Cesarean · Episode 3

Mother-assisted caesarean: when you lift your own baby out

Dutch obstetrician Koen Deurloo explains the mother-assisted caesarean (MAC), a gentle C-section where the mother guides her baby out with her own hands.

Born to be Wild · 2026-09-28

Listen to the episode

Koen Deurloo is an obstetrician at the Diakonessenhuis hospital in Utrecht, in the Netherlands. Nine years ago, a pregnant woman asked him a question he had never heard: could she lift her own baby out during her planned caesarean?

That question led to the mother-assisted caesarean (MAC), a procedure he now performs close to a hundred times a year. On episode 3 of the Born to be Wild podcast, he explained to Irene Jaspers how it works, what the data shows, and what it taught him about listening to women.

Where the idea came from

The woman, Camilla, came to his office with her doula. Her previous birth had been vaginal but traumatic: she had feared for her life and her baby's. For her second birth, she felt that guiding her baby out during a planned C-section would help her heal.

Koen had never read anything about it, and there was nothing on YouTube or in the medical literature. With a few enthusiastic colleagues, he practised in the operating room with a doll and surgical drapes until they found a safe way to do it.

"The whole operating room fell silent when she lifted her baby out."

How a mother-assisted caesarean works

A MAC is a planned, low-risk caesarean under spinal anaesthesia, like any other. What changes:

1. The mother is dressed like the surgical team: a sterile gown and sterile gloves, which takes about four to six extra minutes.
2. She waits with her hands on her chest. Once the uterus is open, the obstetrician gently pushes the baby out "like a tube of toothpaste".
3. The baby is born into the mother's hands, and she lifts it onto her chest, with help from the obstetrician.
4. A pre-cut opening in the gown is torn open so the baby goes immediately skin to skin. The baby stays with the mother unless a medical check is needed.

The extra cost, according to Koen: two pairs of sterile gloves and a gown, about 9 to 10 euros.

Is it safe?

Colleagues first worried about temperature loss, infection and blood loss. Koen has documented every MAC he has performed. Across several hundred procedures, he sees no difference in blood loss, temperature or complication rates compared with a standard caesarean. The data has been submitted to a scientific journal; until it's published, these are his own figures.

What he does see is a big gain in trust, self-confidence, the birth experience, breastfeeding and bonding. Some parents describe it as a healing experience after a previous trauma.

Not for everyone, but open to everyone

Koen doesn't think every woman needs or wants a MAC. Most women opting for a C-section simply want a gentle caesarean: calm, with immediate skin-to-skin and no routine separation. Early skin-to-skin contact is recommended after a caesarean too (NICE, 2021), and it supports breastfeeding (Cochrane, 2016). At his hospital, about 10 to 20% of women having a planned caesarean choose a MAC, often those who have had a traumatic birth or who want to actively take part.

Partners have a role too: they are close by, supporting, and welcoming the baby.

Why more hospitals don't offer it

A medical student asked 15 Dutch hospitals why they don't offer MAC. The main reason: they don't really know the procedure. People imagine something bloody or risky, when it's actually "sweet and nice". Koen now helps hospitals from Argentina to Norway and Belgium set it up, often with just a video call.

Guidelines guide, they don't rule

For Koen, good care combines three things: the guidelines, the doctor's experience, and the woman herself, including her values, her plans and the risks she is or isn't willing to take. The same medical indication can lead two women to different, equally valid choices.

He also names a bias doctors should be aware of. In a hospital with 3,000 births a year, a 0.1% risk happens three times a year. Doctors see rare complications often, and fear can shape their advice.

When a woman says "no"

Early in his career, Koen pushed a woman into an induction for a baby he feared was too small. Mother and baby were fine, but she told him afterwards: "You pushed me into it. I could have said no."

It changed his practice. Today, when a woman declines his advice, he asks why.

"Informed consent is fine, and informed refusal is fine too, as long as it's informed. Then you explore: what can we do to help you?"

Advice for expecting parents

• Question the routine. Your care provider knows the protocols, but not you: your fears, your plans, what matters to you. Saying so isn't rude, "it's just normal care".
• Prepare for plan B and C. According to Koen, in the Netherlands about 80% of first-time mothers end up in hospital care during pregnancy or birth, and around one in six has a caesarean. It's not failure, it's reality. Knowing it in advance helps.
• Change comes from women. Many improvements, including partners' greater role in MAC, came from women's requests.

What about Portugal?

MAC is still rare, and caesarean rates in Portugal are high, especially in private hospitals (see what they don't tell you about giving birth in Portugal). Koen believes the approach is especially relevant in systems like Portugal's. If you are planning a caesarean, you can ask your obstetrician and hospital about a gentle or mother-assisted caesarean: immediate skin to skin, lowered drapes, no routine separation.

Read also Rita's story: IVF alone, a premature birth and the MAC that changed everything, and what they don't tell you about giving birth in Portugal.

Frequently asked questions

What is a mother-assisted caesarean? A planned caesarean where the mother, dressed in a sterile gown and gloves, helps lift her baby out of her belly and brings it straight to her chest for skin-to-skin.

Is a mother-assisted caesarean available in Portugal? It is still uncommon. Ask your obstetrician or hospital directly, and look for care providers open to a gentle caesarean. Browse the obstetricians in our directory.

Does it take longer or cost more? According to Koen Deurloo, it adds about four to six minutes to dress the mother, plus a sterile gown and two pairs of gloves.

Sources

What our guests share comes from their own experience and practice. The medical and legal information in this article is based on the sources below. It doesn't replace advice from your care team.

• NICE (2021). Caesarean birth (NG192)
• Moore et al. (2016). Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Review

Listen to the full episode

This article is based on episode 3 of Born to be Wild, the podcast: This is how a caesarean can look when women take the lead, with Dr Koen Deurloo. Listen on Spotify.