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Cesarean birth is recognized as a physical and psychological stressor for many women. Maternity practices during cesarean birth should meet women's needs, while maintaining safety, to optimize the experience. Family-centered cesarean birth is a package of interventions that encourages a woman to participate in choosing interventions that would be h...
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... testing various surgical gowns and room temperatures, the decision was made to maintain a room temperature of 21.5°C (71°F). To assist with maintaining maternal and neonatal warmth, the neonate was dried during the initial 5-minute assessment, warm blankets covered the woman and neonate during skinto-skin care, and a forced-air warming system was used to keep the woman warm (Figure 2). ...
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Abstract Background Mother and newborn skin-to-skin contact (SSC) after birth brings about numerous protective effects; however, it is an intervention that is underutilized in Iraq where a globally considerable rate of maternal and child death has been reported. The present study was conducted in order to assess the effects of SCC on initiation of...
Citations
... The benefits of these practices have been widely demonstrated [12,13], and this approach should be extended to cesarean sections, where maternal-fetal conditions allow. This type of cesarean section is also known as "gentle caesarean" [14], "natural caesarean" [14] or "family-centred caesarean" [15]. ...
Background and Aims: Efforts to humanize childbirth focus on promoting skin-to-skin contact, labor accompaniment, and breastfeeding. Despite these advancements, cesarean sections often lack a consideration of immediate mother–child contact, early breastfeeding initiation, and follow-up. This underscores the need for a ‘natural’ approach to cesarean sections, aiming to ‘humanize’ the procedure and emulate some aspects of vaginal birth. Materials and Methods: An observational longitudinal cohort study was conducted, involving pregnant women scheduled for a cesarean section. Two comparison groups were established: one undergoing conventional cesarean sections and the other receiving a humanization intervention. While in “conventional cesarean sections,” newborns are separated from mothers at birth, preventing actions such as early breastfeeding or skin-to-skin contact, and maternal companionship is lacking in the operating room, the intervention of cesarean section humanization was based on avoiding the separation of the mother and newborn, promoting skin-to-skin contact, early breastfeeding, and maternal accompaniment during surgery. Descriptive data on maternal and neonatal variables, including breastfeeding initiation, maintenance, and baby weight trends, were collected. Additionally, a validated survey assessed the pain, satisfaction, and anxiety among the 73 participating women. Results: Women undergoing natural cesarean sections reported higher satisfaction, lower anxiety, and reduced postoperative pain, requiring less analgesia. Although their exclusive breastfeeding rates at 10 days postpartum showed no significant difference, statistically significant differences favored natural cesarean sections at 3 months (67.5% vs. 25%) and 6 months (50% vs. 4.5%). Neonates in the natural cesarean group exhibited greater weight gain at 10 days postpartum compared to those delivered conventionally (+49.90 g vs. −39.52 g). No significant differences in blood counts were observed between the groups. Conclusions: This study underscores the manifold advantages offered by the natural cesarean procedure compared to the conventional cesarean approach. Notably, a NC demonstrates superior outcomes in terms of heightened maternal satisfaction with the obstetric process, the enhanced sustainability of exclusive breastfeeding, and augmented neonatal weight gain.
... In healthy women with non-compromised singleton fetuses at term, "natural caesarean" allows for parental participation by dropping the surgical drape during delivery, allowing time for autoresuscitation, and promoting early skin-to-skin contact. In the following years, attempts to establish a "family-centered" or "gentle" caesarean delivery method mainly focused on early skin-toskin contact [15][16][17][18]. Only scarce data have been collected regarding birth experiences, especially outside of planned CD [12]. ...
... Chalmers et al. [7] reported that in conventional CS, only 62% of women held their baby within the first hour after birth, even if the baby was not admitted to a neonatal ward. Earlier studies have shown that early skin-to-skin contact can be safely and successfully established in the operating theater [15,18,26,27]. In our present study population, 72% of women who received CCB said that their child was brought to them immediately after delivery, and in 75% of these cases, the neonates stayed on their mothers' breast until surgery was completed. ...
