Is there Such a Thing as a “Natural” Cesarean Section?
Introducing….the concept of the “natural” cesarean…
I have struggled with whether or not to post on this YouTube video for some time. The title, in and of itself, is aggravating. And I don’t mean from a judgmental standpoint, but simply from a realistic standpoint: cesarean birth—whether positively, clinically indicated or not—is not “natural.” It is an alternative method to birth compared to how nature originally designed it.
I have heard many others refer to the practices described in the video as “gentle cesarean.” This, at least, seems to be a bit more accurate—except for the cutting, pushing, tugging, pulling, suctioning, cauterizing, and externalizing of the uterus that goes on. (In a former career life, I used to surgically assist on cesareans, so I’m pretty familiar with what the procedure looks like.)
A list serve I’m a member of has recently spent a lot of time debating practices that surround cesarean births: should hospital policy allow for placement of baby skin-to-skin with mother directly following birth? Should breastfeeding be allowed in the OR while mom is still being sewn up? Should separation of mom and baby in the minutes and hours be avoided following a C-section in the same way this practice has taken hold in the vaginal birth setting?
Other questions about cesarean birth discussed frequently in my own local birth network include: Should birth plan elements such as low lighting, quiet music and delayed cord clamping be integrated into the C-section setting? Should doulas be allowed into the operating room to provide the emotional support the mother/parents hired her for? (An aside here: the most common argument against allowing doulas into the OR at my local hospital is that, “the OR is too small to have an extra person in there.” Every time I hear this I nearly explode: the OR seems to be large enough to admit medical and nursing students at-will, along with the various OR staff coming and going from the room throughout the procedure. And yet the presence of a doula sitting quietly and still beside the birthing woman/couple seems to take up WAY too much space!)
The “Natural C-Section” video encourages many of the issues discussed above. It follows a second-time-mama into the OR for her second cesarean birth and features obstetrician, anesthesiologist and midwife talking heads who all describe this version of a cesarean birth in a universally positive light. In fact, mood lighting does seem to be implemented. The sterile drape separating mom’s head and the rest of her body is dropped in time for her to see her baby being pulled from the incision in her belly. The doctor holds the baby up, legs spread, so mom and partner can “discover” the baby’s sex on their own, as the OB narrates, “…it’s one of them.” Baby is placed right away, vernix, fluid, blood and all, on mom’s chest. Dad cuts the cord following a delayed cord clamping. In this video, the midwife’s job following the baby’s birth is explained as being focused on facilitating bonding measures like skin-to-skin contact and early breastfeeding, while also assessing baby’s well-being.
Interestingly, the anesthesiologist included in the video describes the birthing woman as ‘awake and participating in her baby’s birth.’ I have a hard time agreeing with his sentiment. While it is certainly preferable for the mother to be awake and aware the moment her baby exits the womb, I’m not sure how much ‘participating’ she is doing when strapped down with 2/3 of her body numb and immobile.
For women who must deliver via cesarean—I can definitely see the appeal in this version of a surgical delivery. It attempts to come up to speed in so many ways. There is no hour-long separation between mom and baby. When mom goes to the PACU (Post Anesthesia Care Unit), so does baby. The midwife in the video even acknowledges the associations between postpartum depression and cesarean rates as well as decreased breastfeeding initiation rates amongst women who have undergone a cesarean birth. She then goes on to imply that this gentler approach to the C-section might just ameliorate some of this association.
Criticism Against the “Natural Cesarean”
Here is the cause of my hesitation: does this promotional video of the “Natural C-Section” run the risk of making surgical birth look so enticing that the risks of C-section get pushed under the table?
Dr. Andrew Kotaska, an obstetrician in Yellowknife, NT, Canada describes his concern over the “Gentle Cesarean” this way:
“It is admirable to minimize the necessary disruption of normal early maternal- neonatal contact associated with NECESSARY cesarean section. The gentle measures employed will not, however, reduce the maternal risk of amniotic fluid embolism, pulmonary embolism, operative injury, infection, severe hemorrhage, and death – all several times higher with C/S than vaginal birth. They also will not help achieve the neonate’s normal immune system activation during labour, perhaps leaving it more vulnerable to autoimmune disease later in life.
