Womb it may Concern

It's your womb. You should be concerned.

Gentle cesarean, difficult discussion

with 7 comments

With women pressing for better birth options and doctors eager to explore new techniques, surgical birth is getting a make over. Or rather, a make under—with the help of the Gentle Cesarean (GC). As Rhode Island Family Health Practitioner Suzanna Magee, M.D. puts it, a GC is “every bit as magical” as a vaginal birth.

GCs are easy enough to understand and carry out. A GC retains all the the “gives” of a vaginal birth (baby slowly emerging and mom holding her baby as soon as possible) and loses all the “takes” of a cesarean birth (doctors bantering with each other during surgery and discouraging skin-to-skin contact ’til well after surgery is complete).

With that kind of description, it’s hard to see from the ordinary person’s perspective why the idea has been slow to implement. From the extraordinary perspective of a birth supporter, to embrace GC almost seems like sleeping with the enemy.

GC is a contradiction in the birth-world because cesareans have come to symbolize maternal victimization, iatrogenic harm, and overall trauma and stress for mom and baby. There are even professional birth supporters who would shun GCs altogether, seeing the guidelines as just another way for providers to talk a woman into getting on the operating table.

As we struggle to lower both the primary and repeat cesarean rate, GC can look like a wolf in sheep’s clothing. How can we encourage lovely c-sections without discouraging lovely vaginal births? Won’t glamorizing surgical deliveries boost the c-section rate? Aren’t there doctors out there who will perfect GCs and then convince their patients to skip labor altogether?

The simple answer is, no. Cesareans by maternal request are reported as rare by all statistical studies. A little mood music and not having to hear about a doctor’s golf plans during surgery will not send hordes of pregnant women to the ORs of this country in a riotous c-section demanding frenzy. If that were all it took, there are many hospitals that would not ignore such a cash cow and would have changed their cesarean policies by now!

Birth support is as much about advocacy as it is about activism. We cannot advocate for the best birth possible for each client if our activism for natural birth gets in the way. A GC when cesarean is unavoidable does not mean GC when vaginal birth is still an option (although some will never believe it).

On the most extreme end of the birth beliefs spectrum, there is the unspoken-yet-tangible sentiment that cesareans are unpleasant for a reason: to teach the recipient that next time, she should try harder to have a vaginal birth. (And by try harder, we mean not ask for or accept drugs, refuse non-medical inductions, not let herself be strapped into monitoring equipment, refuse breaking her bag of waters, etc.)

It sounds harsh. It is harsh. If we are to truly serve women, we must examine our own prejudices and put them aside in the best interest of maternal health, both body and soul.

Cesareans are not a punishment or a reward. They are a mode of birth.

I think we can all agree that regardless of the people or equipment involved, we strive for the very best births we can achieve every time a baby is born.

When cesarean becomes the only option, we should make it the best option. Period. Mothers who end their pregnancies under the knife deserve the same compassion and care as those who do so in their living rooms or leaning over a hospital squat bar. Even when said with good intentions, a recovering mama never needs to hear that she may not have needed that c-section if she hadn’t agreed to a saline drip and thus brought the cascade of interventions down on her head.

The stage is set for GCs to spread, but it’s a three-pronged effort. Mothers, medical care providers and birth supporters (I’m looking at you, doulas) all have to be energized enough to move the idea forward.

Moms-to-be must educate themselves and ask for the option. High quality care is patient driven, but hospitals won’t know which road to go down until a patient asks for a different route.

Doctors and midwives must also educate themselves, engage in peer-to-peer discussions and examine the impact GCs could have on their patients. Dr. Magee and Dr. John Morton are two physicians working with their patients to change the way birth unfolds in one set of Rhode Island operating rooms. And under Dr. Magee’s supervision, Brown-educated physicians are learning the technique as well, taking GCs into the future with every new class of MDs.

Finally, birth supporters must be educated and able to accept GC when it becomes the right path at the right time. There is nothing worse than watching a heartbroken client trying to put herself back together after major surgery, knowing that you may have held the key to something better. One of our primary goals is to honor a mom’s birth preferences. If she wanted a healthy mom and baby, but she is nursing mental and physical postpartum wounds, we failed her. A defensive attitude toward GCs will only make them less attainable for every woman who could benefit from a GC—which is every woman who gives birth surgically.

Take a moment and examine your own heart when it comes to Gentle Cesarean.

Does it get your goat?

And if it does, what’s catching it?

—–

LINKS!

A minute-by-minute account of a GC as performed by Dr. Nick Fisk, the father of the Gentle Cesarean technique:

http://www.guardian.co.uk/society/2005/dec/03/health.medicineandhealth

More information on GCs, as presented by Dr. Magee and Dr. Morton on December 5, 2010 at Bellani Maternity in Warwick, RI:

Gentle Cesareans (GC) are being orchestrated at Memorial Hospital in Rhode Island, an institution that averages about 380 births a year. Statistically in the US, that means approximately 114 Memorial families will give birth in the OR. For the families choosing GCs, the experience is worlds apart from the standard surgical birth.

At Memorial Hospital, a GC is an “opt in” program, which means a mom-to-be must ask for it. All of the staff has been specially trained to accommodate a GC safely and compassionately. A GC can be planned in advance (ex: for a breech, since Memorial does not attend vaginal breech births) or can be implemented during most emergent cesarean situations. Dr. Magee and Morton agreed that c-sections that are a true medical emergency are incredibly rare but are not compatible with GC protocol.