Background: In this study, we aimed to assess the safety of a modified caesarean delivery (Charité caesarean birth) in an extended frame of indications, and to examine its impact on parents’ birth experience and long-term effects. Methods: This prospective cohort study was performed from January to June 2019. A standardized questionnaire was given to all women who gave birth as an inpatient delivery. Eight months after hospital discharge, all women who gave consent were sent a follow-up questionnaire including questions on current feelings, breast feeding, bonding, and support system, as well as a screening for postnatal depression. Indications for caesarean delivery included preterm birth, fetal malpresentation, fetal malformation, twin pregnancy, and maternal pre-existing conditions. Results: The study cohort included 110 women. The mode of delivery was spontaneous in 49%, per vacuum extraction in 15%, conventional caesarean section in 7%, and Charité caesarean birth in 29%. The groups with Charité versus conventional caesarean delivery did not significantly differ in neonatal admission rates, umbilical cord parameters, maternal blood loss, or duration of surgery. Compared to conventional caesarean delivery, women who underwent a Charité caesarean delivery were significantly more satisfied with their birth experience. At follow-up, the mode of delivery was not associated with significant differences in postnatal depression, breast feeding, or bonding parameters. Conclusions: Outside of emergency situations, Charité caesarean birth improves patients’ well-being, without increased maternal and neonatal morbidity.
... 21 Following the promising publication of NCD in 2008 by Smith et al., 11 the editor commented that no outcomes or safety data are presented to justify widespread use of this technique and that the technique should be adequately studied with appropriate clinical trials. 26 Additionally, Newman et al. reported that the term natural implies a process associated with fewer adverse outcomes than the traditional technique, although the practice changes suggested by Smith et al. do not reduce any significant adverse effects related to CD. 27 To date, only small-sample-size studies regarding safety have been published, 28,29 with a lack of consistency and missing data that do not enable the drawing of conclusions. ...
... Early mother-infant closeness is possible in the operating theatre if the staff and the parents are trained and prepared. Early skin-to-skin contact is one element of a family-centred caesarean birth [13] and has been found to reduce maternal oxidative stress [14]. However, mothers who undergo a caesarean section often spend less time with their infant, are less likely to hold the infant close to their body during the first 2 h after birth and breastfeed their infant less frequently during the first months after giving birth [10]. ...
... If they encountered obstacles, they tried to limit the mother-baby separation time, or support the father or partner in caring for the infant [12,17]. They showed knowledge and awareness about the proven importance of skin-to-skin contact immediately after birth and the risks and benefits to mothers' and infants' emotional and physical health, their bonding and general wellbeing [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20]. The midwives' experiences also highlighted the differences in managing this issue in elective and emergency caesarean sections [18] and gave a wide range of obstacles that midwives needed to overcome to support skin-to-skin contact and shorten separation time. ...
Objectives: The purpose of the study was to contribute to knowledge about how midwives manage the separation between mother and child after a caesarean section and how they try to manage the difficulties they encounter.
Methods: Data were collected from 12 interviews and subjected to inductive qualitative content analysis.
Results: The findings showed the importance of enabling midwives to reflect on their daily work and indicated that the partner’s role and participation after a caesarean section should receive greater focus and be part of routine care. Collaboration between the surgical and maternity wards could be improved by drawing up written guidelines to establish local routines. Together with national guidelines on minimising separation after a caesarean section, these suggestions could lead to more equal delivery of care for families.
... The mother and partner may observe the moment of birth through clear or lowered drapes, the partner may cut the cord near the operative fi eld, and the mother may hold her newborn skin-to-skin and initiate breastfeeding while in the OR. Nursing tasks may be done with the mother or partner holding their baby and the baby is only separated from the mother if there is a medical indication (Armbrust, Hinkson, von Weizsäcker, & Henrich, 2016;Schorn, Moore, Spetalnick, & Morad, 2015;Tillett, 2015;Wisner, 2016). ...
... Given provider concerns about staffi ng and space challenges, those who attempt to implement a gentle cesarean program should address these concerns. Prior studies have reported the addition of a nurse to assist with skin-to-skin greatly increased nursing comfort with the practice (Schorn et al., 2015). Our study supports the notion that successful change will need to realisti- ...
Background:
Protocols for neonatal care and mother-baby interaction at cesarean birth frequently differ from those at vaginal birth. There is increasing interest in adopting family-friendly or gentle protocols for women having cesarean birth. Current evidence suggests challenges in achieving interdepartmental cooperation and consensus are potential barriers to implementing gentle cesarean protocols.
Purpose:
To describe how care providers' professional role and characteristics may affect perception about gentle cesarean birth techniques and inform specific concerns about protocol changes.
Study design and methods:
A cross-sectional survey with mixed-methods analysis incorporating quantitative and qualitative conventional content analysis was used. A structured survey was distributed via email to all care providers on the labor and birth unit, including attending physicians, resident physicians in training, fellows, labor nurses, respiratory therapists, and operating room technicians. Quantitative responses were analyzed with bivariable tests and logistic regression to describe associations between provider attitudes and provider characteristics. Open-ended responses were analyzed with conventional content analysis to develop a model describing influences on overall provider attitudes.
