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The Family-Centred Approach To Caesareans

Mother & Baby at the Queen Charlotte & Chelsea Hospital

Giving birth has become a much more family-focused experience over the past few decades. Gone are the days when fathers-to-be paced through the hospital corridor awaiting good news. Today, new parents get to have that first precious cuddle with their baby as soon as possible.

This is all well and good if you’re having a normal vaginal birth, but what if you’re having a caesarean section by preference or on medical advice? Even though giving birth should be one of the most important life experiences for parents, having a caesarean can unfortunately still feel like a highly medical and impersonal procedure.

The team looking after women on the Sir Stanley Clayton Ward at Queen Charlotte’s & Chelsea Hospital is working to change this. They are doing this with an innovative family-centred approach, also known as the ‘natural caesarean’. The team includes Lead Midwife – Jenny Smith; Professor of Obstetrics and Gynaecology – Phillip Bennett; and Consultant Obstetric Anaesthetist – Felicity Plaat.

The team at the Queen Charlotte’s & Chelsea Hospital have been using this family-centred approach for around 10 years now, and the mums who’ve had a baby in this way are overwhelmingly positive about the experience. Jenny refers to the experience as ‘life changing’, especially if the mum has experienced a traumatic birth in the past.

Queen Charlotte Chelsea Hospital Entrance

The family-centred concept
A caesarean section is usually performed when a normal vaginal birth could put a mum or her unborn baby at risk – it may be planned, or it could be carried out as an emergency procedure.

In most hospitals, after a caesarean is performed, the baby is quickly whisked off by the midwife for routine checks and weighing before the mother gets to see or hold them. Mums are often left waiting and wondering if their baby is okay. The team at Queen Charlotte’s & Chelsea Hospital questioned why mum couldn’t hold her newborn more quickly.

It’s thinking outside the box and trying to look at what the mother’s wishes are, and think how can we fulfil these but ensure safety,” explains Jenny. The idea behind the family-centred approach is to have a birth experience that’s as normal as possible for the mum and her partner. “You’re having a baby and you’re having an operation, but you’re really central to the whole process.” This means that the team puts the needs and wishes of the family first wherever possible, instead of focusing on non-essential procedures. However, at no point do they compromise on the safety of mum and baby.

Baby born by natural caesarean

How does the approach work?
While the procedure is similar to a traditional caesarean, there are some important differences that enhance the birth experience.

Along with comprehensive pre-birth care, the parents meet with the surgical team beforehand and see the operating room so they know what to expect on the big day. Good communication is central to the process and the team are in close contact with each other and with the parents before, during and after the procedure.

On the day, the anaesthetist will give the mother an anaesthetic with an epidural catheter; the anaesthetist can tailor the dose of anaesthetic to make mum numb where she needs to be but still able move and safely hold her baby. If for some reason the procedure goes on longer than usual, the anaesthetic is prolonged via the epidural catheter. The anaesthesiologist takes special care in administering the anaesthetic to ensure mum can have that all-important first cuddle with baby without any unpleasant side effects such as heavy arms.

The team also ensures that the birth experience is enhanced by making small practical changes. The team strive to keep mum and her partner feeling good – perhaps by playing music, or reducing unnecessary lighting, ECG sensors are put on the mother’s shoulders rather than her chest, so they do not inhibit the baby lying skin-to-skin on mum. They also make sure the oxygen pen is on the mother’s toe rather than finger so it doesn’t get in the way when mum is bonding with baby. It’s these subtle but important changes that make the family-centred approach so uniquely special.

A partition is raised while the obstetrician makes a small incision in the abdomen and womb, so both mum & dad don’t need to worry about seeing this part of the procedure. The next step is described by the team as ‘walking the baby out’. The operating screen is lowered enough for mum to watch the baby coming up out of the womb, but without seeing the incision. Once the baby’s head is out of the womb, the surgeon gently helps the shoulder out, and then through a combination of contractions, the baby wriggling and surgeon supporting — the baby comes out.

This unique process is different from a traditional caesarean because the baby wriggles out of the womb slowly over the course of 1-2 minutes, allowing the parents to watch that special moment together. “Families adore it. Sometimes they don’t know sex of the baby, and so you can lift the baby up and the parents can see the sex of the baby for themselves,” comments Jenny.

