Are we unwittingly perpetuating fear of C-sections; and contributing to birth trauma outcomes by doing so???

Are we unwittingly perpetuating fear of C-sections; and contributing to birth trauma outcomes by doing so???

You’ve all read the headlines, the sensationalist introduction to link to new studies on the latest medical research, the byline underneath the headline:

“Moms beware! C-section may harm your baby’s ‘concentration’ “

“Mother’s agony as anaesthetic wore off during C-section”

“Are women losing ability to give birth naturally? They’re relying too much on C-sections and drugs, says expert”

“The mothers made to feel guilty about their C-sections by OTHER MOTHERS”

“A study revealing the prolongation of labour, thanks to epidurals, has been useful in identifying the iatrogenesis – doctor induced harm – at the root of the cesarean problem”

“BIRTH IS THE KEY in breastfeeding: a natural birth unlocks breastfeeding potential and so much more”

“Induced labor may double the odds of C-section”

“Cesarean birth without labor associated with breastfeeding problems say two new studies”

“C-section babies more likely to become overweight”

Then we have the commonly rolled out “statistics” on how having a doula attend your birth means a “40% decrease in the risk of having a cesarean” or how “One-to-one midwifery care reduces C-sections and improves health care”, and the ever so helpful article entitled: “How to reduce your risk of having a Cesarean”, followed by a provocative article asking “Once a Csection, always a Csection???”….I saw that one and thought of the brave, courageous ladies who come to share their hopes and fears in the VBAC Support Group and thought “oh dear – how would you be feeling about your planned VBAC after reading that tagline?”

There I was, scrolling away on my Facebook page the other day – and the newest well intended article about how Csection babies seem to have a higher chance of having Autism, ADHD, obesity related illness, a bad temper*, longer eyelashes*, multiple nipples*, a recurrent ingrowing toenail* and a tendency to smile later* than babies born via the vaginal canal popped up in my news feed. Following my own positive experience of a C-section and subsequently well documented break up with the Natural Birth Movement these articles do intrigue me and I almost always click in to read them, review the science, consider the message and absorb what I can to support my son’s health. I read the article and noticed my mood had worsened. So I observed the feelings, felt them. Fear, worry, dismay, guilt….and then the thought struck me:

“Are these articles doing more harm than good – are we perpetuating fear of Cesarean birth and contributing to birth trauma by doing so ???”

First of all it is important to say: I don’t know the answer. I don’t believe that there is a binary answer to the question. I’m questioning whether or not I should even pose the question publically or just ponder this further alone?! As a disclaimer I will also point out that I have no science to back up this question or subsequent questions.

The criteria for experiencing birth trauma are well clarified by the Birth Trauma Association with a very clear list of potential contributary topics which contribute to birth trauma.

  • High levels of medical intervention
  • Traumatic or emergency deliveries, e.g. emergency caesarean section

These are two very clear very distinct definitions from a list of sixteen identified contributary factors. How do these events lead to trauma in some mothers but not others? They are not unusual birth outcomes. Is it the physical trauma of the body within these birth circumstances leading to a psychological trauma, or these birth circumstances having been feared/dreaded/denied as a possibility by the mother/never considered as an option meaning that when these circumstances unfold in this manner; the subsequent experience is therefore psychologically traumatic? It’s a bit of a chicken vs egg anomaly. How could we ever really study the impact of having read articles denouncing the perils of Csections on any women, let alone a wide ranging statistically meaningful group of women? Perhaps the only thing we can really do is to be conscious of the question as we encounter another article with a shocking headline?

When it comes to the notion of birth trauma and headlines like these contributing to birth trauma; the more comprehensive question would be

“By repeatedly using sensationalist and confrontational headlines when we publish these studies and their findings regarding birth by Cesarean are we:

a) setting women up with irrational fear of a procedure that sometimes becomes inevitable in an emergency?

b) paving the way for great disappointment in not “achieving” the optimal spontaneous vaginal birth?

c) laying the foundations for trauma by inherently invalidating and dismissing many women’s experience of birth by cesarean as suboptimal? ”

I certainly don’t believe that if we are perpetuating the fear of Cesarean birth in this way that we are doing so consciously – although unfortunately I have seen well meaning birth workers commenting on how “graphically violent” an image of a baby being born by Csection was (which seems a little counter productive to the notion of unconditional birth support).

I read the research, studies and their findings keenly (despite the way the headlines are worded) as a birth professional too; as I stand for informed choice. Informed choice in childbirth should be fundamental, always – whether the choice comes in an emergency situation, a semi emergency situation or even as a choice earlier in pregnancy. I can see and have seen that risks, benefits and options are not always explored fully with expectant or labouring families by medical professionals; and so I can see that by using sensationalist headlines information comes to parents through other channels which otherwise they may not encounter. New research which is consistently being conducted means that sometimes people who made a certain set of choices a few years ago, may well discover something that would affect their decision were they given the opportunity to make the same choice again now; sometimes those people are deeply effected by these articles too. I hope their concerns can be somewhat allayed by reminding them that we do our best with the knowledge that we have at the time.