“In no way can the “gentle cesarean” be construed as making C/S safer. In the best quality prospective data set on elective C/S, 1/2300 women died. Soft, family-centered window dressing does not change the cold, hard risks; it is important practitioners and women keep this in mind.” (Landon; NEJM 2004)
In the United States, we are struggling against an ever-increasing cesarean rate. Readers of this blog are well-aware of the ~ 33% C-section rate that doesn’t seem to be decreasing any time soon. In an age when we should be working to reduce the C-section rate to somewhere at least close to that which the WHO recommends, the promise of a gentler, naturalish surgical birth could threaten the work many maternity care professionals and normal birth advocates, alike, are doing to properly inform women (and some providers) of the true risks associated with cesarean birth.
On the same list serve I mentioned above, another related thread developed: should we “allow” post-cesarean moms to initiate breastfeeding while still in recovery? The meat of the debate was whether or not women with anesthesia levels up to the nipple line will suffer nipple damage from incorrect infant latches, if they cannot feel the latch. Hospitals apparently have policies on this: when a mother is and is not allowed to nurse her baby, depending on the type of birth they have experienced (and the resultant side effects—such as prolonged numbness). Since when did it become reasonable for maternity care facilities to dictate when a woman is and is not “allowed” to feed her own child?
This is exactly the type of down-stream effect of surgical birth that 1) likely does not get discussed prior to consenting for a cesarean and 2) is not erased by a gentler approach to the procedure and 3) involves the institution of policies that certainly are not evidence-based.
A Wolf in Sheep’s Clothing
I will never become the person who denies the importance of C-section as an option in a few, particular cases: umbilical cord prolapse, placenta previa, abruptia or accreta to name a few. The cesarean method of birth was, after all, developed to be a life-saving measure and, to this day, continues to be just that in a handful of circumstances. And when a C-section is truly indicated (but not emergent) then, YES, incorporating gentle, respectful, best-practices elements into the cesarean experience should be done. To me, this should quickly cease to be a point of debate at all. But for the remainder of women who find themselves in the position of contemplating the type of birth they’d like to experience—those who might be considering an elective C-section; those who have had a previous cesarean and are toying with whether or not to go for a VBAC—the promise of a “Natural C-Section” may turn out to be a wolf in sheep’s clothing.
As one participant on the list serve summarized:
“Can we work to make cesareans less common and also kinder–at the same time?”
Click on image below to watch the entire video on YouTube
Posted by: Kimmelin Hull, PA, LCCE
Cesarean Birth, Films about Childbirth, Science & Sensibility, Uncategorized, Vaginal Birth After Cesarean (VBAC)
Thank you for bringing this issue to the birthing community, but as a mother who suffered p.t.s.d. after a emergency cesarean some of this post rubbed me the wrong way.
The idea of the “natural cesarean” is from a 2008 medical article found here but not ever referred to in your post…
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2613254/
I believe that ALL cesarean should be done in a better, more human way. To imply that making them more “natural” will result in more women picking them I think is not giving women enough credit. As you point out no matter how humanly a cesarean is done it is still major surgery with potentially life long implications.
I also believe that one of the reasons that woman choose repeat sections is that their first section was not the experience the wanted and they believe, and are often told, that a planned section is much better then a emergent one. Perhaps if the initial sections were not so trauma inducing women would be emotionally more ready to choose a vaginal birth next time.
It seems wrong to not do what ever we can to promote emotional health of the mothers and babies, and I firmly believe that every care provider should be striving for the most holistic birth possible, even if that ends up being a “natural cesarean”. Emotional health is a part of birth that is often an after thought,but it shouldn’t be. I believe doing woman friendly cesarean can help avoid the increasing cases of p.t.s.d., a debilitation and potentially long term health issue.
One of the saving graces of my sons emergency c.s. is that he was placed skin to skin in the OR with me. It a moment that I use to help balance the rest of my experience which was very non “natural cesarean”.
