10 April 2009

"natural" cesareans

Food for thought during Cesarean Awareness Month. Love this & hate this...what do you think?

http://www.timesonline.co.uk/ tol/life_ and_style/ health/article60
28478.ece

From The Times
April 4, 2009

The new "natural" Caesarean
With more babies being born by Caesarean section, a new movement is
campaigning to make the event a more "natural" experience

Charlotte Edwardes

The lights of the operating theatre are dimmed and there is a mood of calm
among the hospital staff. A midwife softly narrates a continuing procedure
to a patient who is squeezing her husband's hand. The surgeon gives the nod:
it's time. The drape across the patient's abdomen is lowered and her head is
raised. Her eyes widen as she and her husband watch their baby, tiny and
pink with a mop of black hair, being gently delivered from her. There is a
moment of collective awe before the newborn's cry fills the air. "It's a
boy!" his mother gasps, before enveloping him in a warm hug.
This mother has just had a "natural Caesarean", a revolutionary technique
that attempts to turn one of the world's most common operations into an
experience closer to vaginal birth. The idea was conceived by Professor
Nicholas Fisk, formerly a consultant obstetrician at Queen Charlotte's
Hospital in London, in response to the rising numbers of Caesareans in the
UK. Caesarean deliveries account for 24 per cent of all births. More than
half are emergency C-sections rather than planned, and maternal age is a
factor; according to the National Sentinel Caesarean Section Audit, mothers
under the age of 20 have a C-section rate of just 13 per cent, compared with
33 per cent for mothers aged between 40 and 50.
There's no doubt that a Caesarean is major surgery. It is also the joyous
moment of arrival for parents and this is what Professor Fisk, and two
colleagues - Dr Felicity Plaat, consultant anaesthetist, and Jenny Smith, a
senior midwife and author (see panel) - set out to emphasise.
"It struck me that all the effort was going into changing normal childbirth
but that Caesarean section was still steeped in old surgical rituals," says
Fisk. "In some cases I was horrified; the baby would be dragged out like a
tumour and passed to several medical staff before the mother. It was ripe
for reform."
His team concentrated on three areas. First, parental involvement: this
meant dropping the drape that "divorced" the mother from her abdomen, to
allow her to see her baby's head emerge; the baby itself blocks the mother's
view of the operation.
The second point was physiological: Fisk showed that when a Caesarean is
performed slowly the baby is able to "autoresuscitate" - start breathing
unaided - while still attached to the placenta, as in normal birth. The baby
is "half-delivered" and a combination of the naturally contracting uterus
and the baby's vigorous wriggles allow the lungs to expel fluid in a similar
way to a vaginal birth. This reduces the risk of the baby needing help to
breathe; a common occurrence after a Caesarean.
Finally, Fisk wanted to see newborns handed immediately to their mother for
skin-to-skin bonding. "There are now official standards for skin-to-skin
bonding in childbirth, but these are almost never met with Caesareans," he
says. One obstruction is that the monitoring equipment needed for patients
in surgery is routinely attached to the mother's chest. "In a natural
Caesarean we attach the ECG wires to the back of the chest so that the baby
can be placed on the mother after birth," Plaat says. The anaesthetic dose
is lowered so that there is no "heaviness in the arms" to prevent holding
the baby, and a clip that measures oxygen in the blood is attached to the
toe.
Plaat knows from experience how important it is for a mother to be given her
child as quickly as possible: "My son was passed around, measured, weighed,
dressed and even had his hair washed before being given to me. A crucial
player, therefore, is the midwife . She has to be enthusiastic and involved.
It's not just 'dumping baby on mum' and writing up notes; it's making sure
that the baby is safe, is not going to slip off, and is warm. We put towels
over the baby and even bubble-wrap - the kind you buy in big rolls in
Ryman."
Smith, whose book Your Baby, Your Body, Your Birth advocates a softer
general approach to birth, adds: "And while keeping both mother and baby
safe, we focus on the fact that this is a birth. We bring in the elements of
normal birth: the mother can see her baby's sex at the same time as the
operating team. The father can perform a second 'cutting of the cord' and
the midwife can show him where to clamp it. It is entirely different from
the experience parents have had before."
While plans to audit the effects of the natural Caesarean on mother and baby
are in the pipeline, women who have heard of the technique want it now. The
procedure is unsuitable for babies who are in the breech position, or when
the baby or mother, or both, are in danger, or for premature babies whose
lungs are not mature. But Ruwan Wimalasundera, consultant obstetrician at
Queen Charlotte's, says that 90 per cent of his patients ask for the natural
Caesarean and more than 100 have been performed in the past 18 months.
"Parents love it," he says. "The benefits are obvious: mothers bond with
their baby earlier."
Those who have had a natural Caesarean could not be more effusive. Camilla
Fisher had one last summer, after an emergency Caesarean two years before.
"It was the most relaxing environment: calm and reassuring," she recalls.
"The staff and my husband were all in green surgical gowns, but it didn't
feel like an operation. When you've had a natural Caesarean you wonder why
it was ever different. I've never felt that I was deprived of a 'natural
birth'."

