DiversityNursing Blog

JENNIFER SCHMIDT

There are many reasons women need cesareans. Sometimes the situation is truly life-threatening. But often the problem is that labor simply isn't progressing. That was the case for Valerie Echo Duckett, 35, who lives in Columbus, Ohio. After receiving an epidural for pain, Duckett's contractions stopped. By late evening she was told she'd need a C-section to deliver her son, Avery. Duckett says she has vague memories of being wheeled into the operating room, strapped down and shaking from cold.

"They were covering me up with warm blankets,"she says. "I kind of slept in and out of it." Her only memory of meeting her newborn son for the first time was from some pictures her husband took.

This is the experience many women have. The cesarean section is the most common surgery in America — about 1 in 3 babies is delivered this way. But for many women, being told they need a C-section is unpleasant news. Duckett says she felt like she missed out on a pivotal moment in her pregnancy.

"It took me a long time even to be able to say that I gave birth to Avery," she says. "I felt like I didn't earn the right to say I gave birth to him, like it was taken from me somehow, like I hadn't done what I was supposed to do."

Duckett's reaction to her C-section is unfortunately a common one, says Betsey Snow, head of Family and Child Services at Anne Arundel Medical Center, a community hospital in Annapolis, Md.

"I hear a lot of moms say, 'I'm disappointed I had to have a C-section.' A lot of women felt like they failed because they couldn't do a vaginal delivery," says Snow.

Now some hospitals are offering small but significant changes to the procedure to make it seem more like a birth than major surgery.

In a typical C-section, a closed curtain shields the sterile operating field. Mothers don't see the procedure and their babies are immediately whisked away for pediatric care — a separation that can last for close to half an hour. Kristen Caminiti, of Crofton, Md., knows this routine well. Her first two sons were born by traditional cesarean. She was happy with their births because, she says, it was all she knew. Then, just a few weeks into her third pregnancy, Caminiti, who is 33, saw a post on Facebook about family-centered cesarean techniques catching on in England.

"I clicked on the link and thought, 'I want that,' " she says.

The techniques are relatively easy and the main goals simple: Let moms see their babies being born if they want and put newborns immediately on the mother's chest for skin-to-skin contact. This helps stimulate bonding and breast feeding. Caminiti asked her obstetrician, Dr. Marcus Penn, if he'd allow her to have this kind of birth. He said yes.

When Caminiti told Penn what she wanted, his first thought was it wouldn't be that difficult to do. "I didn't see anything that would be terribly out of the norm," he says. "It would be different from the way we usually do it, but nothing terrible that anyone would say we shouldn't try that."

Family-centered cesareans are a relatively new idea in the U.S., and many doctors and hospitals have no experience with them. Penn and the staff at Anne Arundel Medical Center quickly realized the procedure would require some changes, including adding a nurse and bringing the neonatal team into the operating room.

And there were a bunch of little adjustments, such as moving the EKG monitors from their usual location on top of the mother's chest to her side. This allows the delivery team to place the newborn baby immediately on the mother's chest. In addition, Penn says, the mother's hands were not strapped down and the intravenous line was put in her nondominant hand so she could hold the baby.

At the beginning of October, Caminiti underwent her C-section. She was alert, her head was up and the drape lowered so she could watch the delivery of her son, Connor. Caminiti's husband, Matt, recorded the event. After Connor was out, with umbilical cord still attached, he was placed right on Caminiti's chest.

"It was the most amazing and grace-filled experience to finally have that moment of having my baby be placed on my chest," Caminiti says. "He was screaming and then I remember that when I started to talk to him he stopped. It was awesome."

And the baby stayed with her for the rest of the procedure.

Changes like this can make a big difference, says Dr. William Camann, the director of obstetric anesthesiology at Brigham and Women's Hospital in Boston and one of the pioneers of the procedure in the U.S. At Brigham and Women's, their version of the family-centered cesarean is called the gentle cesarean. Moms who opt for it can view the birth through a clear plastic drape, and immediate skin-to-skin contact follows.

Camann says the gentle C-section is not a replacement for a vaginal birth; it's just a way to improve the surgical experience. "No one is trying to advocate for C-sections. We really don't want to increase the cesarean rate, we just want to make it better for those who have to have it," he says.