I wish that we would all stop talking so much about “mother’s request” c-section. It has been shown to be a red herring, and yet we keep using it as a reason to avoid implementing sound policies. I’m ready to move on from requested surgical births. Let’s talk about gentle c-section methods for those for whom a non-emergent surgery is warranted. Those do exist, and I’m willing to bet are far more common than requested c-sections.
so can we agree that gentler (notice the difference between calling something “gentle” and “gentlER”?) cesarean is not safer, from a medical standpoint than any other kind of cesarean, but is “nicer” for the family and perhaps emotionally safer? we will need some studies and a more widespread use of these practices before we know for sure if the gentler practice help women avoid PTSD and PPMD. my gut says it will decrease these issues. mothers i’ve cared for as a doula who had some of these features (less separation from baby, earlier breastfeeding, baby in PACU, doula in OR and PACU) report greater positive feelings than mothers who’ve had traditional cesareans.
then we can move on to speak to the real problem – decreasing the incidence of cesareans themselves. 33% of births happening via gentler cesarean sure won’t make this birth advocate happy. what we know decreases cesareans is a lot harder to implement than low lighting in the OR ~ more midwifery care and less obstetricians in charge of births, more doula attended births, less fetal monitoring, less induction (and perhaps to get that we also need less late-pregnancy testing), more freedom to move, assume physiological laboring and birthing positions and to eat and drink as desired, better prepared partners, less of an emphasis on pathology in labor in the media and a more positive attitude toward labor itself among birthing women. tough stuff. maybe that’s why we are all easily distracted by mother demanded and “natural” cesareans.
let’s make surgery as humane as possible, and as rare too.
Anyway to make a C-section gentler on mom and baby and preserving the normal mother/child bonding process is a good thing. Nothing will ever make a C-section natural but we can make it emotionally easier and less traumatic.
Thoughts on this doc in UK:
http://www.guardian.co.uk/society/2005/dec/03/health.medicineandhealth
@Karen
Edited: I pasted the wrong URL
http://www.theage.com.au/articles/2007/04/14/1175971419538.html
This is the radical C-section I was referring to, not the UK article
“Emotional health is a part of birth that is often an after thought,but it shouldn’t be. I believe doing woman friendly cesarean can help avoid the increasing cases of p.t.s.d., a debilitation and potentially long term health issue.”
MJ–you get it. thank you for your post.
@mj
I agree with MJ also. I have clients as a doula that need c-sections and I feel like it is absolutely necessary to advocate for a gentler c-section. I think it’s okay to call it natural(though I can see some people getting mad about that term), because they are trying to make it more natural…the skin to skin, the family involvement…that’s all natural, even if the birth method isn’t. There are lots of other natural birth practices in this video that aren’t seen in most c-section rooms.
We need to be working at both ends of this spectrum…making c-sections more “natural”, and making sure we are decreasing the rates at which they are performed.
Interestingly, I just wrote about skin-to-skin post-op on my blog yesterday (http://thejugglingmatriarch.wordpress.com/2011/05/18/after-a-surgical-birth/). I agree that using the term natural to refer to c/s is a huge problem. Then again, I avoid the term natural most of the time; I prefer to say physiological, as I think that’s what we really mean, whereas natural has all kinds of connotations and posits a false nature/culture dichotomy. But be that as it may, I still think that the intentions behind this are spot-on, and like others I chafe at the suggestion that improving the circumstances under which women have cesaerean births will make the surgeries seem more attractive. The reality is that while we must work to reduce the alarmingly high c-section rate, it is critical for the women who do find themselves being cut (whether indicated or not) that hospitals adopt more woman-/baby-/family-centred protocols. I would still never trade my vaginal birth in 1997 for my emergency c/s in 2006, but if I had been treated even a little bit like the docs in this video treat their patients when my second daughter was delivered, it might have saved me a lot of heartache, anger, and depression. In other words, surgery would never be my first choice; but if I needed another one, it would be good to have one in a hospital that still aimed to support me as an individual (as opposed to just a patient or a uterus) throughout the process.
