The Natural Cesarean

With more babies being born by Cesarean section, a new movement is campaigning to create a more natural experience for both mom and baby. It’s known as the “Natural Cesarean” or “Family-Centered Cesarean”. So, what exactly happens during this procedure? How can it improve bonding between you and your newborn? And why are some medical providers against it?

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Preggie Pals
The Natural Cesarean
Episode 2 , July 1, 2012

Please be advised, this transcription was performed from a company independent of New Mommy Media, LLC. As such, translation was requixaed which may alter the accuracy of the transcription.

[00:00:03]

Dr. Nick Capetanakis: With more babies been born by cesarean section ,a new movement is campaigning to make the event a more natural experience. It’s known as a Natural Cesarean or Family Centered Cesarean. I am Dr. Nick Capetanakis, an OB/GYN who believes birth should happen as simply as possible which is why I provide this excellent alternative to my patients. This is Preggie Pals, Episode 2.

[Theme Song]
Sunny Gault: Welcome to Preggie Pals broadcasting from the Birth Education Center of San Diego. I am your host Sunny Gault. Thanks so much for joining us. Preggie Pals is all about our listeners. Visit our website at http://www.preggiepals.com for more information on how you can become part of our show. You can join our conversation by following us on Facebook, Twitter and Google Plus. And you can also send us comments or suggestions through the contact link on our website or my favourite, you can call the Preggie Pals hotline is 619-866-4775.
Ok, I am joined by two other pregnant women here in the studio. I’m pregnant as well. As I said my name is Sunny; I’m 34 years old, I’m Web video host and producer. My due date is, I’m just going to go with April 23rd, because I’m having a C-section and that is the date they have scheduled it for. The gender is a little boy; this is my second little boy. I already have a son at home and yeah, like I said C-section, I would love for it to be a natural cesarean but we’ll see about that. Go ahead Amy.
Amy Barnes: Hi, I’m Amy. I’m 35, I’m a stay at home mum. My due date is July 1. The baby is a boy, we have a little girl at home and we are hoping for a vaginal birth.

Cherri Christiansen: I’m Cherri Christiansen, am 30 years old and I work in Market research. Am due with my first baby on the 20th of June and we are going to wait till then to find out whether it’s a boy or girl for the grand reveal; and if everything goes according to plan, we are going to have a home birth with my two fabulous mid wives.
[Music]
[Featured Segment: Prenatal Fitness Tips]
[00:02:28]
Sunny Gault: Before we start today’s show, here are some great prenatal fitness tips.

Lisa Druxman: Hi Preggie Pals, I am Lisa Druxman, Fitness expert and Chief Founding Mom of Stroller Strides, a fitness program for moms and babies. Am here to answer some of your most common questions. Today am here to answer, How much exercises should I do while pregnant?

Seems like so many moms are still thinking that exercise is something that they shouldn’t be doing while pregnant, and maybe they are a little bit scared, but am here to tell you, pregnant women should exercise, get this, most days of the week. It’s the same as the general population. The American College of Sports Medicine states that regular exercise is preferred over intermittent activity for pregnant women. And three times a week is the minimum recommendation. Here’s what I want you to get out of this. The most important thing is that you are consistent with you exercise program. It’s not good for someone, even if they are not pregnant, to exercise once in a while and then jump into it, it’s very taxing on the body. Whatever you are feeling your baby is feeling even more. So the best gift you can give your baby is to exercise and exercise regularly. Dr. James Clap is someone who I will mention many times on this radio show and he is one of their foremost researchers on pregnancy and exercise and he found out that beginning exercise early in pregnancy at a frequency of 3 to 5 times a week actually enhances the growth of the baby. So I’m here to say, please make sure that you are exercising and even though you might get tired as the pregnancy goes on and on, it is very, very important that you don’t stop. Now you will need to cut back. So what you were able to do on the first trimester, you might not be able to do on the second or the third. But you don’t want to exercise trimesters 1 and 2 and then just stop, it’s important that you keep yourself active and moving and a well designed fitness program that’s safe for you will be safe for the baby and will benefit you come that day of delivery and be good for both you and for the baby. Visit http://www.strollerstrides.com for more great information on how to stay fit through your pregnancy and through parenthood and be sure to listen to Preggie pals for more great pre-natal fitness tips.

