Letters to the Editor: Letters & Announcements
To the Editor
Although “natural childbirth” is well established for vaginal deliveries, the cesarean delivery rate in the United States is approximately 35% and increasing, and the surgical nature of this procedure can distract from the very essence of the event, namely, the birth of a child. A growing movement is attempting to make the cesarean delivery a more natural, or family-centered, event.1 Modifications of the standard technique include early skin-to-skin contact in the operating room, a slow delivery (with intent to mimic the “vaginal squeeze”), placement of IV catheter, oximeter, and blood pressure cuff all on the same and nondominant arm to allow a completely free arm for maternal contact with baby, and placement of electrocardiographic leads on the back, to allow a free chest for early maternal skin-to-skin contact, or even intraoperative breastfeeding. Benefits of this approach include a more family-centered experience for the mother and partner, possible improved thermoregulation of the neonate,2,3 and overall greater satisfaction with the procedure.
Some mothers and their partners wish to view as much of the actual delivery as possible. Lowering of the surgical drapes at the time of delivery may allow this to some extent but issues related to possible contamination of the sterile field and blood and other fluid spillage might preclude a complete view by this method. The use of a clear, see-through surgical drape will allow a full view of the delivery while still maintaining full sterile and other precautions (Fig. 1). Clear surgical drapes are available from a variety of manufacturers. Our patient satisfaction is very high among those motivated to be a more active participant in the birth despite the surgical nature of the procedure. A cooperative obstetrician and nursing staff are essential to ensure full team involvement particularly if early, intraoperative skin-to-skin contact is desired. We suggest having available a clear surgical drape for those patients wishing a more complete view of the birth as part of the “natural cesarean birth” experience.
We acknowledge that there is no evidence that attempts to make cesarean delivery more natural have any positive effect on outcomes or on the overall cesarean delivery rate. Moreover, negative outcomes, such as infectious complications, have yet to be assessed. Some may argue that making the cesarean delivery experience friendlier would be counterproductive to any attempts to decrease the overall cesarean rate. In contrast, any attempt to make any childbirth experience, whether vaginal or cesarean, more pleasant for patients and partners should be considered as part of the services we can offer.
William Camann, MD
Kathleen Trainor, RN, IBCLC
Department of Anesthesiology, Perioperative and Pain Medicine
Brigham and Women's Hospital
Harvard Medical School
1. Smith J, Plaat F, Fisk N. The natural caesarean: a woman-centered technique. Br J Obstet Gynecol 2008;115:1037–42
2. Gouchon S, Gregori D, Picotto A, Patrucco G, Nangeroni M, Di Giulio M. Skin-to-skin contact after cesarean delivery: an experimental study. Nurs Res 2010;59:78–84
3. Anderson G, Moore E, Hepworth J, Bergman N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev 2003;2:CD003519