Many aspects of this “gentler C-section” have already been implemented in some hospitals. When I had my second son in 2008 I had a C-section and when speaking to the doctor about separation from baby during a C-section, she explained that the goal was to have baby and I together at all times. Baby and I were always in the same room. He was born and handed to my husband, who took him to the nurses for cleaning and assessment. He was wrapped and placed on my chest until it was time to go recovery. Hubby held him when they lifted me on to the bed from the OR stretcher and then he was back in my arms for the ride to recovery. I nursed in recovery and they bathed him, did his weight, length, etc all right next to me while in recovery. I had thought it was becoming common practice.
@Stacey and all:
It’s nice to hear stories like this, and I thank you whole-heartedly for sharing. And, truly, implementing this type of approach to necessary, non-emergent c-sections, (I listed examples in the post) is the greatest outcome for the viral spread of this mode of surgical birth. I wish I could say the same for my local hospital but, alas, the practices I see here are still very much antequated and not “gentle.”
As MJ points out, emergency c-sections can lead to complications like PTSD and while, some of the aspects of the “gentle cesarean” highlighted in this video would likely not be implemented in a true-true emergency scenario, some of them could, once baby is delivered and mom and baby are found to be medically sound.
The problem, I think, is with all those c-sections that occur (which push our national rate up to 33% vs. 5-10%, as recommended by the WHO) that truly are not warranted. The c-sections that occur for “failure to progress,” for cephalopelvic disproportion when mom has been lying on her back in bed for the previous few hours and alternate (gravity-positive…hands & knees, etc.) positions have not been utilized. How many c-sections have any of us witnessed that are justified by “prolonged pushing,” but no actual threat to mom/baby actually existed? (I have recently come to know several primiparous women who have experienced 3-,4- and 6-hour pushing phases. Mom and baby were doing well. They were allowed to keep pushing. In all circumstances, babes were born vaginally and healthy.) These are the scenarios I fear, in which vulnerable moms/families will be more easily talked into a cesarean because the “window dressing,” as described by Dr. Kotaska, can obscure the very real and potential side effects of cesarean delivery.
Imagine, particularly, the exhausted woman who lacks significant labor support who is told, “we can do a cesarean now, with low lighting & music…you can watch your baby being retrieved from the womb and hold him on your chest immediately afterward…and you won’t have to go through any more labor…any more effort.” This is not about dissing a woman’s ability to make a good decision. It is about human nature, and what happens when an exhausted, vulnerable woman is presented with a lovely-sounding quick fix in her time of trial, while perhaps lacking the sufficient support and encouragement to press on, and make the truly safer choice. Are there times when “pressing on” can become perceived as suffering? Sure. And that’s when we need to heed advice like that presented to us by Penny Simkin a little while back: helping us to decipher between pain that a woman is still effectively coping with and suffering, in which she is no longer coping. In the case of irreversible suffering, a gentle cesarean becomes the humane choice. But really, with 1 in 3 women giving birth surgically, can we really assume that the time is taken, in each scenario, to contemplate pain vs. suffering, window dressings versus real and true side effect profiles? The skeptic in me says, ‘no.’
Just one other thought. I was a nurse during a c-section when a woman was emotionally scarred. You can see my post here. http://thebeginningofmotherhood.blogspot.com/2010/11/loss-of-trust.html
So honestly, I would rather error on the side of making c-sections appear attractive than ever experience that again, or be a part of that.
They call this “Family Centered Cesarean” here. Perhaps that would be a more accurate name. Sound more like work than “Gentle”…
I gave up my intended all-natural, intervention free birth ideals when diagnosed with Placenta Previa, and began accepting the idea of an emergent Classical Cesarean with my husband far away at work and me under general anesthesia. Then on Mother’s Day one of the many docs responsible for my care while hospitalized decided it was time, before she had to deliver to save us both (this only after seven bleeds- I was 32 weeks, so she didn’t make the call lightly.) So ten days ago they gave my husband an hour to arrive and I get to remember hearing my son cry as soon as he arrived. These are gifts I will never forget. At the same time, I will long dream of what I did miss.
