The ins and outs of Gentle Cesarean
Whether you are going in for a planned cesarean or hoping for a vaginal birth, being prepared with what to expect and having a list of preferences in place is key to experiencing a positive birth even if it happens surgically. With the U.S. C-section rate hovering over 30%, it is certainly not an uncommon procedure but it is different from other surgeries. It is a birth, and should be treated as such. Many hospitals now offer a "gentle cesarean" or "family-centered cesarean" option, but what does that mean? What constitutes a gentle cesarean, and how can you get one? Outlined below are the specific preferences that are included in what would be considered a gentle cesarean.
1. Keep mom and baby together
Offering mothers the option to witness their baby entering the world is the first step in helping them bond. This is a given with vaginal birth, but the standard for c-sections is having a drape separating mom's head from her abdomen. Allowing mom to see her baby emerge, new and sticky, can be achieved through dropping the drape or putting up a clear drape. Once out, getting baby stable and skin-to-skin with the mother as soon as possible has benefits for the well-being of both baby and mom. These include bonding, better regulation of temperature and breathing for baby, better regulation of vitals and hormones for mom, and increased breastfeeding success rates, among other things. To help plan for skin-to-skin, placing EKG leads on the mother's back, putting IV and BP cuff on her non dominant arm while keeping dominant arm free to hold baby, and making sure she isn't wearing anything restrictive under gown is ideal.
Evidence Based Birth article on skin-to-skin after cesarean
2. Allow support team in the operating room
In many hospitals, only one person is allowed in the OR. However, if the family has a doula, there are benefits to having that additional support person join them for surgery. Doulas can take photos, help mom through visualizations or relaxation techniques, hold mom's hand while the partner is with baby at the warmer, explain the process to both mom and partner, and facilitate early skin-to-skin while surgery is being finished.
An example of how doulas can facilitate skin-to-skin in the OR
3. Create a calm atmosphere
A doula can also fall under this category, as can lower lighting, soft music, and aromatherapy. Doctors and nurses should also be mindful of their conversations and remember that this is a very special occasion and the focus should remain on the family and their new baby.
4. Make an effort to mimic the physiology of a vaginal birth.
This includes "walking the baby out" of the incision (meaning baby comes out slowly and gets a bit of a squeeze from the uterus). This may add a couple minutes to the procedure time, but allows for less suctioning and hopefully getting baby with mom sooner. Delayed cord clamping (or at the very least, "milking" the cord so baby gets a larger portion of blood) is another evidence-based practice that can allow for baby to transition to life outside the womb a bit more gently.
A more recent addition to the gentle cesarean is the practice of "seeding" baby's microbiome. There is a growing body of evidence that suggests the flora recieved from the mother's birth canal can have lifelong benefits for the baby. To achieve this with a cesarean birth, a large square of gauze can be folded and placed inside the vagina, then used to swab baby directly after birth.
NPR article regarding microbiome. Also check out the film Microbirth for further information.
The most important part of adding a gentle cesarean contingency to your birth plan is to speak with your provider beforehand about your preferences. Find out how receptive your doctor, hospital, and anesthesia department are to these requests. Often, even if your OB is on board, most of these preferences must be approved by whatever anesthesiologist is on the floor. Also be willing to be vocal, even after your birth, if you didn't get the treatment you were expecting or hoping for. Remember that hospitals are somewhat driven by what consumers want and ask for. Be the "squeaky wheel," for you, and for the women who follow. If enough patients request these practices, they will be offered more and hopefully become the norm for cesarean births in our country.
Photos above: 1. Doula Stefanie with Baby J, who got the benefit of skin-to-skin with his mom in the OR during surgery. 2. Doula Stefanie and a proud new dad geared up to head into the OR.
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