[Music]

[00:04:45]
Sunny Gault: Today on Preggie Pals, we are exploring an alternative to having a traditional C-section and you may not have heard of this before, it’s called the Natural Cesarean, and joining us on here in the studio is Dr. Nick Capetanakis, an OB/GYN who has firsthand experience performing natural cesareans for his patients. Dr. Capetanakis, I’m just going to call you “Dr. Cap”, I know a lot of you patients do. It totally fits your personality. Welcome to this show and thanks so much for joining us.

Dr. Nick Capetanakis: Thank you for having me.

Sunny Gault: So I have to tell you that am really interested in today’s topic because with my son, I had a vaginal birth but had some complications afterwards. I had severe urinary incontinence and I had multiple surgery to try to repair that. Umm, my Urogynecologist recommended right after having my son, that all future babies be Cesarean babies. Literally broke my heart. I had such a good a experience delivering my son. Of course at the time I didn’t realize they were a lot of problems [laughs] but it was such a joyous experience. For someone to tell me that I had to have cesarean from here on out, was really devastating, because I don’t know how many kids we are going to have and am thinking, you know I would love to have all my kids birthed the same way I had my son birthed. Umm, so am in this position where I have to have a cesarean and I hear about this method called [laughs] the natural cesarean and it really appeals to me because I feel like it combines more of what I got with my vaginal birth.

Dr. Nick Capetanakis: The natural cesarean that was video produced last year, I believe it was out of England which kind of shows a different way that we can do a cesarean birth. I kind like to call it an abdominal delivery versus a vaginal delivery and in changing the name a little bit it kind changes what negative connotations may have been be attached with it. I would just describe kind of how I do cesarean section and again everything is with mom and baby’s best interests in mind, so time allowing, if everybody is doing well then certain things can be done differently so that mom can feel that she connects better with the delivery process. So, one, I always walk with my patients into the operating room and spend the time holding their hands or discussing whatever they want to talk about as they are getting their spinal anesthetic. The OR suites are kind of cold. They are bright but you definitely want me to see what I’m doing. So that’s kind of important.

All: [laughs]

Sunny Gault: Right.

Cherri Christiansen: Not a good time of dim lighting?

Dr. Nick Capetanakis: Not a good time for dim lighting

All: Candles, candles? [Laughs]

