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The Gentle C-section: Making Cesarean Birth More Family-Centered

For my first baby, I had a roller-coaster ride through pregnancy and birth, with many health scares and medical interventions. When I got pregnant a second time, I wanted to have as natural a birth as possible.

But at my 30 week ultrasound, I was diagnosed with placenta previa. My placenta was blocking the baby’s exit and the natural birth I was hoping for came with the potential for extensive bleeding. A vaginal birth was out of the question and instead, I now faced a planned c-section.

This was not the news I wanted to hear. C-sections (even planned ones) carry their own long list of risks. In fact, numerous studies have shown the risks of cesarean birth are far greater than a vaginal birth (it’s major surgery after all). Some studies also show correlations in long-term health impacts on children born by c-section, with higher rates of asthma and other chronic diseases. Mothers who had c-sections also reported higher rates of postpartum depression and lower rates of breastfeeding.

 

A vaginal birth was out of the question and instead, I now faced a planned c-section.


The Ever Popular C-section

Despite all of the well-documented risks, the rate of c-sections has increased dramatically in the last two decades in the U.S., now totaling 32 percent of all births. Yet, the World Health Organization’s research suggests just 10 to 15 percent of births have medical complications that require a c-section. Simple math suggests that most of the c-sections in the U.S. are unnecessary.  

There are attempts to dial this back. The American College of Obstetricians and Gynecologists (ACOG) has been actively working to reduce the number of elective cesareans. Hundreds of articles in the mainstream media have been published about its dangers. Yet the c-section rate in the U.S. has dropped just 0.9 percent since 2009.

 

Getting a c-section seems so routine that some friends and family I talked to didn’t understand why I’d feel sad or nervous about having one.

 

In fact, getting a c-section seems so routine that some friends and family I talked to didn’t understand why I’d feel sad or nervous about having one. They stressed the “benefits,” which focused on scheduling convenience and not having to “endure” the physical challenges of labor.

I had a hard time seeing these things as “benefits” to allay my concerns. I’d had abdominal surgery with painful recovery before. I was not eager to re-enter the operating room. The one benefit that I could get behind: my baby’s health. My doctors all agreed that a c-section was the safest way to bring her into the world.


A “Gentle” Approach

Surgical risks aside, my fears about having a cesarean birth also included my baby and I missing out on the positive benefits of a vaginal birth. One of the biggest for me was skin-to-skin contact with her immediately after birth. This seemingly simple moment between mom and baby after birth has been shown to improve breastfeeding rates, bonding between mom and baby, and may promote a baby’s brain development. But for the medical professionals in the operating room for c-section, skin-to-skin contact immediately after birth is not standard practice at many hospitals, even if the mother and baby are stable.

But this is changing.

About 10 years ago, Brigham and Women’s Hospital pioneered a new approach to a cesarean, now often referred to as a “gentle” or “family-centered” c-section. To make this possible, many different medical specialists, from anesthesiologists and obstetricians to pediatricians, had to learn to work together differently in the operating room. Once they did, they discovered they could provide a more positive experience for moms and babies without adding any additional risks.

 

They discovered they could provide a more positive experience for moms and babies without adding any additional risks.

 

Since then, some hospitals around the country have adapted this type of c-section into standard practice.


My Family-centered C-section

I had a “family-centered” c-section in San Francisco, at a hospital that began offering this approach in 2017. This experience differed from a standard c-section in a variety of ways. First, my IV and other monitoring equipment were placed on my arms and sides of my chest in a way that would allow me to hold my baby immediately after birth.

 

We have our own beautiful birth story.  

 

During the procedure, a drape blocked my view of the medical team and my abdomen. But just before the birth, they opened a compartment in the drape made of clear plastic, and I watched them bring my baby out into the world. I saw her cry for the first time. As soon as I saw her, I started to cry, too.

After a brief pediatrician assessment of her vitals, my baby was placed on my chest. I cuddled and nursed her for the remainder of the surgery, which took another 45 minutes.

All of these small details made a big difference. While I found it frightening and stressful to be awake during surgery, I felt supported and cared for by my medical team. Most importantly, I felt connected to my husband, who was at my side throughout the cesarean, and I felt connected to my baby, who I was able to meet immediately after her birth.

 

I cuddled and nursed her for the remainder of the surgery, which took another 45 minutes.

 

While it was not the birth experience I would have chosen, I’ll never forget watching my baby enter the world and the medical team telling her Happy Birthday.

We have our own beautiful birth story.  

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  • ex: JenniferMarks@gmail.com
  • ex: Jennifer