The Gentle Cesarean: More Like A Birth Than An Operation

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There are many reasons women need cesareans. Sometimes the situation is truly life-threatening. But often the problem is that labor simply isn’t progressing. That was the case for Valerie Echo Duckett, 35, who lives in Columbus, Ohio. After receiving an epidural for pain, Duckett’s contractions stopped. By late evening she was told she’d need a C-section to deliver her son, Avery. Duckett says she has vague memories of being wheeled into the operating room, strapped down and shaking from cold.

“They were covering me up with warm blankets,”she says. “I kind of slept in and out of it.” Her only memory of meeting her newborn son for the first time was from some pictures her husband took. This is the experience many women have. The cesarean section is the most common surgery in America about 1 in 3 babies is delivered this way. But for many women, being told they need a C-section is unpleasant news. Duckett says she felt like she missed out on a pivotal moment in her pregnancy.

“It took me a long time even to be able to say that I gave birth to Avery,” she says. “I felt like I didn’t earn the right to say I gave birth to him, like it was taken from me somehow, like I hadn’t done what I was supposed to do.”

Duckett’s reaction to her C-section is unfortunately a common one, says Betsey Snow, head of Family and Child Services at Anne Arundel Medical Center, a community hospital in Annapolis, Md.”I hear a lot of moms say, ‘I’m disappointed I had to have a C-section.’ A lot of women felt like they failed because they couldn’t do a vaginal delivery,” says Snow.Now some hospitals are offering small but significant changes to the procedure to make it seem more like a birth than major surgery.

In a typical C-section, a closed curtain shields the sterile operating field. Mothers don’t see the procedure and their babies are immediately whisked away for pediatric care — a separation that can last for close to half an hour. Kristen Caminiti, of Crofton, Md., knows this routine well. Her first two sons were born by traditional cesarean. She was happy with their births because, she says, it was all she knew. Then, just a few weeks into her third pregnancy, Caminiti, who is 33, saw a post on Facebook about family-centered cesarean techniques catching on in England.”I clicked on the link and thought, ‘I want that,’ ” she says.

The techniques are relatively easy and the main goals simple: Let moms see their babies being born if they want and put newborns immediately on the mother’s chest for skin-to-skin contact. This helps stimulate bonding and breast feeding. Caminiti asked her obstetrician, Dr. Marcus Penn, if he’d allow her to have this kind of birth. He said yes.

When Caminiti told Penn what she wanted, his first thought was it wouldn’t be that difficult to do. “I didn’t see anything that would be terribly out of the norm,” he says. “It would be different from the way we usually do it, but nothing terrible that anyone would say we shouldn’t try that.”

Family-centered cesareans are a relatively new idea in the U.S., and many doctors and hospitals have no experience with them. Penn and the staff at Anne Arundel Medical Center quickly realized the procedure would require some changes, including adding a nurse and bringing the neonatal team into the operating room.

And there were a bunch of little adjustments, such as moving the EKG monitors from their usual location on top of the mother’s chest to her side. This allows the delivery team to place the newborn baby immediately on the mother’s chest. In addition, Penn says, the mother’s hands were not strapped down and the intravenous line was put in her nondominant hand so she could hold the baby.

At the beginning of October, Caminiti underwent her C-section. She was alert, her head was up and the drape lowered so she could watch the delivery of her son, Connor. Caminiti’s husband, Matt, recorded the event. After Connor was out, with umbilical cord still attached, he was placed right on Caminiti’s chest.

“It was the most amazing and grace-filled experience to finally have that moment of having my baby be placed on my chest,” Caminiti says. “He was screaming and then I remember that when I started to talk to him he stopped. It was awesome.”

And the baby stayed with her for the rest of the procedure.

Changes like this can make a big difference, says Dr. William Camann, the director of obstetric anesthesiology at Brigham and Women’s Hospital in Boston and one of the pioneers of the procedure in the U.S. At Brigham and Women’s, their version of the family-centered cesarean is called the gentle cesarean. Moms who opt for it can view the birth through a clear plastic drape, and immediate skin-to-skin contact follows.

Camann says the gentle C-section is not a replacement for a vaginal birth; it’s just a way to improve the surgical experience. “No one is trying to advocate for C-sections. We really don’t want to increase the cesarean rate, we just want to make it better for those who have to have it,” he says.

So why has the procedure been slow to catch on? Hospitals aren’t charging more for it so cost doesn’t seem to be a major factor. What’s lacking are clinical studies. Without hard scientific data on outcomes and other concerns like infection control, many hospitals may be wary of changing their routines. Betsey Snow of Anne Arundel Medical Center says the family-centered C-section represents a cultural shift, and her hospital is helping break new ground by adopting it.

“It is the first time we have really done anything innovative or creative with changing the C-section procedure in years,” she says. Kristen Caminiti says her hope is that these innovations become routine. She says she’d like nothing more than to know that other women having C-sections are able to have the same amazing experience she had.

Enter Abby

For women who wanted a natural childbirth, it can be disheartening – and even traumatic – to end up having a cesarean section. This was surely my experience, especially after my first child (an emergency cesarean) and my third (a planned VBAC birth after two cesareans that ended in another surgery).

What are the repercussions of a cesarean?

C-sections come with plenty of negatives a longer hospital stay, weeks of recovery time, and lifting and driving restrictions. Emergency cesareans often come with added emotional trauma and increased rates of postpartum depression and anxiety.

