The Natural Caesarean: A Woman-Centred Technique
By Smith J, Plaat F, Fisk N. BJOG 2008;115:1037–1042.
Maybe someday this will be how all C-secctions are performed!
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“Although much effort has gone into promoting early skin-to-skin contact and parental involvement at vaginal birth, caesarean birth remains entrenched in surgical and resuscitative rituals, which delay parental contact, impair maternal satisfaction and reduce breastfeeding. We describe a ‘natural’ approach that mimics the situation at vaginal birth by allowing (i) the parents to watch the birth of their child as active participants (ii) slow delivery with physiological autoresuscitation and (iii) the baby to be transferred directly onto the mother’s chest for early skin-to-skin. Studies are required into methods of reforming caesarean section, the most common operation worldwide.”
Perhaps, the biggest obstacle to implementation is reluctance of staff to change roles and give up rituals. A multidisciplinary team approach is key. The surgeon cannot remain aloof behind the drape. The anaesthetic team must embrace the presence of the baby at the ‘head-end’, and midwives need to accept that what is good practice at a vaginal birth is also achievable in theatre. An initial midwifery concern that the technique would delay a busy operating list, with no opportunity to weigh, check and dress the baby or complete the paperwork until the end of the operation, was assuaged once the staff had witnessed the family friendly benefits of a ‘natural’ section.
Caesarean section rates are rising worldwide, and indeed, now exceed one-third of deliveries in many developed world centres such as our own. Given the negative effect that caesareans, whether indicated or discretionary, have on maternal satisfaction, bonding and breastfeeding, improving this experience while maintaining safety should be a priority. We describe an evolving approach, suitable for global export. Studies are now indicated on the effects of naturalising this most unnatural form of birth.
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