A “Natural” Caesarean Section – should they all be like this?

A “Natural” Caesarean Section?

By Roger Marwood MSc FRCOG

A “natural” Caesarean Section?

“No such thing”, I hear you saying.  And , of course you are right as a Caesarean can never be fully natural.  But there are ways that the process can be made to feel less like a major operation in an unnatural and clinical environment and more like an exceptionally moving, astonishing and , dare I say it, enjoyable and unique family event.

For the last few years of my clinical practice , I was lucky enough to be able to achieve, wherever possible, a very satisfying technique which followed the principles first described by Professor Nick Fisk some ten years ago.  Almost without exception, the mother and father, the anaesthetist, the midwives and the rest of theatre staff really felt it was a very special moment to actually watch the baby emerging from the mothers tummy, aided simply by the forces of the mother’s uterus squeezing out the baby, with just gentle support from the surgeon.  And as a surgeon, I just loved it.  The look on the parents’ faces said it all.

There is, quite simply no need in the elective , non emergency situation, to pull the baby quickly from the mothers abdomen. Sadly however, it is still very common practice, either from habit, concern about blood loss, or in attempt to impress the theatre staff.

The so-called Natural Caesarean can be done quite safely, with no extra risk to mother or baby.  It needs a little extra thought and preparation from all those involved.  It’s called Teamwork, and everyone must play their part.

Let’s just list the players

The Mother

Well,  she’s the focal point of the whole exercise, and her safety and cooperation is essential to the whole experience.  She should ideally have at least two or three sessions with her surgeon, her anaesthetist and, of course, her midwife. This is to explain in detail how the whole event will unfold.  She should have had an opportunity to see the Obstetric theatre, and be familiar with environment and understand the role of the 6 to 8 professionals involved in her care.  By this time she will understand that the operation will be done with the safety of mother and baby as the absolute priority , and that at no time will any party be at extra risk just to get some good photos.

Skin to Skin after a Caesarean Section

Skin to Skin after a Caesarean Section

The Father/Partner

He or she is there to support the mother and needs to be well informed, and side by side with the mother.  He/she should be ready to help at the critical moment of the baby’s delivery and afterwards.  He/she can often assist by holding his partner’s head forward to help her see the baby emerging, once the sterile sheets are lowered to reveal the moment of birth.  He may also be called upon to hold the baby and assist the midwife in covering the baby and preventing heat loss.

It always surprises me how well the fathers in particular do this job with skill and sensitivity .

They have the real privilege of watching their baby change from blue to pink! And of course be Officer in Charge of Camera!

The Anaesthetist

Critical and very skilful.  Obviously the mother is usually awake, and the chosen anaesthetic is the Spinal plus or minus an epidural.  They are great.  Quick acting, very effective and last long enough for even the slowest procedure (average operating time for an elective procedure is 25-45 mins).  Some basic monitoring is essential.  Heart rate, blood pressure, oxygen levels and so on.   Any monitoring gadgets can usually be placed in a way that leaves the mothers upper chest clear and ready, if appropriate, to receive the baby , hopefully skin to skin.

The Surgeon

Needs to be calm , experienced and sympathetic.  And not in a tearing hurry to attend the next delivery.  The technique is relatively simple.  Once the abdomen and uterus is opened, the baby’ head is delivered in a standard way.  The shoulders follow soon after, with gentle traction and it is at this stage that the surgeon can rotate the the baby to face backwards towards its admiring parents.  The screen is dropped, and the mothers head supported and then all the surgeon needs to do for the next 30-60 seconds is to support the baby’s back and just be patient, and then it’s the greatest show in town!   The baby’s body slowly rises out of the tummy and once the hands are released , the baby generally makes a spectacular , and welcoming open arms gesture.  This called the Moreau reflex and it is a natural reflex in all healthy newborns and is quite simply a show-stopper. This is when you get the best photos.

Roger delivering a baby by "natural" caesarean.

Roger delivering a baby by “natural” caesarean.

This manoeuvre may add a little extra time to the operation, but there appears to be no extra risk of bleeding as the baby acts as a pressure pad to the surrounding tissues.

Once delivered, the cord needs to be cut, so that the baby is handed to the  midwife, who is in sterile gear, to ensure that the surgical field remains clean .

The rest of the operation continues in a normal way.

The Midwife

She will responsible for the wellbeing  and safety of the baby.  She will assess the baby’s condition amend ensure that no resuscitation is required ( approximately 10% may need some simple help , in which case the baby is taken to the adjacent resuss platform)

If all is well , the baby is dried and, if agreeable, placed skin to skin, on the mothers chest and then covered. Sometimes , it is possible to breast feed whilst the mother is being stitched up, but it depends on the baby, the mothers anatomy, how much tilt there is on the table, and of course, how the mother is.  Not all women feel up to it at the time nor do some of the babies!

Meanwhile , the screen is back in position and the surgical team may spend the next 30 minutes or so putting things back together safely.

Obviously , all of the above depends on there being no complications in the mother or baby’s condition.  At no stage will “Best Practice ” be sacrificed.  With a little extra planning ,team work and attention to detail, a routine operative delivery can be transformed into a unique and unforgettable experience.

This wonderful video of a Natural Caesarean from Jentle Childbirth is a wonderful example of what we have explained above.

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