Woman-centred approach to Caesarean section introduced at UMHL: 04 / 2016

A NEW, woman-centred approach to Caesarean birth has been introduced at University Maternity Hospital Limerick.


The natural Caesarean – otherwise known as a gentle or slowed-down Caesarean – puts maternal choice and control at the heart of the procedure and, critically, allows for earlier and more prolonged contact between mother and baby in the first moments after birth. The technique attempts to replicate as closely as possible the natural delivery while the mother can at all times rely on the support and expertise of the multidisciplinary team in theatre for what is a significant operation.


Although research into the natural Caesarean is ongoing, the technique is believed to have considerable benefits around easier breastfeeding, calmer infants and greater maternal satisfaction in the short and long-term.


Opportunities for early maternal contact following Caesarean have traditionally been limited by post-operative procedures and ritual practices around resuscitation. A natural Caesarean aims to minimise these as much as possible to ensure that it is the mother who is the first person to hold the baby.


Ireland’s Caesarean section rate – at 28.5 per 100 live births in 2013 – was marginally above the OECD average of 27.6 per 100 live births for that year. Caesarean rates are on the rise in developed countries and Ireland’s National Maternity Strategy (2016) identifies a number of possible reasons for this – including “reductions in the risk of Caesarean delivery, increasing litigation, increases in first births among older women and the rise in multiple births resulting from assisted reproduction”.    


One of the strategy’s core ambitions is to give women more choice and control over how their pregnancy and delivery is managed.   It remains the case that all sections are performed when medically indicated but natural Caesareans sit well with the strategy’s vision around maternal choice in circumstances where a natural delivery is not possible.     


Gentle Caesarean involves some simple changes which can make a significant difference for the mother. Heart monitoring wires are placed on the mother’s upper back to allow the obstetrician to place the baby on her chest.   The woman’s non-dominant hand is used for IV and bloods so that the dominant hand is free to hold the baby. The screen between the woman and the surgical team is lowered so the woman can see the baby being born. In a technique called “walking the baby out”, the baby is allowed to clear its lungs by itself and push itself out. And in this way, the mother gets to find out the sex of the baby without having to be told by one of the surgical team. The baby can be placed directly on the mother’s chest and skin-to-skin contact is immediately established in those precious moments after birth.


 One mother to have recently undergone a natural Caesarean at UMHL is Majella Galvin, from Nenagh, County Tipperary. Baby Sarah, the second child of Majella and Brendan, was born on February 26th.


“My eldest boy, Tom, had been delivered by C-section and he was whipped away and put in an incubator. I could see him crying but it was ages before I could hold him. That is so important at the start and you just want to hold your baby. While overall I had a very positive theatre experience and skin-to-skin in recovery, when I look back on his birth, it's the image of him crying all alone that comes to mind,” said Majella.


“I didn’t want to have that experience again. So I had researched it (the natural Caesarean) and I had even sent my consultant (Dr John Slevin) a YouTube video all about it. The main thing for me was that I wanted to get my hands on my baby first. Never mind with an emergency Caesarean, even with a planned Caesarean, it is the medical team and the midwives who get to hold them first. Before I had Sarah, I was on the antenatal ward for a few days beforehand and I was letting everyone know it was going to be different this time. By the time it came to it, everybody was on board: the obstetrician, the anaesthetist and the midwives. It was the first time for some of them too to be involved in this kind of birth but they were all up for it and very supportive.”


“We have beautiful pictures of Sarah on my chest at just a few minutes old which we will treasure forever. Although pictures like these are commonplace in the labour ward, they were not in theatre and this makes them all the more special to us.”


“It was a completely different experience with Sarah. Instead of her being whipped away, you could see her coming out in her own time and when she was good and ready, you could bond with her immediately. It was a much more positive experience; something I enjoyed and appreciated that I was facilitated in doing. My C-sections were for medical reasons and I really had no choice. But at least with this type of Caesarean, you feel like you do have a choice and like you do have more of an input,” said Majella.


Consultant Obstetrician/Gynaecologist Dr John Slevin commented that: “Caesarean section is sometimes a necessary mode of birth for babies, often contrary to mothers’ birth expectations. Gentle Caesarean section allows us to optimise a positive birth experience for both mother, baby and partner.”


And Sandra O’Connor, Clinical Midwife Manager, Theatre, University Maternity Hospital Limerick, said the feedback from nursing and midwifery staff who has been involved in natural C-sections in the hospital had been hugely positive.


“The nurses and midwives in theatre who have been involved in the Gentle Birth experience said it was fantastic and very emotional for the mother to be the first to touch and hold her baby.  Staff expressed that they were delighted and honoured to have enhanced the mother’s birth experience,” said Ms O’Connor on behalf of the nursing and midwifery teams.


Dr Gerry Burke, Consultant Obstetrician/Gynaecologist and Clinical Director, Maternal and Child Health Directorate, UL Hospitals Group,  stated that the gentle Caesarean represented “another small step in the evolution of this most ‘normal’ of all the surgical procedures”.

Last updated on: 13 / 04 / 2016