Changing Cesarean Births

by Asheya on December 3, 2011

The following is a guest post by M.J. Bray, a birth advocate in B.C.  She has firsthand experience with midwife attended vaginal birth, and with emergency cesarean birth.  She is an ICAN chapter leader and graciously agreed to guest post on this topic despite a busy schedule!  Thank you, M.J.!
Childbirth advocacy has achieved many things in the last 60 years; Routine shaving, enemas and episiotomies are no longer.  Holding the baby up by it’s feet and giving it a quick slap is now almost a joke.  Did we really use to do these things? 
Now routine separation of newborns and mothers is a thing of the past, fathers (or partners) are no longer left in the waiting room for news of the baby’s arrival.  Right?  Unfortunately wrong.
Women who give birth by cesarean section are regularly subjected to protocols that are in urgent need of an update.  My own experience, as well as the accounts related to me through my role as a peer support group leader has led me to believe that there is a damaging lack of understanding of the importance of maintaining the essence of childbirth when surgery is involved.  Some of the basic rights women have come to expect during birth have not made their way into the operating room.  Women regularly tell me of doctors discussing unrelated topics; golf, the royal wedding, their lunch dates… while preforming surgery to bring their precious babies into the world.  Even healthy babies are examined and handled by numerous doctors, students and nurses before the mother gets so much as a glance at her new child.  The result of this can be life changing.  Not only can breast feeding and bonding be effected but cesarean mothers have higher rates of post partum depression and post traumatic stress disorder.  The psychological outcome of birth is crucial and it seems that it is too often forgotten when birth ends up in the O.R.
So what can we do about this issue? We need to advocate for more holistic cesarean sections. We need to start by educating ourselves about holistic, woman, family centred, or  natural cesareans.  A couple places to start are:
ICAN’s “Family Centered Cesarean”
Link to a printable page from The Faceless Cesarean with current women and baby friendly recommendations
And my personal favourite as it a scientific journal publication so it can bridge the gap between women and doctors “The natural cesarean: a woman-centred technique:”
My own quick list is of tips is as follows;
Allow a support person to remain with the mother at all times (fathers/support people are not allowed in until about 15 minutes after the mother is in the OR)
In the case of general anesthetic allow the father/support person to remain in the birth room to witness the birth.  Women report that having a first person account of the birth they “missed”  is key to their acceptance of the experience.  Photos are also VERY important in general anesthetic cesareans.
Doctors, nurses and others must keep all non essential talk focused on the birth.
Having the birth’s progression relayed to the mother greatly assists in connection to the birth and baby.  
Minimize non essential handling of baby.  If baby is stable, weighing, measuring, tagging and diapering should all be done after mother has had a chance to be skin to skin with baby.
Skin to skin as soon as possible.  If baby and mother are stable this should be in the O.R. while incision repair is occurring. If mother is unable to do skin to skin immediately, father/partner can do skin to skin until mother is stable.  
Baby and mother remain together in recovery area.
Mother should have the opportunity to view the birth either by lowering the drape or by using mirrors.  More and more accounts are proving that viewing the baby emerging from her body helps the mother bond quickly and deeply as well as providing greater satisfaction in the birth experience.
Music in the O.R. can allow the family to express the mood that they want during their birthing experience.
Considering the family’s desires concerning: the placenta (keep it, view it?), announcing the sex of the baby, cutting the cord and any other requests.
Doula care in the O.R. is reported to greatly enhance the experience of the family.
I’m sure I could find many more things to fill this list out, but ultimately the key is that the sacredness of the birth needs to be preserved.  
For birthing families;
I strongly recommend that, even if cesarean birth seems like only a distant possibility, every birthing family make out a birth plan that includes their wishes in case of surgical birth. And then be ready, if things do go that way, to advocate for yourselves.  Don’t be afraid to ask for what you need.  Even if it seems like the best thing to do is to shut up and let the professionals do their thing, it’s not.  If the doctors are talking about something unrelated, ask them politely to tell you more about the birth they are facilitating.  If the nurse is about the diaper and swaddle baby, state clearly, “No thanks, mom wants to meet the baby first.”  Be bold.  You don’t want years of psychological turmoil because you didn’t want to bother the hospital staff.
For families who are planning a cesarean birth -first of all it is a really good idea to get a second opinion if you are not CERTAIN that a cesarean is necessary.  Cesarean rates in the developed world are far higher then is considered safe- that being said, there are many perfectly legitimate reasons for planning a cesarean and planned cesarean families have the best opportunity to champion better cesarean protocols.  Print out some of the literature, think about what would help your family enjoy the upcoming birth and then be direct and assertive with your care providers to ensure your needs are met.
M.J. and her son, ten minutes after he was born via cesarean section
Care providers;
Please read up on the adverse psychological effects of cesarean births, and methods to prevent injury to the family. Many interesting studies have been done that can help you to understand the issues at hand.  Also please read the above mentioned sources of information on holistic cesareans.
Recently in the news:
Another article of note is (available only through medical journal subscription, unfortunately):
 Holcberg G: On becoming a first-time mother after an emergency Cesarean section: a journey from alienation to symbolic adoption.
Care providers and families share the common goal of wanting the family to experience a successful birth.  I’m sure that, working together, we can update cesarean protocols and protect the psychological well being of families giving birth by cesarean.
On a final note, what should you do if you have already had a birth that has left you feeling traumatized?  Reach out.  It may feel very difficult but it is extremely important to receive help to ensure your recovery is as complete and timely as possible.  Contact your primary care giver and explain your concerns. You may have to make more then one attempt to get support as birth trauma is not commonly understood or recognized–yet! 
Peer support groups are also very helpful.  The International Cesarean Awareness Network www.ican-online.org is a great resource as are many birth trauma groups.  The Vancouver, B.C. group has a very informative website and peer support line www.vancouverbirthtrauma.ca/
Cesarean birth is a complicated issue.  The high rate of cesareans is rightly attracting a lot of attention but I would like to implore us all to also consider vocally advocating for more “natural,” “woman friendly,” “family centred” surgical births. 
M.J. Bray is the mother of two boys, ICAN Lower Mainland Chapter leader, and the author of www.cesareanparents.blogspot.com 