Results:
Physicians and nurses generally have positive attitudes on benefits of gentle cesarean techniques. Their perceptions overall are informed by the balance of concerns about patient safety and logistical challenges versus perceived benefits of the techniques. On an individual level, care provider demographic and professional characteristics of gender and prior experience affected attitudes more than their specific role in patient care.
Clinical implications:
Most labor and birth care providers have positive attitudes about gentle cesarean birth. Implementation of such programs should prioritize patient safety, educate physician and nurses about potential benefits for patients, and use experienced physicians and nurses as ambassadors to increase acceptance.
... Early skin-to-skin contact in the operating room is one element of family-centered cesarean birth. 26 No adverse effects of early skin-to-skin contact in the operating room have been detected 27 and it also seems to decrease maternal oxidative stress. 28 The sample size in this study was quite small; however, data saturation was achieved with repetitive recordings, and the data provided a coherent overview of the topic. ...
Background:
Despite the evidence of multiple benefits of early skin-to-skin contact, it does not always happen and infants are separated from their parents because of different hospital practices. The aim of this study was to explore parent-infant closeness and separation, and which factors promote closeness or result in separation in the birthing unit in the first 2 hours after birth from the point of view of staff members.
Methods:
This qualitative descriptive pilot study was conducted in one university hospital in Finland in December 2014. Midwives and auxiliary nurses working in the birthing unit were eligible for the study. The data were collected with a new application downloaded on a smartphone. The participants were asked to record all the closeness and separation events they observed between the infants and parents using the application.
Results:
The application was used during 20 work shifts by 14 midwives or auxiliary nurses. The participants described more closeness than separation events. Our findings indicated that the staff of the birthing unit aimed for mother-infant closeness, and father-infant closeness was a secondary goal. Closeness was mostly skin-to-skin contact and justified as a normal routine care practice. Infants were separated from their parents for routine measurements and because of infants' compromised health.
Conclusion:
Routines and normal care practices both promoted parent-infant closeness and caused separation. Parent-infant closeness and separation were controlled by staff members of the birthing unit.
b>Background: The purpose of this systematic review and meta-analysis study was to compare various caesarean delivery methods.
Methods: A search for available articles published since January 2023 was accomplished in PubMed, Medline, Embase, and Cochrane literature databases. The search method that encompassed all pertinent publications was developed using terms from the medical subject headings thesaurus and keywords from related literature. We also used the PICO method (where P is population, I is intervention, C is comparator/control, and O is outcome for our study) to establish research question. Whereas Cochrane handbook of “systematic reviews of interventions” was used for risk of bias assessment.
Results: The results showed a significant difference in patient gratification between the gentle/natural/skin-to-skin contact caesarean and the traditional/conventional/standard caesarean. In assessing the satisfaction with delivery mode, the mean variance for these studies similarly revealed a significant difference between the natural caesarean and the conventional one. A skin-to-skin contact caesarean delivery takes less time to start nursing than a conventional delivery, according to the results of the study on the time of breastfeeding initiation after a natural caesarean. There was a low-risk bias among the selected studies.
Conclusions: As a result of greater satisfaction with delivering experience the natural caesarean delivery was most preferred method. The enhanced skin-to-skin contact and breastfeeding suggested that natural caesarean is beneficial over the conventional method.
Problem
There is minimal evidence regarding the role or impact of birth plans from the perspective of women experiencing scheduled caesarean birth.
Background
Quality maternity care requires respect for women’s preferences. Evidence suggests birth plans enable communication of women’s preferences and may enhance agency when vaginal birth is intended, however there is limited evidence of how this translates in the perioperative environment where caesarean birth is the intended outcome.
Aim
Explore the experiences and perspectives of women who had utilised a scheduled caesarean birth plan at an Australian tertiary maternity hospital.
Methods
A cross-sectional design was used; 294 participants completed the survey within two weeks post-birth. Descriptive statistics were used to analyse quantitative data, qualitative responses were analysed using content analysis.
Findings
Over half of the women requested lowering of the surgical-screen at birth, most requested immediate skin-to-skin with their babies; around two-thirds of these preferences were met. Use of a birth plan for scheduled caesarean section supported women’s ability to communicate their desires and choices, enhancing agency and reinforcing the significance of the caesarean birth experience. Qualitative data revealed two main categories: Perceptions and experiences; and Recommendations for improvement, with corresponding sub-categories.
Discussion
Findings provide unique opportunities to consider the provision of woman-centred care within the highly technocratic perioperative environment.
Conclusion
All women, regardless of birth mode, have a right to respectful maternity care that prioritises their wishes and agency. This study provides evidence for the positive utility of birth plans in caesarean birth, local adaptation is encouraged.
