The Gentle Cesarean

The Gentle Cesarean is a cesarean birth where the baby is placed skin-to-skin with their mother immediately after birth.  This is something we have offered at my hospital since 2012.  We often get asked about it and there are a lot of places around the United States who still do not offer Gentle Cesareans.  I believe that this should be the standard of care for cesarean births for healthy mothers and healthy babies.    

Why is this important?  For starters, after a mother has gone through her whole pregnancy, the first thing she wants is to hold her baby.  Listening to mothers talk about their births, especially mothers who have had a cesarean, and if the baby was taken away from them to another room for "procedures", they often feel like they "missed something".  We had heard this for many years.  When we found out about the Gentle Cesarean, we wanted to offer it at our hospital for this reason.  

So, how do you do it?   We were pretty great at getting babies skin-to-skin with their mothers after vaginal deliveries.  We found out about the Gentle Cesareans from Memorial Hospital of Rhode Island and at the time, I had a pretty amazing OB Department Chair, Dr. George Kovacevic.  I shared the information with Dr. George and it was all he needed to hear and we were on our way.  We tried it out with our first mother who was a nurse and she knew she was going to be the first one.  We did pretty good with her Gentle Cesarean but we needed to practice some more!  So that is what we did.  Our staff took turns going back to the OB Operating Room and actually one would pretend to be the patient, the other would pretend to be the baby nurse and another would pretend to be the circulating nurse.  We looked at where we could place the drapes, how we could lower them down beneath the level of the breasts so that we could have room for placing the baby skin-to-skin.   We practiced where to put the leads for the cardiac monitor so we knew exactly where to place them to get a good heart reading and also have them out of the way of the baby.  We practiced where to put the baby and how to place the baby for mom's comfort and for baby's safety.  We practiced placing a mirror near the warmer so that if the baby needed to go to the warmer, the mother would still be able to see her baby while she was having her surgery.  Lots of practice makes perfect!

We kept reading everything we could about Gentle Cesareans and we found a hospital in Boston had started using clear drapes!  So, we found out where to get them and we started offering them to our patients.

We had it perfect!  Mothers were happy and babies were thriving in our Operating Room!  Babies even started to self-attach to the breast in the Operating Room!  This is just amazing to watch!

A lot of people have asked me for a policy of how we do it, but we have chosen not to have a policy for a mother to hold her own baby.  I have however, made a Basic Steps for a Gentle Cesarean Birth.   In addition, I have included a link to our famous mother of triplets who had the first Gentle Cesarean of Triplets in the United States.  

Basic Steps for a Gentle Cesarean

Scheduled Cases/Non-Urgent Cases

·       Explain Skin-to-Skin procedure to all mothers on admission.  This is routine care for all deliveries.

·       Determine mother’s preferences

o   Does she want a clear drape?

o   Does she want pictures?

o   Who will be her support person?

In the OR

·       Inform the anesthesiologist that the mother would like a gentle cesarean

·       Leads to be placed to the sides

·       Drape to be placed under the breast level (IV poles work great with clips)

·       Arms are to be left free, not tied down

·       Gown is to be unsnapped and loosened to receive infant

Preparing for the Baby

·       A mirror positioned by the warmer angled down on the warming bed so that the mother can see the baby in case the infant has to be taken to the warmer.  Check with mother to make sure she can see the warmer

·       Have warmed bath blanket ready

·       Have sterile warmed baby blankets ready to receive the baby from the obstetrician

·       Prepare safety equipment in warmer, suction, oxygen, etc. as usual

·       Inform the Respiratory Therapist that the mother would like a Gentle Cesarean

Receive the Vigorous Baby

·       Nurse receiving baby is in sterile gown and gloves

·       Baby is received into a warmed, sterile baby blanket

·       Is the baby crying and vigorous?   YES?   Continue on with steps below

·       Dry the baby as much as possible with warmed baby blanket

·       Place the baby Skin-to-Skin with mother

·       Remove wet, baby blanket

·       Cover baby and mother with a warmed bath blanket

·       Observe baby.  Often secretions will drain easily with prone positioning of the baby on the mother’s chest 

·       Observe the mother

·       Assist mother and partner with positioning of the baby as needed as the surgery is completed

·       Take photographs for the family as requested

·       Baby may self-attach to the nipple.  Support breastfeeding as needed

Receiving the Baby Who Needs a Bit of Help/Not Sure

·       Baby is received by the nurse and is taken to the warmer

·       Baby is dried and stimulated

·       Is the baby crying and vigorous?  YES?  Begin Skin-to-Skin.  Continue with steps for receiving Vigorous Baby

·       NO?   Continue with observation and treatment until baby is stable

     Surgery is completed

·       Baby is given to support person until mother is transferred from the delivery table to bed/stretcher

·       Mother and Baby go to the PACU together to continue with recovery process All newborn procedures and vitals are possible to do on the mother’s chest

·       Measurements can wait until after first feed.  

·       Bath should be delayed (Wait for Eight!) Document Skin-to-Skin in Medical Record Document first feed in Medical Record

Video of the Triplet Mom who was first in the United States to have a Gentle Cesarean

http://youtu.be/nwP_JXfbKm0

As you can see, our team has worked hard to skillfully perfect the process and it is now routine care for every cesarean birth for healthy mothers and healthy babies.  It has made the world of difference for families receiving care in our facility.   This can be done for cesarean births for healthy mothers and babies.  I feel it should become the standard of care for all cesarean births around the United States.