Bigelow A, Power M, MacLellan-Peters J Effect of Mother/Infant Skin-to-Skin Contact on Postpartum Depressive Symptoms and Maternal Physiological Stress. J Obstet Gynecol Neonatal Nurs. 2012; 41:(3)369-382

Bonnet MP, Basso O, Bouvier-Colle MH Postpartum haemorrhage in Canada and France: a population-based comparison. PLoS One. 2013; 8:(6)

Cammu H, Dony N, Martens G Common determinants of breech presentation at birth in singletons: a population-based study. Eur J Obstet Gynecol Reprod Biol. 2014; 177:106-9

Chen C, Yan Y, Gao X Influences of Cesarean Delivery on Breastfeeding Practices and Duration: A Prospective Cohort Study. J Human Lactation. 2018;

Cooijmans KHM, Beijers R, Rovers AC Effectiveness of skin-to-skin contact versus care-as-usual in mothers and their full-term infants: study protocol for a parallel-group randomized controlled trial. BMC Pediatr. 2017; 17:(1)

Finken MJJ, van der Steen M, Smeets CCJ Children Born Small for Gestational Age: Differential Diagnosis, Molecular Genetic Evaluation, and Implications. Endocr Rev. 2018; 39:(6)851-894

Hannah ME, Hanna WJ, Hewson SA Planned cesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial. Lancet. 2000; 356:(9239)1375-1383

Hofmeyr GJ, Hannah M, Lawrie TA. Planned cesarean section for term breech delivery. Cochrane Database of Syst Rev. 2015; (7)

Kamana KC, Shakya S, Zhang H. Gestational diabetes mellitus and macrosomia: a literature review. Ann Nutr Metab. 2015; 66:14-20

Klaus MH, Jerauld R, Kreger NC Maternal Attachment. The importance of the first post-partum days. N Engl J Med. 1972; 286:(9)460-463

Moore ER, Bergman N, Anderson GC Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst Rev. 2016; 11

Okan F, Ozdil A, Bulbul A Analgesic effects of skin-to-skin contact and breastfeeding in procedural pain in healthy term neonates. Ann Trop Paediatr. 2010; 30:(2)119-128

Posthuma S, Korteweg FJ, van der Ploeg JM Risks and benefits of the skin-to-skin cesarean section – a retrospective cohort study. J Matern Fetal Med. 2016; 30:(2)159-163

Schouten FD, Wolf H, Smit BJ Maternal temperature during labour. Br J Obstet Gynaecol. 2008; 115:(9)1131-1137

Smith ER, Locks LM, Manji KP Delayed Breastfeeding Initiation Is Associated with Infant Morbidity. J Pediatr. 2017; 191:57-62

Smith J, Plaat F, Fisk NM. The natural cesarean: a woman-centred technique. Br J Obstet Gynaecol. 2008; 115:(8)1037-1042

Villar J, Carroli G, Zavaleta N Maternal and neonatal individual risks and benefits associated with cesarean delivery: multicentre prospective study. BMJ. 2007; 335:(7628)

World Health Organization. Statement on cesarean section rates. 2015. (accessed 26 October 2018)

Zsirai L, Csákány GM, Vargha P Breech presentation: its predictors and consequences. An analysis of the Hungarian Tauffer Obstetric Database (1996-2011). Acta Obstet Gynecol Scand. 2016; 95:(3)347-54

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

02 September 2020
Volume 28 · Issue 9



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.


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


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.


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).


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.

Register now to continue reading

Thank you for visiting British Journal of Midwifery and reading some of our peer-reviewed resources for midwives. To read more, please register today. You’ll enjoy the following great benefits:

What's included

  • Limited access to our clinical or professional articles

  • New content and clinical newsletter updates each month