My son was whisked away for his own health. I don’t know when he will come home from the NICU, when he will learn how to eat, when I may breast feed for the first time; but he is healthy-very,very healthy for a preemie. We have so much good fortune and joy.
But I will close with this: I still don’t believe that it is even *legal* for women to elect to have their babies via major surgery. Please, advocate for this- for gentler Sections- for mothers like me, but scare the sh*t out of everyone else. No baby deserves to miss out on so much.
I am very anti the term “natural” c-section and wrote about this some weeks ago: http://sarah-stewart.blogspot.com/2011/04/natural-caesarean-section-codswallop.html
I agree with Rachel.
Honestly Kimmelin, I appreciate your post and your thoughts. I know this sounds harsh, but your comment comes off as saying “we need to keep cesareans unpleasant so women won’t want them”.
No, no and NO. My first c-section was hell, not because the surgery itself was that bad or the loss of a vaginal birth was that bad…but because I lost that time with my newborn. I felt a huge disconnect when they brought him to me two hours later. Was he really mine? How could I be sure? Even though I was exhausted from two days of labor and 4 hours of pushing I could NOT rest for those two hours waiting for them to bring my baby back after a wash and warm up. I cried alone in my room. It definitely impeded bonding and it took a while for us to catch up. ANd i know there are much worse c-section stories out there that caused a lot of damage to the mom and baby and their relationship.
All birth experiences deserve to be as pleasant as possible and provide as much bonding between parents and baby as the situation allows. Let’s not try to punish those who don’t have vaginal births with a bad experience.
As a point of clarification, “we need to keep cesareans unpleasant so women won’t want them” should not be in quotes, as attributable to me. I neither said, inferred, nor intended this conclusion.
As I have stated twice now, for women who need to undergo a cesarean–a gentle approach is, by all means, what should happen. The big issue here is continuing to educate women and their partners on what the true indications for c-section are (and those which are not) and discourage the potential persuasion toward c-section for those iffy situations when a true choices still remains.
Best wishes to you, Kara, in the days and weeks to come. Can’t wait to know when your son is safely home with you!
Natural is a word also used, unintentionally, by our profession to define both birth, and nature to a woman. Anything short of that is transmitted to the birthing woman as an abfall from God, nature, and her very value as a woman. We have to shake it up to get it right. And let us not forget the fact that the father of natural birth was a conservative, highly religious white man who left his wife, and based his theories on watching a poor woman labor in poverty. I suggest Epstein (2010) Get Me Out (Norton: pp. 109-123), for a full spectrum honest look at the founders of natural birth.
It is arguable that based on sound feminism philosophy, the concept of a doula is in essence un-natural, and…oppressive. Yep. I said it. Think about it, we are telling women they can’t birth without the help of others. The locus of control is outside her innate ability to judge the situation HERSELF. Adrienne Rich (1976/1986) was on to this twenty years ago in “Of Woman Born: Motherhood as experience and institution” (Norton).
Secondly, Kimmelin is spot on for bringing this to the forum. And while the topics get passionate responses, I firmly support good, evidenced-based discussion about all aspects of maternal health–not just those I agree with! If anything, my professional learning increases, and my personal perspective widens if I sit with the discomfort of disagreement.
For far too long birth organizations of the privileged have rested on laurels of the past. I am excited that open discussions about the whole lot of white elephants in the room will decrease herd mentality, and increase maternal mortality.
Which brings me to my last point. We would all serve from remembering that 99% of maternal mortality is in developping countries, and lives would be saved by having access to both skilled labor professionals, and C-sections.
Bravo, Kimmelin
I meant decrease herd mentality AND maternal mortality. Rock on sisters…@Walker Karraa, MFA, MA, CD(DONA)
“discourage the potential persuasion toward c-section for those iffy situations when a true choices still remains.”
