Mother-, baby-, and family- centered cesarean delivery: It is possible

Encourage intraoperative breastfeeding. Early contact between the infant’s lips and the mother’s nipple is associated with increased initiation and duration of breastfeeding. Breastfeeding should be started as soon as a possible after birth, preferably within the first hour of life.^19,20 Weighing, measuring, and routine care for the infant can be delayed until after the first feeding is completed.

Keep the mother and baby together. Rather than separating the mother and newborn for the trip to the recovery area, have the mother cradle the newborn on her chest during the transport process.

Challenges
Transient tachypnea of the newborn. Scheduled cesarean delivery is associated with an increased risk of transient tachypnea of the newborn (TTN).²¹ In a review of more than 29,000 deliveries, the incidence of TTN was 3.1% with scheduled cesarean delivery and 1.1% with vaginal delivery.

The plan to promote early STS contact and keep the newborn with the mother may need to be altered if the newborn needs more intensive support at the resuscitation table for symptoms of TTN; symptoms are often apparent at birth, or TTN is diagnosed within 2 hours after delivery. Symptoms include:

• respiratory rate faster than 60 breaths/min (most prominent feature)
• cyanosis
• increased work to breathe (including nasal flaring, intercostal and subcostal retractions, and expiratory grunting).

The syndrome typically resolves within 12 to 72 hours after diagnosis.

Thermal regulation. Although preterm infants are at greater risk than term infants for hypothermia, some term infants will become hypothermic.²² Careful attention to ensuring that the baby is not left exposed to the cold operating room temperatures is helpful to reduce the risk of hypothermia. Early STS contact at cesarean delivery has been reported to improve maintenance of neonatal thermoregulation.²³

Monitor the safety of the baby on the mother’s chest. If the cesarean surgery triggers an episode of nausea and vomiting, the baby may need to be removed from the mother’s chest until the episode is resolved. An additional nurse may be required in the operating room to safely monitor the baby on the mother’s chest as the surgery is completed.

Additional clinicians at the head of the surgical table. Moving the initial care of the infant to the mother’s chest increases the number of clinicians who need access to the head of the surgical table; this may create a “traffic jam.” The anesthesiologist and nurse will need to cooperate to share this space, and also to include any support persons. Moreover, the operating obstetrician and assistant will need to understand that the area above the surgical field may be a bit “busier” than they are used to.

Obviously, there may be limitations in the event of any surgical or anesthetic instability. However, as long as the procedure remains uncomplicated, as most cesareans are, than early infant care at the head of the operating table, or even directly on the mother’s chest, is a very achievable goal. Educational efforts directed at all stakeholders (anesthesiologist, obstetrician, pediatric and nursing staff) will facilitate the introduction of this model of care.

It is possible.
Is it possible to transform a major surgical procedure—a cesarean delivery—into a mother-, baby- and family-centered experience? For many cesarean delivery procedures the answer is a resounding, “Yes.” Re-engineering the clinical processes that surround the traditional cesarean delivery requires the commitment and cooperation of many disciplines. Obstetricians, anesthesiologists, and maternity nurses are the leaders who must work together to facilitate this important practice change.