Above and beyond being crucial in women having all the information they need to make informed choices for their families, the publication and sharing of the research is important and meaningful in the evolution of how we collectively approach birth as mothers, fathers, birth workers, health care providers and policy makers; how medicine and medical protocol advances; and how we can best support our babies’ health post partum, throughout childhood and onwards into adulthood; catering to the specific needs which are unquestionably sometimes a little different to babies who are born via the vaginal canal. This is wonderful as we are actually able to develop practices like seeding the microbiome of the mother’s vaginal canal into the newborn baby’s body post Csection, in order to best replicate some of the benefits of vaginal birth. For more information on this practice head over here. It means that the procedure of the C-section itself can be adapted to offer the mother and baby some of the psychological and physical benefits of spontaneous vaginal birth by performing “Natural C-sections” or at the very least “Gentle C-sections”. For a personal account of a Natural C-sectionby a mother who took part in a study currently being conducted by UCLH in the UK please head over here.

It does seems clear to me though, that some of the aforementioned headlines could be perceived to be perpetuating fear of Csections; intentionally or not.

The question does then broach the bigger picture of the presentation of birth within mainstream media, and the notion of birth as a feminist issue (although birth as a feminist issue deserves it’s own book – let alone a blog post!). I was reminded of the visual presentation of health crisis in the media recently when my beloved grandfather had a heart attack and said a number of times to the emergency healthcare providers; “I can’t believe I’ve had a heart attack – I wasn’t rolling around on the floor groaning in agony with a puce face at any point”. Women’s impressions of birth from mainstream media are often equally misguided, and can range anywhere from “I gave birth on the toilet – I didn’t even know I was pregnant” to “my waters broke as I left the expensive department store, I gave birth in the taxi on the way to the hospital into the taxi drivers hands” to “I fainted in the street and was rushed into hospital via blue light straight into theatre to be put under general anaesthetic and my baby was delivered by emergency C-section”. Certainly any of these situations are possible: but all fairly unlikely. The reality is that there are many opportunities for you as parents to ask questions, discuss your desires for your birth plan, discuss and negotiate the “What Ifs?” or grey areas of birth preferences, and to sometimes even say “I hear that the protocol states we ought to do something to further the progression of my labour right now; but I do not want to and am not ready to agree to any intervention”. Indeed when looking at the reality of pregnancy and planning birth preferences; there is usually very little ‘high drama’ to attract big audiences or a large readership(!)

What can we do with this question? I’m not even sure: doula it? Hold space around it? Consider that client we know who is currently going through the fog of PND or PTSD after having experienced a birth outcome she wasnt anticipating? Consider the heightened intuition of the client who is 39 weeks pregnant and who we know who is digging deep for faith in her body as she prepares to VBAC after having stalled last time she laboured at 3cm? Consider holding space for those clients and others like them before we repost the article unthinkingly and unquestioningly?

It feels important to me to ask the question of myself and the communication I contribute to the discussion around birth; specifically via Caesarean birth.

And so in the name of desensationalising Caesarean birth, in the name of anecdotal evidence to allay your fears about the shocking headlines telling you the dangers and suboptimal outcomes of Caesarean birth: let me finish by telling you the last chapter of a beautiful birth story of a mummy and baby boy I know very well (ahem ahem blush blush) who ended up meeting eachother in the bright, blue, loving and gentle theatre of the OLVG through a stargate wound as opposed to having met in their living room after the full journey through the vaginal canal.

It wasn’t what they had planned.

It was exactly what the mother had feared the most.

But it was beautiful, truly beautiful.

It was deeply healing.

It was what she needed, despite having had a doula, an independent midwife and a best friend as birth attendants to try to  avoid it.

It was a whole host of things underpinned by a whole host of emotions; but it was their unique, wonderful birth story.

She experienced that heart burstingly ecstatic moment right there in the theatre.

The wonder.

The bonding.

The magical miracle of birth, albeit a different kind of magic to the magic she’d been hoping for but magical all the same.

Breast feeding worked out.

The wound healed perfectly and quickly with no infection or complications.

And to date there are no health issues to report in her son, partly because she reads all the articles she can on the health impact of Caesarean birth, and makes the choices that feel right for her and her family in order to best mitigate any “potential long term health impact”.

Words can’t always express the emotion of birth; but I believe these photos capture some of them – a big big thanks to Claudia Van Dijk (midwife from vive: vroedvrouwen in verbinding who took them.

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*Please note* no studies currently prove any link between babies who are born via csection to having a higher chance of having: a bad temper, longer eyelashes, multiple nipples, a recurrent ingrowing toenail, or a tendency to smile later (you’ll be glad to read).

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