A less surgical Cesarean section

“It was beautiful; this C-section brought me comfort not to have been able to deliver the baby naturally.” Dima, 38 years old, has had three C-sections. For her last child, born two years ago, she was one of the first patients to benefit from a participatory C-section at the CHUV. “My first child was born by emergency C-section. I felt like I had been butchered, and the baby was torn out of my womb. It was very violent,” she says. During her second C-section, scheduled this time, she was separated from her newborn for three hours. Her third C-section was done completely differently. “It was so sweet; it reconciled me with previous births,” says Dima. 

The importance of the atmosphere

Sometimes, during pregnancy, complications prevent vaginal delivery that would endanger the mother or the child. When faced with a C-section, expectant mothers are often disappointed; they sometimes have to give up their preconceived idea of what giving birth would be like. When an emergency C-section is not required, a participatory cesarean section may be considered. This practice responds to a need for reappropriation of the childbirth experience, transforming it into a more intimate and human moment.

“We are trying to recreate the atmosphere of a delivery room so that the focus is more on giving birth than on undergoing having surgery.” 

The participatory cesarean section remains a surgical procedure that takes place in an operating room under local anesthesia. But a series of adjustments allows for a completely different experience for families. “We are trying to recreate the atmosphere of a delivery room so that the focus is more on giving birth than on undergoing having surgery,” explains Hélène Legardeur, an obstetrician-gynecologist at CHUV. 

Key stages of the participatory cesarean section

On the day of delivery, the patient walks to the operating room with her partner, who will be present the whole time, unlike a conventional C-section where the presence of the co-parent is limited. During the procedure, the lights are dimmed, the mother can listen to the music of her choice, and the usual opaque sheet is replaced by a transparent canvas that allows the mother to see her baby as soon as it is born. Women who wish to do so can even push, as in a vaginal delivery, to help the baby’s exit. 

After birth, a key part of participatory C-section is the immediate skin-to-skin contact between mother and baby, as recommended by the World Health Organization. “We know that continuous skin-to-skin contact for one hour allows the baby to regulate its temperature better, promote the connection with the mother, and establish breastfeeding. However, it is a real challenge in C-sections because there are risks of discomfort in the child that require constant monitoring, which is complicated in the operating room. We had to innovate,” says Hélène Legardeur. 

To facilitate skin-to-skin contact, the electrodes for monitoring the mother are placed in her back to allow ease of movement. The baby’s oxygen saturation is monitored remotely, outside the room, to maintain the intimate atmosphere of the moment. Finally, a band is placed on the mother’s chest to welcome and keep the newborn safe. The mother and child can be moved together from the operating table to the bed. 

These adaptations are the result of teamwork between obstetricians, anesthetists, midwives, nurses, and technical staff, where each has had to rethink his practice. “Each profession has its requirements which must be respected. We were able to find compromises without any impact on the safety and sterility of the operating room. For example, the room temperature is increased by a few degrees for the well-being of the patient and the baby, but this adjustment does not impact the risk of infection. It’s just a little less comfortable for doctors,” says Alexia Cuenoud, an anesthetist at CHUV.

Informed consent

At a time when obstetrical violence is highly publicized, these changes are also part of a broader questioning of gynecology practices. “There is an awareness of the need to improve information for patients. In a participatory C-section, they are asked to be stakeholders, which is very new. It’s called informed consent. The patient must know what will happen to her in order to accept it or not. The intervention is based on co-decision,” says Hélène Legardeur. 

For families, the change is immense. Initial feedback on parental satisfaction is very positive. The benefits for the health of mother and child are also important, especially thanks to the principle of early recovery (see box). For Dima, who was able to experience it, there is no question about it. “I felt physically fitter after the participatory cesarean. Even though I was in pain, there was no psychic pain, and I am at peace with this cesarean.”