Sassica Francis-Bruce
For the birth of my first child, I had what’s called an “elective” caesarean. Ironically, I wasn’t given a choice.
My baby was breech, and efforts to turn him were unsuccessful. It was not at all how I wanted to give birth, but regardless there I lay, paralysed on the operating table in a cold and brightly lit theatre, surrounded by a dozen very busy strangers.
It was the most momentous day of my life, but I felt powerless, uninvolved and, quite frankly, a little irrelevant. Surely, my role in the birth of my child was more than just lying down and listening to the obstetrician’s playlist?
Immediately after birth, the midwife thought my firstborn baby – who is now a vibrant, almost four-year-old – was unwell and whisked him away for 20 minutes to assess him. No one told me what was happening, and I became so sick from the anesthetic I spent the next 12 hours mostly unconscious while my partner held our son.
Fast forward two years, and I’m in the same operating room for my second child’s birth, having another caesarean. This time I feel empowered and involved, having just played an integral part in the most deeply moving experience of my life. My baby’s warm body lies on my bare chest as he nuzzles closer into my neck. He’s breastfeeding even before I am wheeled out of surgery.
The difference? I had a maternal assisted caesarean.
“A what?” I had asked months earlier when my new obstetrician, Sydney-based Georgina Davis, suggested it.
A maternal assisted caesarean (MAC), she explained, is a modification to a traditional caesarean. It allows a mother to actively participate in her own caesarean by surgically scrubbing in and lifting her baby from her womb to her chest for immediate skin-to-skin.
“The benefits of MAC are maternal satisfaction and walking away from birth feeling completely empowered and in control,” says Davis. For women who have had a previous traumatic birth, MAC can be a healing experience.
So, why had I never heard of this before?
Despite 41 per cent of Australian mothers giving birth by caesarean, MAC is not a standard offering when it comes to caesareans, with not all obstetricians offering them and not all hospitals allowing them (MACs skew heavily towards being offered in the private sector).
The clinical requirements for a MAC, according to Davis, are a singleton baby in a cephalic presentation (head down), with “no other obstetric or pregnancy risk factors that would make a caesarean section more complicated”.
So why isn’t it standard practice to offer MACs to women who meet these requirements?
Ballarat-based obstetrician Lachlan Brennan believes a big part of the hesitancy is an unfamiliarity with MACs.
“Once you get key people on board, they’re actually really open to change,” he says. “We do a lot of work in the background with the anaesthetic and paediatrician teams and theatre staff making sure people are educated, that they know the steps, and that it all flows smoothly.”
Another barrier is a lack of universal understanding of the importance of the birthing journey. “Obstetricians and midwives are increasingly aware of how important the birth experience and theatre environment is for women, but other staff are not as conscious of that,” Brennan says.
Davis thinks another major barrier, from a hospital perspective, is concern around sterility.
“The main thing that we hear is, ‘surely there’s going to be more risk of infection for both the mother and the baby,’” she says. Despite the concerns, Davis has not seen evidence of this.
What she does see are the benefits of MAC, but recognises they mean less when it comes to hospital risk assessments. “Maternal satisfaction and wellbeing is not a KPI, while a surgical site infection and admission to the special care nursery is,” says Davis.
And that’s really the crux of it. Maternal satisfaction should be at the forefront of the birth experience, not relegated to a “nice to have”.
“The birth experience is a really understudied area but one that’s clearly very important,” says Brennan.
In a country where a third of births are described as traumatic by mothers, we need to do better to help women have a positive birth experience. MAC could be a key to that within the caesarean birth sector, but the procedure needs more research, education, awareness and discussion.
Maternal assisted caesarean should be a standard offering for any woman who meets the medical requirements, regardless of the obstetrician or hospital chosen.
I’m one of the lucky ones. My MAC gave me the opportunity to do over my first experience of birth. It transformed a passive and impersonal surgical procedure into a profoundly magical, healing and active birth experience.
All mothers and babies should be given that chance.
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