Maternal and neonatal outcomes for the gentle caesarean section in breech presentation

02 September 2020
9 min read
Volume 28 · Issue 9

Abstract

Background

The gentle caesarean section (GCS) is an alternative to the conventional caesarean section. It aims to optimise the wellbeing of mother and child by mimicking certain aspects of a vaginal delivery when a caesarean section is indicated.

Aim

To compare the maternal and neonatal outcomes of a GCS in cephalic and breech presentation.

Methods

In this retrospective study, the outcomes of 180 women who underwent a GCS were analysed, where 120 fetuses were in cephalic and 60 were in breech position. Comparisons were made using Chi-square, Mann-Whitney U and t-tests. Maternal and neonatal outcomes were analysed.

Results

Apgar 1 was significantly lower for breech position (P=0.019). The Apgar 5 and 10 showed no difference. Neonatal temperature was slightly lower in breech position (36.8°C ± 0.36 versus 36.9°C ± 0.39, P=0.046). Birthweight was significantly lower for breech position (P=0.009). Blood loss was significantly higher in cephalic position (441 ± 230 versus 353 ± 151, P=0.002).

Conclusions

When performing a GCS, there is no clinically significant difference in maternal or neonatal outcome between a cephalic and a breech presentation. It seems safe to perform a GCS for breech presentation.

The gentle caesarean section (GCS) is a woman-centred technique described by Smith et al (2008) as an improvement for the conventional caesarean section (c-section). The GCS aims to optimise several aspects of a conventional c-section, to mimic a vaginal delivery. This is with a view to improving the mother's experience and decreasing morbidity for both mother and child. If there is a necessity for a c-section then, when possible, a GCS is increasingly frequently performed. Parental request for a GCS is also growing.

Reasons for a c-section in general should be an impossibility of a vaginal birth or an unacceptable increased health risk for the mother or the child in the case of vaginal birth (Hannah et al, 2000). The c-section involves several disadvantages and risks compared to a vaginal birth; neonatal morbidity is increased, for example, neonatal respiratory complications such as transient tachypnoea, admission to the paediatric ward, and less successful breastfeeding. Also, several maternal morbidities, such as postpartum infections and a longer admission to the hospital are more common in cases of a c-section (Villar et al, 2007; Moore et al, 2016; World Health Organization [WHO], 2018). Women undergoing a c-section may have a less satisfactory childbirth experience.

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