Implementing The Gentle C-Section-A Birth Experience More Like A Vaginal Delivery

Purpose for the program: Enhance the birth experience and improve breastfeeding within one hour of birth for C-section patients. 

Proposed change:

When a mother dreams of delivering her child, she does not envision an operating room, bright lights, lying on a table and being covered by a drape.  She thinks of the first glimpse she will have of her newborn and of holding her for the first time.  This magical moment can now be achieved for medically appropriate patients by performing a Gentle Cesarean Section.  The Gentle C-section mimics a vaginal birth by allowing the mother to watch the birth and experience skin-toskin contact immediately after birth.

Evidence shows that placing infants skin-to-skin with mom immediately after birth increases the success and lengthens the duration of breastfeeding, promotes bonding and facilitates thermoregulation. Our facility had implemented immediate skin-to-skin into our practice for vaginal deliveries, but realized a gap existed with cesarean deliveries. New ideas for clinical practice were sought from professional literature. Based on evidence found, we proposed to change our practice to provide immediate, skin-to-skin contact after cesarean delivery.

Implementation, outcomes and evaluation:

A multi-disciplinary team which included: obstetricians, anesthesia, nursery, and labor and delivery personnel was formed.  A physician narrated YOU TUBE® video of a Gentle C-Section was shown and supporting literature was provided to the team.  Agreement for the new innovative plan was reached. Logistical challenges, such as ensuring maintenance of a sterile field and creating enough physical space for staff, anesthesia, and the significant other were identified. We also encountered staffing challenges, as a nursery nurse would need to stay with the patient during the entire skin-to-skin contact.  The first two pilot cases were videotaped and feedback was obtained from the parents 03regarding their experience. This helped us identify opportunities for improvement.  The team collaborated and educational materials were created for physicians, staff, and parents.

Implications for nursing practice:

This process took approximately 4 months from the initial presentation to performing our first scheduled Gentle C-section. As of August 6^th, 2013, our facility has performed 5 Gentle Cesarean births.  Of the 5 patients, 100% have initiated breast feeding within the first hour of life – a recommendation put forth by the World Health Organization and one of our nurse sensitive indicators in L&D. Parents have expressed increased satisfaction of their birth experience. Going forward, a marketing campaign is in production to educate women throughout the community for this alternative birth experience.

Keywords: breastfeeding, skin-to-skin, C-Section