Reimagining cesarean sections

June 26, 2017

Providence Health Team

Jamie Lipeles, DO, became an obstetrician/ gynecologist because he knew it would offer an opportunity to get to know and bond with his patients and their families. “It’s a very personal field of medicine,” says Dr. Lipeles, who is affiliated with Providence Little Company of Mary Medical Center - Torrance.

He has built strong relationships with his patients, continuing to follow them over the years and often attending birthday parties and other significant events for the children he delivered. But one aspect of his profession troubled him: cesarean sections. “I noticed there were negative perceptions and a lot of fear around C-sections,” he says. “And as I started to look at the process, I realized there were a lot of aspects that could be modified or eliminated to make the experience much more pleasant for patients.”

Following about five years of research and study, Dr. Lipeles designed a Gentle C-section, or “Gentle C” experience that has been adopted at Providence Little Company of Mary Torrance. The approach recognizes that even if a woman gives birth via surgery, she and her family can still experience the more tranquil environment and personalized elements typical of natural childbirth. These include taking an active role in the birthing process and having immediate access to her baby following birth.

Redondo Beach resident Lauren Trenkle appreciated the approach when she gave birth to her daughter Parker at the medical center in June of 2016. She chose the music that played during the procedure—the mix included the Beatles, Coldplay and Ben Harper—and had her husband, ear, nose and throat physician Geoff Trenkle, by her side in the operating room. Lauren could view as much or as little of the procedure as she wanted because the medical center uses see-through drapes instead of the normal opaque ones. “During the surgery Dr. Lipeles talked me through what was happening,” says Lauren. “I felt involved and included instead of separated from what was going on.”

The Gentle C procedure recognizes the value of letting mothers and their babies bond as quickly as possible. Normally nurses immediately whisk babies delivered via cesarean section away to clean them and place them in a warmer. “I discovered that practice left moms feeling like their babies were being taken away from them right away,” says Dr. Lipeles. “It was needlessly robbing them of the immediate contact with their babies.”

Thanks to the Gentle C, that didn’t happen for Lauren. Instead, Parker was immediately placed on her chest, where nurses gently performed cleaning and warming, and a neonatologist briefly examined the baby. “It’s a little more work for the staff, but it pays off so much for the mother and baby,” says Dr. Lipeles. Lauren couldn’t agree more. “I had waited nine months to meet my child and wanted to see her right away,” she says. “It was an amazing feeling to experience the feeling of her skin on my skin. I believe that immediate contact established an emotional bond that will last forever.”

Another advantage, Lauren says, was that she was barely aware of the second part of the surgery—being sewn back up—because she was so deeply focused on her baby. She was able to begin breastfeeding in the operating room and receive guidance from any of the LDR (labor, delivery and recovery) nursing staff, all of whom are trained in lactation support.

Dr. Lipeles notes that the term Gentle C-section is used widely but can mean different things at different hospitals. A unique aspect of his approach is the focus on decreasing postoperative pain. This is accomplished through.

Avoiding cutting through muscles
Implanting a catheter that can deliver local anesthesia directly to the wound area, and
Using specialized equipment that makes it easier to deliver the baby through the womb in a way that is gentler to both mother and baby

The internal organs remain in the abdomen and the uterus is not brought outside the body as is done in a traditional cesarean section. Less displacement of mom’s internal organs means she experiences less cramping and pain afterwards. “I only used Tylenol and Motrin after my C-section,” says Lauren. “I had a prescription for stronger pain medication but didn’t need it.” Dr. Lipeles estimates that 80% to 85% of his cesarean section patients forgo narcotic medication thanks to the steps he takes to decrease postpartum pain.

Lauren, anxious to return home, had her cesarean section on a Sunday morning and left the hospital Monday evening. “Friends who heard I was having a C-section warned me I’d be bedridden for three weeks, but that didn’t happen.” “I had a toddler at home,” she adds, referring to Parker’s older brother, Hudson. “Within the week, I could pick him up. And even before that, I could get in and out of bed, get to the bathroom and get down the stairs. It made a big difference to be able to do these things for myself and be an active person in my family, rather than being isolated upstairs in bed.”

Looking back on her experience, Lauren expresses gratitude to Dr. Lipeles and to the nurses and staff of Providence Little Company of Mary Torrance. “They were so good at being attentive without being overbearing. They were friendly and comforting and that really put me at ease.” “C-sections are still seen as somehow taboo,” says Lauren. “Even though it was a medical necessity, it was still a desirable option because of how it was handled. I got to have the experience that gave me a bond with my child and recover really quickly.”

Throughout our system, Providence doctors, nurses and caregivers are helping more women like Lauren overcome their fears of delivering their babies by cesarean section. The Gentle C approach truly puts women in control, and eases the path to recovery.

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