How to have a "natural" cesarean

I get asked this one a lot and figured it would be faster to put together a blog with links than to re-type the same email several times a month.

Maybe you have a rare medical condition that requires a scheduled C-section. Maybe you are going to be induced and are aware that induction doubles your risk of needing a C-section and would like to plan to have the best possible C-section if it comes to that. Maybe you're attempting a VBAC and would like to have a backup plan in place. Maybe you're a healthy, low-risk mom who is planning an unmedicated birth (whether at home, birth center, or hospital) and would like to prepare for the slim chance that a cesarean may become necessary. Maybe you are having an elective cesarean.

In any case, all moms have the right to be treated with dignity and respect. Many moms are unaware that they have options to make a cesarean the best possible experience (considering the circumstances) and that often, there are options moms can request to help with bonding with baby, allow immediate skin-to-skin contact with baby, facilitate breastfeeding, reduce your risk of postpartum depression, and more.

"Family centered cesarean" or "natural cesarean" can mean a wide variety of things. You can view some of these options on this sample cesarean birth plan by Preparing For Birth.  Personally, I think it's a good idea for all expectant mothers to have Plan A, Plan B, and Plan C lined up just in case, because a birth plan is not designed to be a script for how the birth should go, but rather, it's a well thought out list of preferences the family would have in the event of different circumstances.

Please remember that no birth plan is legally binding. It's crucial to find a care provider who truly supports you as you work toward the birth you want, whatever kind of birth that is. Many care providers will give lip service to supporting moms, but will deny them at the end. Finding the right hospital and OB to perform a family-friendly cesarean will be worth the effort. Hiring a doula or having your midwife present for this role can help boost your odds of achieving a gentler cesarean. A doula can help calm your nerves in the hours before a planned cesarean while you wait and fill out paperwork, and she can answer any questions you have along the way as to what is going on, why something is happening, whether that's normal, and what options (and legal rights) you have. She can also tag in to the OR if your partner leaves you after the delivery to follow the baby to the nursery, so that you don't have to be alone while they stitch you back up. She can assist you with relaxation and breathing techniques to keep you calm, as well. Here's doula (The Feminist Breeder) Gina Crosley-Corcoran's blog about her experience supporting a client during her cesarean.

The natural caesarean: a woman-centred technique--National Institutes of Health (NIH)

Family-Centered Cesarean--ICAN (International Cesarean Awareness Network) White Papers

Ideas for the best cesarean possible--by Penny Simkin. Free PDF printable.

The new "natural" cesarean--UK Times

"Natural" cesarean mimics vaginal birth experience--Reuters UK

"Every bit as magical": A British doctor is challenging convention to pioneer the 'natural' cesarean. Joanna Moorhead watched one baby's slow and gentle arrival.--Guardian UK

Delivered safely by caesarean with his mother's hands ("assisted cesarean")--The Age (Australia)

The Case for Kangaroo Daddy Care--Baby Gooroo--One family's story of how Dad provided Kangaroo Care for baby while mother was recovering post-cesarean, and why babies can benefit from this.

Above is the 8 minute trailer for the documentary, "Breast is Best," showing how to get breastfeeding off to a good start. The opening scene shows a "natural" cesarean with baby being brought skin-to-skin on mom's chest so he can nurse while she is still being stitched up on the OR table. Immediate skin-to-skin contact on mom's chest immediately after birth helps stabilize baby's breathing, heart rate, blood sugars, and body temperature, all while promoting bonding and reassuring both mom and baby in each other's presence.

12 minute video describing "The Natural Caesarean: a woman-centred technique":

The "natural" cesarean described by the above links, with baby's slow, gentle emergence from the womb, somewhat reduces baby's risk of respiratory distress after cesarean birth, which is common for cesarean babies since they do not receive the benefit of having their lungs squeezed and emptied of mucus, which occurs naturally in a a vaginal birth. 

Having a cesarean birth is compatible with having the placenta encapsulated (placentophagy). If you're unfamiliar with this, you'll have to hang tight until I can post a blog with all the research and reasons why it's a great option for postpartum, regardless of the method of birth. To make a long story short, the placenta can be steamed, dried, ground, and encapsulated into geltabs so that it's no different than taking a multivitamin. Research indicates that placentophagy, which has been traditional around the world for thousands of years, may potentially offer the following benefits: reduced risk of postpartum depression, reduced risk of anemia (by restoring her iron reserves), helps bring postpartum hormones back into balance, improved mothers' energy and sense of well-being postpartum, and a boost in establishing milk supply. While all of these are wonderful benefits for any mom postpartum, they are especially beneficial post-cesarean. Here's a great FAQ on placenta encapsulation, including tips on how to get your placenta released from the hospital.

