Cesarean 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: