La césarienne naturelle

Although the use of postoperative enhanced recovery after caesarean delivery is still incompletely implemented in France today, the concept of natural caesarean delivery is a logical addition in a patient-centred outcome vision of care. The anaesthetist may be seen as playing a minor role in this new step, but his (her) positive and proactive attitude will facilitate implementation. Components of this new concept are really innovative. In the preoperative period, detailed information (aided by written or electronic/video material) and patient's adherence to the process are required. The patient may enter the operating room in a standing position and walking, simplifying intra-hospital transportation and creating an ambiance of reducing invasiveness. In the operating room, while medical care maintains a high degree of safety, monitoring (EKG electrodes, oxygen saturation probe and blood pressure cuff) is positioned differently to facilitate mother-infant contact at birth. The father's presence is highly encouraged. At the time of birth, drapes are lowered (not necessary if transparent drapes are used) and allow parents to directly visualise neonate delivery. The obstetrician only accompanies birth without any traction by placing his (her) hands in the neonate axillas, delivery occurring under the influence of spontaneous uterine contractions which start after uterine incision. Duration of surgery is only slightly altered. Skin-to-skin contact is immediately started and maintained as long as possible. Facilitation in early mother (and father) relationship with the neonate is a well established of skin-to-skin contact, as well as the safety of this approach. The natural caesarean delivery concept is a really innovative approach of care for both healthcare professionals and parents. Implementing such a concept requires both validations by the obstetrical team and appropriate information to the parents in order to alleviate any concern they may have.