For many moms who are planning a cesarean (whether for medical or elective reasons), waiting on labor to begin before going in for the cesarean is an option. If this is a possibility, based on your medical situation, this is helpful for mom and baby both. By allowing labor to begin, you can rest assured that baby was "ready," precluding the all-too-common iatrogenic (doctor-caused) prematurity which is on the rise. Mom and baby both receive the chemical/hormonal benefits of the beginnings of labor, and if mom has a good series of contractions before a cesarean, baby's risk of respiratory distress and other respiratory problems is somewhat lessened because the squeezing effects of efficient contractions help push mucus out of baby's lungs (which occurs naturally in vaginal births).

A gentler cesarean birth is possible--even here in America. However, it is going to take informed consumers to drive this change. If enough moms request this, it can become the standard for cesarean care. With the current state of affairs in American maternity care, I'm not optimistic that I could see that scale of change in my lifetime, but that's irrelevant. You don't have to wait until evidence-based care of any sort--including "natural" cesarean--is the norm. You can find a way to make it possible for *you*, regardless of what everyone else is doing.

It would be irresponsible to post all this information about "natural" cesarean without making sure that you have links to weigh all the risks of cesareans. Cesarean birth is a major abdominal surgery with serious risks and consequences, both short-term and long-term, for mom and for baby. The point of this blog is not to encourage an even higher cesarean rate (32.3% of US births are cesarean as of 2008, while the World Health Organization has stated that 10-15% should be the maximum), but rather to make alternative options more widely available for situations when cesareans are needed or desired, based on fully informed consent.

The Risks of Cesarean Section Fact Sheet--Free printable PDF--CIMS (Coalition for Improvement of Maternity Services). Current (Feb. 2010 publication). Includes checklist for expectant mothers to read during pregnancy and discuss with their care providers.

Cesarean Fact Sheet--ICAN (International Cesarean Awareness Network)

Cesarean Section: Myth vs. Reality--Childbirth Connection

Patient Choice Cesarean Position Sheet--ICAN (International Cesarean Awareness Network)

Where to turn for more information about cesareans--California Watch

A Woman's Guide to VBAC. How to weigh the National Institutes of Health recommendations for considerations of VBAC vs. repeat elective cesarean, based on each woman's individual circumstances.-- Giving Birth With Confidence/Lamaze International.

(Disclaimer: I'm not a doctor. I'm not trying to tell you to have a cesarean or not to have a cesarean. I'm encouraging all expectant families to READ, READ, READ and learn their options so that they may make fully informed decisions with their care providers as to what is the safest route for their individual situation.)

"Is the hCG diet safe for breastfeeding?"

I got an email from a blog reader asking, "Is the hCG diet safe for breastfeeding? the OBGYN's nurse said she doesn't know if its safe to take the HCG drops while nursing. We all agree no one while nursing (probably not even not nursing) should cut back to 500 calories a day... but they say the diet will still work if you just eat healthy and take the HCG drops, it'll just work slower, not so dramatically.
DO you know? Is it safe to take the HCG drops while nursing? Does it cross over through the breast milk? Does it affect the breast milk supply or anything?"

I had never heard of this fad diet and had to Google it.

I think the first question to ask is, "Is the hCG diet safe for anyone at all?" We'll get to that.

HCG supplements/injections are not listed in Dr. Hale's Medications and Mother's Milk guide which I own because it's a supplement and not a medication.

The official hCG diet website says regarding the hCG diet and breastfeeding: "So, is it ok for a woman to breast feed while on the HCG diet? The definitive answer will need to come from her doctor. However, it looks like it wouldn’t be a good idea, simply because the caloric needs during breastfeeding are just too great and not a conducive to following the HCG diet."


Consuming a mere 500 calories per day, as outlined by the hCG diet, is not safe for any adult (man or woman), let alone a breastfeeding mother. Breastfeeding burns about 200-500 calories per day, and the best research says that breastfeeding mothers need to be consuming a bare minimum of 1500-1800 calories per day (often more). If a mother is not eating enough calories, her milk supply will suffer. Here are a few articles outlining how to lose weight safely while breastfeeding, so that you can maintain your health and your milk supply:

http://www.kellymom.com/nutrition/mom/mom-weightloss.html

and an article on herbal supplements and other diet aids while breastfeeding:

http://www.kellymom.com/nutrition/mom/mom-herbalweightloss.html

I am highly cautious with anything involving artificial hormones. While they can have their place in certain medical situations, it's not to be taken lightly. I tried to find info on the side effects of hCG injections and found this about the hCG diet on Discovery Health online. HCG is only approved by the FDA as a fertility drug (you heard that correctly--should newly postpartum moms be taking a FERTILITY DRUG as a weight loss supplement???), and it is not FDA approved as a dietary supplement.

According to Discovery Health, "There have been few reports of health problems developing as a result of the hCG diet, although there are some risks, among them an increased risk of blood clots, headaches, restlessness and depression. Also, you may feel, well, like you're pregnant -- swelling, breast tenderness and water retention, anyone? HCG can also cause a potentially life-threatening condition called ovarian hyperstimulation syndrome (OHSS)."

