"It's a boy!" the doctor announced cheerfully, wiping the baby off with a dark blue towel and suctioning out his nose. Tearfully, the husband and wife exchange a loving kiss, laughing in relief and joy over witnessing the birth of their son.
After a quick assessment from the nurse, their baby is wrapped quickly in warm blankets and placed in his mother's arms. She kisses her son's forehead, and then, like her birth plan dictated, places him on her breast for his first nursing session.
It's a common picture perfect birth moment, with one major exception: It's taking place in the operating room.
Although numerous medical studies have pointed to the benefits of the natural aspects of childbirth, such as immediate skin-to-skin contact and early breastfeeding initiation, the complications of the surgery room make incorporating natural strategies a little more difficult.
But now, there is a push towards a different kind of C-section, dubbed a "natural" or "gentle" C-section. Here’s everything you need to know about the birth trend.
"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., maternal fetal medicine specialist and director of perinatal outreach, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, N.Y. But having a C-section doesn't mean you have to give up your idea of the ideal birth.
"For a cesarean section which is elective and can occur under controlled situations, many women are opting for what is known as a 'gentle C-section,'" says Dr. Gaither.
An article in the British Journal of Obstetrics & Gynecology describes natural C-sections as "woman-centered," but a perhaps more accurate description of the trend may be "family-centered," as they allow for more inclusion of the first family moments together. In essence, a gentle C-section allows parents to incorporate some of the more natural aspects of childbirth that are important to them, such as being able to witness the delivery, holding the infant right away, immediate breastfeeding, and keeping mom and baby together as much as possible.
"To be very clear, a gentle C-section is still surgery," says David Garfinkel, M.D., attending physician at Morristown Medical Center, and senior partner at One to One FemaleCare, in New Jersey. "As a physician, I am not being more gentle as I do the surgery."
Explaining further, Dr. Garfinkel says, "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."
"In a traditional C-section, the baby is delivered quickly and handed to the pediatricians, but in a gentle C-section, the baby's head is delivered, then slowly the rest of the body is delivered, allowing a bit of a squeeze to get that extra fluid from the lungs expelled, then the baby is placed on the mother's chest and breastfeeding is initiated," explains Dr. Gathier. Adding, "There is no quickness elicited in cutting the cord; that procedure is delayed and the baby stays with the mother throughout the entire operative procedure."
"The most common requests that I have seen included in a gentle C-section birth plan call for immediate skin-to-skin contact after delivery and the initiation of breastfeeding in the [operating room]," says Allie Sakowicz, a certified birth doula through DONA and a member of the Maternal-Fetal Medicine research team at Northwestern University's Feinberg School of Medicine in Chicago. She adds that other requests include the mother not having her arms tied down, EKG monitors being placed on the mother's back and side, playing music in the operating room or using a clear drape so the mother can see the delivery.
By offering this more emotional experience, we are not looking to increase the number of C-sections, but as a physician, it is my goal to ensure women don't look at having a C-section as a failure," says Dr. Garfinkel. He adds that a gentle C-section, "allows a woman to be almost as involved as if her birth was happening vaginally and I believe all women should be given the opportunity to be as much part of a part of their births as they want."
Gentle C-sections also have benefits for the baby since skin-to-skin can be initiated early, which can increase "breastfeeding rates and cardio-respiratory stability," says Sakowicz. Adding, "While this is generally common practice after vaginal deliveries, babies who are born by cesarean section should also be able to receive the benefits associated with immediate skin-to-skin contact."
"I recommend that all expectant parents discuss the possibility of a gentle C-section with their physicians, regardless of if a cesarean section is planned or not," says Sakowicz. Adding, "it's much easier to have these conversations weeks ahead of time in the provider's office than in the hospital when a C-section becomes necessary and time is of the essence."
Dr. Gaither agrees saying, "it would be best broached with the health provider at the beginning of prenatal care, to ensure the availability or feasibility of the procedure, and the comfort level of the physician who would be delivering the baby."
Sakowicz also recommends asking for an anesthesiologist consult prior to delivery. "The anesthesiologist is the person in charge of the [operating room], and they have far more control than the [obstetrician] does about things like who is in the delivery room."
"Gentle C-sections are the future," says Dr. Garfinkel, "and more and more patients are asking about them—I've never had a patient turn down an opportunity to have one."