Baby chooses birthday vs. "family centered cesarean"?

This post is my rant about the between-a-rock-and-a-hard-place situation that moms who know they will be planning a cesarean face. This post is *not* for discourse regarding whether a cesarean is or isn't the "best" choice for any specific situation. Whether a mom has a medically indicated reason that is foreknown and is planning to have a cesarean, or whether she is having an elective cesarean, moms deserve to have choices and options open to them.

There's lots of talk in the media now about "family centered cesareans," "natural cesareans," or "gentler cesareans," which allow mothers more involvement in the birth, immediate skin-to-skin contact and bonding after the birth, earlier establishment of breastfeeding, and more.

More and more mothers are aware of the dangers of early elective deliveries (whether by induction or cesarean). There are many awareness campaigns encouraging moms to wait a bare minimum of 39 weeks before scheduling a delivery of any sort. Many moms are also aware that there are benefits to baby if he or she has the advantage of the hormonal changes of spontaneous labor as well as the physical effects of labor (squeezing effect of contractions that help push mucus out of baby's lungs, for instance) and dangers of baby not being ready for birth if it's scheduled (higher likelihood of respiratory distress, NICU admission, neurological issues, breastfeeding problems and more). These moms know that in many instances, it's possible to wait on spontaneous labor to begin before going to the hospital and requesting the aforementioned cesarean that she had planned.

Here's where the problem lies: it's difficult for moms to have a "family centered cesarean" without having it scheduled. Most OBs are in a rotation of who is on call, and most American OBs have never performed (nor even heard of) a "family centered cesarean," "gentler cesarean," or "natural cesarean." If a mother is blessed enough to find a care provider who will support her desires to have an atypical, involved, gentler cesarean birth, odds are that the other OBs in the practice will not honor her birth plan. If mom doesn't schedule her family centered cesarean, she's not likely to achieve her birth goals (unless she happens to go into labor when "her" OB is on call).

It shouldn't be this way! Moms shouldn't be forced to choose between "best cesarean birth for mom" (family centered cesarean) and "best cesarean birth for baby" (allowing baby to signal readiness to be born and having a cesarean at the onset of active labor). I can't see any good reason (legal or monetary reasons benefitting OBs don't count as a "good reason") why moms shouldn't be able to request a family centered cesarean on demand at the onset of labor. In fact, I can't see a compelling reason why gentler cesareans shouldn't be the norm for cesarean births and offered for all non-emergency cesareans (the majority of them).

I know that this is available in other areas (UK and Australia), so it's possible here, but it will take educating mothers and educating care providers to make it happen. It will take a push from consumers to request a better cesarean experience, or take their healthcare dollars elsewhere to an OB who *will* accommodate their birth wishes.


What are your thoughts? Have you had or attended a family centered cesarean? Was it scheduled or upon natural onset of labor? How did mothers/doulas/birth activists make alternative cesareans available in your area?