Making The Case For A Gentler C-Section


 
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By Anya Sostek

Cesarean sections have long been the stepchildren of the labor and delivery world. But now, the procedure is getting a makeover.

At one hospital, a dedicated "stork nurse" is placing the baby "skin to skin" on the mother, and even initiating breastfeeding, while the mom is still being sewn up. At another hospital, a trial program has given mothers the option of a clear window in their drapes during their C-sections, to see their babies at the very moment of birth. And at another hospital, doctors are exploring options such as not strapping down the mother's arms and letting the father cut the umbilical cord.

The changes follow a national and international movement toward "gentle C-sections" or "family friendly C-sections." The newer procedures generally aim to place the baby with the mother within five minutes or so after birth, rather than waiting an hour or longer until the mother's surgery is finished, and she is moved out of the operating room.

"It's a culture change," said Wendy Camlin, director of obstetric and newborn services at a hospital, which started doing skin-to-skin contact in the operating room in February. "It's just a different way of doing things."

About 33 percent of women require the surgical removal of babies through an incision in the lower abdomen when complications arise or labor does not progress.

With the changes at these hospitals, babies are briefly placed in a warmer and given the 1-minute Apgar assessment to make sure they are stable before being brought to the mother.

Although the changes may seem minor, they made a big impact on Kristi Reynolds, who had her third child via C-section at West Penn Hospital in February. West Penn made changes to its C-section procedures in April of last year.

"It wasn't a clinical feel," she said. "It was personal and family-birth oriented."

When her first son was born eight years ago through a C-section in Maine, she didn't get to touch him until she had been moved into recovery. She remembers, through an anesthesia fog, her son being out of sight from her and her husband. With her second son, born vaginally, she treasured the immediate bonding time. When doctors recommended a C-section with her third baby, she was nervous about going back to her first birth experience.

But with the help of stork nurse Sandra Stanley providing an extra hand, Reynolds got to hold the baby right away. "My babies, I want them with me all the time," she said. "Even after I get home I wear them a lot. For that to happen at the hospital makes a big difference."

The changes are not just for sentimental reasons. Research has shown improved outcomes when babies are immediately placed skin-to-skin on their mothers, known as kangaroo care. Benefits include more stable temperatures for the baby and better initiation of breastfeeding.

Preliminary data from West Penn Hospital also shows that women are requiring less pain medicine and less anxiety medicine when the babies are placed on their chests. "I say the phrase, 'Baby is the best drug there is,'" said Stanley. "Once the baby is on the mom, things change."

The gentle C-section movement was pioneered a decade ago in England by doctors trying to improve the birth experience. Some practices used there are not accepted in the Pittsburgh area, such as putting the baby immediately onto the mother, sometimes even before the umbilical cord has been cut.

"I'm still doing major surgery, and that's something we can't lose sight of," said Paula Duncan, an obstetrician and gynecologist.

Dr. Duncan and her partners, are open to other tweaks in the C-section process, such as not strapping down a mother's arms. "We always crack the joke that we don't need any assistance and to keep your arms at your sides," she laughed. Dr. Duncan is also considering new roles for the father during a C-section, such as letting him roam around the operating room and even cutting the umbilical cord once the baby is off the sterile field.

One the hospital by midsummer hopes to offer women the choice of a drape with a clear window, so that they can view the baby immediately at birth. A view of the actual incision site will likely be blocked by the mother's stomach. A trial use of these was positively received by patients.

"They are a great option for a sub-set of patients who want this experience," she said.

That won't be an option any time soon at other hospitals. "I think all the dads would pass out," laughed Stanley. "We're able to maintain sterility and maintain that warm and fuzzy thing without making the dad another patient," chimed in Lorrie Just, manager of labor and delivery and antepartum.

The biggest change at West Penn has been the addition of the stork nurse during deliveries, who is in charge of the baby and in promoting mother/baby bonding, including helping with breastfeeding. Minor changes have included things like moving chest leads for heart monitoring higher up, to make room for the baby on the mother's chest.

It's also a philosophical difference for nurses, said Stanley. Rather than focusing on completing certain tasks, the goal is to first initiate mother/baby bonding and breastfeeding.

"A lot of the things that we do with our babies can be delayed the weighing, measuring, administration of medications," she said. Nurses are sometimes opting to wait to do the five-minute Apgar test until the baby is already on the mother.

And for mothers like Reynolds who would have preferred a vaginal birth but have been told that a C-section is medically necessary, it can help make the experience more positive.

"At least if she has to have a Cesarean, it does add a bit of sparkle to her birth that she thinks might be lacking," said Stanley. "We want to treat any woman here like she's the only woman here to give birth, and we want her to be special."



 
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