Gentle Cesarean Section as a Humanistic Surgical Birth Model

According to the Clinical Protocol on Cesarean Section Surgery (2022) , the number of cesarean deliveries has been increasing in all countries in the modern era. In various countries, cesarean sections account for 5% to 50% of live births. The reduction of perinatal losses through the increased frequency of cesarean sections is possible only up to a certain limit. According to WHO recommendations, when the rate of cesarean deliveries exceeds 15% of total births, it no longer contributes to a decrease in perinatal mortality.

In Azerbaijan, over the last five years, the frequency of cesarean sections increased from 31.2% in 2016 to 39.6% in 2019 and was 38.7% in 2020. All developed countries also observe a similar upward trend, despite differences in absolute rates.

At the same time, Gentle Cesarean has emerged recently as a more humanistic model of surgical birth worldwide. The aim is to transform the procedure from being solely a medical intervention into a process that is more natural and emotionally supportive for both mother and newborn. The primary focus is on immediate skin-to-skin contact between the newborn and the mother and ensuring early bonding. Early contact accelerates the establishment of physical and emotional connections, promotes the timely initiation of breastfeeding, and enhances the mother’s psychological comfort.

What is the “Open Window” effect, and why is it used?

In gentle cesarean, the so-called “transparent drape” is actually a clear plastic window located in the upper part of the surgical drape. An opaque drape completely separates the mother from the surgical field during a standard cesarean, preventing her from seeing any part of the procedure. In a gentle cesarean, however, the mother can see her newborn through this transparent window the moment the baby is delivered. Sterility is maintained, as the area where the surgeon operates remains fully covered. This visual contact enhances the mother’s sense of involvement in the birth process and establishes the first step in bonding with her baby.

In which countries is gentle cesarean practiced?

This approach was first implemented in the United Kingdom. It later spread to Australia, Canada, Germany, and the Scandinavian countries. In the United States, it is known as “family-centered cesarean.” The level of implementation varies between countries: in some clinics it has become standard practice, while in others it is offered only to selected patients.

Why is a gentle cesarean considered advantageous?

The most important advantage of a gentle cesarean is the early initiation of contact and more successful breastfeeding. The newborn is placed immediately on the mother’s chest. This skin-to-skin contact increases maternal oxytocin levels. Oxytocin accelerates milk let-down and induces calmness in the mother. The infant’s sucking reflex is activated early, which leads to an increase in prolactin and enhances milk production. The mother’s body naturally regulates the baby’s temperature and blood sugar, helping the infant conserve energy and feed more effectively. All these factors contribute to a smoother and more natural start to breastfeeding.

Disadvantages and challenges

Gentle cesarean may not be suitable for every pregnancy. This model is not applied in cases of emergency delivery, high-risk situations, or when the newborn requires resuscitation. The presence of a neonatal physician in the operating room, the involvement of additional staff, and changes in the logistics of the procedure can also create certain challenges. Some physicians approach this type of cesarean cautiously because they are reluctant to deviate from standard protocols.

Why is it less common in Azerbaijan?

Clinics may require structural changes, staff training, and full participation of a neonatologist during delivery. Fear of breaching sterility and a sense of responsibility increase the caution of specialists. The absence of clear, official protocols for gentle cesarean also contributes to delays in implementing the procedure.

What can be done to increase gentle cesareans?

For this model, the development of safe protocols and short training sessions for staff are sufficient. Educating pregnant women and including the option of gentle cesarean in the birth plan are also important. Providing information within clinics that this approach does not conflict with sterility rules can reduce the cautious behavior of specialists.

The impact of early contact on breastfeeding

Placing the newborn on the mother’s chest during the first hour after birth is the most important stage for initiating breastfeeding. Skin-to-skin contact naturally increases oxytocin and prolactin levels in the mother. These hormones enhance milk let-down and production. The infant feels secure on the mother’s chest, stabilizes heart rate and respiration, conserves energy, and feeds with a stronger sucking reflex. All of these mechanisms positively influence the success and sustainability of breastfeeding.

Author: Zivar Eldarova
Gynecologist