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

Specializes in Reproductive & Public Health.

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.

I can't imagine that they would be any more at risk of hypothermia if they are s2s with warm blankets on top, as opposed to in a warmer. Our OR was as cold as any other, and we never had a problem (anecdote, I know.)

We also do not restrain mom's arms.

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Specializes in Community, OB, Nursery.
I can't imagine that they would be any more at risk of hypothermia if they are s2s with warm blankets on top, as opposed to in a warmer. Our OR was as cold as any other, and we never had a problem (anecdote, I know.)

We also do not restrain mom's arms.

We don't restrain Mom's arms either as a matter of routine, but anesthesia/OB do require that she have them out to the side on the armboards.

My concern isn't that they'd get cold s2s with the warm blankets, it's that they'd get cold because Mom can't really use her arms to keep blankets etc close to baby/baby close to her....directly r/t her arms being out to her sides as required. It's a bit of a safety concern for me as well WRT baby falling....in theory the magical boobies would hold baby front and center. In practice, babies squirm and we don't have the personnel to hold baby there for mom if her arms are out to the side.

I absolutely agree that we can and should humanize c/s as much as possible.

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Specializes in Reproductive & Public Health.

Our moms are able to use their arms to hold their newborn. Nobody requires them to keep them out on the arm boards. I can definitely see the concern, if that wasn't the case.

This is an example of a simple culture shift- it is easy to allow moms to hold their babies on their chests if they want to.

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Not a nurse yet, love the idea. I think it can be done safely. I also think that it will help facilitate proper attachment and help to heal the birth story. I see a healthy mother's mind as more important than potential liability. Figure out a way to make it as safe as possible and let it happen. Two people are on either side as it is, no reason why 3 sets of hands can't be on baby to make sure he doesn't fall. It'd be a good way to facilitate delayed cord clamping as well.

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Specializes in Reproductive & Public Health.
Not a nurse yet, love the idea. I think it can be done safely. I also think that it will help facilitate proper attachment and help to heal the birth story. I see a healthy mother's mind as more important than potential liability. Figure out a way to make it as safe as possible and let it happen. Two people are on either side as it is, no reason why 3 sets of hands can't be on baby to make sure he doesn't fall. It'd be a good way to facilitate delayed cord clamping as well.

Just be careful here- a c/s is not necessarily a traumatic or negative experience that one needs to "heal" emotionally from. I fully support physiologic birth (i used to be a HB midwife and had my own kids at home), and I do everything I can, whether working as an RN or a CNM, to facilitate a family centered experience. Sometimes a c/s can be very upsetting for a mother, especially one who had her heart set on a certain birth experience, and these moms need to be identified and given the support they need to process their birth. But for many (maybe most) moms that I have taken care of, it is an overall positive experience.

During my third pregnancy (as a gestational surrogate), I had an emergency c/s for the second twin after the first was born lady partslly. I did not need to emotionally heal from that experience, not at all. It was scary and unexpected but the staff was great about communicating with, and caring for, me.

Sorry to jump on an offhand comment like that, but I don't think we do women any favors by acting like a natural, intervention-free birth is the Holy Grail of birth experiences, and that anything less is traumatic and requires emotional healing. That just sets women up for feeling like a failure when they don't get that awesome natural birth that they were told they could have, if only they ate the right food during pregnancy and practiced their comfort measures religiously during their third trimester. It's just plain old not true, and does not reflect the reality that labor HURTS LIKE HECK, and that complications (everything from minor deviations to full blown emergencies) are relatively common.

Of course, we do have a problem with overmedicalization of birth, and surely that can lead to emotional difficulties for mom. I have 100% empathy for that.

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I think the type of mother that would request a maternal assisted cesarean birth would be one of the ones that would need help healing with the experience. Not every mother vocalizes their feelings about birth, especially since everyone is so quick to say, "at least you have a healthy baby." I had to heal from my first birth that wasn't even a cesarean and no one validated my feelings so I learned not to speak about it. I don't think there is any harm in validating a mother a feelings if she feel that this type of birth would make for a better experience.

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Specializes in Reproductive & Public Health.
I think the type of mother that would request a maternal assisted cesarean birth would be one of the ones that would need help healing with the experience. Not every mother vocalizes their feelings about birth, especially since everyone is so quick to say, "at least you have a healthy baby." I had to heal from my first birth that wasn't even a cesarean and no one validated my feelings so I learned not to speak about it. I don't think there is any harm in validating a mother a feelings if she feel that this type of birth would make for a better experience.

I agree, and I hope I did not come off as dismissive. It is absolutely appropriate to validate a woman's feelings about her birth. And it is totally normal and okay for a mom to be disappointed in her birth experience, despite "having a healthy baby." You can be grateful that you and your baby are safe, and still be disappointed or sad about how the birth went.

I only mentioned it because there is a tendency for the natural birth community (i'm generalizing here of course, and I also feel it necessary to point out that I was a HB midwife for years and had my own kids at home) to view a natural, uncomplicated, low intervention birth as the Ideal, and to (consciously or unconsciously) promote the idea that anything less than that represents failure.

C/S and highly medicalized births (even inappropriately medicalized births) can still be incredibly powerful and affirming experiences for women, and it's just as important not to negate that, as it is to provide support and affirmation for women who aren't happy with their experience.

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Specializes in many.

If your facility doesn't already aim for skin to skin in the OR and have anesthesiology on board with this project you may need to defer. This is a very large culture change and once a mom gets to do it, word will spread and many more will want to do it.

Find some provider champions, look at the barriers and then start your research before writing a policy about this.

Good luck!

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That's kind of a frightening concept! I mean, I'm not judging the mom, if she really wants this, then at least she voiced that desire. But there are so many things that could go wrong... (Not to mention suddenly needing to throw up at the sight of a gaping hole in your abdomen... I recently had leg surgery, and while I'm usually totally fine with gaping wounds and blood and whatever, when it was seeing that incision on myself, I nearly, well, tossed my cookies).

But if the hospital allows this, and you've been asked to assist in writing the policy and having things ready, I wish you- and the family- the best of luck.

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