Dr. Nick Capetanakis: If patients want to bring in music, I you know I applaud them. Bring in some music, the anesthesiologist usually doesn’t mind and you can bring in some music to kind make the mood a little bit different so that you feel a little bit more comfortable. Ahh, you know you’re going to meet your anesthesiologist before you go in, so you should feel comfortable with him or her. Once you go in the spinal takes 10 minutes to be placed and then you know you lay down on the bed, you’re cleaned before the catheter is placed. All the while I’m in the OR and so at least you know some friendly faces. We like to keep our OR’s quiet. The same way our birthing suites are quiet, I want my OR to be quiet. I want to be able to talk and listen to all the key members in case there’s things I need to hear. Once you steril, we do put up the blue drape. The blue drape comes a little bit above your belly, below your breast and once we know you are numb, then we can bring in your husband or your partner. They will sit at the head of the bed. Usually at this point, you know the procedure’s begun and a few minutes you hear a baby crying and then you may get a quick glimpse and then the baby is you know is either brought to the warmer or umm, is taken to some place you may not have that connection. So the procedure then begins and one thing I should mention, the anesthesiologist has to place some lead on the mom’s chest to kind of monitor the heart rate, or moms heart rate and make sure everything is fine from that same point. Those leads can be placed somewhere on the back so that mom’s chest can be available to receive baby after delivery. So that’s one way the anesthesiologist can help out. Once we begin and then we make the incision on the uterus, I always let the mom know that we are really close, dad can stand up and take pictures. At this point I have usually had a discussion with the anesthesiologist and if he or she feels comfortable we can drop the drape so that mom can actually watch the birth of her child. So If you think about the view, it’s the same view the mom would be seeing if you were in a vaginal delivery. Sometimes the anesthesiologist can raise the table a little bit, so that mom can look over her belly and see the birth of her baby and kind of be the first, you know, sight that the baby sees is mom looking back at him or her. Then you can just slowly let the uterus contract out the baby and give it a little bit of time to extrude any fluid that the baby might have in his or her lungs which will help with breathing afterwards. Once baby is out, mom can, you know see the gender and then usually we kind of put the drape back up because then things are a little bit more clinical again. You can wait, you know, a few moments if you wanted to, to let the cord kind of pulsate and now you know people are feeling that waiting for delayed cord clamping has some benefit, so you can wait a little bit. This is where I differ a little bit from the video, because you also have an open abdominal wound. So you don’t want to wait too long because mom you know can be bleeding somewhat. Then baby is handed off to the waiting nurses; they quickly assess baby as long as baby is pink, crying, dad comes over, can trim the cord right there in the operating room and then baby can go back to mom and dad as quickly as possible. I have had patients breastfeeding in the OR. You can put baby on mom’s chest. I personally don’t need anything above you know the belly. If the anesthesiologist is going well and feels comfortable, the baby can be placed skin to skin, right on moms chest. And again I have had patients breastfeeding in the O.R.. Now all of this is done assuming that everybody is doing fine. That’s is the biggest thing. And then after the case is finished, dad is always with the baby. Dad leaves a few minutes before because we have to transfer mom over to, you know a different kind of gurney to get her out of the operating room. But somebody is always with the baby, a family member is always with the baby and then mom is quickly reunited back in the recovery room, so you know mom is with the baby the whole time.

Sunny Gault: Do a lot of women opt to do it this way as opposed to the typical way of having a C-section?

Dr. Nick Capetanakis: You know some moms don’t want to see necessarily the birth happening, you know it is an operation, so there is, I’m going to say, some blood, you know, to be seen, and some moms don’t necessary want that. But as far as having the baby come as quickly back so that she can hold the baby. That is another thing I should mention. Some anesthesiologists feel more comfortable with moms arms kind of being strapped down a little bit and that’s really for sterile reasons. Because you don’t want necessarily mom reaching into the operating field because you kind of get a little bit disconnected and your hands can go into the sterile environment so it’s very important to have control of those hands but you don’t necessarily need them strapped down, you can just remind mom that her hands ,you know needs to be on her chest and so she can hold her baby and feel his or her breath and warmth and touch, so...

Amy Barnes: Is this an option that is available to all moms out there or does it have to be a cesarean section that is planned? Like what if this is an emergency C-section, can you still do a natural caesarean?

Dr. Nick Capetanakis: You can, it just depends on the emergency. If it’s mom has been in labor for an extremely long time, baby is doing well, but you know labor you know has stopped progressing. Those are still considered urgent C-Sections because you don’t want necessarily wait for a long time. So you still can do that as long as mom and baby are doing well.

Cherrie Christiansen: And am curious why you decided that you wanted to offer this to patients. What was it about the procedure? Why was it so important to you?

