Monday, October 14, 2013

Should the "Gentle Cesarean" be Marketed?

A few months ago I wrote a post about Mother-Friendly cesareans, debuting a Ceci-Jane video of a "gentle cesarean".   It was a necessary post at the time, not to mention a relatively new phenomenon.  Since then, they have gained in popularity and the word is out!  Women are flocking to the OB who will give them a "gentle" cesarean.  I know of dozens of women who have had these cesareans now.  The out-of-hospital midwives are super excited too because they feel they are not sending their transfers off to the butcher, but their couples can still have aspects of their birth plan honored.

I actually wouldn't even be discussing this again except for the fact that the Texas Health Resources mini magazine just came in my mailbox yesterday, and in it is an article called, "A Gentle Welcome to the World." I admit that I cringed the minute I saw it.  Now, now, before you get upset with me, I'm not saying that women shouldn't have access to this type of cesarean. Just the opposite! Really, in a perfect world, all cesareans should be "gentle" (we'll come back to the word choice in just a minute), for the sake of both mother and baby.

What concerns me is marketing its availability.  Women are already so terrified of childbirth, a cesarean seems so much easier.  They opt for it without ever feeling a single contraction.  And now, to be able to still have your baby placed on you right after surgery, possible delayed cord clamping, more bonding time with baby... Well, where do I sign up?!

Addressing the word "gentle" in regards to this type of cesarean, according to Dr. Laura Bradford, "It's called 'gentle' cesarean section because that's exactly how the baby perceives it."  I feel like swearing, but I won't.  She went on to talk about the benefits of not separating mom and baby immediately after birth, like this is new to everyone!  Then why wasn't this done long before now?!  Again, great marketing!  They are doing it for the babies, everyone!  The impression is that a "gentle" cesarean is easier on the baby than a vaginal birth.  Ugh.

As part of the Management Team over at Birth Boot Camp, we've had lots of discussion about including a "Mother-friendly" or "gentle" cesarean as part of our birth video selection.  Here's the problems we always come back to:

1.  When you watch natural birth films, most moms are working hard.  She probably doesn't have any makeup on.  She's probably sweating.  She's likely making sounds.  She might have facial expressions that are not "normal" - eyes closed, mouth open, bearing down when pushing.  While extremely beneficial in preparing for a natural birth, some women fear what they will look or sound like in labor.

2.  In the "gentle" cesarean videos, her hair and makeup are beautiful.  She's not making any uncomfortable noises or facial expressions.  She doesn't feel a thing, in fact.  It just looks so... easy.  And this is where the problem lies. The allure of the "gentle cesarean" is just so powerful.

For the very small percentage of women who actually need a c-section, this is so wonderful that this type of cesarean birth is being offered.  It's the marketing and overuse that is bound to happen that makes me sad. It's a smart marketing move though.  The hospitals and doctors offering the "gentle" cesarean are bound to make bank.  In a nation that says they are trying to figure out how to lower the c-section rate, where does the "gentle" cesarean fit it?  I can't help but think this has the potential to cause it to grow higher...


Unknown said...

Maybe someone needs to go home with the postoperative woman who is trying to take care of a newborn with staples in her belly and see how good she looks then. I'm all for the option being there in necessary cases but glamering it up like a Hollywood movie might not be the best thing.

Marlene Dotterer said...

What Melissa said. Now that I think of it, I've never seen a video that shows the after-effects of cesarean. We need one that contrasts V vs. C, both during birth and afterwards.

I agree, the marketing allure is shameful. Every OB should perform a "gentle" cesarean every time they do this surgery - it should be SOP unless there's a sudden and dire emergency. Honestly, what crock.

Allison said...

I love the idea of a video showing a week post-op compared to a week post natural, physiological birth. When I finally had my vaginal birth, it took me a bit to realize that I could laugh and cough and move without the pain I associated with my previous births!

How I wish that my cesarean births had been more gentle, but it's such a deceiving term. They cannot possibly be more gentle as they cut a 6 inch incision through all the layers of skin and then forcibly pull abdominal muscles out of the way to insert a sharp scalpel into your unborn baby's home. It often takes much force to pull baby out of the incision. So, gentle really cannot be the word to describe the surgery IMO.

I'm so glad that OR's are now a place were a mom and baby can greet each other and stay together for a time after birth. But even most "gentle c-section" videos are likely to leave out the way mom's numbed body is tugged and moved around in the process of getting baby out. Glad that you are not including it in your curriculum!

Sara said...

I agree, they should show the ACTUAL surgery and baby being pulled out of a relatively small incision (NOT GENTLE) and then see if they get any takers.

ablc said...
This comment has been removed by the author.
ablc said...

in my humble view, a c-birth can NEVER EVER be gentle.. planned or otherwise. a c-birth will always stressful to the baby and mummy because of the method itself (it is not a minor operation) and the drugs needed to support the operation. mummy is drugged with a powerful narcotics, which would affect the baby too. the skin-to-skin is pathetic (5 minutes at the most.. and literally and strictly cheek-to cheek only). direct (breast) feeding in the operating theatre is a no-no. in most cases, baby will be given formula because mummy needs time to be stitched up and monitored in the recovery room. when mummy finally gets to see the baby (usually 1-2 hours later) in the ward, baby is usually knocked out and refuse breastfeeding. mummy is too tired and groggy from the drugs and operation, if not in pain. it takes a week before mummy can walk without assistance.. not before going through the dreaded "u-need-to-force-urself-to-walk-third-day-physiotherapy".. im sure many-many c-birth mummies would remember this pain when reading this.. and the home recovery..? is long if not painful. mummy will be prescribed powerful painkillers for a week if not two. i am not surprised if any c-birth mummies resorting to formula during the month long recovery period.

there would be trauma caused to the baby, and definitely the mummy..

so PLS, PLS, tell me.. which part is gentle in a c-birth?

Unknown said...

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Unknown said...

I was just questioning this the other day and while I too love the option for mothers who need a cesarean, I fear that this will take our society in the exact opposite direction than it needs to go.

Cori Gentry said...

Excellent call on the part of the BBC Board.