Gentle caesareans

By Barbara Hanrahan – Registered nurse and midwife, masters in midwifery

 

A caesarean is more than just surgery – It is the birth of a baby.

A caesarean can be more than surgery!

 

Gentle caesareans facilitate the mother’s participation in the first moments of her baby’s life

  • Seeing her/their baby as it is being born
  • Environmental accommodations for a more tranquil experience
  • Receiving the baby immediately after birth
  • Facilitating development of the microbiome and baby’s immunity through skin to skin contact and vaginal seeding
  • Facilitating the physiological synergy between mother and baby after birth
  • Experiencing cutting the umbilical cord

Lobel in his research in 2007 – says traditional caesareans can prevent mothers from connecting with the important physical and emotional aspects of birthing. There are higher negative perceptions about their birth, themselves and their babies. The research shows poorer maternal – child interactions. There is also a higher risk of postpartum mood disorder for the mom.

 

Background

All the clinical, safe and sterile procedure in the operating theatre remains intact.

But there is a process change

  • Parents watch the actual birth of their baby from when the head is lifted out of the incision. The drapes surrounding the Caesar being done are lowered or see-through.
  • The doctor can conduct a slow… delivery “walking the baby out” with the intent to imitate the “vaginal squeeze” to shift the fluid from the baby’s lungs.

All the benefits to both mother and baby of skin to skin contact immediately AT the birth apply to caesarean births too.

 

Process

  • The mother’s dominant arm must be free to hold her baby.
  • The blood pressure cuff is covered and the ECG dots are away from mom’s chest.
  • Once the umbilical cord is cut and any stimulation required initiated, a surgically sterile staff member receives and places the baby on the mother’s chest. She dries the baby and puts a beanie on the baby’s head. All these procedures are done while the baby is on the mother’s chest.
  • The naked baby is placed prone on mother’s chest.
  • The head and back are draped with a warm dry towel covered by a sheet of bubble plastic
  • Through thermal synchrony, the skin to skin contact allows the mother’s chest to warm the baby’s body.
  • Newborn care tasks can be done while the baby is on the mother’s chest – so that there is NO separation of mother and baby and hence less colonisation of hospital organisms for the baby.
  • The father can do skin to skin with his baby under his hospital theatre scrubs when mom is being transferred onto the trolley.
  • Baby is put back skin to skin with mom and transferred to recovery.
  • Mom is assisted in initiating breastfeeding in response to baby’s cues.

 

Environmental accommodations

Minimize extraneous noise.

Minimize non-birth related conversations between members of the clinical team.

Evidence proposes that selected audio-visual media used during surgery can produce an anxiolytic effect in the patient by decreasing activity in the nervous system and decreased neuromuscular arousal.

 

Making a mind shift

The perioperative team utilizes an evidence based approach that facilitates physiological and psychological benefits for both mother and baby.

The biggest barrier is peoples “power” and reluctance to change particularly within the professional team doing the caesarean.

All elements of gentle caesareans are refinements of standard practice that will positively impact on mothers, fathers and babies for the rest of their lifetimes!

Mothers dream about the moment of birth and holding their baby and soothing the baby’s cries. The surgical nature of a caesarean detracts from valuable elements of birth. Minor changes allow the mom and dad to witness the birth, experience skin to skin and bonding with their baby, improve the baby’s temperature, breathing and blood sugar regulation and reduce stress for the mother and the baby.

Advocating for Gentle Caesarean must NOT be confused with promoting elective caesareans!

The prospect of more patient centred, kind and gentle caesarean care for mothers and their babies is exciting!

The Natural Caesarean – a woman centered technique

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