In 2021, nearly one third (32.1%) of all births in the United States were via Cesarean section (C-section), according to the Centers for Disease Control and Prevention. But a July 2021 Scientific American article by Ann Ledbetter noted that research shows C-section rates over 19% don’t lead to healthier moms and/or babies. With 19% as the ideal benchmark and 32% the reality, that translates to “about half a million unnecessary surgeries every year,” by Ledbetter’s estimate.
While the number of excess C-sections performed each year is startlingly high, and has negative implications for maternal mortality in the US and elsewhere, Ledbetter (and virtually everyone else) acknowledges that C-sections can be a life-saving procedure for some moms and babies. Still, as we’ll discuss today, not every C-section experience is created equal, and the “gentle C-section” option could have a lot to offer moms and babies for whom C-sections are necessary. In other words, pregnant women have good reason to think critically about their options should they need to receive this operation.
Many moms feel like passive, not active, participants in C-section birth
One of the most common complaints about C-sections is that afterwards, a woman feels she wasn’t an active participant in the birth of her child. This is particularly true if anesthetics were involved. Especially if your desire was for a more natural childbirth experience, it can be difficult to emotionally grapple with the shortfalls that C-sections bring. You might also be concerned about how breastfeeding and bonding can be made more difficult without the “golden hour” after birth. As the La Leche League states, “alert and active participation by the mother” are key in setting up a successful breastfeeding relationship.
How gentle C-sections help moms take a more active role in their children’s births
Luckily, in many cases, you can still have alert and active participation in a C-section birth. A growing number of women request a “gentle C-section” or “family-centered Cesarean” or “natural Cesarean,” such that the topic was directly addressed in an American College of Obstetricians and Gynecologists (ACOG) committee statement in 2019. Women who seek a gentle C-section hope to create a peaceful atmosphere in the delivery room that is more similar to the environment of a natural birth. Certainly, a gentle C-section is still very different from a vaginal birth, but it offers some key ways to improve the C-section experience for both mother and baby.
Let’s look a little deeper into what exactly a gentle C-section is, what the benefits are, and how to ask for one from your medical team. And to be clear, we’re primarily referring to planned or otherwise non-emergent C-sections, as for placenta previa. In an emergency, your and/or your baby’s safety may require different procedures to be followed.
What could a gentle C-section look like?
There is no one universal definition of a gentle C-section, but a number of factors can make a C-section a more peaceful experience for moms and babies. It all begins with the atmosphere—what would make things more calm for you? You could request specific music to be played, or for the operating room to be quiet. You could ask your doctor to calmly talk you through your delivery as it takes place.
Your support people are in the operating room with you
Another key part of the atmosphere is who is there in the room with you. Do you want your spouse or partner right next to you? Would you like them to hold your hand and lead you in prayer or birth affirmations? Do you want a doula or other support person to quietly support you through her presence and take photos of the big moment? Think about what would make you feel the most at ease and in control of the situation.
You receive regional, not general, anesthesia
It’s also vital to think about the amount of pain medication or anesthesia you receive during your C-section. Today, most C-sections use regional anesthesia like an epidural or spinal block rather than general anesthesia. This is a good thing, as it means that you probably won’t go completely ‘under’ for your Cesarean. Other medications are sometimes given to women to help control anxiety or nausea during the procedure. If you’d like to remain as alert as possible, make sure to notify your anesthesiologist.
Thanks to a clear drape, you can see your baby’s birth
Now for the most important part—the birth of your baby! If you desire a gentle C-section experience, request that your medical team uses a sterile surgical drape with a clear window. This allows you to fully see your baby as he is being born and helps you feel like an active participant. Alternatively, the drape could be dropped just during the moment of birth to achieve the same result.
You have skin-to-skin time right away like you would after a vaginal birth
In a gentle C-section, the moments directly after the birth will look much more similar to those of a vaginal birth than your typical Cesarean. Your baby can be put directly on your chest to immediately begin the bonding process that leads to successful breastfeeding. The power of skin-to-skin in the moments (and hours and even days) after birth is proven. It is typically possible to receive these benefits even if you have a C-section. If you are not alert enough to hold your baby, request that he have skin-to-skin time with your spouse or partner instead.
You wait to clamp the baby’s umbilical cord
You can also request delayed cord clamping after a C-section. Delayed cord clamping has myriad benefits for your newborn, no matter how they are born. If the sex of your child is unknown before birth, you can also ask for your spouse or partner to be the one to announce if it’s a boy or a girl, rather than the operating doctor.
