Updated: Aug 23, 2020
Gentle C-Sections are not fiction, they are real and happening everyday. It may also be referred to as a "Family Friendly C-Section" or a "Natural C-Section". This concept and practice began in late 2014 and has slowly been gaining traction throughout the United States.
In 2017 the C-Section rate in the Unites States was 32%, hospitals are making a concerted effort to improve this statistic, but as on now "Cesarean Sections are one of the most common surgeries performed on women in this country," acknowledges Kecia Gaither, M.D., M.P.H., F.A.C.O.G., of Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, N.Y.
A Gentle C-Section is still surgery and it does not change the medical steps involved in the surgery itself. But as Dr. David Garfinkel, M.D., attending physician at Morristown Medical Center describes, "A gentle C-section is a change in the attitudes toward C-sections, where the care team [the obstetrician, anesthesiologist, and nurses] aims to make the C-Section experience in the operating room as similar as possible to the labor and delivery room."
So what is the point?
Many women look at a C-Section as a failure, by offering this gentle approach studies have shown that women have a better perception of their birth experience, which in turn leads to a healthier recovery in the postpartum period.
What does it look like?
Each hospital and provider has different standards, many of which are moving in this direction. I am going to outline a variety of options that have been used in Gentle C-Sections around the world.
Walk in to the Operating Room
If possible, walk in to the operating room, it can be a very empowering moment that you are meeting head on and not one that is being thrust upon you. If you can't walk into the room for any reason, try and close your eyes as your are wheeled in and embrace the moment. Take back emotional control of the situation.
Introduce yourself to everyone in the room
They are serving you and your child, you have the right to know their names and be comfortable with them. It can be intimidating to have so many people in the room, many whom you have never met, by introducing yourself you are allowing yourself dignity and strength. It is a small step, but a healthy one.
Play your choice of music
We have all seen TV Shows where surgeons play their favorite music to relax them while working, did you know that this is possible for you. Make sure to talk with your provider before hand, but you can ask them to play the music of your choice during the surgery. Play something that will help you relax or set the tone for the room when you meet the baby. Have fun with it and make it memorable.
Placement of ECG Leads
You can ask that the ECG leads that monitor your vitals be placed on your back so that when it comes time to have skin to skin contact with your baby, there is nothing to get in the way of that contact.
Watch your baby come out and announce the gender yourself
In traditional C-Sections there is a blue drape that lands on your chest, this is meant to keep the surgical site clean and so that the birthing person does not see anything that might scare them. Now there are the options for a clear drape attached to the blue one. When the doctor is ready to bring your baby into the world, the blue portion can be lowered and you can see your babies big entrance. If you have decided to not find out the gender, you or your partner can also be the one to announce to the room the babies gender. (Make sure to let the team know that you want to make that announcement).
Delayed cord clamping
According to the American College of Obstetrics and Gynecology (ACOG) "Delayed umbilical cord clamping increases hemoglobin levels at birth and improves iron stores in the first several months of life, which may have a favorable effect on developmental outcomes. Given the benefits to most newborns and concordant with other professional organizations, the American College of Obstetricians and Gynecologists now recommends a delay in umbilical cord clamping in vigorous term and preterm infants for at least 30–60 seconds after birth." This is now standard practice with vaginal births, but it is also possible to do in C-Sections. If the baby is not in distress and is breathing well on it's own, it is possible to still delay the clamping if the cord.
Partner cut the cord
If this is important to you and your partner, speak with your provider and ask if there is a way for this still to happen. It is all about open communication and having a healthy discussion with your provider.
Immediate Skin-to-Skin and Breastfeeding
In a traditional C-Section your arms are spread out and strapped down to the table, some hospitals are now allowing for the arm straps to be removed once the baby is born and placed on the patients chest. If not both arms, ask that your dominant arm be made free so that you can touch your baby and the other arm can still be on the table with the blood pressure cuff and IV's.
Plan to have help with positioning, either from your partner, doula or nurse. You will be lying flat with your baby on your chest, and you may not have full use of your arms or may be groggy due to medications. Your helper should be prepared to support and monitor the baby to keep her stable on your chest, and to make sure that the baby’s airway is clear. (If skin to skin is important to you, it might be easier to have your gown unbuttoned before the surgery or to have it removed before surgery and a warm blanket be placed over your chest till the baby can be placed there).
And if it is just not possible for you to hold your baby skin-to-skin and breastfeed immediately after your c-section, research shows benefit to your partner holding your baby skin-to-skin. One study showed that infants held skin-to-skin by fathers after c-sections stopped crying, became calmer, and reached a drowsy state earlier than infants placed in a cot.
Ask for two support persons
This is something that is still not common, but it doesn't hurt to ask. The reason for having two support persons comes from the idea that once the baby is delivered your partner then turns their attention to the baby at the warmer, leaving your side. If you hare able to have a doula or second support person, this guarantees that someone is there to care for your emotional and physical needs throughout the whole procedure.
Essential Oil for Nausea
It is quite common for the birthing person to become nauseous during the procedure, for a variety of possible reasons such as: reaction to medication, anxiety, smell of the room and hoe your body reacts to the hormones of birth. Peppermint oil can help for that feeling to ease. You can put some peppermint oil on a cotton ball and place it in a ziplock bag or a vomit bag, have your partner ready to bring it by your face if you begin to feel nauseous or start vomiting, the smell often times can lift the feeling. Make sure to discuss with your provider or nurse before the surgery.
ACOG defines "vaginal seeding is the practice of inoculating a cotton gauze or cotton swab with vaginal fluids to transfer the vaginal flora to the mouth, nose, or skin of a newborn infant. The procedure is most often performed in conjunction with cesarean delivery. Cesarean delivery performed before the onset of labor or before the rupture of membranes prevents the fetus from coming into contact with vaginal fluid and bacteria. The intended purpose of vaginal seeding is to transfer maternal vaginal bacteria to the newborn. As the increase in the frequency of asthma, atopic disease, and immune disorders mirrors the increase in rate of cesarean delivery, the theory of vaginal seeding is to allow for proper colonization of the fetal gut and, therefore, reduce the subsequent risk of asthma, atopic disease, and immune disorders. The lay press in the United States and abroad has shown an interest in the concept of vaginal seeding. As a result, it has become increasingly common for patients to discuss the possible benefits of performing vaginal seeding with cesarean delivery with their obstetrician–gynecologists or other obstetric care providers."
As stated at the beginning of this post, the goal of a Gentle C-Section is to have the birthing parent feel that they have more control of their child's birth. Make sure to discuss with your provider any or all of these options. Healthy communication with your chosen medical team is the best way to ensure a positive physical/emotional birth experience.