How Can I Have a Gentle Caesarean?
What is a ‘Gentle Caesarean’?
There are myriad reasons why you might be planning a caesarean, perhaps it’s medically necessary, perhaps you have chosen this route for your own personal reasons, or maybe you’re putting a back-up plan in place for if things don’t go the way you envisage.
Whatever the reason, you might have heard about ‘gentle caesareans’ and be trying to plan for this. But it can be pretty hard to know what a gentle caesarean actually involves and how to achieve it in practice.
There is no official agreement on what constitutes a ‘gentle caesarean’, but generally ‘gentle’ refers to the medical team taking steps to mimic, as far as possible, some of the processes of a physiological birth. I like to think about this as being broken into two parts. The first considers how you might mimic some of the environmental preferences that might be incorporated into a physiological birth, the second considers the birth itself and how the process of a surgical birth can be adapted to more closely align with physiological birth. Let’s take a look at some of the possibilities in both areas:
Environmental Considerations
Achieving the environment you want for your caesarean birth is normally achieved by informing the medical team of your plans in your pre-surgery meeting. Sometimes you might need to advocate for yourself, but all of the following considerations are possible to facilitate in a surgical setting, Things you could consider are:
What music might you like playing in the theatre?
Can lights that are not required to perform the surgery safely be dimmed?
If your caesarean is not an emergency, would you like staff to take the time to introduce themselves so that you know who is with you as you deliver your baby?
Birth Considerations
Delivery
Your baby can be delivered more slowly to mimic some of the processes of a vaginal birth and to support both you and your baby in participating in the birth.
The theatre team can lower the surgical drape if you would like to see what is happening. As your baby’s head comes through the incision, their body can remain inside your uterus to allow for the pressure of uterine contractions to assist in pushing the fluid from the lungs. The obstetrician then eases out the shoulders and the baby lifts out their own arms. Throughout the procedure the obstetrician observes the baby’s vital signs and supports the baby and their head, whilst they wriggle out, supported to do so by uterine contractions. A walk-through of how this procedure might look can be found here.
Skin-to-skin
Unless you or your baby are unwell, it is possible to facilitate immediate skin-to-skin in a caesarean birth. You might like to prepare for this by asking your medical team to place ECG leads on your back or down from your chest so that your upper chest is free for skin-to-skin and/or immediate chest feeding if this is something that you would like to do. You can also wear your hospital gown back-to-front or with your shoulders bare and ask for your IV line to be placed in your non-dominant hand to make this easier.
Optimal cord clamping
The cord does not need to be clamped immediately in a caesarean birth any more than it does in a physiological birth. Consider telling your medical team that you will be having optimal cord clamping (or that you would like to keep the cord intact). According to NICE guidelines, ‘delayed cord clamping; is when the cord is left intact for one minute following birth. It is worth considering that for some babies, placental transfusion (the transfer of residual placental blood to the baby) will have finished after one minute (or less), but for others this will take longer. ‘Optimal cord clamping’ will be different for each baby and involves waiting until the cord has stopped pulsating. If you would like your baby to receive the maximum amount of blood from the placenta then you will need to ‘wait for white’.
If you would like to have skin-to-skin contact with your baby whilst the cord is still intact, then this should be possible (depending on the length of the cord). The surgical drape can be lowered and the baby can be passed over the drape in order for you to achieve this.
A note on unwell babies - there is evidence to suggest that babies who are unwell at birth do better if their cord is kept intact. This is called intact cord resuscitation. You might consider discussing with your care team how your baby will be supported if they require any extra help with breathing at birth. This paper provides some useful insights into how medical teams can plan to support intact cord resuscitation if it is needed.
Vaginal Seeding
Vaginal seeding involves placing a sterile cotton gauze or cotton swab into the vagina shortly before surgery (normally an hour) to allow it to absorb vaginal fluids. The gauze is then wiped over the mouth, nose and skin of the baby shortly after birth. The theory behind this practice is that it may transfer beneficial vaginal flora to the baby which they would have received during a vaginal birth.
This is currently a theory and, as with all practices in birth, something which should be considered in light of its potential benefits and potential risks. Dr Sara Wickham has written a comprehensive article that balances all of the points in relation to this). If this is something you decide to add into your birth plan, you can discuss getting support for this with your medical team. If your medical team do not support vaginal seeding then you can do this yourself by bringing a sterile gauze and sterile specimen pot to your surgery, placing the gauze into your vagina about an hour before your surgery, removing it shortly before surgery and placing it into a sterile container and then wiping the gauze over your baby’s nose, mouth and skin shortly after birth.
Breast/chestfeeding
If you wish to breast/chest feed then immediate skin-to-skin contact with your baby once they are born can support this. You should be able to feed your baby whilst still in theatre if this feels right for you, and if you have already prepared for skin-to-skin by having ECG leads placed on your back and having your chest exposed then this will support with immediate feeding.
Babies born by caesarean have an altered gut microbiome to those babies who are born vaginally, however recent studies have shown that exclusive breastfeeding can reverse the changes associated with a baby being born by C-section. If your baby is going to be born via caesarean, particularly earlier than planned, and you wish to breastfeed, it can be a good idea to get some support during pregnancy in order to prepare for feeding, educate yourself on the signs that feeding is going well or that more support may be needed and to increase your confidence before your baby arrives.