Dr. Nick Capetanakis: You know when we had a vaginal delivery it’s done in a certain way usually my vaginal delivery’s, the lights are dim, if mom and dad want the music on, that is fine. You know, the bed is it necessarily broken down all the way. I don’t put on a blue gown. It’s not a sterile procedure. Anybody who’s had a baby can, you know, tell you that it’s not very sterile and I put on a pair of gloves and then we just have baby delivered and the receive him immediately on mom’s abdomen. Mom is able to bond with baby immediately, we wait for the cord to stop pulsating and then baby is on mom the whole time. So how can we take that experience of you know low stress easy, going and move that into an operating room where mom can still feel the connection was something that was important to me. Again you know I deliver in a place that allows me to do this. I deliver in a place where the nurses are comfortable with this and I deliver where the anesthesiologists are comfortable with it. It’s not that we are breaking any rules. Everything is sterile, everything is by the book, it’s just a different attitude towards the procedure. You know once you go in there it is still about the mom. It’s not about just doing something in then walking out. You know, It should all be focused on mom, and mom’s experience and that’s how that kind of translated to that. But, you know, at Scripps Encinitas, the nurses, the anesthesiologist are amazing and they allow us to do it this way and if mom want it that way.

Sunny Gault: Right, right.

Cherrie Christiansen: So are there other doctors in your hospital who are doing the same type of cesarean as well?

Dr. Nick Capetanakis: I guess I can’t say what everybody is doing. I think we all try to make it a special event as far as being with our patients, as far as getting baby back to mom, as far as getting baby back on mom chest as quickly as possible. I don’t know how many are necessarily dropping the drape and having their patient you know see the birth of the child but there are plenty of the OBs that you know the majority of that procedure.

Sunny Gault: But of course not all medical providers are willing to perform natural cesareans. We will learn more about why this procedure is considered a little bit controversial when we come back.

[Music]
[00:15:19]
Sunny Gault: Alright, welcome back. So with natural cesareans, there is a little bit of controversy with this. I actually know this firsthand because when I first saw the video, this YouTube video which we will put up on our website, so you guys can see it, take a look at it. I was all excited [laughs] about this procedure and the first thing I did was talk to my OB about it. And granted, my OB is part of a much larger establishment if you will, in medical community, and there are certain rules and there are certain regulations and I will be honest, she pretty much kind of laughed. She actually had never even heard of natural cesarean before. So am curious and was really bugged out because I really wanted to explore this option and have been getting a lot of resistance. So Dr. Cap in your opinion, why is they this resistance about it or what hang ups do the medical community have with this process?

Dr. Nick Capetanakis: First let me say, the way we do the natural cesarean at my hospital is all about sterility it’s all about safety it’s just tweaking a few things to make sure that mom feels that she has a little more control and she is more part of delivery of a child. I don’t think that is a wild concept and if we can, you know, do little things to make that a reality. I don’t think that is too far-fetched. I can’t really explain why some people may have some push back, I mean there are always questions about sterility, but again everything is done sterile. There may be some questions about having moms arms you know kind of strapped down a little bit and whether or not that will interfere with the procedure but again you can remind mom to keep her hands out of the sterile field and the tray does covers wide enough that she could have reach around it and up to get into the sterile environment. It’s hard to say. Having practiced the way I practice, I cannot necessarily say what other practitioners are thinking except for that’s kind of the way it’s been. Being able to take baby over to the warmer quickly, assess baby, give baby some APGAR scores and then get baby back to mom’s chest it doesn’t interfere with my operation and it doesn’t interfere necessarily with what the anesthesiologist is trying to make sure that mom is doing ok. So, I don’t see where the necessary push back would be on that aspect of it either.

Sunny Gault: I think the biggest hang up my OB had was when I said the blue curtain is dropped. And then baby comes to mom chest. I think at that point she was like, “You are breaking into the sterile environment, you cannot break the sterile environment,” I guess what would be your response to something like that or how do you guys ensure that you are not breaking a sterile environment?

Dr. Nick Capetanakis: Sure, you can drop the sterile drape from the front and just enough so that mom can see, you know the anesthesiologist grabs it from the non sterile side and he or she, you know drops the drape just enough so that mom can look over, see the birth of her child and again we wait till the head is delivered and then mom can then watch the rest of the body you know like kind of being delivered so she is not necessarily seeing anything. She is not seeing her insides, she is really just seeing from her top of belly down. Once baby is delivered, the drape can be raised by the anesthesiologist again and it’s still completely sterile.

