article

Helping Parents To Prepare For A C-Section Birth Plan

9 minutes

28/08/2020

In 2018 35% of births were by caesarean section (c-section) in Australia1

The caesarean birth experience can present different challenges and concerns for parents-to-be, compared to a traditional vaginal birth.

This article provides guidance for how to help parents-to-be prepare for what happens in the theatre so they can develop their own birth plan accordingly. Special focus is given to skin-to-skin contact immediately after the birth and how to ensure parents can maximise this important first step in bonding with their newborn.

Although a c-section is a relatively short procedure (approximately 1hr in total) compared with a vaginal birth, this does not diminish the personal experience of the birth. Often new parents may not be aware of the options available to them during the birth and immediately after so it’s worth going through a checklist in their last appointment ahead of the birth to ensure they feel fully prepared. Protocols vary between hospitals but new parents will appreciate knowing what is and isn’t possible beforehand.

A checklist for guiding parents*

  • Make sure expectant parents know the set-up of the theatre i.e. how many people on the delivery team and their roles, the equipment, etc.

  • Reassure that the mother will have her birth partner present during the surgery. Inform the birth partner they will need to be dressed in scrubs which will be provided for them on the day

  • Discuss whether the parents want a screen during the surgery

  • Tell them that they can request quiet during the birth so that mother’s or father’s voice is the first their newborn hears

  • Advise that they ask the delivery team to practise delayed or optimal cord clamping for maximum benefit from the placenta

  • Go through the details of the assessment immediately after the baby is delivered

  • If cameras/phones can be taken into the theatre, inform the birth partner they will likely be the one taking all the pictures as the staff have their hands full! Encourage filming of baby’s assessment, e.g. weighing, etc. if permitted

  • Let parents know if they can play their own music

  • Explain when skin-to-skin contact (SSC) occurs. If SSC between mother and baby is not possible in the theatre, advise if the birth partner can do this in the meantime or discuss alternatives

  • Inform parents of what happens in the recovery area and the postnatal ward, e.g. checks on vitals and vaginal bleeding, pain relief, support to feed their baby, transfer to the postnatal ward, removal of catheter and when mother will be up and moving again

*Reference: 2,3,4

Finally, it is worth informing parents who may have a vaginal birth planned that sometimes an emergency Caesarean may be necessary so the above checklist can also be used in this case.

Skin-to skin-contact in the theater

Why skin-to-skin is so important

SSC is defined as placing a naked newborn on a mother’s bare chest immediately after birth5 during which routine care, such as cord clamp and temperature monitoring, can be performed.6The efficacy of SSC has been well-documented in scientific literature. Key benefits include stabilising the blood-oxygen level, body temperature and breathing rate of newborns. In addition to encouraging breastfeeding initiation, SSC is known to reduce infant crying, boost infant growth and development and strengthens the parent-child attachment relationship.7In one study tracking births over a three-year period, researchers reported a significant decrease in the proportion of Caesarean births transferred to the NICU for observation after implementing SSC.5

A newborn baby with its mother after a c-section

Did you know?

As babies born by Caesarean section do not acquire maternal vaginal microbes, SSC immediately after birth enables microbial colonisation of the newborn with maternal skin microbiota.8

The stages of skin-to-skin

Timings of SSC can vary but these are the three main stages9

  • Immediate [first minute]

  • Very early [30-40mins]

  • Early [first 24hrs]

As part of the WHO and UNICEF’s Baby Friendly Hospital Initiative to promote breastfeeding, the guidance states that an important step is to ‘facilitate immediate and uninterrupted skin-to-skin contact and support mothers to initiate breastfeeding as soon as possible after birth.’ This is recommended regardless of the method of delivery and should ideally occur within five minutes of birth4,10. Various countries have incorporated this initiative into their own practices, including UK, Japan and Australia11,12 ,although policies can still vary between healthcare providers within these countries.

