Maternal assisted cesarean birth

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Help, we have had a request for a maternal cesarean birth, and my director wants me to write up a policy for it, and have everything ready for when she comes in. She will also be delivering twins. Does anyone out there do these, have done them? I would love to hear from you. Thank you

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Specializes in NICU, ICU, PICU, Academia.

I'm not being sarcastic. What does this even mean?

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I'm not being sarcastic. What does this even mean?

Same here. 😧

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Woah...just googled it. They scrub up mommy and put sterile gloves on...as they pull the baby out, moms hands are guided to the baby and mom brings baby right up to her chest.

I've got some very mixed emotions about that.

I don't know what to tell you OP. Wish I could help.

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I believe this is when the mother lifts the babies out?

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Specializes in NICU, PICU, PACU.

Oh man, I have mixed feelings on that one! I'd be going to risk management about it and see if they even recommend this being allowed.

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Specializes in PCT, RN.

I don't think I like that idea. Mom could accidentally squeeze too hard or pull to hard and injure the baby. Babies are also slippery when they come out, the fear of mom accidentally dropping it would stress me the eff out.

I know my opinion isn't what you're looking for, but I had to say something.

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Specializes in OB.

I saw a YouTube video of this very thing, and thought it was lovely that the hospital accommodated this. However, if I ever (knocking on wood) had to have a section, I can't imagine anything I'd rather see LESS than my own abdomen open while I pull my own baby out of my uterus. I do wish my hospital would facilitate skin-to-skin in the OR routinely, though. Much easier to coordinate.

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Specializes in Community, OB, Nursery.

Obviously it can be done, but I wouldn't know where to begin with the ins and outs. Whatever you do when writing your policy, make sure you involve risk management. Personally (and this is just me, no policy behind it) all bets would be off if fluid is not clear or baby is under 37-38 weeks....though it sounds like this is a planned section, so gestation would not likely be an issue.

I do wish my hospital would facilitate skin-to-skin in the OR routinely, though. Much easier to coordinate.

It would be nice. We put our kids skin to skin as they're rolling out the OR door to go to recovery. Our ORs are so cold I worry about baby freezing while they're sewing Mom up, and Mom's lying flat on her back with arms out so she can't really hold baby and keep him covered and close very well. Guess that makes a good case for reducing the c/s rate, although ours is one of the lowest in the country already.

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Specializes in ICU.

Did a google search on the subject and came up with some articles-

The natural caesarean: a woman-centred technique

Cesarean Delivery on Maternal Request - ACOG

P&P from an Australian hospital on the subject:

http://kemh.health.wa.gov.au/development/manuals/O&G_guidelines/sectionb/7/b7.10.pdf

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I could maybe..maybe see this happening for a singleton delivery..but twins? How is she going to help grab the second baby while she's trying to hang onto the first baby flat on her back? Usually with twins we are in a bit of a rush trying to get both babies out, get cord segments and cord blood. How will you keep the infants warm in the freezing OR? What about the sterile feild? What about the drape? Who is going to glove her and when? I think I would have her sign a consent that she is aware of the increased risk of infection and ask your scrub techs how they would go about the process. Very interesting topic, please let us know what happens!

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Specializes in Reproductive & Public Health.

The hospital I worked at during my last semester of CNM school had very family-oriented c/s practices. No one asked for a maternal-assisted birth but we routinely kept healthy babies skin to skin with mom in the OR. We had a mom of twins request low lighting so all the lights in the OR were turned off except the surgical lights. Babies are often nursing before they get to PACU. I've had more than one mom request the drape be lowered for delivery. It goes back up for the repair afterwards; I can't imagine any woman wanting to watch her uterus externalized, yikes.

In a non-emergent c/s, I can't see any reason why this request cannot be accommodated. With a standard twin birth, there is no huge time crunch. Mom scrubs beforehand and is gloved by a circulating nurse or even the anesthesiologist. The sterile field can be maintained even with the drape dropped. I remember seeing a video of this online and it was beautiful. I can totally imagine wanting to do that if I had a scheduled c/s, and I can see how this would be especially meaningful to a woman who had been hoping for a more "natural" labor experience.

Even if maternal-assisted c/s is a bit "out there," it's a normal reaction to the sometimes callous way we treat these births. There is plenty of room for humanizing cesarean birth, all it takes is a bit of culture change.

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