Family centred caesareans – the ‘natural’ caesarean 10 years on

Many women will experience a caesarean delivery (for example 1 in 4 births in the UK and Spain, 1 in 3 in the US, 1 in 2 in Turkey, 1 in 5 in France).

Some of these caesareans will be emergencies, some will be planned. For those which are planned – whether for medical reasons or not – there are adjustments that can be made to the birth plan which can make for a more ‘natural’ experience.

The idea of ‘natural’ caesareans was first discussed over a decade ago by Senior Midwife Jenny Smith (at Queen Charlotte’s and Chelsea Hospital in London) and her colleagues Professor Nicholas Fisk, (Consultant Obstetrician) and Dr Felicity Plaat (Consultant Anaesthetist).

This form of birth is now more commonly referred to as a ‘family centred’ caesarean primarily because there has been quite a bit of push back over the use of the word ‘natural’ by those who believe the fact of the caesarean makes the experience anything but, and who were concerned the use of ‘natural’ might drive an increase in requests for caesarean delivery. (Incidentally, this increase has not materialised – in the UK at least). However, according to those who coined the phrase, the term was simply meant to convey the idea that the process incorporates a number of procedures which aim to optimize the birth experience for women having caesareans section [by] putting women at the centre of care”.

The primary idea behind a ‘family centred’ caesarean is to slow down the surgical process and allow Mum and birth partner to participate in and/or witness as many aspects of the birth as possible. It also allows for additional environmental decisions to be made by the family rather than the surgical team.

The possibility of a ‘family centred’ caesarean is entirely dependent upon the way in which your pregnancy has progressed to date, any risk factors associated with your pregnancy and the experience and willingness of the clinicians providing your care.

So what is different about a ‘family centred’ caesarean?

In no particular order:

  • Slower delivery, also known as ‘walking the baby out’
  • Skin-to-skin as soon as possible – even while still in surgery – you will be asked to bring an appropriate top
  • Lowering of the screen (after initial incision and baby’s head has emerged). Some hospitals will offer a clear screen instead
  • Delayed delivery – extends compression while baby’s body is still in the womb to facilitate liquid expulsion from lungs
  • Favourite music playing during surgery
  • Favourite pillow
  • APGAR tests conducted, vit k injection, attaching of labels etc. within sight (weighing is postponed till transfer to recovery room)
  • Dimming periphery lights during delivery
  • Delayed clamping and cutting of the cord. Birth partner may shorten or trim the cord (but not the initial clamp and cut)
  • Saving the placenta

As Jenni Smith says “It is about the mother. After the incision is made, the curtain is removed and the mother is able to see her little baby wriggle out. It is a special moment that is missed otherwise…The baby remains in the abdomen for up to four minutes and the mother can look at it, see its little face and eyes, and when it wriggles out it is the parents that first determine the sex.”

Is a family centred caesarean safe?

Reports are very good “Since publication of our paper there have been no reports of complications associated with the technique. In fact, a recent study from Germany found improved breastfeeding rates, and significantly better patient experience compared to the traditional technique, with no increase in complications.”

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