My natural caesarean was a joyous experience
Traditional C-sections are entrenched in surgical rituals, but a new method takes a gentler approach, says Cherrill Hicks
Pregnant with her first child over three years ago, Lucinda Montgomery was keen to have as natural a labour and birth as possible. She wanted it to be drug and surgery-free and to take place in a birthing pool, with low lighting and gentle music.
“I’d done so much preparation and even practised hypnobirthing to make delivery easier,” says Montgomery, now 42.
Unfortunately for Montgomery, things didn’t turn out the way she had hoped. At 36 weeks, for medical reasons, she was advised by her team at Queen Charlotte’s Hospital in London to have a planned caesarean delivery.
“I was disappointed and naturally apprehensive,” she recalls. “I felt it would be a very clinical process with lots of intervention and bright lights. I feared it would be like being in a factory line, with my own personal experience meaning nothing to the team.”
What happened proved to be the opposite of her fears. Montgomery, a freelance publicist, had a “natural” caesarean, a pioneering technique that seeks to make this major operation as near-to-normal and the birth as slow and gentle, as possible.
In a natural caesarean, the drapes which normally screen the operation from the mother are lowered – so she (and her partner) can actually see the baby being born. The baby is also given time to “wriggle out” of the womb, rather than being instantly lifted out by the obstetrician. The newborn is then placed on the mother’s chest for her to hold, instead of whisked off for weighing and measuring.
Of course, a natural caesarean is not and never would be drug-free – but regional anaesthesia is carefully used to ensure the mother is alert and able to hold her baby.
Montgomery, who lives in Nunhead, south-east London, with her husband, Edward, 43, was thrilled with the experience. “It was so special,” she recalls. “For a birth with so much clinical intervention, it was such a memorable and joyous occasion. Having a natural caesarean meant
I was able to experience all the elation of a natural birth.”
Montgomery’s first child, India, is now nearly four; her other two children – Jasmine, aged two, and Orlando, born 16 weeks ago – were delivered by the same method.
“The wonderful thing was, all my babies started suckling within seconds of being placed on my chest,” she says. “Having that skin-to-skin contact so quickly formed an instantaneous bond. I’ll always remember and cherish those moments.”
With about 20-25 per cent of pregnant women in the UK now giving birth by caesarean, experts are calling for this groundbreaking approach to be made more widely available, arguing that it encourages bonding, increases breastfeeding rates and enhances maternal satisfaction.
Jenny Smith, a former midwife at Queen Charlotte’s and one of the team who pioneered natural caesareans, says that the aim is to make a caesarean as “normal” an experience as possible.
“There is no reason that a woman having a caesarean can’t wear her own shirt, bring her own pillow, have the music she likes and turn down the lights, even if the birth is taking place in an operating theatre,” she says. “A traditional caesarean is like any other operation – the patient is having something ‘done’ to them by a medical team. The new approach is to make the woman, the family, centre-stage, just as in a vaginal birth.”
Dr Felicity Plaat, consultant anaesthetist at the hospital, says that while a more woman-centred approach to vaginal birth is now encouraged, the caesarean section remains “entrenched in surgical rituals”. Yet research has found that traditional caesareans delay parental contact with the baby, reduce the chance of breastfeeding and result in a less satisfying childbirth experience than vaginal birth, while mothers who have caesareans are more prone to postnatal depression and bonding difficulties.
Preparation for a natural caesarean starts as normal, with drapes in place to screen off the surgery. “The electrodes to monitor the mother’s heart rate are placed on her back, leaving her chest free for the baby,” says Smith.
However, once the surgeon has made incisions through the abdomen into the womb and brought out the baby’s head, the drapes are lowered and the theatre table raised so the mother (and partner) can watch the baby emerging. “Some women have expressed concern they may see inside their own abdomen, but as the mother’s head is only slightly inclined, she can only see the baby,” says Smith.
Instead of being lifted out of the womb straight away, the baby is left to slowly wriggle out, aided by uterine contractions and with gentle support from the surgeon – a process that can take a few minutes.
Still attached to the placental cord, the newborn is immediately placed on the mother’s chest, staying there while she undergoes post-surgical stitching.
“In a traditional caesarean, the baby is taken away at once to be dried, examined, wrapped up, and so on,” explains Smith. “In a natural caesarean, the name-labelling, cord-clamping and cutting by the partner and vitamin K injection [to prevent serious bleeding] are all carried out while the baby is being held by the mother.”
However, there has been vociferous opposition to the idea of natural caesareans, partly on the grounds that they may be unsafe. One concern is that the air conditioning used as an infectioncontrol measure in theatres may lead to a baby wet from the birth and left unwrapped getting dangerously cold. “Which is why, while baby and mother have skin-to-skin contact, we use blankets, bubble wrap and a hat to keep the baby warm,” says Smith. Other concerns are potentially higher risks of contamination and of excessive bleeding in the mother due to a slower delivery, although so far the research has shown that such complications are not increased.
“Obviously, if there were any problems such as bleeding, we would not delay the delivery,” says Smith. “Of course, we have to be vigilant and monitor the baby and mother at all times to ensure all is going as it should. “
‘Having that skinto-skin contact so quickly formed an instantaneous bond’
In fact, this woman-centred approach may have various health benefits. A controlled trial of 205 pregnant women in Germany, published in 2015, found improved breastfeeding rates after a natural caesarean and a greatly improved patient experience. Dr Plaat says that although more research is needed, there is evidence from vaginal births that instant skin-toskin contact increases bonding.
Also, it is thought the delay of a few minutes in the birth allows pressure from the uterus to expel liquid from the baby’s lungs – as happens in a natural vaginal delivery – and may reduce the risk of lung problems, which can be more common after a caesarean.
Some doctors have also criticised the new approach on the grounds that by making the operation more attractive to women, it will increase the already high caesarean rate in the UK – a contentious issue.
Dr Plaat points out that there is no evidence this would happen and that fewer than one in 20 caesarean births in the UK is requested by the mother, with no medical reason.
“Denying women a more natural approach in order to discourage them from considering this mode of delivery is, in my opinion, completely unethical,” she says.
Lucinda Montgomery treasures the memory of her children’s births. “Actually, seeing my babies being born and having them placed on my chest for me to hold was magical,” she says.