What Are Gentle C-Sections?

"It's a boy!" the doctor announces cheerfully, wiping the baby off with a dark blue towel and suctioning out his nose. Tearfully, the parents 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 the breast for a 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 immediate skin-to-skin contact and early breastfeeding initiation, the complications of the surgery room make incorporating such 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 gentle C-sections and how to choose one for your family.

What is a Gentle C-Section?

A gentle C-section is a Cesarean section that incorporates certain of aspects of a parent's birth plan, such as skin-to-skin contact, immediate breastfeeding, and partner involvement as much as medically possible while the baby is still in the OR. Some parents may choose to watch their baby be born or even have photographers or a doula in the room. The term "gentle" refers to gently mirroring some of the aspects a vaginal birth experience might bring.

A 2008 article in the British Journal of Obstetrics & Gynecology describes gentle C-sections as "woman-centered," but today, a more accurate description of the trend is "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 aspects of childbirth that may be important to them, such as being able to witness the delivery, holding the infant right away, immediate breastfeeding, and keeping parent and baby together as much as possible.

Nothing about the surgery aspect of a gentle C-section changes; instead, it's mean to be more inclusive to the birthing experience. "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."

That being said, certain aspects of what happens after the surgery may be approached differently with a gentle C-section. "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. 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.. 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."

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."

Should You Consider Gentle C-Section?

Gentle C-sections are not a birth "trend" that doctors are offering to make C-sections more attractive. Instead, they represent a general move by pregnancy care providers to include parents and care for the whole family in the best way possible. While many pregnant people aim for a vaginal birth, in some cases, C-sections are the best choice of delivery for parent and/or baby and a gentle C-section aims to incorporate the best of both worlds as much as possible.

"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," explains Dr. Garfinkel. He adds that a gentle C-section allows a new parent to be almost as involved as if the birth was happening vaginally if they choose to do so. "I believe all women should be given the opportunity to be as much part of a part of their births as they want," he notes.

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."

How to Write a C-Section Birth Plan

You can write a gentle C-section birth plan just as you would any other birth plan, nothing your preferences for:

• Who can be in the room with you
• If you want to initiate breastfeeding right away
• If you want delayed cord clamping done
• If you want to do skin-to-skin with the baby on you or a partner
• If you'd like the baby to stay with you as long as possible
• Preferences such as music, lighting, comfort items as able
• If you'd like to watch the birth
• If you'd like your baby's first bath delayed

"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 parent not having their arms restricted, EKG monitors being placed on the back and side, playing music in the operating room or using a clear drape so the parents can see the delivery.

How to Request a Gentle C-Section

"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. That way, all preferences are documented in the event a C-section does occur. "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," she points out.

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."

And with the way things are going, you may not even have to ask for a "gentle C-section," as the practices incorporated into them may just be the new norm for C-sections. (Although be sure to double check, just in case.)

"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."