Cesarean Inter-Section
by Terah R. Lara

[Editor’s note: This is an excerpt of an article which appears in Midwifery Today, Issue 107, Autumn 2013. View other great articles and columns in the table of contents. To read the rest of this article, order your copy of Midwifery Today, Issue 107.]

Cesarean section is the most commonly performed surgical procedure among women in the US (Trimble 2009). The World Health Organization’s (WHO) recommended optimal rate of cesareans is between 10 and 15% while the US cesarean rate as of 2010 is 32.8% (Gibbons 2010). This number has varied minimally over recent years regardless of the increased awareness concerning cesarean statistics. Women served by certified professional midwives are attempting to avoid the high cesarean figure by electively choosing an out-of-hospital natural birth. Their chances of undergoing a cesarean are dramatically reduced, although not eliminated.

Opinions differ on the benefits of achieving an empowering birth experience. For many women, giving birth is a transforming life event, one that is anticipated for months or even years. Unexpected events can cause postpartum depression or posttraumatic stress disorder (Alcorn et al. 2010; Allen 1998; Griebenow 2006; Smith et al. 2000). Evidence shows that the majority of women who have a cesarean have a less-than-satisfactory childbirth experience (Smith, Plaat and Fisk 2008).

A new cesarean method has been designed by an anesthesiologist and a midwife in the UK and has been acclaimed by participants. Anesthesiologist Felicia Plaat and Jenny Smith, CNM, co-created a “natural” cesarean in which women can have greater participation in the birth of their child regardless of their surgical route of delivery (Jentle Childbirth Foundation 2011). Overall, research has shown that mothers are more satisfied with their cesarean delivery when the surgery is family-centered (Plaat and Smith 2010). Providers can implement techniques to help achieve this satisfaction when a cesarean is anticipated. There are also tactics to help women recover postoperatively, especially in circumstances where a cesarean could be considered traumatic.

One technique being highlighted by the natural cesarean approach is early skin-to-skin (STS) offered in the operating room. Studies have proven that immediate STS after birth leads to less breast engorgement and pain and fewer maternal anxiety disorders. For the newborn, STS offers more effective suckling, less crying, more stable vitals and regulated blood sugars. Researchers found no risk to implementing STS for nearly all babies and WHO recommends all newborns receive STS care, regardless of weight, gestational age, birth setting or clinical condition (Dekker 2012).


References

  • Alcorn, K, et al. 2010. “A Prospective Longitudinal Study of Posttraumatic Stress Disorder Resulting from Childbirth Events.” Psychol Med 40 (11): 1849–59.
  • Allen, S. 1998. “A Qualitative Analysis of the Process, Mediating Variables and Impact of Traumatic Childbirth.” J Reprod Infant Psychol 16 (2): 107–31.
  • Dekker, R. 2012. “The Evidence for Skin-to-skin Care after a Cesarean.” Evidence Based Birth. Accessed July 24, 2013. http://evidencebasedbirth.com/the-evidence-for-skin-to-skin-care-after-a-cesarean.
  • Gibbons, L, et al. 2010. “The Global Numbers and Costs of Additionally Needed and Unnecessary Cesarean Sections Performed per Year: Overuse as a Barrier to Universal Coverage.” World Health Report (2010), Background Paper, 30. World Health Organization. Accessed July 24, 2013. http://www.who.int/healthsystems/topics/financing/healthreport/30C-sectioncosts.pdf.
  • Griebenow, J. 2006. “Healing the Trauma: Entering Motherhood with Posttraumatic Stress Disorder (PTSD).” Midwifery Today 80:28.
  • Jentle Childbirth Foundation. 2011. “The Natural Family-centred Ceasarean.” Video file. Accessed July 24, 2013. http://www.jentlechildbirth.org.uk/portfolios/the-natural-caesarean/.
  • Plaat, F, and J Smith. 2010. “The ‘Natural’ Caesarean.” Midwives. April/May:36–37.
  • Smith J, F Plaat and N Fisk. 2008. “The Natural Caesarean: A Woman-centred Technique.” BJOG 115 (8): 1037–42.
  • Trimble, E. 2009. “Hysterectomy Fact Sheet.” Office on Women’s Health, US Department of Health and Human Services. Accessed July 24, 2013. http://womenshealth.gov/publications/our-publications/fact-sheet/hysterectomy.cfm.

Terah R. Lara is a midwife (LM, CPM) who resides in Enumclaw, Washington. She strives to be a midwife who provides compassionate, unrushed and meticulous care to her clients. She also offers photography and placenta encapsulation as part of her services. In her spare time, she enjoys taking care of her three young children as well as speaking at local community colleges about birth.


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