Response: Re: Promotion of Family-Centered Birth with Gentle Cesarean Delivery
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* Susanna Magee
* Cynthia Battle
* John Morton
* Melissa Nothnagle

*To the Editor:* We thank Dr. Pust for his comments and for reiterating the goal of promoting vaginal birth as the ideal mode of delivery whenever possible.

The context of our gentle cesarean work is a small urban hospital caring for a largely underserved population, including many high-risk obstetric patients. All well babies are placed skin-to-skin after birth regardless of the mode of delivery. Rooming-in is the norm—we have renamed the nursery the “procedure and monitoring room” and use it as such. In 2013, 458 deliveries occurred at our hospital; 29% of these were cesarean births, including 21% primary cesareans. Vaginal birth after cesarean was successfully achieved in 21 of 24 patients undergoing trial of labor after cesarean. Despite our largely underserved, often high-risk patient population, we are pleased that our primary cesarean rates remain the same or lower than national averages.1

We note, however, that these statistics are not a perfect assessment of labor and delivery practices at our facility. In recent years a number of women desiring skin-to-skin contact after a planned cesarean birth have elected to transfer care to our facility toward the end of their pregnancy to participate in our gentle cesarean program, so that they may keep their baby with them in the operating room, assuming no emergencies arise. These women are included in the total and primary cesarean rate listed above.

We agree that cesarean delivery is a major surgery and should not be recommended as the mainstay. Yet when operative birth is needed, and mother and baby are healthy, we urge providers and hospital administrators to consider the benefits of the family-centered approach to cesarean delivery that we detailed in our article.2 We believe early skin-to-skin contact between mother and child is possible for most cesarean deliveries and is a potentially important step in the bonding process, in achieving a successful early latch, and in helping to promote sustained breastfeeding.

Sincerely,

## References

1.  1.Osterman MJK, Martin JA. Primary cesarean delivery rates, by state: results from the revised birth certificate, 2006–2012. Natl Vital Stat Rep 2014;63:1–11.
    
    [PubMed](http://www.jabfm.org/lookup/external-ref?access_num=25252091&link_type=MED&atom=%2Fjabfp%2F28%2F1%2F161.1.atom) 

2.  2.Magee SR, Battle C, Morton J, Nothnagle M. Promotion of family-centered birth with gentle cesarean delivery. J Am Board Fam Med 2014;27:690–3.
    
    [Abstract/FREE Full Text](http://www.jabfm.org/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NToiamFiZnAiO3M6NToicmVzaWQiO3M6ODoiMjcvNS82OTAiO3M6NDoiYXRvbSI7czoyMjoiL2phYmZwLzI4LzEvMTYxLjEuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9)