Although skin-to-skin contact (SSC) during cesarean birth has been promoted for almost a decade, there is a growing discussion about altering other elements of traditional cesarean birth to promote patient and family engagement and satisfaction, encourage successful breastfeeding and bonding, and support a patient- and family-centered birth experience. These cesareans have been described as gentle cesarean (Magee, Battle, Morton, & Nothnagle, 2014), natural cesarean (Smith, Plaat, & Fisk, 2008), family-centered birth (Schorn, Moore, Spetalnick, & Morad, 2015), and the Charite' cesarean birth (Armbrust, Hinkson, von Weizsacker, & Henrich, 2016).

Changes to the surgical environment may include warming the operating room (OR), dimming lights (Armbrust et al., 2016), and using a warming blanket (Magee et al., 2014) or special infant covering (Smith et al., 2008) to promote infant thermoregulation during SSC. Music chosen by the woman may be played and ambient noise and conversation is minimized (Armbrust et al.; Magee et al.; Schorn et al., 2015). Engagement in the birth process may be encouraged by allowing more than one support person to attend the birth and inviting the woman and support person(s) to visit the OR prior to planned cesarean. When possible, they can be introduced to physicians and nurses who will be involved in the surgery (Smith et al.). Viewing the baby can be enabled by lowering the surgical drape when baby is born (Armbrust et al.; Smith et al.) or using a drape with a clear viewing window (Schorn et al.). The support person can be invited to cut the umbilical cord (Armbrust et al.).

Immediate SSC and uninterrupted maternal-infant contact have been emphasized in all reports of gentle cesarean. Measures that have been described to promote implementation and duration include placing the intravenous catheter in the nondominant arm in a location that does not restrict movement (Magee et al., 2014), considering whether bilateral arm restraint is clinically necessary, moving electrocardiogram leads toward the woman's sides and back, and moving the pulse oximeter to the toe (Smith et al., 2008). Encourage breastfeeding while in the OR if maternal and infant assessments are stable and a clinician or support person is available for breastfeeding support (Magee et al.; Smith et al.). Perform infant assessments without separating the mother and baby, and encourage uninterrupted maternal-infant contact during care transitions.

Smith et al. (2008) suggested a hands-off approach after the fetal head presents from the incision, whereby the surgeon allows for a delay of up to a few minutes to deliver the rest of the body. The benefits of this technique have not been studied; however, proponents theorize that it facilitates expulsion of fetal lung fluid from pressure exerted by the uterus and surrounding soft tissues, slows down the birth process to allow visualization of the birth by the woman and support person(s), and promotes a delay in cord clamping (Armbrust et al., 2016; Smith et al.).

In a recent randomized trial of 205 women having cesarean birth, benefits of gentle cesarean included increased patient satisfaction and increased breastfeeding rates (Armbrust et al., 2016) with no reports of adverse fetal or maternal outcomes. More research is needed to empirically evaluate outcomes; however, it seems reasonable for perinatal nurses to consider what elements of gentle cesarean may be feasible in their setting and consider implementation of this patient-centered approach to cesarean birth.

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