In the United States, one in three babies is born via cesarean. Every expecting mother should be knowledgeable about cesarean birth, even if that is not your primary birth plan. As cesarean births have become more common, options have expanded to make the procedure more mom- and baby-friendly. In recent years, the idea of a gentle cesarean has emerged. This is also called a family-centered cesarean, family-centered birth, or natural cesarean. A gentle cesarean involves adjustments that make the surgical procedure more mom- and baby-friendly and has many evidence-backed benefits.

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What to Expect in a Cesarean Birth

A cesarean section, also known as a C-section, is a surgical procedure to deliver a baby through incisions in the mother’s abdomen and uterus. Every expecting mother should be knowledgeable about cesarean birth, even if that is not your primary birth plan. In the United States, one in three babies is born via cesarean. Often, unplanned circumstances in labor lead to a cesarean birth. Labor is an intense experience, and a lot can happen that puts you in a position where you or your care provider has to make quick decisions and may not have time to explain your options at length. Knowing what to expect in a cesarean birth will better prepare you for labor and give you confidence to navigate any scenario. I highly recommend you listen to the episode on what to expect in a cesarean birth before listening to this episode.

Gentle Cesarean

As cesarean births have become more common, options have expanded to make the procedure more mom- and baby-friendly. In recent years, the idea of a gentle cesarean has emerged. This is also called a family-centered cesarean, family-centered birth, or natural cesarean. A gentle cesarean involves adjustments that make the surgical procedure more mom- and baby-friendly and has many evidence-backed benefits. Let’s examine how a gentle cesarean differs from a conventional cesarean surgery.

Meeting Your Surgeon

The first step in a gentle cesarean is meeting the obstetrician who will be performing the surgery. This may sound trivial, but it is a significant change from meeting the doctor who will be delivering your baby in the operating room minutes before the surgery. Ideally, the OB performing the surgery is the same OB you have been seeing throughout your pregnancy for your prenatal care. Often, the OB present for your birth is whoever is on call.

Visiting the Operating Room and Adjusting Your Environment

Next, you would be able to see the operating room before surgery. The idea is that the environment may be less intimidating and more familiar if you have been there before.

The environment you give birth in can majorly impact your experience. Operating rooms are sterile, and you might smell cleaning products. They also tend to be cold and brightly lit. The goal is to set up your birth room environment to be calming and safe. You may have less control in an operating room than in a standard labor and delivery room, but you can still have some options.

One request you can make is to play your music rather than not having music or the music selected by your doctor. You may request any unnecessary lights be dimmed or turned off, although the function of the bright lights is to ensure that your doctor and all staff can see well. You can request that doctors and nurses refrain from talking shop. Your birth is one of the most significant moments of your life. You should be able to be present for it without hearing about what your doctor is doing over the weekend or any other conversation that doesn’t involve you or your baby. Check out this episode for the evidence on how your environment impacts your labor and birth and more tips to improve your birth room.

Support People

Typically, only your partner or one support person is permitted in the room with you. However, in a gentle cesarean, you may have the option to have someone else present, like a doula or a photographer.

Differences in Interventions

A gentle cesarean has some differences from the standard interventions used in a cesarean surgery. In a conventional cesarean, your arms are out to your sides and strapped down so doctors and nurses have easy access to veins and portals if medications need to be administered. In a gentle cesarean, your arms are not strapped down, so you can move them. A pulse oximeter, which measures the oxygen saturation in your blood, is put on your foot rather than your finger, so you have fewer things connected to your arms.

IVs would be placed on your non-dominant arm. You could have IVs for medication, antibiotics, or fluids. If you are right-handed, the IV line would be placed on your left arm so that when you hold your baby, you can use your dominant right arm. This would also apply to blood pressure cuffs.

An EKG, typically with lines attached to your chest, could be moved to the side to allow your chest to be clear of wires. This way, when your baby is placed on your chest, it is not placed on wires and has direct contact with your skin.

Replacing the Cloth with a Clear Drape

In a conventional cesarean, an opaque sterile cloth is hung up at about your chest. Everything on the other side of the screen is considered a sterile field for the surgery and is out of your view. Most of the nurses and doctors will be on the sterile side of the cloth. The anesthesiologist will be on your side of the fabric next to your head. A gentle cesarean replaces that opaque cloth with a clear plastic drape so you can see your baby being born. If a clear drape is not an option, you can ask that it be lowered so you can see your baby when they are born. Even with a clear or lowered drape, you will still not be able to see the incision or watch the surgery.

