Of course you probably know by now that I am a strong advocate for normal physiologic birth. However, even the most “crunchy” of us agree that there are times when a cesarean birth is absolutely the right choice. For those families who need a cesarean, they too deserve to birth surrounded by compassion, joy and gentleness. Yes, it’s major surgery. But still the birth of a baby, of a family. Particularly when planned ahead of time, in a non-emergent situation, a more family centered approach is working in other parts of the country, and can work here too. You just might have to ask for it! If you know you need a Cesarean in advance, consider taking my Planned Cesarean Birth Class.

What is Family Centered Cesarean Birth? How is it different from the routine Cesareans we have been doing?

Routine Cesareans typically go down like this: Mom goes into the OR to get prepped for surgery. Her one support person enters when it’s time for the surgery to begin. The doctor delivers the baby within about 5 minutes and the baby immediately goes to a warmer with a nurse for assessment and suctioning. Usually after a few minutes, if the baby is doing well, they swaddle the baby and allow the support person to bring the baby to mom for a quick meeting. They might be able to enjoy a whole 5-10 minutes together before a helpful nurse says “Ok Dad, let’s take that baby over to nursery”. The chosen support person and baby are escorted to nursery where Baby gets a more thorough assessment, basic meds (eye ointment and vitamin K shot) and sometimes a bath. Meanwhile, mom has been left “alone” in the OR so the medical staff can complete the repair portion of the surgery, which typically takes 30 minutes. During this time it’s not unusual for an anesthesiologist give the mother “something to help her relax” which makes her sleepy and she typically “checks out” during this period. She’s taken to the Recovery Room where she’s monitored closely following the surgery. When she is alert and ready for baby, they will re-unite mom with her support person and baby. (Typically 1-1.5 hrs after the birth, but there can be delays)  If there is time, she may be able to hold and/or breastfeed her baby in Recovery before being moved again to Postpartum.

Family Centered Cesarean Birth takes a slightly different approach. Recognizing it’s still a surgical procedure, but instead of just thinking about the efficiency of the hospital and staff, there is focus on the EXPERIENCE of the family. It starts the same, with the chosen support person at the mother’s head as the surgery begins. The mother may listen to music or her partners voice to keep her calm and relaxed. The doctor may allow the surgical screen to be lowered at the time of birth so both mother and her partner can see the baby emerge. They may have even allowed another support person (doula or midwife) to be present to offer emotional support and to explain what is happening during the procedure, and/or to take pictures. The baby is dried off and suctioned if necessary but quickly taken to the mother where she can hold her baby skin to skin across her chest. Her arms are as free as possible so she can touch and hold her baby. The baby stays on the mother, covered in warm blankets as the repair takes place, allowing the family to get to know each other. Instead of using medications to aid the mother in discomforts of the surgery, the partner, doula or midwife may encourage the mother to use deep breathing/visualization or other natural methods to cope. That person may also offer touch and massage, even aromatherapy to distract from some of the unpleasant smells and sensations related to the surgery. The family stays together throughout the entire surgery and goes into the Recovery Room together, where baby is typically ready to breastfeed, since there has been no separation.

What are the results of Family Centered Cesarean Birth (FCCB)? Families that have a much greater satisfaction with their birth experience, and memories and pictures of the first few moments they met their baby. Babies benefit from the immediate skin to skin have higher APGARS at 5 minutes, and transition better in general. Their respiration is normal, they stay warmer, and their glucose levels are stabilized. (Particularly helpful in gestationally diabetic mothers) Babies breastfeed much better and more easily when there has been no separation.

How can you get a FCCB in Austin? For a small number of practices in town, this is their new “norm”. For the rest, you’ll have to ask. Bring it up with your provider ahead of time– especially if you are higher risk for a cesarean birth. It does require some minor changes in where staff is (Baby Nurse stays in the OR instead of heading back to Nursery) but is well worth the work. Want to see how it’s done? Check this out: Family Centered Cesarean Video

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How does a doula really make a difference?
Results from different studies have all suggested that having a doula reduces the overall cesarean rate by 50%, Pitocin use by 40% and requests for epidurals by 60%. The use of a doula also showed a major reduction in the length of labor due to fewer stress hormones being produced in the laboring woman’s body.

The Doula Book © 2002; Klaus, Marshall, Klaus and Kennell.