Family-Centered Cesarean Birth

clear drapes c secCesarean delivery is both a major surgical procedure and a momentous and miraculous event in the life of a family. Historically, the rituals and processes common to major surgical procedures have dominated the cesarean birth process. For vaginal delivery, many obstetrical units have developed mother, baby and family-centered birth processes that emphasize immediate skin-to-skin (STS) contact and the early initiation of breastfeeding. In contrast, in many obstetrics units babies born by cesarean delivery are brought to a resuscitation stand, examined, cleaned, banded, administered medications, weighed and swaddled before being introduced to the mother. In cesarean deliveries, early skin-to-skin (STS) contact and early initiation of breastfeeding are not common. Research indicates that many mothers report that these surgical rituals and processes prevent them from connecting to important physical and emotional aspects of the birth process.

Various techniques can be utilized to make the cesarean delivery a more family-centered experience. For example:

  • The anesthesiologist can allow a totally free arm to interact with the baby, and place ECG leads on the back or side to facilitate intraoperative breastfeeding or STS contact.
  • Permit the patient and her support people to view the birth of their baby as active participants. Use clear drapes to permit the patient to view the birth of the head of the newborn, or drop the drapes prior to the birth of the head of the newborn. Raising the head of the table can facilitate the mother’s view of the birth of her baby.
  • For mothers who have enlisted the support of a doula, consider welcoming the doula along with one other support person into the operating room for the birth.
  • Immediately transfer the baby to the mother’s chest. Dropping the surgical drapes prior to delivery will help with this transfer. If mother’s chest is not available or accessible for any reason, consider early STS with the father. Benefits of this approach include better temperature control in the newborn. Careful attention to ensuring that the baby is not left exposed to the cold operating room temperatures is helpful to reducing the risk of hypothermia. Early STS facilitates maintenance of neonatal thermoregulation.
  • Encourage intra-operative breastfeeding. Early contact between the infant’s lips and the mother’s nipple are associated with increased initiation and duration of breastfeeding. Breastfeeding should be started as soon as a possible after birth, preferably within the first hour of life. Weighing, measuring and routine care for the infant can be delayed until after the first feeding is completed.

The “culture” of the operating room needs to adapt and embrace this concept. The anesthesiologist and nurse will need to cooperate to share this space, and also to include any support persons. Moreover, the operating obstetrician and assistant will need to understand that the area above the surgical field may be a bit “busier” than they are used to. Educational efforts directed at all stakeholders, including anesthesiologist, obstetrician, pediatric and nursing staff, will facilitate the introduction of this model of care.

Is it possible to transform a surgical procedure, a cesarean delivery into a mother, baby and family-centered experience?  For many cesarean delivery procedures the answer is a resounding “Yes”.

Dr. Camann shared his experiences bringing this model of mother and baby focused care to one of the nation’s most respected birthing hospitals and answered many questions from both parents and clinicians. Watch the webinar now:

About William Camann, M.D.

William Camann, M.D., is the director of obstetric anesthesia at the Brigham and Women’s Hospital in Boston, and an Associate Professor of Anesthesia at Harvard Medical School.

Dr. Camann is an internationally recognized authority on obstetric anesthesia and pain control during childbirth. He has appeared on The Today Show with Katie Couric, The Dr. Oz Show on Oprah.com, Good Morning America, and has been interviewed in The New York Times, Newsweek, Wall Street Journal, FitPregnancy, Pregnancy Magazine, and American Baby. Dr. Camann is the co-author of Easy Labor, Every Woman’s Guide to Choosing Less Pain and More Joy During Childbirth. “Easy Labor” won the “Best Pregnancy/Childbirth Book of the Year – 2006” from the National Association of Pregnancy and Parenting books (NAPPA).

8 Responses to Family-Centered Cesarean Birth
  1. KAthleen Hoff
    April 2, 2013 | 1:48 pm

    I received the email from DPH to register for this webinar and was not able to do so. Could you forward me the link?
    Thank you,
    kathleen.

  2. Katie
    April 2, 2013 | 2:28 pm

    Love this article! My recent CS was def. way more family friendly and what a difference from the first! We did skin to skin in the OR, and I got to hold baby with my free arm. It was incredible!

  3. Kong Choon Yen
    April 2, 2013 | 11:06 pm

    Won’t that be great if all women gets to hold their baby immediately after birth even for a cesarean birth? A more calming and satisfying birthing experience for mom, dad and most importantly the baby.

  4. Nancy Travis
    April 12, 2013 | 5:14 pm

    Does anyone know where you can get those clear drapes??? We offer the “Gentle Cesarean” at Cape Coral Hospital (SW Florida, Lee Memorial Health System) and do skin to skin in the OR. BUT, I would LOVE to have those clear plastic drapes!
    njtravis@comcast.net

    • Nancy Holtzman RN IBCLC CPN
      April 13, 2013 | 7:47 pm

      Dr. Camann said that they are available through the usual surgical supply sources – it’s possible that the vendor your OR currently uses can source them for you.
      Best wishes,
      Nancy

  5. Jessica Queller Katz
    May 5, 2013 | 10:34 pm

    Hello and Thank You for the beautiful and amazing work you are doing to educate the public on this topic and for sharing such resourceful information. I am a co-founder of a New Jersey BirthNetwork (NJBN) and one of our current projects is advocating to NJ hospitals to implement Family Centered Cesareans as standard practice for surgical deliveries. Dr. Camann’s webinar was so clear and concise, and the images depicted a clear presentation of what exactly a Family Centered Cesarean consists of. May I ask who to contact to obtain permission to use any of the content/images in the presentations we will be making to hospital administration, OBs, RNs, etc?
    NJBN is a collective of volunteers all working for mother friendly maternity care statewide and the Family Centered Cesarean is near and dear to our hearts.

  6. [...] Dr. William Camann, Director of Obstetric Anesthesia at the Brigham and Women’s Hospital in Boston, MA, and an Associate Professor of Anesthesia at Harvard Medical School, is encouraging a positive transformation in the culture of the operating room. A cesarean delivery can be a mother, baby and family-centered experience. Watch the video. And read his blog post. [...]

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