Your Baby’s Birth

In a conventional cesarean, your baby is removed by a doctor more quickly than in a gentle cesarean. In a gentle cesarean, your baby’s head is assisted out first. Once its head is out, your baby can breathe through its nose and mouth, but it is still attached to the placenta and gets oxygen through the umbilical cord. Rather than pulling them out right away, your doctor waits for a minute while the pressure from the uterus helps to expel some liquid from the lungs. This mimics what happens in a vaginal birth. When a baby goes through the vaginal canal, their lungs get squeezed, and a lot of the liquid is squeezed out. This is one of the reasons why respiratory issues are much more common with a cesarean birth.

Once your baby cries, your doctor eases out the baby’s shoulders. After that, your baby will likely get their arms out. Then, your doctor supports them for a minute before gently assisting them out along with contractions from your uterus. Remember that you can see this above the lowered drape or through the clear drape to watch your baby being born. You can also see the sex of your baby at the same time as your doctor and medical staff.

Skin-to-Skin Contact

A vital component of a gentle cesarean is the immediate placement of your baby on your chest for skin-to-skin contact. The actual birth happens relatively quickly, and the majority of your time in the operating room is after your baby is born while your incisions are being sutured. Having your baby placed on your chest while you are being sutured gives you immediate skin-to-skin contact and allows you to start breastfeeding sooner in the operating room. If you cannot be skin-to-skin with the baby, your partner should be skin-to-skin as quickly as possible. You can listen to this episode for more evidence on the benefits of skin-to-skin contact.

A review found that immediate or early skin-to-skin contact after a cesarean section may increase breastfeeding initiation, decrease the time to the first breastfeeding, reduce formula supplementation in the hospital, increase bonding and maternal satisfaction, maintain the temperature of newborns, and reduce newborn stress. A review analyzed data from over 2,000 births and found that skin-to-skin contact was associated with fewer neonatal intensive care unit transfers.

One study compared a skin-to-skin cesarean section with a conventional cesarean delivery. Fewer babies who went skin-to-skin with mom after birth were admitted to the pediatric ward, and fewer had a suspected infection. If a doctor suspects a baby has an infection, protocols are in place to asses them further. This involves separating a baby from its mother to determine whether an infection is present. There was no significant difference in maternal outcomes in the skin-to-skin group, and the mean operation time was about five minutes longer.

Maximizing Your Time with Your Baby

A gentle cesarean maximizes your time with your baby. This starts with immediate skin-to-skin contact and includes holding your baby when wheeled into recovery and keeping your baby with you. You can request any procedures done to your baby take place while your baby is on your chest. You may also delay routine procedures like weighing or bathing your baby.

Delaying Cord Clamping

Another common aspect of a gentle cesarean is delaying cord clamping. The American College of Obstetricians and Gynecologists recommends a delay in umbilical cord clamping for at least 30–60 seconds after birth. Benefits of delayed cord clamping include increased blood volume, reduced need for blood transfusion, decreased incidence of intracranial hemorrhage in preterm infants, and reduced frequency of iron deficiency anemia. In addition, a longer duration of placental transfusion after birth may be beneficial because this blood is enriched with immunoglobulins and stem cells, which provide the potential for improved organ repair and rebuilding after injury from disorders caused by preterm birth. An in-depth episode examines the research and offers many more details on delayed cord clamping, which you can check out here. You may request a longer delay if that is important to you. If you are considering cord blood banking, it may be challenging to delay cord clamping while banking cord blood. This episode is a must-listen if you are considering banking your baby’s cord blood.

Vaginal Seeding

The science of bacteria and the microbiomes in our bodies has expanded rapidly in recent years. When a baby is born vaginally, they are exposed to all kinds of bacteria in the vaginal canal. A baby born vaginally may also potentially come into contact with fecal matter at birth. Yes, you will likely poop during labor. There is an episode on pooping during labor if it is something you are nervous about. A baby born via cesarean does not get exposed to the same bacteria as a baby born vaginally. While we tend to think of bacteria as bad, we couldn’t exist without it. A balance between “good” and “bad” bacteria keeps things like our guts healthy.

A research paper that compared bacteria profiles between babies born vaginally and via cesarean. The babies born vaginally had bacteria communities that resembled their mother’s vaginal microbiota. The babies born via cesarean had bacteria communities resembling those found on their mother’s skin. This study had several limitations, including the small sample size of only nine babies and the mothers who gave birth via cesarean were administered antibiotics. While this doesn’t give us conclusive evidence that we should introduce vaginal bacteria to a baby born via cesarean, it does indicate that we should be taking a deeper look into the role of bacteria during birth.

