In the early 1980s, Professor Romano Forleo, the Head of the Department of Obstetrics at Fatebenefratelli Hospital in Rome, was one of the first in Europe to introduce in a Department of Obstetrics the so-called humanized childbirth (humanizing birth means considering women’s values, beliefs, and feelings and respecting their dignity and autonomy during the birthing process). The idea was to introduce the “home in the hospital” rather than reproducing the home-like environment proposed by the birthing centers which sprung up in the USA in the 1970s, as alternatives to the heavily institutionalized maternity hospital [1].

A women-centered labor and delivery performed within a hospital department was thought to be more complete, adding the chance of a pain-free labor and delivery upon the woman’s request. Therefore, in parallel, the anesthesia department was called on to contribute to this project, starting an epidural service and increasing the use of epidural anesthesia for cesarean section and creating one of the first full-time obstetric anesthesia departments in Italy, led by Prof. Giorgio Capogna. One of the major changes for all of us was the different way of considering the women as mothers rather than as patients, but also the involvement of the father and his presence in the labor and delivery room and in the cesarean section theater contributed to change and adjust our anesthetic procedures [2].

At that time, the UNICEF maternal best practice standards had not yet been published, but we already used to let the mother hug her baby immediately after birth after cesarean delivery, even if for only a short period of time and after the neonatologist’s assessment, and the rooming-in was one of the most frequent maternal choices after delivery.

Nowadays, cesarean section is one of the most frequent surgical procedures in many European countries and North America and it is perceived as a “normal surgical procedure,” a routine practice that is not performed exclusively to save the life of the mother and of the baby, as it was originally designed for, or as a necessary or advisable procedure due to obstetrical reasons, but also for various nonmedical reasons, like the wish of the parents. The anesthesia approach is in favor of spinal anesthesia except for emergency cesarean section. One of the advantages is that both parents can experience the birth of their child. However, in many hospitals the cesarean section is still approached as a strict surgical procedure and therefore only the mother is allowed in the theater. Nowadays, in more and more hospitals the father is allowed to be present in the operating theater, but more can be done in order to satisfy both parents. Despite the general awareness of encouraging parent participation, rigid protocols define the appropriate behavior in the operating theater, and therefore the couple’s participation is usually limited by the medical staff’s needs as well as by the material and hygienic constraints of the surgical setting, according to the different hospitals’ habits and procedures.

In addition, most frequently cesarean sections are performed as an emergency procedure or as an elective, programmed surgery due to pathological reasons, and therefore an immediate contact with the parents is often not possible or advisable, due to the neonatal or maternal conditions.

Even if the mother and the baby are doing well and are at term, an immediate maternal–neonatal contact might be denied for many not well-defined reasons. For example, although the mother is generally awake during the surgery, she usually does not see her baby coming out, because a drape separates her head from her abdomen. Unfortunately, in some institutions, the mother may be routinely under the effect of tranquilizers to help her face the atmosphere of the operating theater and the sensation of her body being operated on. In addition, it is not unusual for the baby to need assistance because he/she cannot breathe autonomously. Moreover, after the delivery, the baby is quickly shown to the mother and transferred to another room next to the theater together with the father. Subject to the health of mother and baby, the time of separation between the woman and her child after surgery can last one or more hours according to the hospital routines.

As a consequence, cesarean section does not allow the immediate skin-to-skin contact deemed beneficial in promoting bonding between mother and baby [3].

To increase the satisfactory birth experience, another approach is needed. In many years of research in cesarean section, the focus has been on improving the surgical technique and to reduce or to prevent complications. This has led to a reduced perioperative risk, but there was no focus on a very important point which is generally accepted in vaginal delivery, namely, the immediate skin-to-skin contact between the mother and her child. Also generally accepted is that due to this interaction several important factors are positively influenced like breastfeeding, bonding, glucose levels, and cardiovascular and respiratory stability [4–6].

Therefore, another approach in cesarean section is needed to improve not only the mother’s satisfaction but also the maternal and neonatal outcome.

There are now a great number of studies [4–6] that demonstrate that mothers and babies should be together, skin to skin immediately after birth. The neonate’s temperature, heart and breathing rates, and glycemia are more normal and stable. In addition, skin-to-skin contact immediately after birth allows the baby to be colonized by the same bacteria as the mother and this, plus breastfeeding, is believed to be very important factors in preventing allergic diseases. From the point of view of breastfeeding, babies who are kept skin to skin with the mother immediately after birth for at least 1 h are more likely to breastfeed without any help, which is seen in vaginal delivery. Prolonged skin-to-skin contact during the first few months after birth may also decrease total neonate crying, improve sleeping and decrease the incidence of maternal postpartum depression [7].

The first hour after birth after vaginal delivery, which is also to be expected in cesarean section, has been defined as the “sacred hour,” a period of time during which skin-to-skin contact provides physiological stability and maternal attachment behaviors, favors optimal brain development, decreases the negative effects of separation, and increases breastfeeding rates and duration [8].