You nurse your baby while you’re still in the operating room
Now that your baby is born and on your chest, you will have some time as your doctor finishes sewing up your surgical incision. This is a great time to initiate breastfeeding with your baby, which you can do as you lie on the operating table. If this is your preference, make sure you communicate this with your medical team before the C-section begins, as there could be small tweaks that need to be made (such as not strapping down your hands or placing the IV differently).
If both you and your baby are free of serious complications after birth, you should be able to fully experience the first minutes with him in your arms and potentially initiate breastfeeding, rather than immediately handing him over to be weighed or cleaned. Experiencing the “golden hour” after birth is not just reserved to moms giving birth vaginally, but it will require you to communicate with your medical team. From there, you can also ask to be the one to hold your baby as you are wheeled to the recovery room together. This increases the amount of baby’s first moments with you, rather than with medical personnel.
What are some of the benefits of having a gentle C-section over a more traditional Cesarean?
These changes to your Cesarean experience can benefit you in multiple ways. This ‘woman-centric’ approach gives you the opportunity to have a calmer experience, which may lead to an improved retrospective viewpoint of your delivery [2]. Although a C-section may not be your desired mode of delivery, more control over what your C-section looks like could help to ease the disappointment some women grapple with when vaginal birth isn’t possible.
The overwhelming benefit of a gentle C-section is that you have skin-to-skin contact with your baby right away, and for as long as possible. And it’s evidence-based! Skin-to-skin or kangaroo care is recommended by basically every major health organization. It helps decrease stress for both you and your baby and strengthens your bond. It releases hormones to ease delivering your placenta, and encourages early successful breastfeeding [3]. These factors are so important that researchers claim that skin-to-skin after birth “must be protected by evidence-based routines of staff” [3]. It’s vitally important for women to have these benefits, whether they give birth vaginally or via C-section.
How to ask for a gentle C-section if you require a cesarean birth
If you are having a scheduled C-section due to a medical issue like placenta previa, make sure you have a conversation with your doctor during your final pregnancy appointments to talk about what your C-section will look like. Bring up your concerns about environment, partner involvement, cord clamping, and immediate skin-to-skin. Many OBs will be very open to this, as it requires fairly minor tweaks to a normal cesarean operation.
If you plan on a vaginal birth but know that you would request a gentle C-section if you needed one, be sure to put it in your birth plan. Specify that you do not desire a C-section unless it is absolutely medically necessary, but if you need a Cesarean, you would like it to look like the gentle C-section described above. Be specific about what you want and do not want, and voice these concerns with your doctors and nurses. Don’t be afraid to speak up, and don’t feel embarrassed—you deserve to have your desires for your birth heard and thoughtfully considered by the members of your birth team. And because labor and birth are such an emotionally vulnerable time for moms, ensure that your support person knows your preferences so they can speak up if you’re not able to.
(Final note: Since a great deal of unnecessary C-sections take place globally today, it’s a great idea to educate yourself on normal childbirth and how to know if your doctor might be leading you into an unnecessary procedure [1]).
This article was updated on October 4th, 2023, to include a link to ACOG’s statement on gentle C-sections.
References:
[1] Nahar Z, Sohan M, Hossain MJ, Islam MR. Unnecessary Cesarean Section Delivery Causes Risk to Both Mother and Baby: A Commentary on Pregnancy Complications and Women’s Health. Inquiry. 2022 Jan-Dec;59:469580221116004. doi: 10.1177/00469580221116004. PMID: 35920002; PMCID: PMC9358345. [2] Smith J, Plaat F, Fisk NM. The natural caesarean: a woman-centred technique. BJOG. 2008 Jul;115(8):1037-42; discussion 1042. doi: 10.1111/j.1471-0528.2008.01777.x. PMID: 18651885; PMCID: PMC2613254. [3] Widström AM, Brimdyr K, Svensson K, Cadwell K, Nissen E. Skin-to-skin contact the first hour after birth, underlying implications and clinical practice. Acta Paediatr. 2019 Jul;108(7):1192-1204. doi: 10.1111/apa.14754. Epub 2019 Mar 13. PMID: 30762247; PMCID: PMC6949952.Additional Reading:
The 6 things every woman considering a natural childbirth needs to know
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