One study aimed to find out if it was possible to restore the microbiota of a baby born via cesarean by transferring bacteria from the mother’s vagina. Remember, a baby born vaginally picks up bacteria when traveling through the vaginal canal and out through the vagina. This study was small, but the results are promising. Researchers put a piece of sterile gauze in the mother’s vagina before her having a cesarean section. After the baby was born, the gauze was used to swab the mouth, face, and body. Bacteria samples were taken at six points for 30 days after birth. The babies who were swabbed with the gauze had a bacteria profile much more like the babies born vaginally than the others born via cesarean.

We could see additional research in the future that gives us better insight into whether this is a safe and beneficial practice, but it doesn’t come without its risks. Some doctors have expressed concerns about transferring infections like group b strep. Vaginal swabbing is often cited as a component of a gentle cesarean. If you want to do this, you should discuss it with your doctor. I would expect some pushback on this request since there are still a lot of unknowns. Hopefully, we will see more research in this area in the future.

Regardless of how your baby is born, there are some things you can do to benefit its microbiome. One is to have lots of skin-to-skin contact and to breastfeed your baby. Both of those things will share some of the beneficial bacteria from you with your baby.

The Difference in Your Birth Experience

A huge aspect of the gentle cesarean is the mother’s experience. A trial at a hospital in Germany compared traditional cesarean birth to a modified cesarean birth with immediate skin-to-skin.

Birth experiences were rated significantly higher in the modified group compared to a classical cesarean section. The outcome that birth experiences were rated higher may not seem like a big deal but it is. Ideally, you can reflect on your birth as a positive experience. Unfortunately, not everyone can do that. If a gentle cesarean can increase the number of women who have a cesarean birth and rate their experience higher, that is a massive win for everyone.

Obstacles for Gentle Cesareans

Gentle cesareans are becoming more common, but there are a lot of barriers to making this standard practice. Perhaps the biggest obstacle is getting doctors and hospitals to change their routines. An article in the Journal of the American Board of Family Medicine addressed how one US-based hospital successfully implemented gentle cesareans into its practice. It required a long process of input from many departments and professionals and revision of the policies over time.

Initial concerns from the anesthesia department included the positioning of the equipment, the support people present, and the baby. The anesthesiologists wanted to make sure they had access to keep an eye on the mother and her anesthesia needs throughout the surgery. Neonatal caregivers, which included nurses, family physicians, and pediatricians, were concerned about newborn hypothermia. Operating rooms have cooler temperatures for infection control.

Successfully implementing gentle cesareans required time to change protocols, creating new habits, and training all of the medical staff. When they examined gentle cesarean births, complication rates were similar to or lower than those for traditional cesarean births. The researchers found that by offering a more mother and baby-centered cesarean, more mothers chose to give birth at their hospital over others in the area, even when they planned a vaginal birth. Hopefully, we will see more hospitals incorporate aspects of a gentle cesarean into their routine procedures.

Planning for a Gentle Cesarean

A gentle cesarean is a relatively new and evolving concept. There is not a clear black-and-white definition of what this entails. After hearing about many things you could include in a gentle cesarean, you can decide which aspects you want to include. A fantastic way to get clear on your preferences is to create a birth plan. If you know you are having a cesarean, you can build your birth plan around your preferences for that. If you are planning a vaginal birth, I recommend creating a backup birth plan in the event you need a cesarean section. Remember that one in three babies is born via cesarean. Creating a backup birth plan will help alleviate some fears and give you more confidence to navigate any scenario.

The Pregnancy Podcast has several resources to help you create your birth plan: 

Talking to Your Doctor

The key to getting as close as possible to the birth experience you want is working with your doctor throughout the process of creating your birth plan. Handing a physical birth plan to your doctor does not guarantee that they will support your preferences. The only way you can have a gentle cesarean or incorporate some aspects of it is if your doctor supports it.

Your doctor’s or the hospital’s policies may make it challenging for them to support some aspects of a gentle cesarean. If you do run into resistance from your doctor, please discuss your options to see if you two can work together through any challenges. Your doctor may also help you understand some risks or aspects you are missing. Having conversations with your doctor as you work on your birth plan will help you narrow down what is truly important to you.

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