I believe that gentle/gentler and more mother- and baby-friendly c-section practices should become the norm. Although I know it wasn’t directly the intention of the author, the post does come across to me as being wary of improvements in c-sections (fluffy improvements; ones that make the mother feel better about the c-section and might be good for the baby in terms of initial bonding and breastfeeding) because it might entice women to choose a c-section. Again, I really think that as it has been shown, maternal choice c-section is not a primary factor here. And there are very few women, who in the throes of a difficult labor, are going to opt for the c-section primarily because they can get nice music and won’t be guaranteed separation from their babies. Those women will be choosing the c-section because they’re in pain, they’re exhausted, and their doctor is offering/recommending a c-section – in most cases, because the c-section is being recommended. It seems to me, quite frankly, ludicrous to suggest that if you make c-sections less traumatizing, women in labor who were planning vaginal births will be more likely to choose to have a c-section just because the c-section isn’t completely terrifying and/or traumatizing. I think women deserve more credit than that. And I think that for the overwhelming majority of women, the person who makes the c-section call is the doctor, not the laboring mother. Laboring mothers are mentally, emotionally and physically busy people. Many women are highly susceptible to suggestion during labor, and all of them want to have a healthy baby. I think movement towards lowering the c-section rate really needs to originate with changes in standard obstetric practice, and I think any potential “risk” of more c-sections or distraction from the risks of major surgery as a result of making a c-section a less emotionally traumatizing experience is imagined.
Failing to fully get behind efforts to make c-sections less traumatizing and unpleasant for mothers and babies is just disappointing and wrong. Women seeking unmedicated, low-intervention vaginal births are fully supported in wanting things like low lighting, music, and a gentle approach. I don’t believe in only offering those sorts of nice, fluffy accommodations to women who are birthing in a particular way; instead, I think birth should be made as mother- and baby-friendly as possible; as gentle and supportive as possible.
I am all for gentler c-sections and it is the kind I would want to have if I had to have a c-section. I don’t think it does any favors to women for them to be terrified of needing a c-section (as I am) because what I’ve heard from many who have had one is that it involves prolonged separation from the baby, callous and even rude doctors, feeling or being abandoned alone in the OR without a support person (husband or doula), etc.
@Kristin
I appreciate this! I always feel the need to explain why I had to have repeat c-sections. It never had ANYTHING to do with my wishes, only about what was truly best for me and my babies. If I’d had my wish, I’d have had all natural births and VBACs. Even after people trying to tell me I probably really didn’t NEED my c-sections, I know that I was educated and knew which situations warranted a c-section and unfortunately, those were the situations I was in! I’m having my 4th c-section in about 6 weeks and I’d never be for any non-necessary c-section. However, they have their place and just. are. necessary. sometimes. I’m thankful for my life and the lives of my children!
@Jane “Failing to fully get behind efforts to make c-sections less traumatizing and unpleasant for mothers and babies is just disappointing and wrong” I totally agree! Thank you for your post.
If this topic were a way to make cesareans physically safer there would be no debate. A technique to prevent maternal deaths from cesareans would be embraced. I really can’t see how can any birth advocate justify denying “gentle” or “natural” cesarean techniques . I recently read that p.p.d. and p.s.t.d. can result in suicide. It is also reported that cesarean mothers are at greater risk for these disorders. I feel it’s not too far fetched to infer that doing protocols that lessen the trauma experienced during a cesarean is life or death matter. I think it’s terribly harmful to try to prevent the dissemination of good information in suppressing “natural cesarean” techniques simply because of fear and a misguided attempt to influence the cesarean epidemic this way.
To me the natural, woman friendly, family centred, or gentle cesarean is a topic that should be addressed outside of the debate as to how to reverse the tide of the dramatic overuse of cesarean sections in the developed world.
Empowered women make good choices, not women living in fear of outdated protocols.
Think of how ridiculous it would seem if home birth advocates were calling for routine separation of mothers and babies in hospital to try to convince woman to home birth.
It is misguided to defend leaving cesarean protocols as they are as woman are being harmed. I’m ashamed to hear otherwise wise birth advocates(both here and in other forums) bowing to fear and trying to prevent harm reduction techniques
Yes. And again, yes. @mj
Ecofeminist, Ceclia Herles, (2001) offered interesting distinctions regarding natural, female, etc.
