"Natural" cesarean mimics vaginal birth experience

NEW YORK Thu Aug 28, 2008 10:57am EDT

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NEW YORK (Reuters Health) - A cesarean childbirth procedure developed in the UK takes a "woman-centered" approach and incorporates many important aspects of natural childbirth, according to a recent report.

"Vaginal birth has evolved markedly in the last 2 decades so that much greater emphasis is now given to the experience of the parents and to early bonding," Professor Nicholas M. Fisk told Reuters Health.

By contrast, cesarean birth has changed little, said Fisk. The emphasis is still on speed and resuscitation, even though these are not necessary in straightforward cesarean deliveries performed under epidural anesthesia rather than general anesthesia.

This led Fisk and his colleagues, from Queen Charlotte's and Chelsea Hospital and Imperial College London, to modify the obstetric, midwifery, and anesthetic practices of traditional cesarean childbirth "to emulate as closely as practicable the woman-centered aspects of 'natural' vaginal birth," they explain in the medical journal BJOG.

The "natural" cesarean allows parents to actively participate in and observe their child's birth, explained Fisk, who currently directs the University of Queensland Centre for Clinical Research in Brisbane, Australia.

At the start of the procedure, surgical drapes block the incision area from the parents' view until delivery of the infant's head. The field is then cleaned and the woman's partner may view the birth at that point.

The obstetrician then slows delivery so uterine contractions can help clear the infant's lungs, "just as happens at vaginal delivery," Fisk noted. The baby's shoulders are eased out "and the baby then frequently delivers his/her own arms in an expansive gesture."

The mother can then see the half-delivered baby, and watch the rest of the birth. The newly delivered infant is placed directly on the mother's chest for bonding.

The set-up maintains the option of immediate traditional c-section for babies showing unexpected distress, but babies are usually crying and squirming before delivery is complete, Fisk said.

He also noted that there were "very few negative reactions" among parents, and that hospital staff favored the concept.

However, evaluation of the procedure in clinical trials is necessary, notes the editor of the journal, since the current report doesn't included outcomes or safety data "to justify widespread utilization of this technique."

SOURCE: BJOG: An International Journal of Obstetrics and Gynecology, July 2008

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