One aspect of the question was whether hCG supplements could cause a drop in milk supply, even if the mother ate a sufficient number of calories. While this might be a question better answered by an endocrinologist, I would be concerned that along with the other pregnancy symptoms that are a side effect of hCG supplementation, a drop in milk supply could be a potential side effect. I looked far and wide to find the chemical mechanism by which many mothers experience a drop in milk supply when they become pregnant while still nursing. Rising levels of progesterone are responsible for the drop in milk supply, but I could not find an answer as to whether hCG supplements could stimulate a rise in progesterone (subsequently causing a drop in milk supply even if mom's caloric intake were sufficient).

The hCG diet official page states a breastfeeding myth, "If she fails to eat properly, this will negatively affect the quality of the milk she produces. The baby may not receive nutritious milk if a woman does not eat enough or enough of the right things." Contrast that with research from La Leche League on the quality of mom's diet and its effect (or lack thereof) on the quality of her breastmilk: "In recent years, research has confirmed that even if some nutrients are missing in a woman’s daily diet, she will still produce milk that will help her child grow. There is very little difference in the milk of healthy mothers and mothers who are severely malnourished. For example, if a mother’s diet is lacking in calories, her body makes up the deficit, drawing on the reserves laid down during pregnancy or before." Mother's milk supply may drop and her health may suffer for her lack of adequate nutrition, but the quality of her breastmilk will not be affected.

I'm not really in the loop in terms of what's popular, and since this diet fad seems to be having its 15 minutes of fame, I wanted to make sure that moms had the info to weigh the risks.

So thankful to make a difference.

I had such a wonderful private childbirth class tonight, for two couples, first time parents. This was my second private class for them, and while I really *need* 12-15 hours of face-to-face contact to cover what first-time parents need to know, I had to condense it to 6 hours (2 private classes, each 3 hours long). I couldn't shortchange them; I had to stay to cover what they needed/wanted covered, 1 1/2 hours "late" tonight. I didn't charge extra and didn't want to. I *wanted* to help. It is my pleasure, my joy, my heart's desire.

I so relate to one of my midwives' recent blog (Jennifer Stewart of Joy in Birth Midwifery) titled, "Can I help you? Please?". I can't stand to see mothers have traumatic births when there were preventable interventions that led to the trauma. (I'm not implying that all interventive births are traumatic, because they are not. I'm not implying that all traumatic births are preventable, because they are not. Many are both, and therein lies my struggle.) I don't teach childbirth classes because I hope to get rich in the process. (Trust me, childbirth educators, doulas, and midwives do not get paid much. They're in it because they believe in it.) I teach birth classes because I am compelled to, driven to. It would be unethical if I did not share this information, not for my sake or glory, but so that families have the evidence-based info they need to make empowered, educated decisions regarding their pregnancies, birth, breastfeeding, parenting, and childbearing year.

When I hear that a friend or acquaintance who turned down my help has an outcome she did not want, a traumatic birth that did not have to be, separation due to complications and/or NICU, I am so distraught for them. Sometimes I cry for days, mourning for their loss. I pray for their recovery, for health for mom and baby, and for God to make a way to reunite and bond the family.

I realize that not everyone wants my help. I try to mind my own business and only give information if they ask. It's so hard to sit aside and say nothing if I see that a family is making fear-based decisions or are accepting the default routine interventions that their care provider does to everyone in their assembly-line birth practice. I can accept any decisions that someone makes for their birth--if I feel confident that they have researched their options thoroughly and are making their decisions with purpose, rather than by default or backed into a corner. Just ask my variety of clients I have served: planned homebirth with midwives clients; birth center with midwives clients; hospital unmedicated birth clients; planned induction clients; and elective scheduled cesarean clients. Regardless of their choices, I want them to know what their options are and how to have the safest birth possible, considering their circumstances.

Tonight was so refreshing. It's easy to become weary when looking at American maternity care as a whole. It's easy to get discouraged when so many expectant parents turn down my help, saying, "Thanks, but I trust my doctor. I'm sure s/he wouldn't do anything unsafe," without researching their birth options. These two couples, each expecting their first child, were eager learners and renewed my soul. They were thankful for my help. Once in a while, God puts people like this in our lives to help recharge and inspire us so we can continue with our work. I'm reminded why I do what I do, and that while I can't help everyone, I am making a difference for *someone*. I'm so thankful for that.

Wordless Wednesday: beautiful nursing toddler (guest post)

Thanks to Christine for sharing these beautiful, intimate professional portraits taken with her husband and their first child when their son was 17 months old in January 2004. Photographer: Kathleen Swisher. (You might remember Christine from her birth story posted here, home waterbirth of her 4th child with cord wrapped around his neck 4 times.)

And for good measure, in case you are wondering why on earth someone would nurse a toddler beyond a year of age:

Breastfeeding past infancy: fact sheet (from kellymom.com)