My main goal for Evidence Based Birth® is to provide summaries of the latest evidence on birth practices for both consumers and clinicians. However, I will continue to present interviews with women, family members, and clinicians who have put evidence-based birth information into practice. Although individual experiences are perhaps the lowest acceptable form of scientific evidence, these interviews are a very helpful way for consumers and clinicians to share with others how they have put evidence into actual practice. Personal stories and testimonies can be an effective way to promote changes in practice.
This interview is a follow-up to my evidence-based article on skin-to-skin care after a Cesarean, which you can read here.
There are 3 main types of skin-to-skin that can take place around the time of birth. Immediate skin-to-skin starts in the first minute after birth. Very early skin-to-skin starts within 30-40 minutes of birth. Early skin-to-skin refers to any skin-to-skin that takes place in the first 24 hours.
The research we have so far demonstrates that there are many benefits to skin-to-skin care for all moms and babies after uncomplicated vaginal births and Cesarean births. Conversely, there are NO benefits to routinely separating a healthy mother and child after an uncomplicated vaginal or Cesarean birth. Many women are interested in requesting “immediate” skin-to-skin care that takes place in the operating room/theatre after a Cesarean. Although the research on this technique is limited, researchers so far (from one randomized controlled trial and 2 quality improvement studies) have not reported any adverse effects from immediate skin-to-skin care after uncomplicated Cesareans.
V.F. wanted to share some pictures of her immediate skin-to-skin time after a Cesarean, and I asked if she would be willing to do an interview to accompany her photographs.
Tell us a little bit about yourself and your pregnancy.
My name is V.F. I live in Australia, I’m studying to be a doula and have a one year old girl. I have a neurological condition which causes muscle weakness and requires me to use a wheelchair. The pregnancy was not easy – I had a severe case of morning sickness (aka hyperemesis gravidarum) for the first few months, the weight of my belly affected my mobility further and I had excruciating pubic symphysis pain for the last couple of months. I had a plan and every intention to have a natural birth but on my due date exam my daughter was in a funny position (sitting with her shoulder/neck to the cervix, possibly caused by a severe scoliosis I have) and after considering all risks (including possible cord prolapse as head wasn’t fixed in the pelvis) and much deliberation, I agreed it’s safer to go with my doctor’s suggestion to have a Caesarean. I insisted on having the surgery be as family-friendly as possible and my daughter was born 3 days after her due date.
When did you first hear about the possibility of doing skin-to-skin in the operating room (theatre)?
I can’t remember when exactly. Birth and pregnancy were an interest of mine for a while before getting pregnant, and I used to regularly read online articles on the subject. I think it was in one of them that I heard about it first and I thought if I ever have to have a Caesarean, I’d definitely want to have the skin-to-skin contact and not be separated from my baby.
Was this a routine procedure for your hospital?
As far as I know, the hospital practised skin-to-skin for Caesareans but only if the parents asked for it. I talked to my doctor and he said it’s not a problem. The way it’s routinely done is that after a baby is born, it’s taken to a little station where it’s wiped, checked, weighed and wrapped, then placed on mum and unwrapped while both baby and mum are under warm blankets. My doctor is up to date with latest research in the field and a fan of skin-to-skin, so he suggested we go a step further and have the baby given to me immediately, before the cord is even clamped.
Tell us about the experience of doing skin-to-skin right after your baby was born. What was it like?
Just before the surgery my doctor suggested a different way of doing the skin-to-skin to minimise exposing baby to the cold air in the theatre and to allow for amniotic fluid to go on my skin – something that helps with establishing breastfeeding and bonding. The procedure would involve lifting the surgical sheet covering me so the doctor could slip bub on my belly as soon as she’s pulled out. A midwife would then reach for the baby from the other end of the sheet and pull her up to my chest and in doing so still maintain sterility of the surgical area. It all went as planned. As soon as she was on my chest, we had warm blankets piled on us.
The obstetrician is lifting the baby out of her belly and is just about to slide her up on her abdomen under the surgical sheet (another doctor is seen lifting the sheet up). (Permission is NOT granted to copy or use this photo).
I was ecstatic having my daughter on me – the feel of her warm, wet, soft body on mine, the distinct smell of the amniotic fluid, the feel of her little hands reaching up on my face and her body wriggling on me – it was just heaven. I hugged her, kissed her and tried to take it all in! She didn’t have her nose and mouth suctioned, so they drained on their own as she lay on me. She was making quiet whimpers from time to time but not really crying, it was obvious she was calm and happy. She stayed like that throughout the surgery with a small break in between – my blood pressure dropped at one point, I felt faint and struggled breathing with bub on me so I asked that my husband take her for a bit, four minutes later I felt better and she was back on my chest.
We had our first breastfeed while I was still in theatre. Skin-to-skin contact continued in the recovery area as well, where we had another breastfeeding session. All in all, it was great being able to have that contact, despite not being able to have a natural birth. It helped with bonding, decreased stress and was just a beautiful experience.
Here you can see the midwife adjusting her on my chest, after pulling her up. We were immediately covered in warm blankets to preserve body heat (as the operating theatre is quite cold). (Permission is NOT granted to copy or use this photo).
A barrier to skin-to-skin after a Cesarean for some women is that there needs to be more than one nurse present– one to watch the mom and one to watch the baby. How did your hospital handle this?
During recovery, there is typically only one midwife who looks after both baby and mum. She’s the one who pulled my daughter up on my chest (you can see her hands in the photos), she made sure baby was well positioned on me, warm enough and well covered, she also helped me with the breastfeeding.
How did the skin-to-skin impact your recovery?
Not sure if it affected my recovery on a physical level, but mentally and emotionally it was huge for me. I was feeling really down for not having a natural birth and I’m sure that would have spiraled into a depression if it wasn’t for the joy and bonding that the skin-to-skin contact brought. When I think back of the birth, it’s all that I remember – the contact with bub, how we snuggled and all the love, as opposed to details about the theatre, doctors, the stress and surgery in general.
What advice would you have for families who desire immediate skin-to-skin after a Cesarean?
Talk at length to your doctor about what you want and how you want it. If they say it can’t be done, ask them why and show them proof that yes, it has been done and it’s not a problem. If they are still hesitant or resistant, get a new doctor!
One of the first kisses I gave to my daughter. (Permission is NOT granted to copy or use this photo).
Do you have any questions for V about her experience? Also, I know that some of you live in areas where there are NO surgeons or hospitals that provide this option. Does anybody have any suggestions for women or care providers living in those areas who would like to implement this?
