Study themes and representative quotes
| Theme | Description | Representative quote |
|---|---|---|
| Support for skin-to-skin cesarean birth | Participants reported feeling supported practically and emotionally by their families and the medical team in their decision to pursue a skin-to-skin cesarean delivery and during the birth itself | It was a very relaxed situation. … The nurses were amazing. The anesthetist was amazing. He was helping with making sure that [the baby] was able to get onto my chest. … It was a really nice situation. … Everybody introduced themselves and told me who they were and what they were going to do. It was incredibly supportive, and they made sure I was comfortable. (M1) I was really thankful and grateful for the staff. … I couldn’t believe the quality of care I received. And how well I was treated. … They were so sensitive and thoughtful about how they approached me and how they talked. … I felt so confident in the staff that it took a big burden away from the situation. (M6) |
| Control | When participants compared their experiences of standard cesarean birth to the skin-to-skin method, they described a shifting locus of control and a clear sense of empowerment with skin-to-skin cesarean birth | The thing that made the big difference to me was to be able to have the baby come right to me from being born. Come right into my arms and have skin-to-skin and basically no to very minimal separation. I didn’t have that with [my previous C-section], so I was really excited about that. … It was great. Another thing was the fact that I had the option to let the cord pulse out on its own instead of being cut immediately. That was something that I really wanted, and it wasn’t an option with the standard C-section. (M2) It was better than what I had been expecting. The feeling of not having had to have a separation from [the baby]. It felt a lot more like what I had hoped to have if I [had] had a vaginal birth. It felt a lot more natural. … It felt like the way it should be. The baby comes out of your body and it’s given to you right away. … With my first baby, when they took her away, I didn’t even get to see her. … They took her before I could get a good look at her, so that really bothered me. (M2) |
| Connection with infant | Participants described that skin-to-skin cesarean birth enabled maternal–infant connection and intimacy, an intangible sense of closeness that carried through their first year of mothering, and a sort of replication of the experience of a vaginal delivery | [The baby] was rooting right away. … She started nursing right on the operating table. … It was a cool experience just letting nature take its course. It was uninterrupted by people intervening. It was nice that when she was ready, she got to do it right away. (M4) I had more of an instant connection with my second son, when we did the skin-to-skin. … I definitely feel like there was an immediate connection with him. Everything was at ease. … We seemed very much at ease, very much relaxed compared with [my] other pregnancies postpartum. … We were instantly at ease and not overly anxious. I think a lot of it also [had] to do with the fact that he was able to latch [on] immediately, and any concerns that I had about not being able to breastfeed and all these issues that I had with my first son [were] at ease. (M5) [Skin-to-skin] is the most amazing experience. What you feel when they put the baby on your chest right away. What you feel and the bond. You connect so well. I feel like he’s more in tune with me. … The minute I hold him, he completely stops crying. And I feel like the difference is from skin-to-skin. (M10) The births were extremely different even though I had a C-section both times. It was much more isolating the first time. I wasn’t as connected. Whereas with [skin-to-skin], I felt very connected. Even the feeling in the [operating room] made it feel like being part of the birth … rather than isolated from it. … It’s weird to say that [because] of course I was part of it, but I didn’t really feel part of it. Whereas the second time, I felt like I was in the middle of it. The birth was right there. I was part of it. It was definitely a better experience. … It was much calmer. There was a peacefulness almost to it. It was calm and it was laid back and there was nothing tense about it at all. … It was incredibly meaningful, and it was magical to be part of the first breaths and the first movements, and it kind of makes me sad that I wasn’t part of that with [my first baby] because it feels like I missed out on that, but I’m so grateful that I had it with [this baby]. If I was to have another, I would definitely do this again. (M1) |
| Logistic considerations | Participants recognized that skin-to-skin cesarean birth required additional staff in the operating room and that breaking the sterile field changed standard procedures; they consistently expressed gratitude for this option | [Skin-to-skin] exceeded my expectations. … They tell you that, depending on staffing, and if there [are] any emergencies, there’s a chance that it may not be able to happen. So, you are prepared then. It might be a regular C-section. And then, when I got to … hold my baby right away, it was amazing. I was very grateful. (M4) |