What Are Gentle C-Sections?

Gentle C-sections are a type of cesarean section that incorporates aspects of a labor and delivery experience that parents might have with a vaginal birth, such as skin-to-skin contact, immediate breastfeeding if desired, and even witnessing the baby's birth.

Although numerous medical studies have pointed to the benefits of immediate skin-to-skin contact and early breastfeeding initiation, the complications of the surgery room can make incorporating such strategies a little more difficult.

But now, more hospitals and doctors are offering a different kind of C-section, dubbed a "natural" or "gentle" C-section. Here’s everything you need to know about gentle C-sections and how to choose one for your family.

What Is a Gentle C-Section?

A gentle C-section is a cesarean section that incorporates as many aspects of a person's birth plan as medically possible while the baby is still in the OR. The term "gentle" refers to gently mirroring some of the aspects a vaginal birth experience might bring.

A gentle C-section could include:

• Skin-to-skin contact
• Immediate breastfeeding or chestfeeding
• Birth photography
• The presence of a doula
• Partner involvement
• A clear drape to see the baby being born
• Other comfort measures, such as playing preferred music
  

The British Journal of Obstetrics & Gynecology described gentle C-sections as "woman-centered," but today, a more accurate description is "family-centered," as they allow for more inclusion of the first family moments together. And a 2023 study on gentle C-sections concluded that many of the interventions involved with a gentle C-section, including a clear drape, were preferred by the majority of people having a surgical birth.

Gentle C-Section vs. Traditional C-Section

The actual technique of surgery in a gentle C-section does not change; instead, the term refers to what happens between the family present. "To be very clear, a gentle C-section is still surgery," says David Garfinkel, MD, attending physician at Morristown Medical Center and senior partner at One to One FemaleCare in New Jersey. "As a physician, I am not being more gentle as I do the surgery."

That being said, certain aspects of what happens after the surgery may be approached differently with a gentle C-section. Kecia Gaither, MD, MPH, FACOG, maternal-fetal medicine specialist and director of perinatal outreach at Montefiore Medical Center and Albert Einstein College of Medicine Bronx, New York, explains that in a gentle C-section, the baby will go first to the parents instead of right to the medical team after birth whenever medically possible.

"In a traditional C-section, the baby is delivered quickly and handed to the pediatricians, but in a gentle C-section, the baby's head is delivered, then slowly the rest of the body is delivered, allowing a bit of a squeeze to get that extra fluid from the lungs expelled, then the baby is placed on the mother's chest and breastfeeding is initiated," she says.

Delayed cord cutting can also be part of a gentle C-section. "There is no quickness elicited in cutting the cord; that procedure is delayed and the baby stays with the mother throughout the entire operative procedure," says Dr. Gaither.

Dr. Garfinkel also explains that gentle C-sections mirror a shift from a doctor's perspective as well, in seeing a C-section as a birthing experience, rather than just a surgery. "A gentle C-section is a change in the attitudes toward C-sections, where the care team [the obstetrician, anesthesiologist, and nurses] aims to make the C-section experience in the operating room as similar as possible to the labor and delivery room," she notes.

Should You Consider Gentle C-Section?

While many pregnant people aim for a vaginal birth, in some cases, C-sections are the best choice for the parent and/or baby and a gentle C-section aims to incorporate the best of both worlds as much as possible.

"By offering this more emotional experience, we are not looking to increase the number of C-sections, but as a physician, it is my goal to ensure women don't look at having a C-section as a failure," explains Dr. Garfinkel. He adds that a gentle C-section can allow a new parent to be almost as involved as if the birth was happening vaginally if they wish. "I believe all women should be given the opportunity to be as much part of a part of their births as they want," he notes.

Gentle C-sections also have benefits for the baby since skin-to-skin can be initiated early, which can increase breastfeeding rates and cardio-respiratory stability, says Allie Sakowicz, a certified birth doula through DONA and a member of the Maternal-Fetal Medicine research team at Northwestern University's Feinberg School of Medicine in Chicago. "While this is generally common practice after vaginal deliveries, babies who are born by cesarean section should also be able to receive the benefits associated with immediate skin-to-skin contact," she adds.

How to Write a Gentle C-Section Birth Plan

You can write a gentle C-section birth plan just as you would any other birth plan, noting your preferences for:

• Who can be in the room with you
• If you want to initiate breastfeeding right away
• If you want delayed cord clamping done
• If you or your partner want to do skin-to-skin with the baby
• If you'd like the baby to stay with you as long as possible
• Preferences for atmosphere such as music, lighting, or comfort items as able
• If you'd like to see the birth
• If you'd like your baby's first bath delayed

"The most common requests that I have seen included in a gentle C-section birth plan call for immediate skin-to-skin contact after delivery and the initiation of breastfeeding in the [operating room]," says Sakowicz.

She adds that other requests include the birthing parent not having their arms restricted, EKG monitors being placed on the back and side, playing music in the operating room, or using a clear drape so the parents can see the delivery.

How to Request a Gentle C-Section

"I recommend that all expectant parents discuss the possibility of a gentle C-section with their physicians, regardless of [whether] a Cesarean section is planned or not," says Sakowicz. That way, all preferences are documented in the event a C-section becomes necessary. "It's much easier to have these conversations weeks ahead of time in the provider's office than in the hospital when a C-section becomes necessary and time is of the essence," she points out.

Dr. Gaither agrees saying: "It would be best broached with the health provider at the beginning of prenatal care to ensure the availability or feasibility of the procedure and the comfort level of the physician who would be delivering the baby."

Sakowicz also recommends asking for an anesthesiologist consult prior to delivery. "The anesthesiologist is the person in charge of the [operating room], and they have far more control than the [obstetrician] does about things like who is in the delivery room."

While it's always advisable to share your preferences with your providers, the good news for birthing people is that many of the practices associated with gentle C-sections are becoming more standard. "Gentle C-sections are the future," says Dr. Garfinkel. "More and more patients are asking about them, [and] I've never had a patient turn down an opportunity to have one."