So why has the procedure been slow to catch on? Hospitals aren't charging more for it — so cost doesn't seem to be a major factor. What's lacking are clinical studies. Without hard scientific data on outcomes and other concerns like infection control, many hospitals may be wary of changing their routines. Betsey Snow of Anne Arundel Medical Center says the family-centered C-section represents a cultural shift, and her hospital is helping break new ground by adopting it.

"It is the first time we have really done anything innovative or creative with changing the C-section procedure in years," she says.

Kristen Caminiti says her hope is that these innovations become routine. She says she'd like nothing more than to know that other women having C-sections are able to have the same amazing experience she had.

Source: www.npr.org

Ben Brumfield

Days before he's scheduled to leave the hospital, he's already gone viral on social media because he was born 'en caul.'

Silas was completely encased in his amniotic sac, said Los Angeles' Cedars-Sinai Medical Center in a Facebook post. That's so rare, that even doctors delivering babies hardly see it. So Silas' doctor snapped a photo with his cell phone.

It looked like the baby was trapped in a big water bubble.

"Even though it's a cliche -- we caught our breath," neonatologist William Binder told CNN affiliate KCAL. "It really felt like a moment of awe." 

Then Binder got to work helping Silas to breathe - and giving him special care, because Silas was born three months before his due date via Caesarean section.

Later, Silas' grandmother showed the cell phone photo to his mother, Chelsea Philips.

"It was definitely like a clear film, where you could definitely make out his head and his hair," Philips told the affiliate. Silas was curled up in fetal position inside.

What is 'en caul'

 The amniotic sac is an opaque bubble that covers all babies in the womb from right after conception. As the baby grows, it fills with fluid, including the baby's urine. 

The sac cushions the baby from bumps and jostles during mom's daily ups and downs.

Normally, during a birth, it breaks, and the fluid rushes out, which is where the term 'breaking water' comes from.

But sometimes, the sac can get stuck around part of the baby, according to Dr. Amos Grunebaum, an obstetrician and gynecologist, who publishes a website on birth and baby care. 

It can, for example, get stuck on the baby's head, which makes it look like its wearing a glass space helmet. That's also where the term caul comes from -- it derives from Latin words that refer to a helmet.

Such amniotic sac helmet births are rare enough, but to have the entire baby inside the sac, or 'en caul,' occurs in less than one in 80,000 births, Cedars-Sinai said.

When Philips heard how rare her Baby's birth was, she was flabbergasted. "I was like, oh my gosh, Silas, you're a little special baby," she told KCAL.

It's particularly surprising in a C-section, because the scalpel usually pierces the amniotic sac.

The doctors must have missed Silas's.

Source: www.cnn.com

By Robert Preidt

Cesarean delivery was the most common inpatient surgery in the United States in 2011 and was used in nearly one-third of all deliveries, research shows.

The new study found that 1.3 million babies were delivered by cesarean section in 2011. The findings also revealed wide variations in C-section rates at hospitals across the United States, but the reasons for such differences are unclear.

"We found that the variability in hospital cesarean rates was not driven by differences in maternal diagnoses or pregnancy complexity. This means there was significantly higher variation in hospital rates than would be expected based on women's health conditions," lead author Katy Kozhimannil, an assistant professor in the School of Public Health at the University of Minnesota, said in a university news release.

The researchers analyzed data from more than 1,300 hospitals in 46 states. They found that the overall rate of C-section was about 33 percent. Between hospitals, however, that rate ranged between 19 and 48 percent, according to the study.

For women who'd never previously had a C-section, the overall C-section rate was 22 percent. Depending on the hospital, that rate ranged between 11 percent and 36 percent, the researchers said.

C-section rates ranged from 8 percent to 32 percent among lower-risk women and from 56 percent to 92 percent among higher-risk women, according to the study published Oct. 21 in the journal PLoS Medicine.

The findings highlight the roles that hospitals' policies, practices and culture may have in influencing C-section rates, the study authors concluded.

"Women deserve evidence-based, consistent, high-quality maternity care, regardless of the hospital where they give birth, and these results indicate that we have a long way to go toward reaching this goal in the U.S.," Kozhimannil said in the news release.

Source: www.nlm.nih.gov