A cesarean mama might feel that her birth experience didn’t measure up to what it was “supposed” to be, to what her friends experienced, or to what she heard about in the media. She might have been completely unconscious when her baby was born with her arms strapped down and loved ones out of the room. Baby might have been 10 feet away, surrounded by doctors, or even taken to the NICU.

Mama might not meet her newborn, let alone breastfeed him or her, until hours later.

Does a cesarean have to be a traumatic experience?

No. The answer is simple. You can make your surgical birth experience almost everything you dreamed of when you planned a natural birth. It’s thankfully a new trend we’re seeing in some hospitals and the practice is called Gentle Caesarean.

A gentle cesarean can be part of your birth plan if you know you’ll need a c-section, or it can be part of a back-up plan if your intended natural birth and/or VBAC fails.The best part about a gentle cesarean is that you can pick and choose which aspects will create your ideal birth atmosphere.

What is a “Gentle Cesarean”?

A gentle cesarean (sometimes called a family-centered birth) includes many features, but its overall purpose is to invoke a peaceful, calm atmosphere that closely mimics what happens during and immediately after a natural childbirth.

If you prefer a gentle cesarean to the traditional protocol, you’ll want to add the following to your birth plan

  • Mama should request an epidural or spinal block; general anesthesia should be avoided at all costs, barring any emergencies
  • Mamas should request that anesthesiologists do not automatically give her extra drugs to relax, so that she can be fully present for the experience
  • If mama cannot be conscious, father should be allowed to hold baby skin-to-skin immediately after birth, barring any medical complications with baby
  • If mama has EKG or baby monitoring devices, they can be placed in areas that don’t infringe her ability to see, hold or breastfeed baby.
  • Mama can watch baby lifted from her belly through a clear drape; if this is makes you squeamish, the drape can be lowered and baby can be lifted above it
  • Mama’s gown can be lowered and baby can be placed on mama’s chest while mama is being sutured. To facilitate this, mama must ask that her arms are not strapped down
  • Baby can breastfeed immediately while in the operating room
  • Parents can request cord clamp/cut delay until it stops pulsing
  • Parents can request that the placenta be saved and/or frozen until discharge from the hospital
  • Music of the parent’s choice can play in the operating room
  • Doctors and nurses are asked to refrain from “shop talk” (I distinctly remember hearing doctors converse about my scar tissue and incisions during my second cesarean) or their weekend plans
  • Ask your doctor for a vaginal swab to give your baby the best micro biome possible (see below)
  • Baby can be held by mama while wheeled into recovery, and continue to bond with parents there
  • Any and all usual post-birth procedures such as cleaning the baby and weighing the baby are delayed until parents are ready
  • A doula, grandparent, or friend are permitted to photograph or videotape the birth so that parents can concentrate on bonding

What is a vaginal swab, and how does it help my baby?

When a baby goes through the birth canal during a vaginal birth, he or she is exposed to a plethora of microbes in baby’s mouth and on the skin. These bacteria help build a healthy microbiome for your baby, which could reduce his or her risk of inflammatory illnesses like Crohn’s disease, heart disease, infections, and much more.

The absence of this bacteria transfer in cesarean babies might explain why some studies have found that cesarean babies have higher rates of asthma, allergies, obesity, and other health concerns. Does a cesarean mean that your baby has to go without the benefits of these microbes?

Not necessarily. With a gentle caesarean, your doctor or midwife can collect a vaginal swab and wipe it on your baby’s skin and in his or her mouth to contribute toward a positive microbiome. Another option is to take a swab of your vagina and wipe it on your nipples before baby breastfeeds.

While this is a relatively new practice, (indeed, I missed out on it with my three kids – a shame since I suffer from Crohn’s and its related enemy, arthritis), research is currently underway to study the efficacy of the practice.

Here are four steps to prepare for having a gentle cesarean

1.Implement your birth plan

Include your wishes for a gentle cesarean, even if you are planning a natural childbirth, in your birth plan, and keep several copies of it handy – in your hospital bag, your car’s glove compartment, and your purse. Everyone involved in your birth (obstetrician, midwife, doula, neonatologist, pediatrician, anesthesiologist, and operating room nurses) should also have a copy and be willing to abide by it.

2. Find a doctor who is open to the idea

Find a doctor who is open to the idea and ideally familiar with the concept of a gentle cesarean. If you are facing a doctor on-call with whom you are not familiar, make sure you have an advocate with you who is willing to voice any concerns you may have. It is well within your rights to take the extra time prior to surgery (barring any emergencies) to put in place a birth team who is willing to make this work for you.

3.Read up beforehand

Read up on your hospital’s policies and procedures beforehand so that you are aware ahead of time of any obstacles that may get in the way of your gentle cesarean. Hospitals sometimes have regulations in place that are different than your doctor’s practices, and hospital rules override even your doctor’s wishes. Hopefully, you can have every aspect of your birth that you desire, but if everything does not go according to plan, take the time to grieve! Even in the best of circumstances, we all have our “Mama Wound”.

4.Remember, this is your birth experience

Remember, this might just be another day for them, but this is YOUR birth experience – something that you will remember and reflect upon for the rest of your life. Make your wishes known! This is not the time to be shy.

A gentle cesarean is the best way to get through a surgical birth with compassion, peace, and grace, and it is often extremely healing for mamas who have been through a previous traumatic surgical birth.

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