Family-Centered Cesareans: A Holistic Approach to Cesarean Sections

1) In short, what is a family-centered cesarean?

A family-centered cesarean is a cesarean birth that places a high importance on involving the mother and her partner in the birth experience as active participants. Incorporating elements of a vaginal birth, a family-centered cesarean aims to make the birth as "normal" as possible, giving the mother and her partner more control and greater opportunities for participation in the birth itself.

2) What makes a family-centered cesarean different from a conventional cesarean?

While a conventional cesarean is looking at birth through a purely medical lens, a family-centered cesarean looks at birth more holistically, putting a great deal of value on normalizing the birth and allowing the parents to be active participants in the experience. Where a conventional cesarean occurs at a rapid speed, a family-centered cesarean is slightly delayed, allowing more time for the birth to occur.

3) What characterizes a family-centered cesarean?

There are many different facets to a family-centered cesarean and the manner in which a woman's family-centered cesarean will play out will depend on her desires, as well as the cooperation of her care provider and hospital staff. Similar to the diversity of vaginal births, not all family-centered cesareans will look the same. Below is one explanation of a family-centered cesarean...

Prior to birth:

During pregnancy, a woman and her partner are educated on the choices that she has within her cesarean. They may be shown video clips of family-centered cesareans and/or they may have the opportunity to tour the operating room so as to become familiar with the environment and have an opportunity to ask questions. The woman is encouraged to bring her own music to play in the operating room, as well as may be allowed to bring her own clothing to wear in place of a hospital gown.

Preparing for the birth:

The electrocardiogram (ECG) is placed and positioned in a way that leaves her chest bare where the baby will be placed. The pulse oximeter is positioned on the mother's foot, so as to keep her hands free to hold her baby once he/she is born. In addition, the intravenous line is placed in the non-dominant hand. The anesthetic block is given in a manner that provides pain-free surgery without requiring any supplementation that could alter the woman's responses during the cesarean. In order for the mother to be able to hold her baby, it is important that the medication does not affect her upper limbs, nor cause nausea, lightheadedness, or vomiting.

Delivery:

Once the uterine incision is made, the surgical drape is lowered and hte head of the bed is lifted so that the mother can watch the birth. The partner may also be invited to stand to observe the birth. Once the baby's head emerges, the surgeons take a much more "hands-off" role and allow for the baby to establish respiration while still attached to the placental circulation in a technique called, autoresuscitation. This delayed delivery method allows for the pressure of the uterus and maternal soft tissues to work to expel fluid from the baby's lungs, resembling the action seen in a vaginal delivery. The baby's shoulders are then delivered slowly, allowing the baby's arms to emerge on their own. At this point, the baby may be left supported for up to a minute in order fort he mother to be able to observe her child. The baby is then fully delivered by means of both passive expulsive efforts of the mother's contracting uterus and active assistance as the obstetrician supports the baby's head and torso.

Following the birth:

Once baby has been born, the cord is clamped and cut in full-view of the parents (often times a small bit of cord is left in order for dad to perform a "ceremonial cut" later on). The anesthetist clears the mother's clothing from her chest so that she can hold the baby skin-to-skin. The midwife/nurse (who is fully scrubbed), receives the baby from the surgeon so as to prevent contamination. The baby is then placed on the mother's chest and kept warm with fresh towels and bubble wrap. Both the anesthetist and the midwife/nurse remain at the head of the mother and the midwife/nurse continues to monitor the baby from this position. All necessary infant procedures, including labeling and any injections are given to the baby while still skin-to-skin. The baby is positioned so that he/she can initiate breastfeeding. During the time that the mother is transferred to her bed, the partner holds the baby. The baby can also stay with dad while he/she is weighed and measured, which is done only after surgery is finished. One mom has settled into her bed, the baby is then placed back on the mother's chest for skin-to-skin contact.

4) What are some of the benefits of a family-centered cesarean?

The benefits of a family-centered cesarean have been shown to be multi-dimensional. Not only does a family-centered cesarean improve the satisfaction of the parents by allowing them to be active participants in the birth, but it also provides both physical and psychological advantages to mother and baby. Pausing the delivery of the baby and allowing for the physiological expulsion of lung fluid as seen in a vaginal delivery may promote respiratory adaptation. Babies born in a delayed manner through a family-centered cesarean often achieve healthy Apgar scores before they are officially "born." The early skin-to-skin contact between mother and baby as seen in a family-centered cesarean has a profound effect on both mother and baby. Research has shown a multitude of benefits resulting from early skin-to-skin contact, including a reduction in infant crying, an improvement in maternal affection, and an increased rate and duration of breastfeeding. The entire process of a family-centered cesarean involves the mother and her partner, making the experience more personal and intimate than that of a conventional cesarean.

5) Is it safe?

The first and foremost priority in every cesarean is safety. The delayed nature of the family-centered cesarean may not be appropriate for certain emergency situations, but is a safe and valid option for many women having a cesarean birth. With a well-educated staff and proper safety protocols set in place, a family-centered cesarean is no less safe than a conventional cesarean birth.

6) How can I make a family-centered cesarean a reality for me?

Talk to your care provider ahead of time about your desires should a cesarean birth become a reality for you. Discuss your options and ask about his/her experience with family-centered cesareans. If family-centered cesareans are not common practice in the hospital where you will be delivering your baby, talking this over and making a plan well in advance of your due date is a wise idea. You may not be able to have all of your desires met, but your caregiver may work with you to incorporate aspects of a family-centered cesarean into your plan. Once you have had a discussion with your caregiver and have discovered your options, create a cesarean birth plan outlining your wishes, In the event that you end up needing a cesarean, you will be forever grateful that you have already discussed your desires with your caregiver and created some sort of plan so that you can continue to be active participants in the birth of your child regardless of delivery method.

Below is a helpful video outlining the family-centered cesarean technique...

https://www.youtube.com/watch?v=m5RIcaK98Yg

For further information, check out the 2008 article The natural caesarean: a woman-centered technique published by BJOG: An International Journal of Obstetrics & Gynaecology