Sunny Gault: Ok.

Dr. Nick Capetanakis: From that same, point as long as nothing goes over the drape as long as nothing touches, sterility is still maintained.

Sunny Gault: Ok, so baby actually kind of goes around the curtain as opposed to over the curtain?

Dr. Nick Capetanakis: Right, but again baby still goes to the warmer. So that’s a little bit different from the video where baby comes kind of over the drape and on to mom. So our initial assessments are still done in the warmer.

Cherrie Christiansen: And what is the reason for that? Why do you feel that the baby needs to go the warmer first before going to the mom’s chest?

Dr. Nick Capetanakis: It’s little bit easier to make sure that baby is doing well and if you think of mom’s chest she has a monitor there, the anesthesiologist is sitting at the head of the table along with her significant other, so space is a little bit limited, and so you really need to take baby over to the warmer to make sure baby is breathing again. Sometimes in cesareans all fluids isn’t extruded out of baby’s lungs and so respiratory issues are a little bit more common than in a vaginal delivery. You just want to make sure baby is doing better and you assess baby under good lighting before transferring baby over to mom so that you know when you give baby to mom you know that baby is doing fine.

Sunny Gault: And when the baby is brought to the mom’s chest, this was another issue my OB had. Obviously, you know, when you are operating on someone, there is a lot of sharp utensils, you know in the area and I know we talked a little bit about you know, do moms arms need to be tied down and stuff like but in a moment like that, you know sometimes we forget. We’re concentrating on our baby we may kind of do things really we are not supposed to do. So how do you ensure that mom isn’t injured or anything by all this utensils and stuff that are going around?

Dr. Nick Capetanakis: You know most of the instruments are still much farther down on mom’s belly; any sharp instruments are not on the fields for any significant amount of time. You use the instruments and its taken off the field and put on a stand. Again mom’s arms are going to be underneath the drape but you know higher up than any area that she would be able to get, you know harmed by any instruments because at that point, we are working a little bit lower down.

Sunny Gault: Ok.

Cherrie Christiansen: It sounds like it’s really dependant on the practice and things like that but if you had any advice on someone who, you know wasn’t planning on going to hospital. I am planning a home birth so if I do end up in hospital its because I absolutely have to be there or its an emergency situation where a C-section is called for I going to be meeting those people pretty much for the first time [laughs] and I don’t know what they are, how receptive they would to something like this, so you know there are certain things you think might be easier to ask for verses asking of all of this things, perhaps you know, maybe it doesn’t have to be all or nothing but I don’t know are there certain things that you think might be good for me to ask for in lieu of asking for everything.

Dr. Nick Capetanakis: Sure. I think you know probably one of the most important things is just to try and get baby as quickly to you as possible and having that skin to skin. You know, dropping the drape, watching your child being born is an amazing thing, but maybe not something you want to bat with the OB who you know is on call at night who is going to be delivering if you know you have to go to the hospital but you know asking the nurses and just telling them that I want my, you know my child brought to me as quickly as possible after he or she has been assessed and everything is fine, bring him to me and let my husband hold him or partner hold them and let me get some skin to skin, I think it’s a reasonable request. Also, in recovery just having baby recover with you in the room if possible is also something that allows you to bond. I mean you can go back, you can recover along with the baby on your chest the whole time and that I don’t believe it’s unreasonable request.

Amy Barnes: How long is recovery?

Dr. Nick Capetanakis: It’s usually about 2 hours.

Amy Barnes: Ok

Dr. Nick Capetanakis: Yeah, usually about those 2 hours guests are kind of minimized you just one to make sure moms blood pressure is doing fine and her bleeding is doing ok, the baby is transitioning ok.

Sunny Gault: And I know we have mentioned this video several times but are there other resources you would recommend for people that want to learn more about the natural cesarean?

