The Natural Cesarean?

While talking with my friend Dr. William Camann, director of obstetric anesthesiology at Brigham and Women's hospital in Boston, I was surprised and excited to learn that he recently helped the hospital adopt components of what is being called "the natural cesarean" technique.  Bill is co-author of the book Easy Labor: Every Woman’s Guide to Choosing Less Pain and More Joy During Childbirth, and the Brigham is Boston’s largest maternity hospital, so its adoption of these methods is good news.  In the past, some mothers reported feeling “a disconnection from their cesarean baby because they did not actually see or feel the baby born,” according to the International Cesarean Awareness Network (ICAN).  The natural cesarean technique offers parents the option of viewing the emergence of the baby if they wish.  (For years, ICAN has been a pioneer in proposing guidelines for family-centered cesareans, as well as advocating for other reforms related to the use of cesarean sections—I encourage everyone to support their work!)  Below, Dr. Camann explains the concept of the natural cesarean.

“Natural childbirth” is a concept that is well established for vaginal deliveries. Is there any such thing as the “natural cesarean”? The concept of the “natural cesarean” originated at Queen Charlotte’s Hospital in London, and a nice video of their experience can be seen here:

The cesarean delivery rate in the United States is approximately 35% and increasing, and the surgical nature of this procedure can distract from the very essence of the event, namely the birth of a child. A growing movement is attempting to make the cesarean delivery a more natural, or family-centered, event.

Modifications of the standard technique include:

·       Early skin-to-skin contact in the operating room (with either mom or dad)

·       A slow delivery (with intent to mimic the “vaginal squeeze”)

·       Placement of IV catheter, oximeter, and blood pressure cuff all on the

same and non-dominant arm to allow a completely free arm for maternal contact with baby

·       Placement of ECG leads on the back, to allow a free chest for early maternal skin-to-skin contact

·       Intraoperative breastfeeding

·       Clear surgical drapes to allow better view of the delivery

Benefits of this approach include a more family-centered experience for the mother and partner, improved thermoregulation of the neonate, better bonding, early feeding, and overall greater satisfaction with the procedure.

Some mothers and their partners wish to view as much of the actual delivery as possible. Lowering of the surgical drapes at the time of delivery may allow this to some extent but issues related to possible contamination of the sterile field, or blood and other fluid spillage, might preclude a complete view by this method. The use of a clear, see-through surgical drape will allow a full view of the delivery while still maintaining full sterile and other precautions.

We have begun to use these clear drapes for cesarean deliveries at Brigham & Women’s Hospital, for those patients who wish to visualize the birth during a cesarean. Of course many patients and their partners do not wish to be able visualize the birth, thus proper patient selection is important. Our patient satisfaction is very high among those motivated to be a more active participant in the birth despite the surgical nature of the procedure. A cooperative obstetrician and nursing staff are essential to ensure full team involvement particularly if early, intraoperative skin-to-skin contact is desired. Some patients and their partners have even reached up and felt the baby, through the clear drapes, within seconds after birth.

There is no evidence that attempts to make cesarean delivery more family-centered have any positive effect on outcomes or on the overall cesarean delivery rate. Moreover, negative outcomes, such as infectious complications, have yet to be assessed. Some may argue that making the cesarean delivery experience friendlier would be counterproductive to any attempts to decrease the overall cesarean rate. In contrast, an attempt to make any childbirth experience, whether vaginal or cesarean, more pleasant for patients and partners should be considered as part of the services we can offer.

William Camann, MD

Director, Obstetric Anesthesiology

Brigham & Women’s Hospital, Boston

Co-author:  Easy Labor: Every Woman’s Guide to Choosing Less Pain and More Joy During Childbirth.

Photo published with consent of the patient.