IF it has to be a cesarean......
then this is how I would want it to be.....
A British doctor is challenging convention to pioneer the 'natural'
caesarean. Joanna Moorhead watched one baby's slow and gentle arrival
Saturday December 3, 2005
The Guardian
The scent of lavender fills the air and classical music is playing quietly.
On the bed, Jax Martin-Betts, 42, is calm, focused and in control. With the
birth of her second child just minutes away, the midwife, Jenny Smith, is
giving her a massage. Her husband, Teady McErlean, is whispering words of
encouragement: just a tiny bit longer, and our baby will be in our arms!
It could be a natural birth at any maternity unit in Britain, but we are in
an operating theatre at Queen Charlotte's and Chelsea hospital in west
London, and the birth we are about to witness sounds a contradiction in
terms: a "natural" caesarean section.
Jax has been on the theatre table for half an hour, and the obstetrician,
Professor Nick Fisk, has almost completed the incisions through her
abdominal wall and into her uterus. "OK, the baby is about to be born," he
says. "Let's prop you up so you can see him coming out."
Smith removes the blue drape between Jax's head and her belly, and the head
of the bed is lifted to give Jax a clear view. Fisk cuts into the amniotic
sac and a fountain of fluid rises into the air before he rummages around to
locate the baby's head. In a few seconds it comes into view, covered with
the milky-white vernix that has protected it in the womb. For the next few
moments, the atmosphere in the theatre is electric: Jax and Teady gasp in
wonder at their new son, who is now looking around, although his lower body
and legs are still inside his mother's uterus.
This groundbreaking approach to surgical delivery - Fisk calls it a
"skin-to-skin caesarean", or "walking the baby out" - has been pioneered by
him partly in response to the rising caesarean rate, which according to
recent statistics reached a new high at 22.7% (of deliveries in England,
2003-04). "Whatever your view on caesareans, for some women it's always
going to be the safest choice," he explains. "And while couples having
normal deliveries have been given more and more opportunities to be fully
involved in childbirth, very little has been done to see how we could make
the experience more meaningful for those having caesareans."
As Fisk started to examine the conventions of surgical delivery, he was
struck by how easily they could be challenged. Why, for example, did they
need to be done so quickly, when slowing them down would give the parents
more chance to participate in their child's delivery and might give the baby
a gentler experience of coming into the world? Why, too, was it so important
for the parents to be screened off from the mother's abdomen? And was it
really essential for the baby to be whisked off for an immediate medical
examination, rather than delivered into the arms of his mother?
"What I realised was that caesareans were done a certain way because they've
always been done a certain way, but in fact they can be done differently -
and in a way that parents love," says Fisk. Other doctors are sometimes
shocked when they hear what he is doing. "They say, but surely you have to
get the baby out fast so she can get oxygen straight away? And I say, when
the baby is being born she's still attached to the umbilical cord and is
still getting oxygen from the placenta. Caesarean birth can be gentle, just
as vaginal birth can be gentle.
"Obstetricians are too hung up on getting from the point of incision to the
birth of the baby as quickly as possible: that's been the benchmark of a
skilled surgeon. But I'm challenging that because, from the baby's and from
the parents' point of view, it's not very helpful.
"There's also a view that because the baby's chest hasn't been squeezed
going through the birth canal, there are greater risks of breathing
difficulties. But by leaving the baby's body inside the uterus for longer
once the head is out, the body is squeezed and you see the lung liquid
coming out of the baby's nose. Unless there are other risk factors, I've
never known a baby born by my method to have problems - going straight onto
the mother's chest helps regulate breathing."
Smith, who works closely with Fisk, says it's a hit with parents. "They feel
more involved, which gives them a better start to family life. Breastfeeding
is easier to establish, and you can see how much calmer the baby is."
For Jax, the birth of Finn - who weighed 3kg 25g (7lbs 3oz) - was
"spellbinding".
"I had an emergency caesarean last time around. I'd wanted a natural water
birth, but for some women it just doesn't work. This was every bit as
magical: seeing Finn there in my tummy was a sight I'll savour for the rest
of my life."
How the baby Finn is born
Minute by minute
09.24 Our first sight of baby Finn comes as Fisk gently lifts his head
through the incision in Jax's abdomen. In a normal caesarean the baby would
be lifted clear of the uterus immediately and the umbilical cord clamped and
cut within seconds. The skin-to-skin caesarean gives the baby an experience
of birth that is closer to a vaginal delivery. Instead of being pulled out
quickly, Finn's emergence into the world is slow and calm, and the cord
remains attached for some moments. His body is being squeezed slightly by
being still inside the uterus, which helps drain fluid from the lungs.
09.26 Fisk begins to lift Finn up out of the uterus. In a normal caesarean
the focus would now be on the baby's ability to breathe unaided, as the
umbilical cord would already have been cut. But in the skin-to-skin
caesarean the cord is left intact for several minutes during the delivery,
so the baby is still receiving oxygenated blood from the placenta. At this
point, the birth has been so gentle that Finn still seems to be asleep.
Instead of being pulled quickly out of his mother, Finn is able to
acclimatise slowly to his new surroundings.
09.27 Finn is now beginning to make tiny spluttering noises and is becoming
aware of the fact that his surroundings have changed dramatically. At this
moment, though, he is literally suspended between his old life in Jax's
uterus and his new life in the outside world. His upper torso is outside his
mother, but his lower body and legs are still folded inside the womb.
Officially speaking Finn is not yet born, as it is only when his body has
fully emerged that he is deemed to be an independent being. Jax now has a
clear view of Finn as his head is lifted up.
09.28 The moment of birth, as Fisk lifts Finn clear of Jax's body. He will
now hand him to Smith, centre, who will put him onto Jax's chest. Keeping
the operation site sterile is a crucial consideration in the skin-to-skin
caesarean, and Jax and Teady are warned not to try to touch their baby until
he has been handed out of the sterile zone by Fisk. Finn is now moving his
arms around and his breathing is clearly audible. Babies born by caesarean
are often crying at this point - which is traditionally welcomed as a sign
that they're breathing well.
09.29 Within seconds, Finn is placed on his mother's chest for a cuddle.
Studies show immediate skin-to-skin contact results in a baby who is less
likely to cry, has a more stable temperature, is more able to regulate his
own breathing and has better blood sugar levels. In a normal caesarean, Finn
would now be on a resuscitaire table, crying and throwing out his arms and
legs. The skin-to-skin approach means he can acclimatise slowly to the world
beyond the womb: so far, he has not cried. Lying on Jax's chest, hearing her
heartbeat and voice, he is a picture of contentment.
posted by Amy at
12:32 PM
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