Dr. Nick Capetanakis: I think the best thing to do is just have a conversation with your OB and talk to him or her and say you know, if I need to have a C-section or am having a planned C-section, “What are some of the things we can do to make this more experience about me and bonding?”. Not to diverge or whatever, but I had a patient who came to me who had a C-section with her first, because it was a breach and her second she wanted to have a vaginal delivery. 37 weeks baby was breach. We were able to do a aversion and kept baby’s head down and then we waited and waited and waited for labor and 42 weeks she still hadn’t had a baby and she wasn’t in labor and she did everything humanly possible. And we had to have repeat cesarean because I think for me that was the safest way. And she had had such bad feelings about her first C-section, that I talked to her about you know natural cesarean and she agreed and after the procedure watching her daughter being born. She cried and cried and she was like, “I feel like am healed, I feel like I have delivered a baby, I feel like I completely part of the process and I wasn’t so disconnected. And to this day, I just think about that one patient who actually feels she is whole again and she’s actually has delivered a baby and she feels like if you talk to her, that it was a vaginal delivery. For all intents and purposes that is how she envisioned it and it just something that will stick with me forever.

[00:24:37]

Sunny Gault: I love that. I’m just tearing up as you are saying that.

Cherri Christiansen: I was going to say, don’t make me cry…..

Sunny Gault: But that’s what I want. I want to have an experience that is as close to the vaginal birth that I had with my son and that’s exactly what I want.

Dr. Nick Capetanakis: It is possible

Sunny Gault: It is possible

Dr. Nick Capetanakis: It’s definitely possible.

Sunny Gault: Thank you so much Dr. Capetanakis for joining us today it’s been great chatting with you, the information has been fantastic. If you want to learn more about Dr. Cap and his practice, simply visit the episodes page on our website and look for today’s topic.

[Music]
[Featured Segment: Baby Registry Secrets]
[00:25:11]
Sunny Gault: Before we wrap today’s show, here are some baby registry secrets.

Havia Hi Preggie Pals, my name is Havia, Sales Associate and I got a baby, here to discuss some tips you want to consider when creating the perfect baby registry.

The first step is start early. This gives the store enough time to help you prepare your registry. An early start means we would be able to get the word out about your registry as well as give everybody time to review it and purchase the items you have requested. If you have registries in multiple locations, you will also be able to give everyone time to actually visit each of the locations and give them a wider range of items to pick from. It will also allow us to introduce you to different products as well as inform you about the latest trends and styles you may not be aware of. We would be able to tour the store with you and give you details about all of the products that catch your eye. You will be able to ask questions and get useful tips about all of these items so you are well educated about each product and can make confident decision about whether or not to include the item. Starting early will also give you the opportunity to make any changes if you feel there are necessary after finding more about the products. This is especially useful if you are new mother because you will be able to use new information that you just gather from other moms, classes and even your own research. For more tips on creating the perfect baby registry as well as what to include in the registry visit http://www.aganababy.com or follow us on Facebook and twitter at aganababy and be sure to listen to Preggie Pals to for more great registry tips in the future.

Sunny Gault: And that’s it for today’s episode. If you have a pregnancy topic you would like to suggest, we would love to hear it. Visit our website http://www.preggiepals.com send us an email through the contact link and if you have any questions of about today’s show or the topics we discussed, you can call our Preggie Pals hotline 619-866-4775 and we will answer your question on our upcoming episode.

Coming up next week, we will be revealing the truth about gestational diabetes. What is it and how does it impact you and your baby during pregnancy and what kind of effect it can have on labor and delivery?

Thanks for listening to Preggie Pals, Your Pregnancy, Your Way.

[Disclaimer]

This has been a New Mommy Media production. Information and Material contained in this episode are presented for educational purposes only. Suggestions and opinions expressed in this episode are not necessarily those of New Mommy Media and should not be considered facts. Both information and materials are related to be accurate. It is not intended to replace or substitute for professional, medical and advisor care. And it should not be used for diagnosing or treating house care problems or disease or prescribing any medication. If you have questions or concerns regarding your physical or mental health or the health of your baby, please receive assistance from a qualified health care provider.

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