As Easy as A, B, C-Section

When Ashley Vos of Seattle gave birth to her second son, Eames, via cesarean section in January 2016, she was a seasoned C-section mom. She’d delivered son Arlo by cesarean four and a half years earlier. Both cesareans took place after she’d attempted vaginal birth and both resulted in healthy babies — and that, she says, is where the similarities end.

Vos’ first birth, in 2011, was a traditional cesarean; the baby was whisked away for routine exams right after being born. Vos says she had little input into the entire experience. She remembers little of the labor and didn’t get to hold Arlo for nearly an hour after she gave birth. That’s common in traditional cesareans, as the baby undergoes more routine exams and prodding following birth than with a vaginal delivery. The whole experience felt like a blur, Vos says.

By contrast, during Eames’ birth, the medical team draped a special clear curtain across her middle so Vos and her husband, Shea, could view their son’s first breaths and cries. After a quick check, Eames was placed on his mom’s chest, where he began breastfeeding right away, with Vos’ birth photographer clicking away the entire time.

Snuggling with newborn Eames in the operating room is “one of my most cherished memories,” says Vos. “It was special. It felt like a birth, and it felt like it was just my husband, my baby and me” — even though she was in a sterile operating room and Vos’ OB-GYN, Ali Lewis, M.D., was still stitching up her midsection while she nursed.

Reclaiming birth

Each year, one-third of U.S. births — some 1.2 million — are via cesarean, according to the Centers for Disease Control and Prevention (CDC). So, it’s no surprise that many parents are asking for more personalized, less standard-issue cesarean surgery; for something that feels more like a birth and less like an operation.

I definitely see providers being more sensitive to patients’ wishes, doing what they can to make it feel like a birth and not like a medical procedure.

According to South Sound–area doula Michelle Rickard, these types of births — often known as “gentle” or more family-centric cesareans — are on the rise. The tide started turning a little more than five years ago — no coincidence, says Rickard, since C-section rates peaked in 2009. As more parents faced the prospect of a surgical birth, they began asking for more agency in their delivery and, Rickard says, doctors listened. “I definitely see providers being more sensitive to patients’ wishes, doing what they can to make it feel like a birth and not like a medical procedure,” she says.

This modern style of cesarean includes many aspects of a vaginal birth, with the baby placed immediately on the mother’s chest, breastfeeding taking place very soon after delivery and a quiet, serene atmosphere (or perhaps the sounds of the parents’ own personal birth playlist) in the operating room.

Other options include the ability to view the birth through a special clear drape, as Vos did; wrapping the infant in a special blanket from home instead of a hospital blanket; and delaying the cutting of the cord or bathing the newborn after birth.

Space permitting, more hospitals are also allowing other family members, doulas and birth photographers into the OR, says Anna Panighetti, M.D., an OB-GYN with University of Washington (UW) Medicine. Panighetti delivers babies at Northwest Hospital & Medical Center, where Eames was born.

Boosting outcomes

These options may make the birth more memorable and less medical, but it’s not just about feeling warm and fuzzy. These births are backed by science. Decades of research show the benefits of early skin-to-skin contact between mom and baby, including an easier start for breastfeeding and better temperature regulation for babies. Last December, The American College of Obstetricians and Gynecologists (ACOG) began recommending a 30- to 60-second delay in umbilical cord clamping to encourage healthy circulation and lower rates of some complications in infants. And promising research published last year in Nature shows that swabbing the baby with bacteria from the mom’s birth canal can encourage the growth of a healthy internal microflora.

Perhaps most telling, complication rates for these gentle cesarean births are similar to or lower than those from traditional cesarean births per a 2014 study of 144 gentle cesarean births published in the Journal of the American Board of Family Medicine.

Although service varies from hospital to hospital, this type of birth is now becoming standard across the U.S., says Robert O. Atlas, M.D., chair of the department of Obstetrics and Gynecology at Mercy Medical Center in Baltimore, Maryland.

“Of course, the well-being of the baby is paramount, so if the baby has a non-reassuring heart rate or is premature, it may take longer to examine and stimulate the baby,” Atlas says. In other words, any urgent health needs must take priority over options like immediate skin-to- skin contact.

Perhaps most telling, complication rates for these gentle cesarean births are similar to or lower than those from traditional cesarean births.

Bypassing traditional hospital procedures for cesarean birth — like handing the baby directly to parents instead of a scrubbed and sterile nurse, using blankets from home instead of sterile hospital swaddling or bringing an extra support person or two into the OR — may also slightly bump up infection risk, says Atlas. That’s why some hospitals may be slower to adopt these practices.

But for low-risk births, medical professionals recognize the benefits of these family-centered options, says Panighetti of UW Medicine. “As long as the baby is healthy and doesn’t need any special attention, we try in all cases to get baby immediately onto Mom’s chest because that improves breastfeeding outcomes.”

Standard as the procedure may be, don’t assume that you’ll undergo a gentle C if you end up in the operating room, says Rickard. She still recommends careful, intentional planning about the birth options most important to you. Get those thoughts on paper in the form of a written birth plan and make several copies. “You might discuss your wishes for a gentle cesarean birth with your doctor, but that doctor may not be on call when you deliver,” she says.

Ashley and Shea Vos are already making plans. Although they’re undecided about having a third child, Vos has no doubt about how she’d give birth. She’d plan a scheduled gentle C-section in a heartbeat, she says. “During the birth, everyone communicated well and really listened to us,” she says. “It was incredibly healing to have more control over the situation this time around.”