The most recent Cochrane review of the practice of early SSC for mothers and their healthy newborn infants asserts, ‘since we found no evidence of harm in any included studies, we conclude the evidence supports that early SSC should be normal practice for healthy newborns, including those born by caesarean....’13 Furthermore, whilst Caesarean deliveries present certain challenges regarding immediate SSC in the theatre, the published literature, albeit limited, suggests that SSC can be provided safely and immediately in the theatre with the collaboration and education of staff, mothers and partners.14 It could be argued that SSC plays an especially important role in c-section births as this type of delivery is typically associated with reduced breastfeeding at hospital discharge compared with vaginal delivery.15 One study demonstrated that elective caesarean delivery affects short-term breastfeeding success in about 1:4 of mother-infant pairs, citing the lack of immediate SSC contact as a key contributing factor.16 In another study, hospitals that implemented immediate SSC following a Caesarean delivery observed an increased rate of breastfeeding among new mothers.17

Midwife Marie Louise comments: “If a Caesarean is clinically indicated, parents should be encouraged to communicate their decision to begin skin-to-skin in the theatre with their healthcare provider as soon as possible. Healthcare professionals, particularly midwives, play a critical role in advocating to keep mothers and babies together immediately after birth and educating on the importance of immediate, uninterrupted skin-to-skin care and early breastfeeding.”

Whilst there may be some medical or safety reasons for delaying SSC, parents-to-be should be made aware of their options regarding SSC so they can advise their hospital of their plan in advance. For example, if the mother has received general anaesthetic or experiences complications post-birth but the baby is healthy, the father can engage in SSC with his newborn instead.

Fathers and SSC

Despite limited studies on SSC following a Caesarean exclusively, particularly regarding the role of fathers, the research to date has largely concluded that paternal SSC is optimal for the newborn’s well-being when separated from his or her mother after a c-section.18,19,20

In one study, the fathers’ SSC had a positive impact on infant crying behaviour and also appeared to facilitate coordination of the pre-feeding behaviour17. SSC has also demonstrated benefits for the fathers too: helping to facilitate the transition of expectant fathers; hastening the developing of paternal attachment; and, enhancing confidence in assuming a parenting role. 18,19,21,22 These benefits indicate that fathers may assume a greater role in immediate post-partum touch when new mothers are physically weak.17

A father with his twins as the mother looks on

“Skin-to-skin contact presents a great opportunity for fathers to be more involved from the very beginning of his baby’s life. I would like to see more hospitals and healthcare providers expand skin-to-skin approaches to include fathers to aid their transition into parenthood and enhance early bonding” adds Midwife Marie Louise.

The Power of SSC

To demonstrate the true power of SSC between parents and newborns, WaterWipes teamed up with one of the world’s leading experts on kangaroo care, Dr. Susan Ludington to track the impact of SSC on three newborns. Check out the powerful SCC videos to see how SSC regulated their baby’s breathing, heart rate, oxygen levels and temperature within five minutes of being held in this position.

About the spokesperson

Marie Louise is an NHS Midwife, a PTLLS adult educator and hypnobirthing teacher from the UK and Author of The Modern Midwife's Guide to Pregnancy, Birth and Beyond.

References
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1 https://www.aihw.gov.au/getmedia/aa54e74a-bda7-4497-93ce-e0010cb66231/aihw-per-108.pdf.aspx?inline=true, p19.

2NHS, 2017 Caesarean section: what happens https://www.nhs.uk/conditions/caesarean-section/what-happens/ [last accessed April 2020]

3Tommy’s, 2018 What happens during a c-section https://www.tommys.org/pregnancy-information/labour-birth/caesarean-section/what-happens-during-c-section [last accessed April 2020]

4BabyCentre, 2016 Caesarean section birth plan notes https://dev.nct.org.uk/labour-birth/your-guide-labour/what-happens-after-your-baby-born [last accessed April 2020]

5World Health Organization & UNICEF. (2018). Protecting, promoting and supporting Breastfeeding in facilities providing maternity and newborn services: the revised BABY-FRIENDLY HOSPITAL INITIATIVE

https://www.who.int/nutrition/publications/infantfeeding/bfhi-implementation-2018.pdf [accessed April 2020]

6Schneider L, Crenshaw J & Gilder R. (2017). Influence of Immediate Skin-to-Skin Contact During Cesarean Surgery on Rate of Transfer of Newborns to NICU for Observation. Nursing for Women's Health. 21. 28-33. 10.1016/j.nwh.2016.12.008.

