Gentle cesarean, difficult discussion
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?
A minute-by-minute account of a GC as performed by Dr. Nick Fisk, the father of the Gentle Cesarean technique:
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
Written by wombitmayconcern
January 26, 2011 at 1:13 pm
Posted in activism, au natural, beneficial, birth memories, controversial, controversy, doula, failure, guilt, healthy, hospital birth, institution, OBGYNery, physician, respect, satisfaction, self-esteem, support, Uncategorized
Tagged with AROM, birth options, cascade of interventions, cesarean by maternal request, EFM, iatrogenic harm, induction, maternal victimization, narcotic pain relief, new techniques, primary cesarean, repeat cesarean, skin-to-skin, stress, surgical birth, trauma
Subscribe to comments with RSS.