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Thursday, February 17, 2011

How to have a "natural" cesarean

I get asked this one a lot and figured it would be faster to put together a blog with links than to re-type the same email several times a month.

Maybe you have a rare medical condition that requires a scheduled C-section. Maybe you are going to be induced and are aware that induction doubles your risk of needing a C-section and would like to plan to have the best possible C-section if it comes to that. Maybe you're attempting a VBAC and would like to have a backup plan in place. Maybe you're a healthy, low-risk mom who is planning an unmedicated birth (whether at home, birth center, or hospital) and would like to prepare for the slim chance that a cesarean may become necessary. Maybe you are having an elective cesarean.

In any case, all moms have the right to be treated with dignity and respect. Many moms are unaware that they have options to make a cesarean the best possible experience (considering the circumstances) and that often, there are options moms can request to help with bonding with baby, allow immediate skin-to-skin contact with baby, facilitate breastfeeding, reduce your risk of postpartum depression, and more.

"Family centered cesarean" or "natural cesarean" can mean a wide variety of things. You can view some of these options on this sample cesarean birth plan by Preparing For Birth.  Personally, I think it's a good idea for all expectant mothers to have Plan A, Plan B, and Plan C lined up just in case, because a birth plan is not designed to be a script for how the birth should go, but rather, it's a well thought out list of preferences the family would have in the event of different circumstances.

Please remember that no birth plan is legally binding. It's crucial to find a care provider who truly supports you as you work toward the birth you want, whatever kind of birth that is. Many care providers will give lip service to supporting moms, but will deny them at the end. Finding the right hospital and OB to perform a family-friendly cesarean will be worth the effort. Hiring a doula or having your midwife present for this role can help boost your odds of achieving a gentler cesarean. A doula can help calm your nerves in the hours before a planned cesarean while you wait and fill out paperwork, and she can answer any questions you have along the way as to what is going on, why something is happening, whether that's normal, and what options (and legal rights) you have. She can also tag in to the OR if your partner leaves you after the delivery to follow the baby to the nursery, so that you don't have to be alone while they stitch you back up. She can assist you with relaxation and breathing techniques to keep you calm, as well. Here's doula (The Feminist Breeder) Gina Crosley-Corcoran's blog about her experience supporting a client during her cesarean.

The natural caesarean: a woman-centred technique--National Institutes of Health (NIH)

Family-Centered Cesarean--ICAN (International Cesarean Awareness Network) White Papers

Ideas for the best cesarean possible--by Penny Simkin. Free PDF printable.

The new "natural" cesarean--UK Times

"Natural" cesarean mimics vaginal birth experience--Reuters UK

"Every bit as magical": A British doctor is challenging convention to pioneer the 'natural' cesarean. Joanna Moorhead watched one baby's slow and gentle arrival.--Guardian UK

Delivered safely by caesarean with his mother's hands ("assisted cesarean")--The Age (Australia)

The Case for Kangaroo Daddy Care--Baby Gooroo--One family's story of how Dad provided Kangaroo Care for baby while mother was recovering post-cesarean, and why babies can benefit from this.


Above is the 8 minute trailer for the documentary, "Breast is Best," showing how to get breastfeeding off to a good start. The opening scene shows a "natural" cesarean with baby being brought skin-to-skin on mom's chest so he can nurse while she is still being stitched up on the OR table. Immediate skin-to-skin contact on mom's chest immediately after birth helps stabilize baby's breathing, heart rate, blood sugars, and body temperature, all while promoting bonding and reassuring both mom and baby in each other's presence.

12 minute video describing "The Natural Caesarean: a woman-centred technique":



The "natural" cesarean described by the above links, with baby's slow, gentle emergence from the womb, somewhat reduces baby's risk of respiratory distress after cesarean birth, which is common for cesarean babies since they do not receive the benefit of having their lungs squeezed and emptied of mucus, which occurs naturally in a a vaginal birth. 

Having a cesarean birth is compatible with having the placenta encapsulated (placentophagy). If you're unfamiliar with this, you'll have to hang tight until I can post a blog with all the research and reasons why it's a great option for postpartum, regardless of the method of birth. To make a long story short, the placenta can be steamed, dried, ground, and encapsulated into geltabs so that it's no different than taking a multivitamin. Research indicates that placentophagy, which has been traditional around the world for thousands of years, may potentially offer the following benefits: reduced risk of postpartum depression, reduced risk of anemia (by restoring her iron reserves), helps bring postpartum hormones back into balance, improved mothers' energy and sense of well-being postpartum, and a boost in establishing milk supply. While all of these are wonderful benefits for any mom postpartum, they are especially beneficial post-cesarean. Here's a great FAQ on placenta encapsulation, including tips on how to get your placenta released from the hospital.