A GC at Memorial means:

-a quiet room, free from extraneous noises/conversations and filled with the mother’s choice of music

-more than one support person for mom and partner

-each member of the OR room team focuses on mom and partner’s birth experience

-delayed umbilical cord clamping

-skin to skin contact between mom and baby on the OR table; if mom is not able, birth partner is encouraged to do skin to skin with baby until mom can do it herself

-minimizing separation of mom and baby during and after birth; once a vigorous (and naked!) baby is in mom’s arms, both are covered with warm blankets and baby is not removed until mom agrees to baby being weighed and measured

A GC at other hospitals may also include:

-allowing mom to visualize the birth, through the use of mirrors

-propping mom up on the table to help her see her baby emerge

-slowly bringing baby through abdominal opening to simulate vaginal birth

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7 Responses

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  1. I’m not sure if I’m done having children, and since I’ve already had two cesareans I’m not sure if I’ll ever get adequate support to have another VBAC. The choices in my area are pretty limited, and I also don’t know if I’m comfortable doing a homebirth. That said, if I have more children and have no other choice but a c-section, it will be on MY terms. Much of this article rings true for me and I wish it had been different during my last cesareans. It would definitely help to humanize the process more, instead of making women feel like objects or slabs of meat.

    The Deranged Housewife

    January 27, 2011 at 8:45 am

    • ACOG just put out a stance saying that VBA2C is “reasonable” (whatever that means!). What matters most, though, is that it is as you said “on your terms”. A vaginal birth can be just as unsettling/traumatizing/awful as a cesarean.

      In study after study, women continue to say that what influences their birth memories and satisfaction the most is feeling respected, cared for and valued. Birth should never HAPPEN TO a woman, it should be something she is involved in DOING. Whether that means pushing her baby out of her vagina—or telling her doctor that she wants to announce the baby’s sex after it is pulled from the belly—depends on the situation of each mother.

      But part of the reason I was compelled to write this was because I ran into a friend at the grocery store who is expecting her third birth to be surgical, just like the first and second. As far as I know, her first section was for FTP and her second was a RCS because she didn’t know she had a choice. Now, with her third baby, she’s more comfortable going with what she knows. I asked her as gently as I could what her birth plans were, just to see if I could pass her any information on VBA2C (since no one did it with her RCS). The light went out of her face, and her eyes became downcast as she said, “No, I’m taking the easy way out. I’m having another surgery.”

      I hugged her so tight! I couldn’t believe that she felt like having a surgical birth and THEN coming home to a 4-year-old, a 2-year-old and a mostly empty house (cause her husband will be deployed yet again within a few weeks after baby is born) is the easy way. I wish no woman ever felt like c-sections were the cut-and-dried (no pun intended) method of birthing, that it was easy-peasy and no sweat off anyone’s nose. Especially as a doula, I get it a lot—women think that the only birth I could value is a totally unplugged, unattended vaginal birth in the back of a VW bus. I’ve supported a planned c-section and it was “every bit as magical” as every other birth I’ve been to.

      Birth is birth, and every single mother deserves the compassion and respect of her caregivers, to be listened to and supported in her desires. Birthing a baby is just as intimate as making a baby, even when it happens in an operating room.

      wombitmayconcern

      January 27, 2011 at 11:28 am

  2. yes yes! Good blog post. Like it muchly.

    You are so right to say that we need to educate ourselves and ensure that our activism doesn’t get in the way of our advocacy!

    Mars
    http://www.doula-lly.blogspot.com

    Mars Lord

    May 7, 2011 at 7:13 pm

  3. I am a women who is medically required to have a c-section. It saddens me greatly.
    Reading this article gives me hope.
    Are you aware of Rhode Island Hospital allowing Gentle Cesarean’s? My OB is phenomenal. Also, do you know of any other resources where I may learn more?
    Thank you for your time.

    Sabrina

    May 10, 2011 at 10:24 am

  4. I think the term Gentle C-section is going to mislead alot of women into thinking that it is something that it is not. It is not really about music and getting your way. It is about major abdominal surgery and heightened risk to the mother’s life no matter how you sugar coat it. And, if anything happens – cord around the neck, uterine rupture, etc., that baby is coming out as fast as they can go, so the whole plan is out the window anyway. My last c-section came with inadequate anesthesia, and quite honestly I wanted it over with as fast as possible. No matter how great the surgical experience is (my first was pretty much ok, with seeing the baby over the barrier, etc.). The recovery was still very tough. Anyone who says it is the easy way out is full of sh*t – I am tired of women comparing birth experiences as though that is the measure of your entrance into motherhood. Self-sacrifice is the hallmark of motherhood and it begins with the birth experience for a lot of us. Yes, birth HAPPENS to you, whether you are DOING it or it is being DONE to you. I am all for improving the care and compassion towards women giving birth as I have been one of them, I just don’t believe in misleading them as to how it is going to really be and how much control they are really going to have.

    Pink

    March 13, 2012 at 10:48 pm

  5. Here’s what “gets my goat” about advocating for ‘Gentle Cesareans’… We shouldn’t have to advocate for them – not for ‘gentle cesareans’ or ‘gentle vaginal birth’. It should be a given that a woman should have more control over the environment in which she gives birth. I worry that advocating for “gentle cesareans” misleads women into thinking that they’ve had a good experience if the medical staff have “LET” them play music and wear their own pyjamas while receiving crappy care (whether for a vaginal or cesarean birth).

    I 100% support the idea of gentle cesareans – and that every woman, no matter how she gives birth, deserves to have control over her surrounding environment. But I worry that when we focus on things like dimming the lights, playing soft music, and lighting candles, we take the focus away from the things that will truly result in happy and healthy moms and babies – things like evidence-based practice (which would mean fewer interventions and fewer c-sections), informed choice (which means honouring the birthing woman as the decision-maker), and so on…

    I advocate for better care….. period.

    Allison

    May 7, 2012 at 10:51 am


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