best version of a c-section I thought possible.”
Published July 2017