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The Gentle Cesarean: More Like A Birth Than An Operation


4 Star



The Gentle Cesarean: More Like A Birth Than An Operation

Our Review Summary

This NPR story was a pleasure to listen to, as well as read. It was full of color, anecdotes and scenes, at least in the audio piece. But the two mothers who are proponents of so-called family-centered C-sections ran the whole show, and there were no counter-arguments to put their experiences into perspective. One comes away from this story wondering whether there are any disadvantages at all to family-centered cesareans. For example, is it possible that watching the procedure could be traumatic for some mothers? Seeking out the perspective of an independent expert — perhaps an ob/gyn who who routinely performs standard C-sections — would’ve been a good way to balance the enthusiasm of proponents with a more objective viewpoint.


Why This Matters

Almost a third of babies are delivered via C-section in the United States, and many mothers are not happy with their cesarean birth experience, preferring the natural delivery method instead. The family-centered cesarean holds the potential to improve some mothers’ birth experience while also providing long-term health benefits to their infants. Well-written explanatory pieces in the mainstream media could also help new procedures gain acceptance in US hospitals and the medical community.


Does the story adequately discuss the costs of the intervention?


The story said hospitals aren’t charging more for the family-centered cesarean. We’ll judge this nod in the direction of costs to be sufficient for a satisfactory rating, but ideally we’d like to see a dollar estimate for what a traditional cesarean costs. In addition, we’d note that the family-centered cesarean does involve some additional resource costs — for example, extra nursing staff and the logistics of getting the neonatal team into the operating room — that should be considered, even if these are not currently reflected in typical hospital charges.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

The family-centered or gentle cesarean is put forth as a good alternative to traditional C-sections, since mothers play more of more of an active role during and after the birth of their children. The piece talked about how the family-centered cesarean allows mothers to see their babies being born, with newborns being placed immediately on the mother’s chest after birth. The skin-to-skin contact helps to stimulate bonding and breast feeding, the report said.

While the benefits are addressed in broad strokes, we can’t rate the story satisfactory because there are no numbers to back them up. (There are studies that could’ve been used to quantify benefits.) We’d also caution that while the notion of a more active role for the mother seems intuitively desirable, there is no balance in this story from the perspective of a woman who might not be so gung-ho about the idea of watching a baby being extracted from her pelvis. We do know that not all patients like to watch procedures they are undergoing.

Does the story adequately explain/quantify the harms of the intervention?


Although the story did not address specific harms per se, it did mention that there was a lack of clinical studies on this topic – implying that nobody really understands the potential risks of this approach compared to a typical C-section. The piece also pointed out that infection control is a potential concern with family-centered C-sections, and that hospitals would be slow to change their routines without hard evidence on infection rates. We think that’s enough to merit a satisfactory rating here.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

Although the story pointed out there is a lack of clinical studies, that doesn’t mean that there haven’t been any studies at all. What was missing from this piece was context. Why has this procedure caught on faster in other parts of the world than in the US? The piece could have also mentioned how early contact (or a lack of) with the mother could have long-term health effects for the newborn, instead of telling the story only from the mother’s point of view.

In addition, the heavy reliance on anecdotal evidence from the mothers placed an overly positive spin on the procedure, as there weren’t any other comments to put those experiences into perspective. For example, the language used in the last sentence of the report is a bit over the top: “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.”

Does the story commit disease-mongering?


There is potential for disease-mongering in the concept of the family-centered C-section. If it ends up increasing the number of women who deliver surgically instead of vaginally, then that would represent a further unnecessary medicalization of the birth process. However, the story specifically quotes an expert who says that’s not something advocates are looking for: “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.”

While that’s a useful sentiment, we think it would have been helpful for the story to explicitly acknowledge the problem of high cesarean birth rates in the U.S. compared with other economically advanced nations.

Does the story use independent sources and identify conflicts of interest?

Not Satisfactory

It seems that all the experts interviewed in the story have ties to the mothers who are advocates for this approach or to the concept of the family-centered cesarean. One of the people interviewed was Dr. William Camann, a pioneer of the procedure in the US. It would have been interesting to hear from a doctor who opts for a traditional C-section instead of a family-centered one, or one who routinely performs C-sections. That would have been a good opportunity to put an independent perspective into the piece and also to expand on the question, “Why aren’t family-centered cesareans more popular in the US if mothers are so happy with them?”

Does the story compare the new approach with existing alternatives?


The piece compared other alternatives to the family-centered cesarean — mainly, the vaginal delivery and the traditional C-section. It mentioned that in a typical C-section, a closed curtain shields the operating field and the baby is quickly whisked away after birth.

Does the story establish the availability of the treatment/test/product/procedure?


This was a tricky one. The piece said family-centered cesareans are not routine, and it did not firmly establish if every mother who asks for the procedure would be accommodated. We’ll give the benefit of the doubt, but we’d note that the story could have addressed how women can find providers who are known to offer family-centered cesareans. It also could have discussed whether hospitals are generally willing to accommodate these practices if asked to do so.

Does the story establish the true novelty of the approach?


The piece presented the family-centered cesarean as a “relatively new idea in the US” and mentioned that it has been “slow to catch on.” But media outlets have been writing about it since London-based professor NM Fisk wrote about the idea in 2008 in the journal BJOG. Brigham and Women’s Hospital in Boston also released a press report in June 2013.

Although the phrase “relatively new” is vague, we think it’s enough for a satisfactory rating.

Does the story appear to rely solely or largely on a news release?


The story does not seem to be based on any press releases. The quotes and sources used show signs of original reporting.

Total Score: 7 of 10 Satisfactory

Comments (1)

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Judith Ronat M. D.

March 16, 2015 at 9:30 am

It seems to me that when not necessary for the health and life of the mother or the fetus, one should consider the late complications of any cesarean section, namely adhesions.