What’s A ‘Natural Cesarean’ And How Natural Is It?

That was my reaction when I read a recent post by my friend Ananda Lowe who writes a blog, thedoulaguide, about childbirth issues of all sorts. (Disclosure: she is also my co-author on a book we wrote on how to have a fulfilling and fully-informed birth experience.)

Ananda explains that a new “natural cesarean technique” is being developed here in Boston at Brigham and Women’s Hospital:

While talking with my friend Dr. William Camann, director of obstetric anesthesiology at Brigham and Women’s hospital in Boston, I was surprised and excited to learn that he recently helped the hospital adopt components of what is being called “the natural cesarean” technique. Bill is co-author of the book “Easy Labor: Every Woman’s Guide to Choosing Less Pain and More Joy During Childbirth,” and the Brigham is Boston’s largest maternity hospital, so its adoption of these methods is good news. In the past, some mothers reported feeling “a disconnection from their cesarean baby because they did not actually see or feel the baby born,” according to the International Cesarean Awareness Network (ICAN). The natural cesarean technique offers parents the option of viewing the emergence of the baby if they wish. (For years, ICAN has been a pioneer in proposing guidelines for family-centered cesareans, as well as advocating for other reforms related to the use of cesarean sections—I encourage everyone to support their work!)

I spoke with Camann today and he said the preferred term for the new technique is “family-centered Cesarean,” or “gentle Cesarean.” The concept has been evolving for several years, he said, with some elements of it — like early skin-to-skin contact between mom and baby in the operating room — becoming more standard. The newest element — a clear surgical drape that allows the mom to actually see the birth — just started a few months ago. “To my knowledge, the Brigham is the only hospital doing that,” Camann says. “It was my idea; the patients love it.”

A "natural" or "family-centered" Cesarean section. (Photo courtesy Dr. Bill Camann)

A “natural” or “family-centered” Cesarean section. (Photo courtesy Dr. Bill Camann)

But a bird’s eye view of a surgical birth isn’t for everyone, he added, and some new moms don’t want to see anything. “You pick up cues from the patients and other providers,” Camann says. “It’s very much a judgement call.”

Here, Camann offers more details on the technique:

A growing movement is attempting to make the cesarean delivery a more natural, or family-centered, event.

Modifications of the standard technique include:
· Early skin-to-skin contact in the operating room (with either mom or dad)
· A slow delivery (with intent to mimic the “vaginal squeeze”)
· Placement of IV catheter, oximeter, and blood pressure cuff all on the
same and non-dominant arm to allow a completely free arm for maternal contact with baby
· Placement of ECG leads on the back, to allow a free chest for early maternal skin-to-skin contact
· Intraoperative breastfeeding
· Clear surgical drapes to allow better view of the delivery

Benefits of this approach include a more family-centered experience for the mother and partner, improved thermoregulation of the neonate, better bonding, early feeding, and overall greater satisfaction with the procedure.

Some mothers and their partners wish to view as much of the actual delivery as possible. Lowering of the surgical drapes at the time of delivery may allow this to some extent but issues related to possible contamination of the sterile field, or blood and other fluid spillage, might preclude a complete view by this method. The use of a clear, see-through surgical drape will allow a full view of the delivery while still maintaining full sterile and other precautions.

He adds that there is no evidence that this family-friendly approach has any impact on lowering the national C-section rate, which is nearing 35%. Indeed, he says, it could have the opposite effect:

Some may argue that making the cesarean delivery experience friendlier would be counterproductive to any attempts to decrease the overall cesarean rate. In contrast, an attempt to make any childbirth experience, whether vaginal or cesarean, more pleasant for patients and partners should be considered as part of the services we can offer.

Please follow our community rules when engaging in comment discussion on this site.
  • looby Lou

    I wish these options were available when I had my C-Sections.

  • Desi

    This is amazing! I have just found out I have CPP (Complete Placenta Previa) which makes it impossible for me to have the full natural (NO DRUGS!) birth I was hoping for. This would be a wonderful way to have a c-section compared to the standard where you don’t get to see or hold your baby until after you leave recovery. If only I was anywhere close to Boston!! I hope they bring this method to CA before I give birth!!

  • Sh.Theofanous

    I wish I had this chance. :(

  • malorva

    This is great news for the mothers/babies who need a c-section. Hopefully this will be adopted at all hospitals.

  • Reasonable?

    This seems like “Rebranding”.
    Sprinkling user experience on an otherwise sterile proceedure.
    It’s like car companies focusing on cup holders and sound systems when core features fail to differentiate competitors.

    However in medicine including Obstetrics, there are still problems with the core features.
    Medicine is a curious industry.

    • wishing for a vbac

      Yes it doesn’t solve the issue of a high c-section rate. However, I had a c-section and the only hospital within a 45 minute drive has a VBAC ban which means if we have another child while living here I am stuck with a c-section. I would love to have this option for the repeat c-section.

    • http://www.facebook.com/stephanie.vaughan Stephanie Vaughan

      It’s true it doesn’t address the core issues of a c-section, but don’t discount user experience as unimportant, either. A person’s experience of a huge milestone moment in their life has long-term effects. I’d like to see hospitals addressing both “core feature” issues and “user experience.”