The natural caesarean: a woman-centred technique

Abstract

Although much effort has gone into promoting early skin-to-skin contact and parental involvement at vaginal birth, caesarean birth remains entrenched in surgical and resuscitative rituals, which delay parental contact, impair maternal satisfaction and reduce breastfeeding. We describe a 'natural' approach that mimics the situation at vaginal birth by allowing (i) the parents to watch the birth of their child as active participants (ii) slow delivery with physiological autoresuscitation and (iii) the baby to be transferred directly onto the mother's chest for early skin-to-skin. Studies are required into methods of reforming caesarean section, the most common operation worldwide.

Figure 1

Autoresuscitation. After delivery of the head, the baby establishes respiration while still attached to the placental circulation. Pausing with the head in this position allows external compression from the uterus and maternal soft tissues to expel lung liquid (arrows A and B—time lapse) as happens at vaginal delivery. Note that neither the surgeon nor the assistant is touching the baby. The baby's trunk is then eased out by a combination of uterine contractions and gentle assistance from the accoucheur to ensure it facies the watching parents (C). The baby often unleashes his/her own arms from the uterus with a vigorous extension reflex (D), and his/her wellbeing is monitored by observing crying and facial reactions (E). Representative photographs from different deliveries (with permission).

Figure 2

Parental participation. Dropping the drape and tilting the head of the bed upwards allows the parents to establish eye contact and learn of the baby's sex as he/she emerges. The father may stand if he wishes. (A) and (B) show representative photographs from different deliveries (with permission).

Figure 3

Early skin-to-skin contact. The baby is handed by the surgeon (left) first to the midwife (right) waiting alongside the mother's head (A), then directly to mother. Skin-to-skin contact is established within a minute of delivery. The screen is then restored while surgical closure is completed, and the baby kept warm with towels and bubble wrap (B). Representative photographs from different deliveries (with permission).