This is fascinating – although an oxymoron (natural cesarean?), it immediately and instinctively appealed to me as a midwife. (Photo is of a cesarean in rural Nepal)

In recent years, even as the cesarean rate has soared, research has acknowledged and supported the advantages of natural vaginal birth including physiological resuscitation as the baby descends through the birth canal, close and immediate parental contact, and early initiation of breastfeeding (enhanced by the baby’s association of the smell of amniotic fluid with that of mother’s milk), in addition to eliminating unnecessary technological interventions.  However, those women who undergo cesarean section are deprived of these advantages.

The authors of an article recently published in the British Journal of Obstetrics and Gynecology “describe a ‘natural’ approach that mimics the situation at vaginal birth by allowing (i) the parents to watch the birth of their child as active participants (ii) slow delivery with physiological autoresuscitation and (iii) the baby to be transferred directly onto the mother’s chest for early skin-to-skin.”

According to the authors, “increasing evidence shows that women undergoing caesareans have a less satisfactory childbirth experience than those delivering vaginally and are more prone to postnatal depression, bonding difficulties and unsuccessful breastfeeding.”   As midwives, our philosophy of care (and common sense) would applaud this new approach to cesarean section.  However, as the commentator says, “…no outcomes or safety data are presented to justify widespread utilisation of this technique.”  Obstetricians are quick to support and point to research outcomes when they justify what they want to do anyway (e.g., mandatory CS for breech, VBAC, etc) but much less likely to accept new procedures or studies that run counter to their prevailing beliefs and current practice.

I am doubtful that this approach will be adopted by the majority of American obstetricians in the short run and without exhaustive research studies (which will be hard to do) without pressure from outside their profession. Midwives need to take the lead in educating our obstetric colleagues about the many advantages offered by this approach, and encourage their adoption.  And parents need to take the lead in demanding “natural cesarean” when they are faced with the inevitability of a cesarean birth. Consumer demand has been shown to be a powerful tool for change, as women demonstrated to obstetricians and hospitals 50 years ago.

Smith J, Plaat F, Fisk N. The natural caesarean: a woman-centred technique. BJOG 2008;115:1037–1042, available online at