7Chen EM, Gau ML, Liu CY, Lee TY. Effects of Father-Neonate Skin-to-Skin Contact on Attachment: A Randomized Controlled Trial. Nurs Res Pract. 2017;2017:8612024. doi:10.1155/2017/8612024

8Dominguez-Bello MG, Costello EK, Contreras M, et al. Delivery mode shapes the acquisition and structure of the initial microbiota across multiple body habitats in newborns. Proc Natl Acad Sci U S A. 2010;107(26):11971–11975. doi:10.1073/pnas.1002601107

9Elsaharty, Aya & McConachie, Ian. (2017). Skin to skin: A modern approach to caesarean delivery. Journal of Obstetric Anaesthesia and Critical Care. 7. 13. 10.4103/joacc.JOACC417.

10Crenshaw JT. Healthy Birth Practice #6: Keep Mother and Baby Together- It's Best for Mother, Baby, and Breastfeeding. J Perinat Educ. 2014;23(4):211–217. doi:10.1891/1058-1243.23.4.211

11Cadwell K, Brimdyr K, Phillips R. Mapping, Measuring, and Analyzing the Process of Skin-to-Skin Contact and Early Breastfeeding in the First Hour After Birth. Breastfeed Med. 2018;13(7):485–492. doi:10.1089/bfm.2018.0048

12NCCWCH, 2011 Caesarean section National Collaborating Centre for Women's and Children's Health, NICE Clinical guideline. www.nice.org.uk [accessed April 2020]

13Moore ER, Bergman N, Anderson GC, et al. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev 2016;25;11:CD003519.

14Stevens J, Schmied V, Burns E & Dahlen, H, (2014). Immediate or early skin-to-skin contact after a Caesarean section: A review of the literature. Maternal & Child Nutrition. 10. 10.1111/mcn.12128.

15Guala A, Boscardini L, Visentin R, et al. Skin-to-Skin Contact in Cesarean Birth and Duration of Breastfeeding: A Cohort Study. ScientificWorldJournal. 2017;2017:1940756. doi:10.1155/2017/1940756

16Zanardo, V., Pigozzo, A., Wainer, G., Marchesoni, D., Gasparoni, A., Fabio, S.D., Cavallin, F., Giustardi, A., & Trevisanuto, D. (2013). Early lactation failure and formula adoption after elective caesarean delivery: cohort study. Archives of disease in childhood. Fetal and neonatal edition, 98 1, F37-41

17Brady K, Bulpitt D, Chiarelli C. An interprofessional quality improvement project to implement maternal/infant skin-to-skin contact during cesarean delivery. J Obstet Gynecol Neonatal Nurs. 2014;43(4):488–496. doi:10.1111/1552-6909.12469

18Erlandsson K, Dsilna A, Fagerberg, I & Christensson, K (2007). Skin‐to‐Skin Care with the Father after Cesarean Birth and Its Effect on Newborn Crying and Prefeeding Behavior. Birth. 34. 105 - 114. 10.1111/j.1523-536X.2007.00162.x.

19Chen EM, Gau ML, Liu CY, Lee TY. Effects of Father-Neonate Skin-to-Skin Contact on Attachment: A Randomized Controlled Trial. Nurs Res Pract. 2017;2017:8612024. doi:10.1155/2017/8612024

20Gutiérre B, Jesús J, Pérez A, del Rosario M, Aguilera M, Victoria M, & Soledad GM. (2012). The role of fathers in the postpartum period: experiences with skin to skin method. Acta Paulista de Enfermagem, 25(6), 914-920.

21Helth, T & Jarden, M (2013). Fathers' experiences with the skin-to-skin method in NICU: Competent parenthood and redefined gender roles. Journal of Neonatal Nursing. 19. 114–121. 10.1016/j.jnn.2012.06.001.

22Anderzén-Carlsson A, Lamy ZC, Eriksson M. Parental experiences of providing skin-to-skin care to their newborn infant--part 1: a qualitative systematic review. Int J Qual Stud Health Well-being. 2014;9:24906. Published 2014 Oct 13. doi:10.3402/qhw.v9.24906

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