“Dualistic ordering is a way of establishing the meaning of difference in a hierarchical framework. This process sets up an entire framework of interrelated dualisms of contrasting pairs such as “male” and “female,” “nature” and “culture,” which according to definition, can exist only in radically separated spheres. The specific entities that make up the contrasting pairs may indeed be dynamic and evolving under the surface, yet they are affirmed as static and absolute. Most
importantly, the structure of the dualistic ordering reflects dynamics of power. The framework sets up an interlocking structure in which not only are differences and distinctions naturalized, but that which is depicted as “Other” is systematically constructed as inferior and devalued. (p. 111)
Herles, C. (2000). Muddying the Waters Does Not Have to Entail
Erosion: Ecological Feminist Concerns with Purity. International Journal of Sexuality and Gender Studies, Vol. 5, No. 2, pp. 109-123.
I agree with the previous commenters who suggested that the tone and implication of this post is rather harsh toward women needing–or receiving, for one reason or another–c/s. I don’t know if I would feel differently about this if I hadn’t had a (necessary but emergent) c/s myself (not for one of the 4 “approved” reasons though), but as a woman who HAD a c/s, it did come across that way, intentional or not.
As an advocate of physiological birth , I completely understand not wanting to make c/s “more attractive” as it is already presented in a very attractive manner in pop culture (scheduling, no labor, etc. etc.–who cares if it’s major surgery…). However, I don’t think making c/s more gentle is going to do make c/s demonstrably more attractive to these women. As someone else noted earlier, during a difficult labor, what’s going to make a difference in a woman’s decision is her sense of how her labor is going and her OB/MW’s sense of the same, not the thought that, “Oh, even though a c/s is major surgery, they’ll have lowered lights, so it’ll be OK”? I agree it’s a little insulting to the laboring woman to suggest otherwise.
It’s just like the hospitals thinking that making L&D rooms more homelike and comfy is going to draw in women who would otherwise pursue a homebirth. We all ridicule that argument on a regular basis. I think the same applies here.
I think it’s a very small portion of the female population generally who are interested in having a gentle c/s–who even realize some of the things that happen in gentle c/s are better for mom-baby–so it’s not going to “sway” many women in and of itself as a concept. For women to whom c/s is a great idea or at least a quickly accepted alternative to vaginal birth, it’s not going to matter one iota–they’d have a c/s regardless. However, it seems to me if gentle c/s can benefit the mother-baby dyad (and I do think it would–especially DCC being made standard and mom/baby being kept together), it SHOULD BE ENCOURAGED by all NCB advocates since it hopefully will have a healthier outcome, both mentally and physically–and isn’t that what we all want?
it seems to me the point has gotten missed a bit – maybe because i don’t see the obstacles to more gentle or family centered cesareans in advocates like Kimmelin, but in hospital administrators, anesthesiologists, OBs, nurses and all others who just wish to keep the status quo and make their jobs as convenient as possible. it’s not Kimmelin who is wishing for separation of mothers and babies or for mothers to be traumatized because of poor cesarean practices. i think the only concern is that those same medical folks will use the “gentler” practices to possibly manipulate women into even more cesareans. and that would be a very bad outcome.
can we make cesarean as humane as humanly possible, and at the same time work very very hard to make it rare? because Kimmelin is right in stating that the better cesareans become, the easier they are to sell (even though they will not be safer….).
ultimately humanizing cesareans, acknowledging the mother’s emotional state and working to meet her needs and the needs of her baby during cesareans could spill over into vaginal births too. shifting the focus from what’s routine and/or convenient to what’s best for mum and baby would improve all of maternity care, and lead to less cesarean.
I agree in that it isn’t about Kimmelin, or any of the posters here for that matter. I am hoping that on a deeper level we will notice we are all participating in defining birth for women, and setting judgments on that definition. The layer beneath that is a tacit participation in good and bad dualistic thinking that ignores the rest of the birthing women in the world. This is a NON-ISSUE for the 99% of women who die in childbirth. And what about the lives, maternal and infant, that cesareans save?
