Gentle C Section: Our Story

She’s here! Vivienne Cecilia arrived as planned on the 22nd of March.   

As with Sebastien’s Birth Vivienne was scheduled to arrive Via Cesarean. Sebastien’s birth was very calm but I wanted just that little bit more. I’ve had time, in the 22 months between babies to do some research in to what is labelled as a gentle section, and set about writing my birth plan (with the help of some lovely ladies from This Facebook page) 

I had concerns that my wishes wouldn’t be met, as my first consultant appointment at 16 weeks pregnant was disastrous, and ended with me having a huge meltdown and threatening to change hospitals. Things improved throughout my pregnancy (with a new consultant!) but it wasn’t until Mike and I met our Surgeon on the morning of Vivienne’s birth that we were sure our wishes in theatre would be met. 
We knew we were having a little girl, and tailored the wording to make her birth plan more personal. This is said plan, word for word as presented to the hospital:

Gentle Caesarean Section Birth Plan for Zoe Cripps

Please could you help our daughter have a gentle birth – Thank you for your support

Due to maternal health, I have requested a C section for the birth of my daughter, as after much research, this will be the safest option for both of us. I am aware that I can help our daughter have a calm birth even when born by C-section. I know by helping my daughter have a gentle birth she will benefit emotionally and physically, short and long term.

Please accept “we” as Mum, dad and baby for the purpose of this document. 

If there is no medical reason to justify why this can not be done please can you support me by performing the csection taking note of guidelines presented below, as demonstrated by Professor Phillip Bennet, Consultant Obstetrician to Imperial Healthcare NHS Trust at Queen Charlottes and Hammersmith Hospitals

To accomplish this we would like:

· Mum (Zoe) will be relaxed and ‘within her birthing body’ so in the first instance any questions to go to Dad.(Mike) 

· Zoe kindly requests that there is no background noise such as radio or music, as she is partially deaf, and finds too much noise somewhat overwhelming. 
· Lights – We realise the need for bright lights around the area of operation but we ask for lights to be dimmed or darker, around mum and baby, when baby is passed to Mum and Dad. 
· The drip in the non-dominant (left) arm so that Mum can hold baby as soon as delivered.
· ECG dots away from front of chest so baby can be placed there after delivery – ECG dots to be placed on the back of shoulders and sides. Gown to be worn backwards to facilitate immediate skin to skin. 
· After uterine incision the drape to be lower or removed, head of table raised to enable Zoe and Mike to watch the birth. 

· Delivery of our daughter to be slowed to allow lung fluid to be squeezed out of her lungs. As her head enters the abdominal incision, the operative field is cleaned of blood and Mike is invited to stand to observe the birth. (If he wishes to do so. We will also be taking photos) The principle for the surgeon is then hands-off, as our daughter auto resuscitates: breathing air through her exteriorised mouth and nose, while her trunk still in utero remains attached to the placental circulation. This delay of a few minutes allows pressure from the uterus and maternal soft tissues to expel lung liquid, mimicking what happens at vaginal delivery.( At this point The half-delivered fetus frequently cries but if not, the obstetrician observes her breathing, colour, tone and movement to indicate wellbeing.) Once crying, her shoulders are eased out, and then baby then frequently delivers their own arms with an expansive gesture. Concurrently, her torso tamponades the uterine incision, minimising bleeding.

