Pregnant with her first child in Spring this year, 34-year-old expat Carla Haibi had been preparing for a natural delivery and was hoping to have a water birth. But in her 36th week, her doctor broke the news that a natural delivery would not be possible due to placenta previa – a condition in which the placenta lies low in the uterus and partially or completely covers the cervix, which can make a vaginal delivery risky.

Her obstetrician, Dr Amber Syed -–who was head of department at Al Zahra Hospital at the time but has since moved to HealthBay Polyclinic on Al Wasl road – advised that they schedule a planned C-section at 38 weeks in order to avoid any complications and haemorrhage. 

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“I was heart-broken at first,” says Carla, who is originally from Lebanon and works as a content marketing manager in Dubai. “But I had to make peace with the idea considering it was my only option. Yet I still wanted to make sure I had a positive experience. I really did not want to check into a hospital and leave with a baby without experiencing any of that sense of empowerment that natural delivery can give a woman.”

Carla reached out to her hypnobirthing instructor, as well as to a couple of pregnancy Facebook groups, and asked for information about caesarean sections. “I had been deliberately blocking all information about any medical birthing procedure until then, so I had to quickly catch up on my research,” she says. This is when she came across information about what has come to be known as a “natural”, or “gentle”, or “family-centred” C-section.

The lowdown

This is a groundbreaking approach to the caesarean that aims to integrate many of the elements that women look for in a ‘natural’ vaginal birth – namely minimal medical intervention, a less clinical environment, a focus on the mother’s preferences and an unhurried delivery of the baby – into the experience of an elective C-section. It incorporates evidence-based elements used during vaginal birth that promote bonding, breastfeeding and enhanced maternal satisfaction, which are usually absent from conventional C-sections.

“I had two weeks to get myself up to speed and change my birth plan,” says Carla. “I decided that having this option would at least allow the birth of my baby to be a slow, gentle one and as close as possible to the birth that I had imagined.” 

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Changing the birth plan

Carla began by rewriting her birth plan, making sure she had researched every point. Then she discussed it in detail with her doctor and asked if she would agree to do it. “She was very open and curious to try it; she had never done one before,” says Carla. “We sent her our birth plan and she shared it with all the team before the due date. She made sure they were all in line with every request mentioned in our birth plan.”

“Over the last few years, a lot of effort has gone into promoting early skin-to-skin and parental involvement at vaginal birth,” explains Dr Amber Syed, consultant OB/GYN at HealthBay Polyclinic, who oversaw Carla’s procedure. “A caesarean birth remains entrenched in medical rituals, which delays parental contact, impairs maternal satisfaction and reduces breastfeeding. A ’natural caesarean’ mimics natural birth, as it allows the parents to watch the birth as active participants. It allows for a slow birth, thus reducing the need for resuscitation of the newborn, and allows for the baby to be transferred to the mother’s chest immediately, for early skin-to-skin contact.”

“Most women are keen to have a natural birth, but sometimes medical reasons preclude them for having one,” continues Dr Syed. “In such cases, natural caesarean is an option. However this can only be offered in planned procedures, not in emergencies.”

Although C-section rates are rising globally – probably due to a combination of factors, including the increasing number of older mothers and the fact that the procedure has become so safe and can be seen as the more ‘convenient’ method of childbirth – Dubai has one of the world’ highest C-section rates (42.1% according to 2014 figures from the Dubai Statistics Centre), so this style of procedure could be a welcome alternative to the more medicalised rituals that are common in the emirates.

 “Natural caesareans have been growing in popularity in UK and USA, but are still uncommon,” says Dr Syed. “In the UAE at the time of writing there have been only two reported natural caesareans – one at Al Zahra Hospital in Dubai, the other at Danat al Emarat in Abu Dhabi.”

For Carla, it was the closest thing to the birth she had always wanted. 

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A magical experience

“Both my husband and I were very calm on the day of the birth. We had been taking hypnobirth classes to prepare for a natural birth, but one of the most valuable benefits of such classes is that they help you remain calm regardless of the turn that the birth might take.

“We had relaxing music playing, we asked to dim the lights around the surgical field. We wanted to have a cosy environment even in the surgical theatre. We wanted to ease our baby’s transition from the womb into the outside world.”

Although it is possible to have the curtain between the couple and the doctor lowered completely, Carla and her husband did not opt for this. Of course even a gentle C-section isn’t going to be wholly ‘natural’ in the sense of being drug-free, but the anaesthetist should administer an anaesthetic that will enable mother and baby to interact immediately, and the whole process is a lot slower than the traditional procedure. After making the incision, the doctor helps to lift the baby’s head out of the womb, but will then leave it to wriggle its head and shoulders out in a way that mimics natural birth. “After delivering the head of my baby, Dr Amber gave me the signal to start breathing. Although I was not feeling anything from chest down due to the drugs, I performed the ‘J breath’ to help my baby push himself out of the womb. Slowly, our baby boy started to push with his feet, and I heard his cry, which made me breathe even harder. I will never forget this moment, both my husband and I were very emotional. We had asked for delayed cord clamping, and after about three minutes, my baby boy was put on my chest directly and we started our magical bonding time.”

Empowering parents

With the growing awareness of the benefits of – and resultant pressure to have – a ‘natural’ (vaginal) birth, women requiring a C-section can sometimes have feelings of inadequacy or even failure. The natural C-section appears to mitigate this, according to research by the ESA*, by increasing parental involvement and bonding opportunities between mother and baby, rather than immediately taking away the baby to be weighed and measured, as usually happens in conventional C-sections.

“There is no doubt that a natural caesarean is better than a traditional one for parents who care about taking an active role in their birth,” 

“This option allows for a slow birth, and for the baby to push himself out of the womb," says Carla, "which mimics his passage through the birth canal and can prepare his lungs in the process as well.”

Carla would recommend the method to any mother without complications who had been preparing for a natural birth and perhaps had to change her plans. She says: “You can and you have the right to have a meaningful birthing experience, even if it’s a caesarean.”

How to plan a gentle C-section in the UAE

“It is not easy to arrange a natural caesarean here, but it is not impossible,” says Dr Amber, consultant OB/GYN at HealthBay Polyclinc. “Support from the leading obstetrician is essential to set it up. All the other members of the team such as anaesthetist, operating theatre staff, neonatologist and midwife have to be supportive as well, to carry it through. Not all hospitals or doctors will offer this option, so please discuss with your obstetrician if you are interested in having one.”

C-Section rates Across the World

The UAE has one of the highest rates of C-sections in the world, with almost half (41.2%) of all births in Dubai taking place via caesarean section, according to 2014 Dubai Statistic Centre figures. This is higher than the average rate of 28% across OECD (Organisation for Economic Co-operation and Development) countries, and significantly higher than the World Health Organisation’s (WHO) ideal rate of 10-15%. And worldwide C-section rates have been rising for years. Why does this matter? WHO states that, when medically justified, caesarean sections can effectively prevent maternal and perinatal mortality and morbidity. However, it has also found that as soon as a country’s C-section rate goes above 10%, it is no longer associated with reductions in maternal and newborn mortality rates. Other factors to consider are the maternal-infant relationship and bonding period, women’s psychological health and breastfeeding – all of which have been shown to potentially be affected by a birth with more medical intervention. 

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*European Society of Anaesthesiology.

Photos by Aiza Castillo-Domingo