‘Natural caesarian’ may not be such a miracle

After months of carefully planning your baby’s drug- and surgery-free arrival, being told in the last few weeks of pregnancy that a natural birth is out of the question is depressing news for many women. 

GENTLER APPROACH: While a caesarian section can be a disappointment for those who had planned a natural delivery, there may be some tweaks that could soften the blow Picture: ISTOCK.COM

However, a new approach in the surgical delivery room may make this forced changed of plan a little easier to accept.

Known in the gynaecological fraternity as a natural or gentle caesarian, this style of delivery attempts to make the major surgery that is a caesarian section as natural as possible.

Preparation starts as normal with drapes in place to screen off the surgery, although the electrodes used to monitor a mother’s heart rate are placed on her back to leave her chest free for the baby. As soon as the lower stomach incision is made and the doctor has lifted the baby’s head out, the screens are lowered so that mother and her birth partner can watch the baby being born.

According to a recent article in The Telegraph, once the incision is made to the mother’s abdomen, the baby is given time to wriggle out of the womb, unlike a normal caesarian where it is lifted out by the doctor. While still attached to the umbilical cord, the baby is lifted from the stomach and immediately placed on the mother’s chest for her to hold, instead of being taken away to be examined, weighed and measured as has been the norm.

A regional anaesthesia is carefully used, leaving the mother alert and able to hold her baby.

Apart from the importance of allowing immediate skin-to-skin contact and the start of breast-feeding, the birth delay common with a natural caesarian is also said to assist in expelling liquid from the baby’s lungs as a result of pressure from the uterus, reducing the risk of lung problems.

This method was first seen in a video shared by UK-based midwife and childbirth educator Sophie Messager in July last year. In the video, which surfaced on social media and has been viewed over a million times since, an unknown woman is seen giving birth via this method.

A group of nurses and doctors are seen standing and watching as a baby wriggles out through the incision in the woman’s lower abdomen. The baby emerges slowly, showing first its head, then shoulders then the rest of its body. Once most of its body has emerged a doctor is seen lifting out its legs and placing it, cord still attached, on its mother’s chest.

Jenny Smith, a midwife quoted in The Telegraph, said the baby’s exit is aided by a combination of uterine contractions and gentle support from the surgeon – a process that can take a few minutes.

“There is no reason that a woman having a caesarean can’t wear her own shirt, bring her own pillow, have the music she likes and turn down the lights, even if the birth is taking place in an operating theatre,” Smith says. “A traditional caesarean is like any other operation – the patient is having something ‘done’ to them by a medical team. This new approach is to make the woman, the family, centre-stage, just as in a vaginal birth.

“In a traditional caesarean, the baby is taken away at once to be dried, examined, wrapped up and so on. In a natural caesarean, the name-labelling, cord-clamping and cutting by the partner and vitamin K injection to prevent serious bleeding are all carried out while the baby is being held by the mother.”

While this sounds great to moms who can’t have a vaginal delivery, East London-based gynaecologist Dr Robyn Spring sounded a note of caution.

She said one had to remember that the main reason women have caesareans is usually that something had gone wrong during labour such as foetal distress, where the baby’s heart rate drops, or cephalopelvic disproportion is discovered, where the baby’s head and mom’s pelvis are a mismatch and the baby cannot get through.

Spring said despite getting some requests for this approach, she had some concerns which she shared with her patients, which allowed them to find a mutually acceptable compromise.

Some of the concerns in The Telegraph piece included the cold air-conditioning in the theatre, used as an infection control measure, which could lead to the baby becoming cold, although Smith explained that during the skin-to-skin contact, blankets, bubble wrap and a hat are used to keep the baby warm. The article also pointed out that the slowness of the delivery can increase the risk of excessive bleeding in the mother.

“Certainly yes, the infant can get cold, although our theatres are quite warm,” Spring said.

“My greater concerns are for sterility – we may not be able to keep our surgical field adequately sterile. And babies are unable to crawl out [of stomachs] otherwise there would be no pushing with a normal delivery.”

Spring said that once the uterus is opened, the flow of blood to the baby is compromised during delivery if there is a delay. “And if there is a delay, the baby may be oxygen deprived. Also, in all honesty, a caesarian is a fairly gory procedure that many people would prefer not to see, especially if it is happening to them.”

South African Society of Obstetricians and Gynaecologists (Sasog) member Dr Alison Shaw said she had not received such a request in all her 16 years of private practice, and she agreed with Spring that in normal circumstances the baby would not be able to wriggle out of the uterus.

“If the incision is made really big to allow for the baby to wriggle out, then it will most probably leave a big scar and most of my patients would be rather unhappy to have such a big scar on the lower abdomen,” she said.

And as far as the baby getting too cold: “I agree. Although caesarian theatres are normally kept quite warm for the baby’s sake, extended exposure without covering the baby can easily lead to a hypothermia risk for the newborn.”

Shaw said blood loss was another big concern.

“Blood loss when the uterus is not allowed to contract because of extended delays in delivering the baby can also be dangerous for the mother.

“Babies born by caesarian will only be removed for a few minutes after delivery for a quick inspection by the paediatrician present to ensure a safe and happy newborn and then the baby will be given back to the parents to hold and bond until just before the end of the procedure.

“This not only ensures safety for mom and baby, but also allows for bonding to start as soon as possible,” she added.

According to The Telegraph, mother Lucinda Montgomery – who was advised to have a caesarian section at 36 weeks for health reasons – feared her surgery would be a clinical process with lots of intervention and bright lights.

Instead, seeing her children born via what she termed “a new childbirth method” was a truly magical process.

But Shaw disputed that it was a new childbirth method, saying most obstetricians allowed the partner to be in theatre, watching the baby being born and even allowed the partner to photograph the memorable event in full detail. — zisandan@dispatch.co.za

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