‘Gentle C-sections’: Bringing a traditional birth experience to the OR

That moment when you see and hold your baby for the first time is something many women dream about during pregnancy. While most pregnant women picture a vaginal birth experience, one-third of the babies born in the United States every year are delivered by cesarean section. Now obstetricians are asking the question: Can there be a kinder, gentler C-section for our patients?

This is an experience I can relate to. During the C-section to deliver my twins, I wanted to know exactly what was happening. I had followed the presentation of the babies over the last few weeks and knew the first one had been breech early on. But then she changed to being head-first, and I was excited – a vaginal delivery was a possibility! But then, another last-minute change back to the breech presentation meant a C-section was the safest plan.

It was frustrating that I couldn’t see them being born. As a doctor, during the surgery I was asking my obstetrician some pretty specific questions (“What layer of the surgery are you on now?”), but as a mom, I really just wanted to know and see where we were in the delivery process!

As the number of C-sections has skyrocketed over the years (a quarter of first-time moms will have a C-section) there’s been interest in figuring out how we can make a C-section more of a traditional birth experience, rather than just another surgical procedure. People have labeled this a “gentle C-section” or a “family-centered C-section.”

In a typical C-section, a set of drapes shields the operating field, which means the mother can’t see what is happening. After birth, the baby is whisked away to be examined by the pediatric team, and mom may not hold her baby for 15 minutes or more – maybe not even before the surgery has ended.

It’s normal to look forward to watching the birth and holding your baby seconds later. So, if we need to deliver via C-section – perhaps because the baby is breech or we are concerned about the fetal heart rate – it’s understandable that you may be disappointed. Some moms who have had a C-section say they feel like they missed out on an important part of pregnancy. However, by making a few small adjustments such as using a window with a drape, we hope you’ll remember the birth, too, and not just the surgery. I’ve included a video with a patient’s perspective of what you might see if you choose a drape with a window – watch it and decide if it is something you’d be interested in using.

What is a ‘gentle C-section’?

A “gentle C-section” brings elements of a vaginal delivery into the operating room – such as letting the mother watch the birth and hold her newborn right away. A C-section is major surgery. We can’t forget that. But we may be able to take a more patient-centered approach.

One of the first things we examine is the environment. For example, in a typical labor and delivery room, women can control the volume of the room by keeping it quiet or set the ambiance by playing music they’ve personally chosen for their labor and delivery. Operating rooms, on the other hand, can be loud, with lots of people talking and machines making noises, so we may ask staff to be mindful of the sound levels. And remember, it’s OK to ask whether your music choices can be played during the delivery in the OR.

Also during a typical vaginal delivery, mom may be able to have several loved ones with her during the delivery. However, most hospitals limit the number of people you can have with you in the operating room – for example, Clements University Hospital usually limits it to one. But we can try to make sure you and your partner know each person in the room and what their role is in your care and your baby’s care.

In a typical C-section, a drape is set up to provide a sterile operating field, meaning you can’t see your baby being born. In a “gentle C-section,” we offer the option of using a clear drape or a drape that has a clear window, allowing you to get that first glance of your baby. Many drapes have the option for covering the window – which might be a good idea during the repair phase of the surgery if you or your partner don’t tolerate the sight of blood.

Finally, we know you want to hold your baby as soon as possible. By placing the blood pressure cuff and IV on one arm, we can leave the other arm unstrapped, potentially allowing you to hold your baby immediately. Along with the pleasure of meeting your baby for the first time, the benefits of immediate skin-to-skin contact – or kangaroo care as it’s sometimes called – are well-known and include:

• Improved breastfeeding rates
• Quicker bonding
• Regulating baby’s temperature, heart rate, and breathing
• Reduced stress for mom and baby

Even though these adjustments may seem small, they can make a big difference in how a mother looks back on the delivery experience.

Who is a candidate for ‘gentle C-section’?

We know “gentle C-sections” are not a replacement for a vaginal birth, and we’re not advocating for more C-sections. But for women who need a C-section, we want to make the experience as traditional as possible.

We can try to do as much or as little as you want. For example, some women are uncomfortable with the thought of seeing more of the C-section, in which case, we can keep the drapes closed. But they may still want that immediate skin-to-skin contact.

There may be circumstances when we can’t use some “gentle C-section” elements, such as:

• If we are worried about the health of your baby. The baby may need attention from the pediatric team, which means you might not get to do skin-to-skin.
• If you have to be put under general anesthesia or you need additional sedation. If you are sleepy or under the influence of some of these drugs, you may not be able to safely hold your baby right away. However, your partner may be able to hold the newborn immediately.
• If there are complications with the surgery. There may be times when we feel it’s appropriate to block the clear drape – especially when it’s difficult for the surgeons to take the time to explain what’s going on because they need to concentrate on the surgery.

Talk with your physician about which of these options are available at your hospital in the event you need a C-section. We know that a C-section is not the same as a vaginal delivery, but we may be able to make the delivery experience more like you envisioned.