First off, let me say that the caesarean section (CS), as a piece of technology, impresses me. Greatly. It has saved countless moms and babies from death and significant disability. Without the CS, my husband wouldn’t have been born alive and his mom would most certainly have died (placenta previa). It doesn’t take long to realize the significance of the CS when you look at the dismal mortality and morbidity (disability/ harm) stats from countries where they are not readily available…oh, like Afghanistan for example.
However, only a minority of pregnant women want to end up in the OR. I don’t think its too much of a stretch to say that women who go into labour spontaneously or are induced tend to picture a vaginal birth outcome. Women that end up in the OR for a planned CS for some kind of complication like a placenta previa or breech or transverse presentation sometimes started their pregnancies envisioning a vaginal birth outcome too. Sometimes when I’m looking after women in the OR their disappointment and anxiety is almost palpable. And it hurts. I understand how it can hurt. And trust me, I don’t want it to hurt. I want the birth of their child to be a wonderful, memorable event…even if it doesn’t occur just the way they originally pictured it.
So what can we do in the OR to make a caesarean section a better experience for women? There is a move towards what is being called the “natural c-section.”
Essentially, simple and easy modifications can be used to decrease the disruption of technology into the birth experience…
put the IV and all the monitors on the non-dominant arm so that after the baby is born she can have one arm absolutely free to touch, hold her baby etc
place the EKG monitoring stickers on the woman’s back so they are out of the way
some OBs are happy to drop the drape but given that surgical wound infection is a very troublesome complication of a CS, others prefer to maintain sterility by using a clear upper drape so that the parents can watch the birth without mom being exposed to a higher risk of infection
have an individual in the room to facilitate skin to skin and breastfeeding with mom if desired (I can’t do this as my responsibility is looking after the anesthetic and the mother however I can facilitate it by making sure that I promptly treat and side effects of the anesthetic like low blood pressure or nausea or shivering so that the woman feels well). This means that the top portion of the drape needs to be placed somewhat lower than has been traditional (many OBs place the top of the drape just under the breasts).
Ensure support for the mother (where I practice the midwives have hospital privileges and they remain with their clients throughout a c-section, even after a homebirth transfer, I am also happy to invite doulas into the OR as well as the woman’s partner or primary support person but unfortunately that isn’t the norm yet)
delay the infant exam until a time acceptable for the parents for infants that obviously have great apgars. Some parents want their baby to be weighed and checked out in the OR, some prefer to wait until later.
Arrange the OR so that the baby isolette is visible to the mother. Seriously, that baby should not be out of her sight even for a moment. And even if the child comes out in poor condition, there is reasonable evidence that witnessing resuscitation efforts is comforting to parents.
Family recovery –
Easy peasy right? Other suggestions? I haven’t discussed things that are in the domain of the OB like delayed cord clamping, slow extraction to mimic vaginal squeeze etc as I’m trying to focus on things that I can facilitate as an anesthesiologist.
Have you had a CS or a “natural c-section?” What did you find most comforting or reassuring during your experience? What do you wish hadn’t happened or had been done differently?