Background
Early skin to skin contact after vaginal delivery increases milk production and may increase oxytocin release, leading to reduction in postpartum hemorrhage (PPH) rate.
Objective
To examine the impact of “natural” cesarean deliveries (NCD) on perioperative maternal blood loss.
Study Design
This is a randomized controlled trial conducted at a single university affiliated medical center, between August 2016 and February 2018. Term singleton gestations scheduled for a planned CD under spinal anesthesia were included. Women were randomized at a ratio of 1:1 to NCD (study group) or traditional CD (control group) during the routine preoperative assessment. Women in the study group watched fetal extraction, had early skin to skin contact, and breastfed until the end of surgery. Neonates in the control group were presented to the mother for few minutes. Blood samples were drawn from all women, during fascia closure, to determine oxytocin levels using an ELISA kit. The Laboratory component was performed after recruitment completion and was accomplished in February 2019. The primary outcome was postpartum hemoglobin (Hb) levels. To detect a difference of 0.5 g/dL between the groups with α = .05 and β = 80%, 214 women were needed.
Results
Of 214 women that were randomized, 23 were excluded. There were no significant differences in demographic and obstetric variables between the groups. Postpartum Hb levels were 10.1±1.1 and 10.3±1.3 g/dL in the study and control groups, respectively (P = .19). There were no significant differences in rates of PPH and blood transfusion. Maternal pain scores, satisfaction, and exclusive breastfeeding, were comparable. Maternal oxytocin blood levels were 389.5±183.7 and 408.5±233.6 pg/mL in the study and control groups, respectively (P = .96). Incidence of neonatal hypothermia was comparable between the groups (P=.13).
Conclusions
NCD does not affect perioperative Hb level or maternal oxytocin blood concentration.
Clinical Trial Registration
clinicaltrials.gov Identifier: NCT02768142.
Giriş ve Amaç: Doğum hizmetlerinin niteliğini geliştirebilmek ve kadın odaklı bir sağlık bakımı gerçekleştirmek için doğum ortamında bireyin gizliliğini sağlama, mahremiyete saygı gösterme oldukça önemlidir. Bu çalışma “Doğum Mahremiyeti ve Gizlilik Ölçeği - Childbirth Intimacy and Privacy Scale-CIPS” nin Türkçe’ye uyarlanarak, Türk toplumunda geçerlik ve güvenirliğinin belirlenmesi amacıyla uygulanmıştır. Ölçeğin kadınların doğum hizmetlerinde yaşadıkları mahremiyet deneyimlerini değerlendirme konusunda önemli bir araç olacağı ve mahremiyete yönelik uygulamaların geliştirilmesine katkı sağlayacağı düşünülmüştür.
Yöntem: Metadolojik tipte olan araştırmanın evrenini T.C. Sağlık Bakanlığı İzmir Sağlık Bilimleri Üniversitesi Tepecik Eğitim ve Araştırma Hastanesi Ege Doğum Evi ve Kadın Hastalıkları Ek Hizmet Binasında Haziran-Aralık 2018 tarihleri arasında doğum yapan ve çalışmaya dahil edilme kriterlerine uyan 362 kadın oluşturmuştur. Rados ve arkadaşları tarafından 2015 yılında geliştirilen ölçeğin Türkçeye uyarlanabilmesi için Melinda Rados’tan yazılı izin ve Ege Üniversitesi Tıp Fakültesi Dekanlığı Klinik Araştırma Etik Kurulu’ndan izin alınmıştır. Kadınlara, Doğum Mahremiyeti ve Gizlilik Ölçeği’nin Türkçe Formu yüz yüze görüşme yöntemi ile uygulanmıştır.
Bulgular: Açıklayıcı Faktör Analizleriyle (AFA) ölçek altı alt boyut altında toplanmış, orijinal faktör yapısı ile benzer sonuçlar elde edilmiştir. Ölçeğin tümü için elde edilen iç tutarlık katsayısı 0.87 olarak belirlenmiş, çok iyi düzeyde güvenilir olduğu sonucu ortaya çıkmıştır. Ölçeğin korelasyon katsayıları -.046 ile .722 arasında değişmektedir.
Sonuç ve öneriler: Yapılan analizler, Doğum Mahremiyeti ve Gizlilik Ölçeği’nin Türkçe formunun geçerli ve güvenilir bir ölçme aracı olduğunu göstermektedir. Elde edilen sonuçların özgün ölçek ile benzer özellikler göstermesi ve her bir maddenin konuyla olan ilişkisi göz önüne alınarak ölçekten madde çıkarılmamıştır.
Anahtar Sözcükler: Mahremiyet, Doğum, Ölçek, Geçerlik ve Güvenirlik
