Enfº Carolina Seromenho

Nurse in Maternal and Obstetric Health

Natural cesarean section
 

HPA Magazine 16

Motherhood is without a doubt the most important phase in the life of a woman and couple. It consists of several experiences, not only physical, but also psychological, emotional, social and cultural that will significantly influence the entire adaptation process to a new reality for the woman and family.
The majority of women deposit their doubts, fears and their greatest expectations on childbirth, which is why preparation and discussion during pregnancy is so important. 
Creating a birth plan permits the future mother not only to express her wishes, but also to decide on possible alternatives, a plan B.
Being aware of a possible plan B, namely, the need for a Caesarean Section (C-section) delivery, will help to alleviate and even prevent the shock between an idealized delivery and the actual delivery. 

This awareness promotes greater acceptance of the experience of childbirth, protecting the woman's emotional balance, thus reducing the possibility of disturbances, such as postpartum depression.
In the constant attempt to provide the most positive experience possible, there have been many efforts by multidisciplinary medical teams and hospitals to develop and promote more humane measures corresponding to the ideals and expectations of the woman and the couple, permitting  above all, to provide and maintain safety for both mothers and babies.
The 1st definition of a Natural C-section came about in 2008, by the Obstetrician Nicholas Fisk, Midwife Jenny Smith and Anaesthesiologist Felicity Plaat, working at Queen Charllote's Hospital, in London. 
The practice of this technique has been developing in several countries around the world without complications, improving the experience of women giving birth by C-section.

DEFINITION
A natural C-section is still a surgical technique, the baby is born via the abdomen, meeting all the safety requirements and protocols to prevent hospital infections. The technical and aseptic procedures of a classic C-section birth are maintained, but with some changes to the environment and surrounding area, providing women and couples with a more positive experience, greater participation and involvement in the process of giving birth to their children.
Procedures that promote an early bonding between mother and baby are encouraged, respecting the WHO guidelines regarding the first hour of birth. Skin-to-skin contact in the “Golden Hour” brings unquestionable advantages for both mother and baby while favouring  early breastfeeding as well as its future success. 
It is important to mention that a natural C-section is not intended to replace natural childbirth, much less promote an increase in the practice of caesarean sections births. It is an alternative capable of providing a more reassuring, albeit technical environment, a more pleasurable, humanized and beneficial moment for parents and babies.
This procedure will always depend on medical evaluation, the type of pregnancy and associated risks, as well as the receptivity and desire of the pregnant woman.

PROCEDURE
The Multidisciplinary Team (Obstetrician, Anaesthetist, Nurse and Paediatrician) will work with a common goal: to provide an environment that promotes the participation and well-being of parents in the delivery and immediate postpartum period.
 · Locoregional anaesthesia will permit the future mother to remain conscious and focused on the moment. Anaesthetists will make minor adjustments if necessary, and if possible, avoid administering medication that might alter the woman’s consciousness.
· Some Teams may also play background music chosen by the parents, promoting a more relaxed atmosphere in the operating theatre.
· The woman will remain lying on her back with arms comfortably supported. The companion will remain close to the woman's head, providing support and preparing to take photographs of the birth, should the team permit it. The Anaesthetist or Nurse Anaesthetist will monitor vital signs, taking care to maintain freedom of movement and placing electrocardiogram electrodes strategically on the woman’s chest, leaving space for skin-to-skin contact after birth.
· A conventional surgical technique is performed. After the uterine incision, the obstetrician supports and stabilizes the baby's head inside the uterus and will ask the woman to collaborate in the birth by encouraging her to exert force or abdominal pressure, collaborating in the externalization of the baby's head. This procedure takes some time and is carried out in smooth movements, promoting uterine contraction and expulsion of fluid from the baby’s lungs, while maintaining circulation in the placenta. While it gradually adapts to the extrauterine environment, the baby´s body then leaves the uterus. 
· A surgical cloth is placed below the women’s chest, which will protect the surgical field, ensuring its sterility. Transparent cloths are used to permit visual contact of the entire procedure facilitating communication between the team and the woman/couple. The umbilical cord can be cut after clamping, if this is possible and if it desired by the couple. It is also possible to touch the baby through the cloth, maintaining the necessary asepsis.
· After a brief observation by the Paediatrician to ensure initial stabilization of the new-born infant, skin-to-skin contact will be permitted. The baby is protected from the cold, kept dry and warm and placed on the mother's chest for skin-to-skin contact while still in the operating theatre. 
· Once in recovery and while being supervised by the Team to ensure that her vital parameters and clinical condition is free from complications, the mother will maintain skin-to-skin contact with her baby.  The three will then be transferred to their Private Room in the Maternity Unit.
 
We want to mark the lives of families in a positive and safe way making sure that the birth of their baby is a happy and unforgettable moment.