Top doctor calls for more awareness of 'gentle' caesareans to improve childbirth experience

  • A special report from ITV Cymru Wales health reporter Katie Fenton and camera operator Tim Ward.

A leading birth doctor is calling for more awareness of ‘gentle’ caesareans to help improve the experience of people giving birth in Wales.

Gentle caesareans - sometimes referred to as ‘natural’ or ‘family-centred’ caesareans - aim to prioritise immediate skin-to-skin contact and delayed cord clamping.

Families are also allowed to have the screen down in order to see the baby emerging from the womb, play their own music and take photos of the birth.

Hywel Dda University Health Board's lead consultant for obstetrician and gynaecology hopes to see his approach become the norm and a move away from the term ‘gentle’.

Ihab Abbasi first came across the concept when he was a trainee in England but initially felt sceptical.

“I remember a woman coming in asking for the light to be dimmed, music to be played, to have the baby skin-to-skin straight away, for us not to rush and cut the cord straight away,” he said.

“I remember the team was thinking ‘no this is just ridiculous, we’re not going to do that, we’re just going to do what we want to do’.”

Consultant obstetrician and gynaecologist Mr Ihab Abbasi has been performing 'gentle' caesareans since 2018.

A few years later his now wife, a counsellor who often deals with birth trauma, asked him whether he had tried it.

In 2018, he carried out his first gentle caesarean and said he has never looked back. 

“I went into the theatre thinking this is the most ridiculous thing, it’s just for show, and I came out thinking this is the only way I’m going to do a caesarean.

“The actual surgical technique doesn’t differ a lot - you’re going to have to make the cut the same way and close the layers the same way - it’s the birth itself.”

Mr Abbasi said mothers have previously told him their experience was “rushed, their baby was taken away from [them], and the baby was wrapped when they came to [them]”.

Families at Glangwili Hospital are encouraged to take photos and videos of the birth and bring their own music which can be played out through speakers in the theatre.

The anaesthetist attaches monitors to the mother’s back, rather than across the chest, so that she can have immediate skin contact with the baby without wires getting in the way.

Families are allowed to have the screen down during the caesarean so they can watch their baby emerging from the womb.

Once Mr Abbasi helps the baby’s head emerge he encourages mothers to push, which he said helps them “feel part of it”.

Mothers can also choose whether they would like the screen down in order to see their baby being born.

“It’s not much to ask and we all know the benefits. We all know how important skin-to-skin is; to keep the baby warm and improve the bonding with the mum, and also how important the delayed cord clamping is to give the baby oxygen and iron.

“There’s no rush in doing these things and there shouldn’t be unless there is a reason. If the baby needs to go and get checked, of course we’re going to do that, but in most planned caesarean births and a lot of unplanned ones as well, the baby is absolutely fine.

“Therefore why would we need to pass it to a midwife who’s going to take them, why wouldn’t the mum be the first one to cwtch her baby?”

Evidence suggests that early skin-to-skin contact can improve bonding, infant feeding, breastfeeding outcomes and infant crying.

Victoria Thomas and Robert Thomas had their third caesarean birth earlier this month and described the experience at Glangwili Hospital as “magical”. 

Speaking after the birth, Victoria said: “I had no experience before of pushing the baby out, to be able to do that and be involved in that was really magical.”

Robert added: “It felt a lot calmer. It wasn’t as rushed and it was much more personal.”

Mr Abbasi and his team collected data to investigate any potential safety concerns and found there was no increased risk of infection, less bleeding and improved outcomes for babies. 

Theatre practitioner Catrin Sykes, responsible for keeping the theatre sterile, said patient safety remains the priority.

“We make sure that the risk of infection is still less, the patient will always be our priority. We would never do anything to put patients at harm,” she said.

“We keep them informed and just let them know what’s going on at all times.

“Everyone in the theatre’s got their own roles and skills and we’re all mixed together to make sure everything is as safe as possible for the patient.”

Studies have shown that these adaptations of caesareans do not cause any increased risk of complications for mothers or babies.

Clinical and operational lead midwife Alison Jones said there has also been “significant” changes in the use of language.

“A very significant change that I have seen is instead of us being involved in the ‘delivery’ of a baby, we are there to support the birth of a baby. It’s very much the mum and the family and that baby at the centre of what we do,” she said.

“Having babies is very natural but it also comes with a lot of fear and a lot of unknown. It’s not an exact science having babies and there’s no instruction book that comes along with it.

“As a midwifery profession we’re central in supporting the mums and families in growing their confidence and supporting them to be at the centre - what they choose is what we will support.”

Mr Abbasi believes a lack of awareness and resistance to change are the main reasons why gentle caesareans are not yet the norm.

He and the team want to see the term ‘gentle’ eradicated.

“I don’t want to give it a different name. I want to have the day that every caesarean is focused on the mum and making sure it’s a birth experience,” he said.

“I feel more awareness of this makes more women want to ask for it and then that will force the doctors to start rethinking the way they’re doing it.” 

Of all births in 2022, one in five arrived via emergency caesarean and close to one in seven arrived via planned caesarean (Stats Wales).

Just over a third of babies in Wales were born by caesarean in 2022, the highest percentage on record, according to the most up-to-date figures from Stats Wales.

Clinical guidelines issued by NHS Scotland in 2022 set out four core principles to gentle caesareans: the promotion of a holistic birth experience, slow delivery of the baby without fundal pressure, optimal cord clamping and early skin-to-skin contact.

Studies have shown that this adaptation of the traditional caesarean does not cause any increased risk of complications for mothers or babies.

It is hoped that by allowing a slow delivery of the baby without the use of fundal pressure - which involves someone pushing on the uterus to assist the birth - a more physiological birth is achieved as well as enhancing the birth experience for the woman or birthing person and their partner.

Early skin-to-skin contact is associated with improved bonding, infant feeding, breastfeeding outcomes and infant crying.

The Scottish guidance is for gentle caesareans to be offered and discussed in the antenatal clinic at the booking appointment for anyone considering a caesarean birth.

While there are no such guidelines in Wales, the Welsh Government has welcomed the work being done in west Wales, adding that it expects a “family-centred approach” during all pregnancies and births.