As soon as the baby is out, the midwife takes him or her from the surgeon and quickly puts the baby skin-to-skin on mum to bond for the remainder of the surgery (provided both are healthy and well). There are many benefits to this approach, as Mr Bennett explains: “Mum has hold of her baby and can cuddle and bond with the baby, and even start breastfeeding.

The procedure itself takes around 5-10 minutes, while the overall process from start to finish is around 1 hour. The approach is also only suitable for planned caesareans where there are no medical concerns and the baby is in normal position (head down). It’s not appropriate for emergencies or for breech babies.

Baby born by natural caesarean

Benefits for the whole family
There are many benefits for both mum and baby when a caesarean is carried out in this way. Placing the baby skin-to-skin with mum helps with the bonding process because the baby can smell mum’s scent and feel her heartbeat as he did in the womb. Additionally, the clamping of the umbilical cord isn’t done straightway as it usually is during a traditional caesarean. This delay is good for the baby because it provides more stem cells and oxygen from the placenta, which helps to get more air into their lungs as they come into the world.

During a vaginal delivery, the squeezing of the baby helps to push all the fluid out of the baby’s lungs, which does not happen with a regular caesarean. The slower delivery processes used in this approach helps clear the baby’s lungs through pressure from the uterus as the baby is pushed out.

The emotional benefits are also hugely important. By ensuring couples have a positive experience; families come away from the procedure feeling like they have had a personal intimate experience of birth.

Queen Charlotte Chelsea Hospital Suite

Enhanced recovery
The family-centred approach doesn’t stop after the procedure ends. The anaesthetist ensures that mum is kept comfortable after the birth with a flexible pain relief regime and by encouraging mobility. “We want mums moving, partly because they have a baby to look after and partly because we want good blood flow in the legs to minimise the risk of blood clots.” explains Dr Plaat.

The team pay close attention to each part of the birth process to see how they can make it better. This ultimately means the parents can take their baby home sooner, and that mum will do better both physically and emotionally. If the surgery takes place before noon and is straightforward, mums can expect to go home as soon as the following afternoon if all are doing well.

Understanding individual needs and wishes
The team in the Sir Stanley Clayton Ward meet with all couples considering or needing a caesarean to understand their wishes and discuss how they can make the birthing experience as special as possible. Some couples begin their journey with the team at the start of their pregnancy, while others choose to come after learning that they need to have a caesarean. The team understands that each couple is different, so the family-centred approach can be tailored to each couples needs and preferences.

The team in the Sir Stanley Clayton Ward encourages mums-to-be to write down their thoughts and wishes in their birth plan, and to speak to their midwife or obstetrician. Jenny says it’s good to have an ideal scenario in mind, but also to acknowledge that sometimes things change and may need to go quicker on the day.

Making your experience special
Caesareans are becoming more commonplace in the UK, making up around one third of deliveries1. Previously, having a caesarean could mean a less than ideal birth experience, but the team in the Sir Stanley Clayton Ward firmly believe this doesn’t have to be the case. By making the birth experience as fulfilling, personal and positive as they can, they ensure couples having a caesarean will have the best experience possible. This is something the whole team feels passionately about, as Jenny says: “You have your little family, but then you have your big family of the whole team here. 

[1] The NHS Maternity Statistics, England: 2013-14 can be found on the Health and Social Care Information Centre website at http://www.hscic.gov.uk/catalogue/PUB16725

The team at The Queen Charlotte’s & Chelsea Hospital has been developing the family-centred caesarean approach since 2005. Details of their technique were published in the British Journal of Obstetrics and Gynaecology in 2008 – citation reference:

Smith, J, F Plaat, and NM Fisk. “The Natural Caesarean: A Woman-Centred Technique.” Bjog 115.8 (2008): 1037–1042. PMC. Web. 28 July 2015.

You can also view a YouTube film of the procedure – click here.

We thank the team at Queen Charlotte’s & Chelsea Hospital, for providing their specialist knowledge for this article.

For further information please contact:

Sir Stanley Clayton Ward
The Queen Charlotte & Chelsea Hospital
Du Cane Road
London, W12 0HS

Tel: +44 (0) 20 3313 1466
Email: imperial.stanleyclaytonward@nhs.net
Web: http://imperialprivatehealthcare.co.uk/our-hospitals/queen-charlottes-chelsea/

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