· Delayed cord clamping – we request the cord is left to fully pulsate. Once the cord has finished pulsating cord blood can be taken to test for rhesus negative blood group. (Mother’s blood group). Dad (Mike) to cut the Cord. Baby is to be placed skin to skin on mothers chest (or as far on to the mothers chest as the cord length will allow whilst the cord stops pulsing) 
Immediate skin to skin, as mentioned above, Zoe’s hospital gown on backwards so that it is open at the front rather than tied up at the back to allow for easier access for immediate skin to skin with baby.
· All midwifery jobs to be done without separation of baby from Mum, in case of emergency baby to remain within Dads sight at all times. Once the cord is cut, skin to skin is to be continued between Mike and his daughter. 
If no medical problems baby not to be taken from parents for at least an hour so she can have undisturbed skin to skin to really allow the oxytocin to flow. We would like to wait until after an hour of skin to skin/until all 3 of us are in recovery/back on the ward to weigh and dress our little girl. This is also when the vitamin K shot can be administered. 
Zoe requests that the pfannestiel incision is closed with Staples rather than sutures, as this is more comfortable for recovery. This will be Zoe’s 3rd abdominal surgery. 
** if NICU is required for baby at any point, then dad to remain with baby. Under NO circumstances whatsoever is formula to be given to baby. Mum is a confident breastfeeder and capable pump mama. A pump is to be brought to mum immediately if for any reason she is separated from her baby. 
• For the remainder of the stay in hospital Mum and Dad would like a private/side room if possible, to support bonding, breastfeeding and recovery. This will also help mum to stay calm and not be overwhelmed by the noises associated with a busy maternity ward. If a side room is not available, then a rapid discharge back to the community midwives (within 24 hours) is requested. 

Catheter to be removed from mum 12 hours after birth (or earlier if possible!) 
References:
Delivery: walking the baby out

The NICE Guidance on Caesarean section (NICE 2011) recommends that medical staff take into account the condition of the woman and the unborn baby when making decisions about rapid delivery and that they should remember that rapid delivery may be harmful in certain circumstances. There is significant evidence that neonatal respiratory complications are more common after elective caesarean than vaginal delivery, in which retained lung liquid is implicated, as is the lack of catecholamine and cortisol surge associated with vaginal birth (Smith, Plaat and Fisk 2008). Whilst there is no yet quantitative evidence of this, pausing the delivery of the baby, after the delivery of the head, to allow physiological expulsion of lung liquid like at vaginal delivery may facilitate respiratory adaptation.
Delayed clamping is now recommended by the RCOG, UK Resuscitation Council Newborn Life Support guidelines, the World Health Organisation and the International Federation of Gynaecology and Obstetrics and NICE 2014. More recently the European Resuscitation Council have advocated a delay of one minute, irrespective of gestation at birth. The National Institute for Health and Care Excellence (NICE) has changed its guidelines. It now states that doctors and midwives should not routinely clamp the cord ‘earlier than one minute from the birth of the baby’, and instead should wait one to five minutes – and longer if the mother requests.

Skin to Skin after Birth I would really appreciate the above and for my baby to take their time and have our time together undisturbed. I know how beneficial skin to skin and there is no reason why a C-Section should deprive a baby from this when they benefit in so many ways, keeps baby warmer, regulates breathing and keeps blood sugar levels higher, enhances bonding, reduces postnatal depression, settles a baby, baby calms and sleeps, better gut health and immunity for baby feed.

Smith J, Plaat F, Fisk NM 2008 The natural caesarean: a woman-centred technique by J Obst Gynaecol 115(8):1037-42 “The technique does not compromise either safety or sterility”

Our surgeon was absolutely fantastic, and met all of our requests with enthusiasm, even instructing one of the midwives to video the part where Vivienne was walked out of my tummy. (Something we will treasure forever!) my husband cut the cord at both ends which was above and beyond what we were expecting! (Which meant he went the other side of the drape and saw the gaping hole in my tummy!)  

 

 
   
   
The only part of our plan that was not met was the request for a side room. The hospital is ridiculously busy and the ward was very noisy, the staff although clearly overstretched were fantastic, and did everything they could to keep things relaxed and calm in the wards (no mean feat with 6 women to a bay!) none the less I found the noise quite overwhelming, and keen to show that I was ready for a rapid discharge I was up and showered less than 10 hours post section. 
 Thankfully by the time Vivienne was 29 hours old we were home! We’ve had a bit of a rocky start to breastfeeding since leaving hospital, something I will blog about on another day, as it’s been a bit of a shock to struggle with it after successfully breastfeeding Sebastien for 18.5 months! Other than that, we are home and settled, Sebastien taking on his role of big brother quite happily (for now at least! ) 

  

Ciao for now! 

Zoe X 
Ps: don’t forget to read Leah’s gentle Waterbirth story 💕