Natural caesarean: Why I chose a gentler version of the operation for my baby after two surgical births

The birth of my first child didn’t quite go to plan. I had set my heart on a water birth in the birthing suite of London’s University College Hospital (UCLH). After which, I’d naively imagined, as a relatively fit 27-year-old, I would spring up, slip back into my pre-pregnancy jeans and return to my normal life – just, this time, with a small baby strapped to my chest. In reality, like an increasing number of women in the UK, I ended up having an emergency C-section as a result of a failed induction.

The recovery – both mental and physical – was a long and disheartening process. Breastfeeding was tricky, I was necking painkillers to stifle the constant burning in my abdomen due to medical complications, and worst of all was the sense that I had somehow failed. I’ve never hankered after the “experience” of birth; but as I’d watched from the operating table as my daughter was whisked away after being lifted from my abdomen, and held under the incubator, screaming, while the midwife recorded her measurements, I couldn’t help feeling like a passive observer in my child’s arrival on earth. Grateful for her safe passage, yes, but also deflated.

When it came to my second pregnancy, in 2013, I was determined to try for a Vaginal Birth After Caesarean (VBAC). But again, it didn’t happen, and I ended up having a caesarean at 42 weeks. Given that I’d prepared for the possibility of having another C-section, this time recovery was more straightforward. Yet still I couldn’t escape the feeling of disconnection, with little more than a quick glimpse of my baby over the paper partition that masked me from the procedure being performed inches from my face. If there was no immediate sign of something being wrong at the point of delivery, why couldn’t I hold my baby straight away like women do following a natural birth? So when Belinda Green approached me earlier this year when I became pregnant with my third child, and asked if I’d like to be the guinea pig in a clinical trial into the effects of so-called natural caesarean – a trial that will launch at UCLH next year – I leapt at the chance.

The procedure is not currently offered on the NHS, though it’s available in the private sector. Dr Green and her team hope to prove through their forthcoming randomised controlled trial the positive outcomes for both mother and baby that this kind of “slowed-down section” can offer. Replicating as closely as possible the experience of vaginal birth for women for whom natural delivery is not a viable option, the benefits of the natural caesarean – or skin-to-skin caesarean, as it is more appropriately known – might include improved bonding between mother and child, more easily established breastfeeding and calmer newborns.

“Caesarean sections rates in the UK are at 26 per cent,” explains Dr Green, who previously ran the birthing centre at UCLH and now works in antenatal with a clinical and research interest in VBAC. “Although there is a continued drive to reduce the numbers of women having a caesarean, we also need to look at the care of women who do. We need to ask whether there are things that we can do to make the procedure more women-friendly, without increasing risks to the baby or mother.”

Dr Ruwan Wimalasundera, a consultant obstetrician and foetal medicine specialist at UCLH, has been performing “natural caesareans” for his private patients for the past 10 years. More common in the US, the procedure is much slower than a standard caesarean, he explains when we meet prior to my elective surgery. The idea for my involvement is that my delivery will be performed as per the skin-to-skin method and filmed – and this film will be shown to women who volunteer to be part of the trial. “There is very limited research to indicate the risks and benefits of this variation in the way caesarean sections are done,” Dr Green says.

Pioneered in the UK by Nicholas Fisk at Queen Charlotte’s Hospital, London, in the 2000s, it has never been formally evaluated. “It is widely known as a ‘natural’ caesarean section because it attempts to mimic the auto-resuscitation of the newborn infant when delivered vaginally.”

While there is little that is “natural” about the process by which my baby will be born, the process will differ significantly from standard procedure. Once the incision is made to the abdomen, as per the standard method, and the baby’s head emerges, Dr Wimalasundera explains in our pre-op meeting, rather than whisking the baby out as quickly as possible and taking it straight off to be cleaned and weighed under the lights – at which point both of my previous babies had screamed uncontrollably while I looked on helplessly, hoping for a glimpse and longing to soothe them myself – the newborn, I’m told, will be allowed to push and squeeze its way out into the world, as long as there are no obvious complications.

This will enable the baby to clear its own lungs, as it would during natural birth, which should be beneficial for its breathing. Once it is free, the surgeon will lift the baby out – with cord still attached, if it’s long enough, which means it will receive cord blood for longer, which is rich in disease-fighting stem cells – and pass it to the midwife, who will hand it straight over to me, where it will rest for several minutes while I’m being stitched back together.

On the day, I arrive at surgery armed with a newborn hat (the greatest concern about immediate skin-to-skin is that the baby will get cold in a theatre environment). Dr Green brings along a roll of tinfoil, to lay over the towel that will rather glamorously enshrine me and the baby. The atmosphere in theatre is one of eager anticipation, and despite the familiar array of catheters, scalpels et al (and needle to administer the spinal epidural), I find myself grinning with excitement.

All goes according to plan, and watching my son’s body slowly emerge, once the screen between us has been lowered, is a moment I can still hardly believe was real – stranger still when watching it back on film. While my other children had screamed for minutes on end after emerging, the moment my younger son’s head is placed on my chest, still covered in mucus, he immediately calms.

For the first time, I am able to marvel at the perfection of my bloodied, puffy-eyed newborn before anyone else. A sense of quiet elation enfolds us both as the buzz of the surgery melts away. All that remains is me, him, his father, a sense of total contentment, and the nagging joy of being one step closer to the sandwich in my hospital bag, after 16 hours of nil by mouth.

A month on, it’s impossible to say for certain quite what the impact of this delivery was, but I can honestly say that of all my three children (all equally delightful, of course), this baby has been by a long shot the most calm and contented, latching on to the breast with ease and hardly ever grizzling or crying. And despite juggling three kids, and all the rest of it, I’ve never felt calmer as a new mother.

Of course, this might have something to do with the reassurance of having done it all twice before, but I also believe that sense of ease is in no small way buoyed by the security provided by the memory of watching my child emerge, triumphantly, into the theatre like a small, warm and very hairy statue of liberty. Not to mention the sense of fulfilment at being the first one to welcome him, soothe and protect him from the throbbing noise and bright lights of the outside world.

Charlotte Philby is the founder and editor of motherland.net