Natural Cesarean (family centered c-section) – staying in charge when vaginal birth is not an option

To some people, lovely stories about homebirths do not seem all that awesome because they make them think of the reasons why they couldn’t or can’t have one. For some it may be pre-eclampsia, HELLP syndrome, placenta previa, or other life-threatening conditions. Some women opt for a cesarean after a previous c-section, when carrying twins, when their baby is breech and cannot be turned, or after a previous vaginal birth trauma, such as a still birth. And some women end up in the O.R. due to time pressure or because of complications after medical interventions – despite the sudden change of plan you do have time to negotiate, unless it’s an emergency (emergency means that there’s no time for anything and the woman is quickly wheeled into the O.R. – if you are given time to think about your options then it is certainly not an emergency). Regardless of the reason for your c-section, you should know that you don’t have to scratch a birth plan off your check list and forget about enjoying the birth. You can do both, actually, while staying completely in charge of your birthing experience. The answer is a natural, or family-centered cesarean.

Natural (family centered) cesarean birth c-section Bamboola Baby

This image is a property of Tamra Cardoza and was used with her permission. Do not use.

A natural c-section is a different approach to a cesarean birth respecting the mother and her baby, and protecting the mother’s memory of birth. It acknowledges the fact that birth is a very important life event for all involved with a large psychological and physical impact. Because for the mother, father and their baby it is a one-of-a-kind experience impacting their lives forever, while for the surgeon and his/her team it is a daily job. And it is nice that surgeons and midwifes in Australia realized this and changed their approach to c-sections. Soon it spread to the UK and is slowly invading the US. Slowly. The power is in your hands. Or rather in your mouth. If you know you are going to have a scheduled c-section, speak up early. Prepare a detailed birth plan, go over it with your caregiver and make necessary arrangements to achieve your desired birthing experience. If your c-section isn’t planned and isn’t an emergency, you still have time to negotiate (from my experience as a doula, all of this can be negotiated right then and there – be prepared though – know your facts, be assertive and be ready do google evidence if needed). Don’t forget for a minute that it is YOUR experience, so whatever the hospital rules are, fight for your rights. Rules can be changed. The memory of your birth cannot. No matter how you give birth you deserve respect. And so does your baby.

{principles of a natural cesarean}

  • IV’s are attached to the non-dominant arm (hence leaving the dominant arm free to move and hold the baby).
  • EKG monitors are placed on mother’s shoulders leaving mother’s chest free of monitors (for immediate skin-to-skin contact).
  • Drape is lowered once the baby’s head is out (so the mother and father can watch their baby being born). This can be a tough point to negotiate due to the fact that one side of the drape is sterile. Nevertheless, it can be safely lowered a bit to allow both parents to see their baby’s birth. Some hospitals use see-through plastic drape which resolves the sterility issue.
  • Baby’s body is pulled out slower (to imitate the big squeeze of a vaginal delivery to get the fluids out of baby’s lungs and prevent respiratory problems).
  • Cord clamping is delayed (this is very beneficial as the baby gets the very healthy rich blood from the placenta which eliminates many health problems). This is another tough point to negotiate but it can be done. Since it’s a surgical birth they may not be able to let the cord stop pulsating on its own, but delaying cord clamping by 1.5 – 2 minutes is usually very doable.
  • Immediate and uninterrupted skin-to-skin contact (which enhances emotional wellbeing, bonding and breastfeeding). This will most definitely raise their eyebrows and they will throw two arguments at your face: 1) “Can’t be done – there’s no space above the drape.” – Wrong. Can be done. The baby may have to be just under the mother’s chin but no mom has ever complained. She can use her arm to hold the baby and daddy usually helps to keep the baby safely on her chest as well. 2) “Can’t be done – it’s too cold in the O.R. and the baby must go to the warmer – at least for 10/20/30 minutes.” – Wrong again. Can be done. There are many evidence-based articles proving that even after a cesarean birth it is safer and more beneficial for the baby to be placed on his/her mother’s chest, skin-to-skin (while coverd all around). Pediatric nurses can do their assessments and periodic temperature checks directly on mother’s chest. Skin-to-skin contact should be not only immediate but also uninterrupted through the duration of the entire surgery. Daddy should hold the baby skin-to-skin while the mother is being transfered from the operating table to the bed – once in the bed, she should resume skin-to-skin bonding.
  • If you do not know your baby’s sex you can ask the medical team to not announce it upon your baby’s birth. Instead, you can discover whether you have a boy or a girl on your own.
Women who have had a normal c-section followed by a natural c-section say the difference is amazing, they usually feel much better emotionally and love the experience. I certainly loved this video summarizing everything beautifully. And then there’s this lovely video (by The Birthing Tree) of a natural (family-centered) cesarean birth of a rainbow baby – I love mama’s emotional reaction while watching her baby girl being born and the emotions that poured over her when she held her baby on her chest, skin-to-skin, while the surgeons were doing their job. I also love that they delayed cord clamping, daddy cut the umbilical cord and no one took the baby away, they all went to the recovery room together to enjoy more bonding and nursing snuggles. It’s very sweet. I suggest you watch both (or more) of these videos if you are planning for a cesarean. It can be life-changing.

. . . . . . . . . .

Recently, I came across this interesting (and very graphic) video showing a pretty revolutionary cesarean technique – it’s called Dr. Shyjus’ technique  which tries to mimic the beauty of vaginal birth by allowing the uterus to contract and virtually push the baby out on its own via the incision in mothers lower abdomen. Developed by Dr. Shyjus who has been successfully using it for a while with intention to be least manipulative when it comes to cesarean birth. The principle lies in several maneuvers:

  • Dr. Shyjus begins Pitocin (synthetic Oxytocin) infusion and ensures the uterus is contracting before making the incision
  • He then makes a large enough incision to allow the baby’s head to pass easily
  • Then he supports the baby’s head with his fingers to allow it to slide out
  • After suctioning the baby he awaits uterine contractions which expel the baby out of the uterus
  • Placenta is also delivered spontaneously (it is pushed out through the incision thanks to the uterine contractions)
  • And then he closes the uterus and abdomen

Approaching cesarean deliveries with this technique allows for:

  • Effortless and “near spontaneous” delivery
  • Avoiding fundal pressure and pulling on baby’s head and body
  • Ensures an easy and complete separation of placenta
  • Reduces hemorrhage
  • Avoids genital tract trauma as well as postpartum uterine atonicity
  • Reduces mother’s post-surgical pelvic and abdominal discomfort since there is no manipulation involved, further reducing analgesic requirements

Here’s a link to his video presentation which had me speechless – what an amazing way to approach cesarean birth. Of course this technique is not appropriate for all but I would love to see obstetricians world-wide using this technique in combination with natural cesarean principles whenever possible. The only negative comment I have is related to the immediate newborn procedures. The extensive suctioning when the baby is barely one second old, and then the skin-to-tray contact with immediate cord clamping – those broke my heart. What an awful welcoming for this precious, brand new little person. I’d much rather see the baby going straight to mom’s bare chest. There’s no better “hello” than mom’s gentle touch and sweet kisses, her warm chest and the calming melody of her familiar heartbeat.

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