Quality Criteria for Caesarean Sections

The caesarean section rate is continuously increasing worldwide, so that today nearly every fifth child (1, 2) is born in this way (in Europe, for example, the rate is 16.1% in Iceland and 56.9% in Cyprus). The World Health Organization states that with a cesarean section rate of more than 10–15%, the health disadvantages for mothers and children are already greater than the health benefits (3). 
Evidence of the long-term health consequences of such an “epidemic” of cesarean sections is constantly growing: children born by cesarean section have an increased risk of developing diabetes (4). They are more likely to suffer from allergies (5), asthma (6), obesity (7) and cardiovascular diseases (8). Mothers can also find it difficult for years to integrate this potentially traumatizing experience (9). They have longer-lasting pain, suffer more often from postpartum depression (10) and have more complications in subsequent pregnancies (11). 

The undisputed benefits of surgery in reducing mortality and morbidity in obstetric emergencies are offset by considerable epidemiological disadvantages that go far beyond the immediate consequences of surgery for mother and child. 
In order to minimize the possible negative consequences of a caesarean section for the child and mother, a group of experts from anthroposophic maternity clinics, working with independent anthroposophic midwives, gynecologists and pediatricians, has drawn up the following quality criteria for caesarean section births. May they serve to further the development of a contemporary “culture of giving birth”. 

Before a cesarean delivery

What we want to achieve:

Mother and child together have attuned themselves to the birth event and have met each other in soul and spirit. 

The caesarean section takes place when both mother and child are prepared.

We can do the following:

• In case of planned caesarean sections, we provide art therapy (e.g., sculpture, painting, music or speech) for relaxation and for strengthening resilience. 
  
• We promote the mother’s self-perception as a place of protection for her baby by providing rhythmical embrocation, oil dispersion baths or compresses (embodiment).  
  
• We stabilize the pregnancy and prepare for the birth event through the use of eurythmy therapy. 
  
• We instruct the pregnant woman on how to manually express colostrum. This stimulates the release of oxytocin and guarantees anesthetic-free milk and an unadulterated taste experience for the baby.
• If it is medically justifiable, we wait until contractions start, in order to include the baby and mother in the timing of the caesarean section.
  
• We announce all the steps necessary for the operation and explain them so that the mother and her partner can understand and agree with the decisions of the obstetrics team.
• We guarantee the continuity of midwifery care in the overall process in order to build a secure interpersonal foundation with the mother. Continuity of personnel increases the safety of the intervention (12).
• We value the placenta as a vital organ of the baby. We do not regard it as waste. That is why we discuss with the parents in advance how to deal with the placenta after birth.
• We include partners and loved ones in our accompaniment and offer clarifying conversations about the changed circumstances, following the principles of non-violent communication.

During the caesarian delivery

What we want to achieve:

The moment of birth appears as a unique experience for the child and as a significant event in the life of the mother. 

The birth room is free from fear and the feeling of being at the mercy of others. 

We reduce unmediated sensory stimuli for the baby. 

The baby is not exposed to traumatizing actions. 

We can do the following:

• As midwife and doctor we accompany the mother. We are ready to maintain a present inner attitude, sometimes on behalf of the mother, in addition to taking care of external necessities. 
  
• We pay attention to the protection of the intimate sphere of the woman through a mindful quality of touch and positioning. The entire team ensures positive auditory, visual, olfactory and tactile sensations for mother and child.
• We use a gentle surgical technique and gently handle the baby’s arrival in a birth-like manner. 
  
• We gently convey all sensory impressions to the baby: we touch protectively and provide warmth. At the same time we shield the baby from loud noises and bright light. 
  
• We encourage the mother or someone close to her to bond with the baby.
  
• We treat the placenta and umbilical cord respectfully as part of the child’s being.

After the cesarean delivery

What we want to achieve:

The mother can affirm her birth experience. After the cesarean birth she feels herself again as an intact being of body, soul and spirit. 

The baby can subsequently experience the missing tactile sensations of vaginal birth.

The baby gradually opens up to the whole richness of the sensory world. The baby develops according to his or her age. 

The partner finds his or her role and identity in the new family constellation. 

We can do the following:

For the mother:

We arrange for the continuous accompaniment and presence of a midwife within the framework of extensive inpatient and outreach postpartum care. 

• We initiate, encourage and support a good, lasting breastfeeding relationship. 
• We encourage bonding with mother, father, siblings or close caregivers. 
• We offer therapeutic measures such as rhythmical embrocation, compresses and healing baby baths (according to Meissner) for mother and child. 
• We enable a chance to talk about the birth with the midwife and doctor at a suitable place and time.
• During the postpartum period, we offer a nonverbal retrospective of the birth with the mother, father or a close caregiver in the form of a joint artistic image creation.
• We encourage a closing ritual for pregnancy and birth and thus support a vision for the future after the birth. 
• We recommend and arrange postpartum physiotherapy, art therapy, eurythmy therapy, biography work or trauma therapy as required. 

For the baby:

• We take care of the baby’s senses and minimize stimuli from outside civilization.
• We observe and support age-appropriate reflex disappearance and development. 
• We arrange for anthroposophic body therapies, such as external applications, eurythmy therapy and later, if necessary, play therapy and early intervention. 

For the father:

• We arrange contacts and conversations with other fathers. 
• We encourage practical work and physical activities to reduce stress. 
• We arrange for art therapy and anthroposophic body therapies for processing traumatic birth experiences.
• We facilitate the return to family life and the social environment, if necessary with domestic help. 
• We encourage the father to take advantage of parental leave and encourage him to enjoy this early time with his infant. 

Two guiding lights for babies born by cesarean section

You’re in a raging storm... You are wet to the bone, frozen, hungry and lost and have an unknown, long way home ahead of you. Now you see a light in the distance – flashlights. There are people coming towards you, they have warm jackets, rubber boots and sandwiches with them... They were waiting for you, were worried and came to meet you.

“When you are in need, you will get help!” – this feeling is given to caesarean-born children for life. Because one day their parents will no longer be there. Maybe they will get into trouble one day while climbing in the Himalayas... but inside of them lives, deeply rooted and eternally pulsating, the certainty: “When I am in need, I will get help!” They have experienced this once, at the very beginning on this earth, and this basic mood will never let them go again... 

Additional Information / Links

Caesarean Section – Information and Recommendations for Parents: https://www.anthromedics.org/PRA-0649-EN

Verein für Anthroposophische Hebammenkunde:
www.vfah.de

Association of Anthroposophic Physicians in Germany:
www.gaed.de

Prepartal Colostrum Collection:
www.stillen-institut.com

Healing Baby Baths According to B. Meissner:
 www.herzensfaden.com

Play Therapy and Early Intervention:
www.der-hof.de