Discuss your views on birth styles at timesonline. co.uk/alphamummy

How to have a 'natural' C-section
Jenny Smith, a leading midwife and author of Your Body, Your Baby, Your
Birth (Rodale UK, £14.99), gives these tips:
Ask if the surgical team will play music and if your partner can take
photographs.
Ask for an epidural dose that won't make your arms "heavy".
Ask for the screen to be dropped so that you can see your baby being
delivered.
You can ask to call the sex of your baby yourself.
Ask the midwife to pass your baby directly to you so that you can enjoy
skin-to- skin bonding immediately.
Ask that the father may perform the second "cutting of the cord" while the
baby is in your arms.

5 comments:

Taryn said...

I love that people are finally realizing the difference in the baby/mom bonding experience that a c-section creates.

At the very least...I think this article will educate the moms that are having a cesearan regardless, and want to increase the quality of the newborn bonding and breastfeeding success.

P.S. I just stared following your blog and am loving it! :)

DoulaMomma said...

Thanks Taryn - I do hope the US will catch up and make changes - institutional change is tough but maybe it can trickle up with women asking for these changes if they should be having a c-section anyway, as you point out.

Hannah said...

It would have helped me, to have my c-section this way. It wouldn't have made me feel happier about having it, and it wouldn't have changed my disappointment. But it would have made me feel more human, more like a real mom. If my doctor had even looked at me, and said something warm, something comforting. If I could have felt any part of my body below my neck. If I could have held my baby before 10 doctors, my husband, my parents, etc.

If I could have SEEN him born. Looked into his eyes, and told him how much I loved him, how excited I was to finally meet him, and how perfect he was in every way!

My son gave me the opportunity for all of this within 12 hours, but I would have love love loved to have the doctors give a crap too.

If you're going to cut me open, at least respect me and my baby. We only get to do this once together, you know?

Hobo Mama said...

Hannah's comment is so moving. Thank you for sharing your experiences and your regrets and wishes. If it's going to be a c-section, it might as well be respectful and life-honoring. I'd expand that to say that's my wish for any hospital birth. I had a home birth transfer to a hospital, and I ended up with a natural birth, but it wasn't as peaceful and respectful as I had envisioned. Can I expand that desire a little more? I wish all medical professionals would respect and honor their patients instead of concentrating on protocol and pointing to their own expertise. Here's hoping there might be some change that direction (but I'm not holding my breath).

But to answer your question — I wouldn't want c-sections to become the norm, even peaceful, "natural" ones, but I'd like this to be an option for the ones that do (need to) take place.

Laura said...

I like the recognition that birth is a natural phenomenon. I like that they see problems with current c-section practices. It is still a birth and the awesome moment of your baby being born into the world. I like that there is a recognition of the sacredness of that moment. However...

If there can be this kind of peaceful mindfulness about it all, what kind of emergency is it really that necessitates a c-section in the first place? And if no emergency, why perform a c-section?

Should the c-section rate really be 25% or even higher? It does impede bonding, and that's not good for the health of the baby or the mother. It is a major surgery that requires healing.

I have mixed feelings.