The emotion is palpable………as the words, “Your baby is ready to come out,” are heard in the Operating Theatre (OT) and a tiny head with black hair emerges from the abdomen of Viveka. Yes, there is blood! The head comes and then the shoulders. The baby is still attached to the precious umbilical cord as [...]


It’s a first for Sri Lanka! A ‘Family-oriented Caesarean’


Soon after delivery, the new family on one side of the screen, while Dr. Probhodana Ranaweera completes the C-section

The emotion is palpable………as the words, “Your baby is ready to come out,” are heard in the Operating Theatre (OT) and a tiny head with black hair emerges from the abdomen of Viveka. Yes, there is blood!

The head comes and then the shoulders. The baby is still attached to the precious umbilical cord as the words: “Here’s your baby” fill the OT.

The baby ‘emerging’ from the abdomen in this Caesarean-section (C-section) mimicking a natural vaginal birth, is seen by Viveka and her husband, Stuart Abela, as the cloth screen which has blocked their view is lowered.

It is not a vaginal birth and it is no ordinary or routine C-section. It is a unique ‘Family-oriented Caesarean’ – a first in Sri Lanka!

Out pours the emotion, as amidst oohs and aahs, tears of joy and “Oh, my gosh,” by Viveka, the baby ‘crawls’ out of the abdomen and is held close to her chest, with immediate skin-to-skin contact. Baby boy Theo is delivered on Wednesday, June 15.

Tibetan chanting in the background from Stuart’s mobile phone continues to soothe and calm the senses.

From a corner of OT 1 of Ninewells, the sole private hospital dedicated to women and childcare, attired in surgical scrubs, I watch the scene unfold, having been permitted by the couple to do so.

Announcing that the placenta is coming out, Consultant Obstetrician and Gynaecologist Dr. Probhodana Ranaweera says that it is only after that that the umbilical cord, the bond between mother and baby, will be snipped by Stuart.

While Viveka strokes the tiny head now ensconced in a long blue cap dotted with little stars and Stuart hugs both wife and son, Dr. Ranaweera jokes: “You guys are not doing naughty stuff over there,” adding that a long journey has come to a fulfilling end.

The first cry gets louder and gustier gradually until the feeding begins, while Consultant Paediatrician Dr. Hashir Ariff is close by keeping an eye on the newborn and Consultant Anaesthetist Prof. Anuja Abeydeera who has administered the spinal anaesthesia before the start of the C-section, is also on hand.

Having closed up the abdomen, the ‘Caesarean enhanced recovery system’ is explained to Viveka – there is no catheter; there will be no fasting unlike those days and she can eat and drink immediately; the nurses would help her off the bed so that she gets mobilized, among other minute details. This allows a C-section to be treated like a normal delivery within a few hours.

Stuart, Viveka and Theo. Photos by Shaveen Fernando (Ninewells)

It is after the labours of the medical and nursing teams are done that the Sunday Times chats with Dr. Ranaweera. He explains that when Viveka conceived, it was a high-risk pregnancy. They discussed the mode of delivery as the time drew near. A normal vaginal delivery she yearned for, was a big risk as she had undergone some operations earlier. When the need for a C-section came up, the couple suggested what a London-based team had performed – a ‘Natural C-section’.

Laughingly, Dr. Ranaweera points out that a C-section cannot be considered “natural” and so in Sri Lanka they dubbed it ‘Family-oriented Caesarean’.

Through this method, the mother has a vaginal-kind of birthing experience even though it is a C-section. The incision (cut) across the mother’s abdomen was done with the mother’s face shielded  from a view of the surgery by a cloth screen. The father sat on a stool at the head of the bed, whispering soothing words and touching her head and shoulders gently. The baby emerges from the abdomen and is immediately kept on the mother’s chest, so that the skin-to-skin contact occurs instantly, he says, explaining that this, of course, is being practised in C-sections by several Obstetricians and Gynaecologists including himself.

Explaining that in Wednesday’s procedure, what they did was go a step further and allow the mother to see the baby coming out of the abdomen, mimicking the natural birthing process as much as possible, Dr. Ranaweera says that it gives “a positive birthing experience”. The umbilical cord is also not severed immediately, but a bit after the delivery. This delayed cord-clamping has many benefits.

He says that this method is not without its advantages, for both mother and baby. The mother has more engagement and is in control of making a decision with regard to the delivery, supported by her spouse, which gives the couple satisfaction. The immediate skin-to-skin contact is good for mother-child bonding. Delayed umbilical-cord clamping has been found to have a positive impact on the baby.

Usually, the cord is clamped after delivery but if the cord is kept for one minute, the baby gets iron to last one year and if kept until the placenta is removed, then much more.

He goes onto explain that such a birth is also said to squeeze out the water in the lungs, opening them so that the baby breathes easier. This helps overcome a challenge faced by some newborns – very fast or laboured breathing in the first few hours of life due to a lung condition known as Transient Tachypnea (TTN).

“With the father becoming hands on as soon as the baby is born, the family bonds are forged in the OT itself. Of course, it has to be done with utmost care about retaining the sterility and infection-free status of the OT,” adds Dr. Ranaweera.

Says Stuart: “We had read that a Family-oriented C-section enabled quicker and easier latching and less fussy babies. We feel that the early and prolonged skin-to-skin contact helped with the first latches being so successful. Viveka’s research had indicated that under this procedure, the removal of the baby is done in a slower way that mimics a natural birth more. The removal of the screen, separating the procedure from the parents, ensured a more connected birthing experience.”

Cuddling Theo close, Viveka says: “This is unreal and we are so happy. It is also different”, as Stuart responds with a broad smile.


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