Gentle C-Sections Could Transform How We Give Birth

In May 2017, Kelly Woolsey had a C-section and welcomed her daughter, Hailey.

Woolsey’s C-section was no ordinary one, though—it was a “gentle” C-section, a procedure growing in popularity that she was familiar with as a CRNA in the labor and delivery unit at BayCare Health System in Clearwater, Florida.

“With my first two children, I had standard C-sections,” Woolsey said. “During my gentle C-section, I was able to watch my daughter being born and touch her through the drape. You’re lying flat on the table and your belly blocks the view of your incision, so you don’t see anything bloody. They took her briefly to the warmer and I was offered skin-to-skin contact within minutes of her birth. My son was over at the warmer and I wasn’t able to have him in my arms until I was brought up to my bed afterward. Hers was definitely a better experience.”

These are the hallmarks of a gentle C-section: allowing parents to view the birth through a clear drape rather than being separated from it by a blue one, and facilitating skin-to-skin contact between mom and baby immediately after delivery. Some hospitals even offer relaxing music and aromatherapy in the operating room, and for doulas to enter the OR with the patient and partner.

“During the delivery, one of the coolest things we can offer is allowing mom and dad to visualize their baby being born. To be able to drop the surgical drape and have a clear partition so they can see their baby being born is magical,” said Alexis Lipton, an obstetrician at BayCare Health System who performed Woolsey’s gentle C-section.

Numerous studies have proven the benefits of skin-to-skin contact for both mother and baby, and that the more immediately it takes place, the more benefits they experience. It helps newborns regulate their sleep cycles and reduce stress following delivery. Babies who get immediate skin-to-skin are more likely to be breastfed, and their feedings last longer, likely because that contact kickstarts their suckling reflex. It reduces the newborn’s cardio-respiratory instability, helps the baby warm up and return their circulation to normal after birth and even reduces the pain felt by the baby during a heel stick blood test. For mothers, skin-to-skin causes the release of higher levels of oxytocin and stress-reducing hormones, which anecdotally reduces anxiety and speeds up bonding as a result.

“We know that data is true from vaginal deliveries so it makes sense it would extend to cesarean deliveries as well,” said Lipton.

But the opportunity for immediate skin-to-skin contact has historically been reserved for mothers delivering vaginally. C-section mothers typically meet their newborn and begin bonding 30 minutes to an hour after birth, when postoperative stitching is done and they return to their room to recover.

“Traditionally the baby wouldn’t come to the patient until sometime after delivery, sometimes until after the patient has left the room,” said Daniela Carusi, director of surgical obstetrics at Brigham and Women's Hospital in Boston and member of the American College of Obstetricians and Gynecologists.

According to a paper published in 2008 by obstetricians at Queen Charlotte’s and Chelsea Hospital in London—the researchers credited with pioneering the gentle C-section technique—most mothers who have C-sections aren’t afforded the same opportunities as moms who birth vaginally because the procedure is mired in surgical routine.

“Although much effort has gone into promoting early skin-to-skin contact and parental involvement at vaginal birth, caesarean birth remains entrenched in surgical and resuscitative rituals, which delay parental contact, impair maternal satisfaction and reduce breastfeeding,” the paper reads. “Caesarean section remains entrenched in hospital routines, seemingly immune to the tide of customer-focused changes that has swept maternity services and labor ward care.”

Lipton agrees.

“Doing skin-to-skin contact after C-section has proven tricky due to trying to keep the surgical field free of any contamination or bacteria as we hand off the newborn,” she explained. “The other barrier to skin-to-skin has been the initial newborn assessment. We’re creatures of habit and used to performing the initial newborn checkup in a baby warmer. With a little training and flexibility, we can do the entire newborn physical on mom's chest.”

Gentle C-section can also be offered to patients having an unplanned C-section as long as mother and baby are not in distress and there is time to discuss the procedural differences.

“We’ve used these techniques in extremely complicated C-sections,” Carusi said. “When a mother is expecting a difficult C-section, she might feel like any component of a nice birth is gone. It’s nice to bring in that moment of seeing the baby to make it worthwhile, so it’s more than just this complicated surgery.”

In what research exists, there are no documented negative side effects of performing C-sections this way. One widely cited study published in 2015 by Charité University Hospital in Berlin, Germany, found that when comparing gentle and traditional C-sections, there was no increase in complications for mother or child. The study even found that mothers who underwent gentle C-sections had more success breastfeeding afterward and overall better experiences compared to mothers who had traditional C-sections.

When offering gentle C-sections was being discussed at Carusi’s hospital, sterility during the operation was a major concern, but has been a nonissue in her experience.

“I’ll say quite honestly we have seen no problems with it. We don’t break the sterile barrier because we leave the clear drape up and bring the baby around it separately.”

Both Lipton and Carusi became aware of gentle C-section practices five to six years ago, but hospitals offering it may still be in the minority. There is no governing body or organization promoting the procedure or tracking which hospitals offer the service, so its implementation in the U.S. has been slow and scattered. Lipton says that’s because it’s simply a choice by physicians who have heard of the procedure, read the literature and opted to offer it to their patients. Because of this, she encourages expectant mothers to ask their doctors if gentle C-section is an option when it’s not explicitly offered to them.

“It seems much of the drive to make C-sections more family- and patient-centered is driven a lot by patients themselves—I heard about gentle C-sections from a patient as well,” said Lipton. “Unfortunately, our medical societies are slow to share this information with the masses. Some hospitals can be slow to adopt change. You have to have staff and physicians with open minds who care deeply about how patients experience a situation,” Lipton said. “The only tangible difference is the clear drape we use, but the rest of the things we do are behavioral. We can be stubborn to change sometimes, but I think it should be offered everywhere.”

Awareness that these techniques exist may be a barrier to more women having access to gentle C-sections. Otherwise they require only a small investment on the part of the hospital into clear drapes, and the willingness of an obstetrician to break from C-section tradition.

“This change doesn't require any alteration to medical, federal or state guidelines. If patients explain why these things are important to them, this should be a no-brainer for any physician,” she said. “Patients deserve better. As physicians and nurses, we should be providing these comfort measures to create a calmer environment for mom and baby.”