Sources interviewed for this article were all quick to point out that they are not advocating increasing the number of cesarean deliveries, but instead trying to enrich the experience for women who are already candidates for an operative birth.
“Some people have said you’re actually making cesareans so pleasant that you might change the cesarean section rate, maybe encourage people to have a cesarean, and I want to directly address that by saying it is simply not the case at all,” Dr. Camann said. “A cesarean should be done only if there are appropriate medical indications, nothing to do with the whole concept we are discussing here. But if there are appropriate medical indications for a cesarean, we can do certain things to make it a better experience.”
The new approach reflects the move toward more patient-centered care across all specialties and rising demand over the past decade for more natural birth processes, both Dr. Aghajanian and Dr. Magee observed.
“It was truly patients that brought it to our attention, and I think that’s important. It’s a patient-centered technique,” Dr. Magee said, adding that the highest compliment came from a mother who remarked, “I know you did surgery on me, but this was a birth.”
Some recent media reports have cast the approach as a major shift in cesarean delivery, but there’s nothing radical about it, according to ob.gyn. Dr. Jeff Livingston and certified nurse-midwife Ms. Rachel Zimmer, both with MacArthur Medical Center in Irving, Texas.
“We’re making minor adjustments with the patient and her family’s interests at heart, always doing it safely, but making it a more personalized and individualized experience,” he said.
For many patients, the most appreciable difference about their “family-centered cesarean” is that they get to actively participate and plan their birth, just as they would with a vaginal birth, Ms. Zimmer said.
For Dr. Livingston, the biggest change is pausing after the baby’s head enters the abdominal field to allow external compression from the uterus to help expel lung liquids, a technique described in an early report on “the natural cesarean” by obstetricians in the United Kingdom and Australia (BJOG 2008;115:1037-42).
An opaque surgical drape is lowered and the mother’s head elevated by the anesthesiologist to let parents watch the birth, but not all patients choose to do so, he said.
Overall awareness of family-centered cesareans is low among new mothers, and they are performed upon request, not as the standard of care, Dr. Livingston noted.
And the trend is being seen outside large urban centers, as well. In Peoria, Ill., Dr. Michael Leonardi of OSF Saint Francis Medical Center, said patients at his hospital are requesting family-centered cesareans. At the same time, the hospital continues to get referrals for the management of placenta accreta from women who’ve had too many cesareans, reflecting the need to have the “bigger conversation” with patients about what they and the hospital can do to safely avoid the primary cesarean and interventions that increase cesarean risk, such as induction of labor with an unfavorable cervix, he said.
“A piece to patient-centered care is not me telling the patient what to do and being paternalistic, but making sure people have the information they need, in a way that makes sense to them, so they can make an informed decision,” Dr. Leonardi said.