C section first assist

A student midwife who’s doing a paper about midwives first assisting at c sections asked for contributions on a discussion board where I sometimes lurk. What I wrote was lengthy enough to share, so why not?

She writes:

I’m a student midwife writing a paper about midwives assisting OBs at sections. I am discussing the positive and negative sides and looking for your stories. I would especially like to hear from you are a midwife who assists in surgery, but I would also like opinions from those who did not. I am particularly examining the issues of continuity (is it better preserved by the mw being involved in the delivery or not), professional relations (how do the midwife and doctors work together, or not), and the promotion of natural childbirth (does it go against the midwifery ideals and goals, or not).

I wrote:

I’m a CNM and have first assisted at c sections. Most of my patients appreciated knowing I was on the other side of the curtain. For some scheduled sections (placenta previa, breech), we actually bantered back and forth from over the curtain.

I can’t speak much more to the experience of the patients, but I can speak for me. I was a CNM employee in an MD owned practice, and my boss sent me to a c section workshop. A year later I got let go, and another year after THAT I started a private home and hospital birth practice with another CNM.

I ABSOLUTELY loved being able to “do it all”. I could help someone have her baby at home; if she needed a transfer I could continue to care for her and catch her baby; and if she needed a c section I could STILL help her baby out.

Speaking to a previous poster*, I did some advocating as the first assistant. During one c section, the doctor was going to close her uterus with a single layer, which increases the risk of uterine rupture in future pregnancies. It was a little tense, but the doctor did a double layer when I mentioned that she wanted more children.

Another piece of advocacy that may be a bit less “important” than a double layer uterine closure is that I ALWAYS asked the doctor to close the skin with a suture/technique that would minimize scarring.

Finally, once the surgeon told anesthesia to give an antibiotic after the baby was out, and I said, “She’s allergic to that one”. Chances are quite good that the anesthesia doctor would have noticed it, but wow, it’s SO GREAT to know my patients as well as I do.

I understand another previous poster that it seems “wrong” and “against midwifery philosophy” to be a surgical first assistant. CNMs make complicated decisions for complicated reasons. In some academic medical center somewhere, CNMs learned how to do circumcisions because the residents were screwing them up. I’m ethically opposed to circs, so I don’t see myself expanding my skill set in that way. In rural areas some CNMs do vacuum assisted births. I’d consider learning how if it were truly needed wherever I was working.

I’ll admit, though, that I like first assisting because I like it. My former midwife partner teased me that I’d be going to med school soon. I think my wretching noises convinced her otherwise. 🙂

Oh, another thing: I’m a reiki master, so when we were closing I would sneak in some reiki during pauses. Who knows if the reiki energy could make it through the surgical gloves, but I like to think that that helped the healing process to some degree.

Adding here: As with anyone, I respect another midwife’s choice to NOT first assist. I’m a little puzzled by the blanket statement, “It’s WRONG for midwives to first assist!” Whatevs. I’m a midwife and I like first assisting. It’s one of my many contradictions, unless one expands the meaning of “midwife” to be a verb. I can midwife a baby into the world through a surgical incision, and likely do it more consciously than most surgeons.

Does first assisting go against midwifery ideals and goals? Well, it depends on what those goals are. If it’s to have a 0% c section rate, sure. But some women need c sections. Specifically, 7% of the women I’ve cared for in the past five years needed one.

If, however, midwifery goals include caring for the whole woman, for honoring her transformation into a mother, and for helping a new being into our world in the safest, most loving manner possible-midwives assisting in surgery actually supports midwifery ideals and goals.

So, MY summary-For me, first assisting at c sections and being a midwife comfortably coexist. Not every midwife would agree, and (s)he is free to not first assist at c sections. To anyone philosophically opposed to midwives participating in surgery-well, go find another blog. Being true to myself has made my life remarkably easier.

* Another poster said that a midwife is more appropriately in the OR as an advocate for the mother, NOT as the surgeon’s assitant. Here I’m saying the two are not mutually exclusive.

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