We desperately need to regroup.
Nothing will ever make a C-section natural but we can make it emotionally easier and less traumatic.
So a woman who has a C-section is ‘Un-natural’? So the 33% of women who have them are un-natural? When will we move beyond using nature as a way of defining the legitimacy of women, their choices, and their births?
@Karen
@sasha
The problem is that if people like Kimmelin don’t advocate for “natural cesarean” type protocols who will?
As you have pointed out few doc, nurses etc are thinking about changing the way cesareans are done.
So then who’s left? I have more then once been told by a “natural birth” advocate that they will keep the natural cesarean article in their files to bring out should a real need arise, meaning a truly indicated cesarean.
Change happens slowly at the best of times, but if many care providers are interested in maintaining the status quo, and the rest are hiding this info away for a “rainy day” then how will cesarean protocols change at all?
I also find this post biased against natural cesareans. There is little information about the benefits and two whole sections disparaging the idea.
“For women who must deliver via cesarean—I can definitely see the appeal in this version of a surgical delivery. It attempts to come up to speed in so many ways. There is no hour-long separation between mom and baby. When mom goes to the PACU (Post Anesthesia Care Unit), so does baby. The midwife in the video even acknowledges the associations between postpartum depression and cesarean rates as well as decreased breastfeeding initiation rates amongst women who have undergone a cesarean birth. She then goes on to imply that this gentler approach to the C-section might just ameliorate some of this association.”
“I will never become the person who denies the importance of C-section as an option in a few, particular cases: umbilical cord prolapse, placenta previa, abruptia or accreta to name a few. The cesarean method of birth was, after all, developed to be a life-saving measure and, to this day, continues to be just that in a handful of circumstances. And when a C-section is truly indicated (but not emergent) then, YES, incorporating gentle, respectful, best-practices elements into the cesarean experience should be done. To me, this should quickly cease to be a point of debate at all.”
Per the above, I think I have made it VERY CLEAR that the “gentle cesarean” approach is a MUST, when medical conditions warrant c-sections. The criticisms contained in this post are not judgments against women who undergo c-sections, nor are they recommendations to “keep cesareans unpleasant so women won’t want them.” That would be akin to my suggesting that epistiotomy incisions and the ensuing repair ought to be done without local anesthetic–so the associated misery would entice the woman to do all she could, the next go ’round, to avoid episiotomy.
The judgment contained herein, is against the system in its present state. With a 33% cesarean rate–an estimated +/- 20% of those surgical births are UNNECESSARY. In these cases, the “gentle approach” is likely to reduce the psychological trauma that some women describe following a cesarean, and yet does not erase the large list of potential complications associated with surgical birth. To the woman who goes on to develop a wound infection, a wound dehiscence, post-cesarean scar endometriosis, or finds herself pregnant later on down the line and attended by a provider who does not support VBAC…suddenly that “gentle” approach pales in comparison to the downstream effect even the loveliest of c-sections can deliver.
This, too, is not about ‘not giving women enough credit to make sound decisions.’ In my locale, VBACs have been on and off the moratorium list several times. Within the past year or so, they have become allowed again and yet, the behind-the-scenes reality is that many obstetrics providers still steer women away from that option–devoid of any clear indication for a repeat c-section. For a provider who fears attending VBACS, it is not a far stretch for her/him to paint a rosy picture of a “gentle” cesarean that meets many of the mother-infant bonding requirements that non-gentle c-sections tended to leave out…coercing an otherwise viable VBAC candidate into a higher risk birth option than necessary.
No, we can’t and shouldn’t judge women for undergoing a surgical birth that was life-saving for her and/or her baby. Similarly, it makes no sense to negatively judge a woman who made/makes the best choice possible, given her situation and perhaps limited amount of knowledge on the subject. But, as childbirth educators and other birth professionals, we are obligated to lay out the information in as black and white a manner as we can–comparing pros and cons of each option, including the down stream effects of those options.
Yes! Fantastic response and thank you for it!