Q&A: A gentle cut?
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Q I had an emergency caesar with my first baby, and my second will be born soon by elective caesar. I was knocked out the first time round, so don’t really know what to expect this time. I’ve heard a bit about gentle c-sections, or sensitive c-sections. What does this entail? Are most gynaes open to it?
A DR MARLIZE LERM ANSWERS:
I can hear you are a bit anxious about another caesarean section after your first birth experience. There must have been true urgency in getting you into the operating room as quickly as possible, to deliver your baby.
Emergency caesars are so called, because that little baby, or babies, need to be delivered as soon as possible. In a lot of life-threatening situations, the anaesthetist (the doctor specialised in putting you to sleep for an operation) chooses the quickest way to make the operation painless for you. This could be to put you to sleep, and this means you’re ”knocked out” during the delivery process.
You had general anesthesia, so you will not remember much, except drifting off to sleep and perhaps waking up in a lot of pain. Hopefully, looking into your baby’s eyes helped you forget the possible trauma quickly.
With the delivery of a baby by caesarean section, anaesthetists prefer to do a local block; this is called spinal anaesthetic. In the right hands, it’s much safer than general anaesthetic.
A spinal injection is given while you’re awake, in a sitting position bending forward. The injection is given into your lower back, between the vertebral spaces L4 and L5. It only goes into that space where the fluid is that surrounds your spinal cord. This causes numbness from below your belly button. Similar to a spinal anaesthetic is an epidural injection, which is used for pain relief during labour, except the dose is lower, and the block does not infiltrate your motor nerves, meaning you can still move your legs freely.
The position in which the anaesthetist will place you before the local block can be a bit uncomfortable and the injection painful, but it is generally well tolerated by soon-to-be-mothers. Paediatricians also agree that this method of anaesthesia is much preferred above putting you to sleep. The baby is not affected by any drugs that were given to you, and your own blood pressure and oxygen levels, if monitored correctly, are also more stable.
In the past, operating theatres were seen as cold and impersonal spaces. Nowadays, especially with an elective caesar, there is time to prepare, and the environment can be made to be as pleasant as possible. For instance, the theatre can be warmed to accommodate the little one. Sometimes, the labour team might even allow some music to be played.
This is what the concept of a gentle or sensitive, a ”softer caesar’’ is all about. It’s gentler for you and your partner – and the newborn, of course.
The idea of soft or gentle caesars has been around for quite a few years.
The experience of having your loved one by your side while your baby is being delivered is priceless. Even if you’re delivering in the operating theatre. You want to be awake and hear that first cry. As an obstetrician, I really cherish that moment I introduce a newborn to the mom, the parents – the sheer joy reflected on their faces!
A soft caesar experience is more personal and, some would say, memorable than the idea we have of a traditional caesar. Here are some things that are typically done during a sensitive caesar: We could drop the screen (a temporary sterile drape at the level of your chest area), so that you can see when the baby is delivered by c-section.
Some obstetrician and anaesthetic teams will even allow direct skin-to-skin contact, with Baby placed on your chest as soon as possible after delivery. Discuss this with your gynae. The anaesthetist and paediatrician would see to it that you and your baby are comfortable.
To maintain sterility, it’s still advised that the obstetrician, and not the birth partner, cut the cord. Remember, the theatre team’s primary goal is to ensure that you and your baby are healthy. Discuss your birth plan with your gynaecologist – you can start talking about it as early as the first trimester. Closer to your delivery date, spend some time discussing the options you have to make your birth experience as enjoyable as possible. I wish you a blessed delivery and hope that this answer helps you in making your decisions. ●