For many moms who are planning a cesarean (whether for medical or elective reasons), waiting on labor to begin before going in for the cesarean is an option. If this is a possibility, based on your medical situation, this is helpful for mom and baby both. By allowing labor to begin, you can rest assured that baby was "ready," precluding the all-too-common iatrogenic (doctor-caused) prematurity which is on the rise. Mom and baby both receive the chemical/hormonal benefits of the beginnings of labor, and if mom has a good series of contractions before a cesarean, baby's risk of respiratory distress and other respiratory problems is somewhat lessened because the squeezing effects of efficient contractions help push mucus out of baby's lungs (which occurs naturally in vaginal births).

A gentler cesarean birth is possible--even here in America. However, it is going to take informed consumers to drive this change. If enough moms request this, it can become the standard for cesarean care. With the current state of affairs in American maternity care, I'm not optimistic that I could see that scale of change in my lifetime, but that's irrelevant. You don't have to wait until evidence-based care of any sort--including "natural" cesarean--is the norm. You can find a way to make it possible for *you*, regardless of what everyone else is doing.

It would be irresponsible to post all this information about "natural" cesarean without making sure that you have links to weigh all the risks of cesareans. Cesarean birth is a major abdominal surgery with serious risks and consequences, both short-term and long-term, for mom and for baby. The point of this blog is not to encourage an even higher cesarean rate (32.3% of US births are cesarean as of 2008, while the World Health Organization has stated that 10-15% should be the maximum), but rather to make alternative options more widely available for situations when cesareans are needed or desired, based on fully informed consent.

The Risks of Cesarean Section Fact Sheet--Free printable PDF--CIMS (Coalition for Improvement of Maternity Services). Current (Feb. 2010 publication). Includes checklist for expectant mothers to read during pregnancy and discuss with their care providers.

Cesarean Fact Sheet--ICAN (International Cesarean Awareness Network)

Cesarean Section: Myth vs. Reality--Childbirth Connection

Patient Choice Cesarean Position Sheet--ICAN (International Cesarean Awareness Network)

Where to turn for more information about cesareans--California Watch

A Woman's Guide to VBAC. How to weigh the National Institutes of Health recommendations for considerations of VBAC vs. repeat elective cesarean, based on each woman's individual circumstances.-- Giving Birth With Confidence/Lamaze International.

(Disclaimer: I'm not a doctor. I'm not trying to tell you to have a cesarean or not to have a cesarean. I'm encouraging all expectant families to READ, READ, READ and learn their options so that they may make fully informed decisions with their care providers as to what is the safest route for their individual situation.)

9 comments:

  1. Great post! I'm bookmarking this one to share with my girlfriend and SILs, who will all three most likely have repeat sections with their next children.

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  2. Hi
    Great post!
    Something not often mentioned on the risks of CS sheets is the impact to baby's gut flora:

    The gastrointestinal tract of a normal fetus is sterile. During birth and rapidly thereafter, bacteria from the mother and the surrounding environment colonize the infant's gut. Immediately after vaginal delivery, babies may have bacterial strains derived from the mothers' feces in the upper gastrointestinal tract.[13] Infants born by caesarean section may also be exposed to their mothers' microflora, but the initial exposure is most likely to be from the surrounding environment such as the air, other infants, and the nursing staff, which serve as vectors for transfer.[14] The primary gut flora in infants born by caesarean delivery may be disturbed for up to six months after birth, whereas vaginally born infants take up to one month for their intestinal microflora to be well established
    http://en.wikipedia.org/wiki/Gut_flora

    AA

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  3. great post! sharing in Sunday Surf

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  4. I am so glad a friend sent this link to me. Thanks to some lovely malpractice with my first birth by both a midwife and an OB, my body was so permanently damaged that I will have to have a c-section should we succeed in having more children. I'm not thrilled with the prospect, but these links have given me hope that my baby and I won't be totally damaged by an "unnatural" means of exiting the womb.

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  5. Thanks mamapoekie, I enjoy your posts and I'm flattered that you stopped by.

    Inkling, Thank you for your comment. I'm glad that you will have more options if and when you have your next baby. I'm so sorry that you had such a bad experience with your last birth--so sad. I hope you are treated with kindness and respect so that you can have your birth your way--even with a surgical birth.

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  6. Even patients with malignant obesity or super morbid obesity, defined as more than 200 pounds overweight.
    pregnancy calculator

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