{ 4 comments… read them below or add one }

Asheya December 4, 2011 at 12:11 pm

Thanks for this thoughtful post! Great suggestions and links.

I do wonder about the term 'natural' though in relation to cesareans: a cesarean is not a natural process, and in our already confused birth culture, I fear that applying this word to surgery will further confuse the issues.

I like family-centered and woman-centered much better, as it puts the focus on the woman's choices and on keeping the family (mother, baby, partner) together during the surgery and after.

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melissa December 4, 2011 at 2:13 pm

MJ, thank you so much for this post. It is so important!! Cesarean birth hasn't changed significantly since the widespread use of spinal anasthesia~it is time to make the experience more humane and more evidence based as far as mother and infant bonding, and breastfeeding, and skin to skin contact.
For my cesarean I felt very detatched from my son. I got to hold him but he was bundled up and did not breastfeed, and then they took him away to the nursery while I was in recovery. That sucked.
It took me five months to feel bonded to him and I am positive it was the way the hospital handled the surgery; which was a totally normal protocol of separation.
And I don't have a problem with the term 'natural cesarean.' Nobody is fooled~it's not natural! But the word natural is closer to what we are aiming for as far as the birth experience, and woman or baby or family centred just doesn't cut it. What we are aiming for is a procedure which parallels the natural experience as much as possible, for the benefit of mom, baby, and breastfeeding. It will never 'be' the natural experience, but as close as we can make it is what we should aim for. IMO!
Thanks again MJ! You are wonderful.

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FabulousMamaChronicles December 4, 2011 at 8:17 pm

Perhaps "gentle cesarean' would be a more appropriate, and less controversial term to adopt. :) Howver, it is not what we call it, but how widespread it is used that is truly important. All women (and their babies!) deserve to be treated with the utmost respect during their birthing experiences, and that means meeting their basic biological needs even during an emergency, or even non-emergency operation.

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MJB December 5, 2011 at 3:22 pm

Asheya, Thanks for your comments. Yes it is too bad that the article best suited to be sited on this issue is called "The natural cesarean:a woman centred technique". I imagin this term was used to try to convey the concept most directly to other medical personal, but that has been little help in diffusing the divide it has created in birth advocacy world. I have lots to say about that in my blog post "Natural Cesarean, Why the Controversy", found here:

http://cesareanparents.blogspot.com/2011/05/natural-cesarean-why-controversy.html

Melissa and Fabulous Mama, thanks for your thoughts, I apreciate them.

All: I'm so glad we are having this conversation, this is what makes change happen!

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