Natural caesareans could be offered to all women across the NHS, with the first clinical trial to measure the benefits of the procedure for mothers and babies scheduled to begin in Britain this summer.
Babies born by a natural — or skin-to-skin — caesarean remain in the womb after it is cut open. Their heads are slowly brought out and they are then left to manoeuvre their shoulders and body out, mimicking the compression of the birth canal.
The method is claimed by its supporters to increase bonding and reduce the number of complications after birth. Clinicians who have witnessed the advantages of the procedure for years hope that the trial will make it commonplace as a birthing option.
“It is about the mother. After the incision is made, the curtain is removed and the mother is able to see her little baby wriggle out. It is a special moment that is missed otherwise,” said Jenny Smith, a senior midwife at Queen Charlotte’s and Chelsea Hospital in London, a pioneer of the method.
“The baby remains in the abdomen for up to four minutes and the mother can look at it, see its little face and eyes, and when it wriggles out it is the parents that first determine the sex.”
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The baby’s movement in the abdomen has no effect on the size of the scar. In some cases, if the baby is unable to manoeuvre itself entirely, the doctor will use a guiding hand.
Unlike an ordinary caesarean, doctors delay cutting the umbilical cord. Supporters claim this allows for a more oxygenated blood to flow from mother to baby, which has been found to reduce the chances of iron deficiency at six months.
Many mothers who undergo caesareans say they are distressed that their child is “whisked away after just a fleeting glance”, or feel detached from the birth. The natural caesarean is intended to address this concern. As soon as the cord is cut, the baby is placed skin to skin on the mother’s chest and remains there for the rest of the surgery.
Charlotte Philby, 32, had two ordinary caesareans before having her third child by the natural procedure last year. “The first two were very clinical. The baby is cut out and immediately bundled up and whisked away,” she said.
“I had to wait so long to see my babies and it all felt quite detached from my own experience. They both started screaming the moment they were lifted away, which was quite distressing. You are lying there unable to do anything.
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“But the moment Xander [now seven months] lay on my chest, skin to skin, he was completely soothed. He was really calm and almost immediately started feeding. It was quite an amazing moment and I realised this is what women meant when they talked about their experience of birth. I had never felt that. It made me quite sad that I’d missed out on that with my other two children.”
More than 160,000 women have caesareans each year in the UK, of which 13.2 per cent are elective. Natural caesareans are mainly carried out in private clinics or at the few NHS hospitals with midwives and surgeons that have knowledge of the procedure.
It is offered only to women who have reached 37 weeks of pregnancy with no complications, and when the baby is head first in the uterus, with a healthy heartbeat.
Despite anecdotal evidence about its benefits, until now there has been little clinical data to back this up. The randomised trial scheduled for this summer, to be led by Belinda Green from University College Hospital, central London, will examine whether the procedure results in fewer babies being admitted to neonatal units with respiratory complications — a symptom common to babies born by caesarean.
“So many women say the bond with their baby is stronger after a skin-to-skin caesarean, and there is evidence to suggest it reduces a number of complications after birth, including problems with maternal mental health,” Dr Green said. “The demand for this type of birth continues to increase and I am constantly being contacted by women who want it. Hopefully this trial will help that to happen.”
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Patrick O’Brien, a consultant in obstetrics and gynaecology, said: “There are really no disadvantages to the method. It costs nothing extra and does not require specialist training. It should be available to every woman. This trial is an exciting step forward in the new direction caesarian surgery is taking.”