My thoughts on caesarean section

I started this blog post after a discussion about what Kirsty Allsop had been saying about birth and parenting. On reading the articles myself I feel very familiar with many of her points. However we have come to quite different conclusions.  As a doula and AIMS member I strive like Kirsty for women’s rights to be respected and within that I want the care we receive to be appropriate for what each of us wants, not that birth be seen as so awful that we should just opt out and not that we feel there are no choices for fear of being judged.

Anyway, with some time to consider Kirsty’s views on birth I wanted to revisit my own feelings after the birth of my son by Caesarean section.

I initially didn’t feel traumatised, or horrified. I struggled to recover and I felt disappointed and annoyed but mainly I felt angry. I was angry with others talking about their births, I felt left out and not full as a mother – I didn’t have this birth story everyone was sharing. I remember distinctly being so jealous of one friend as she described her labour and birth. She actually had a very traumatic and damaging instrumental birth but in my mind at that time I thought that at least she had ‘birthed’, she had laboured spontaneously and her baby had come out the way he was meant to. So here I can understand Kirsty’s frustration that so many women feel like I did.

I was chemically induced (for no other reason than being almost 42 weeks) and after some other interventions due to my body ‘failing’ to progress (or baby not being ready to come yet) and my baby’s heart rate reacting to the epidural (that I was told to have to stop me pushing), I had an EMCS. Some EMCSs are urgent and life saving. I do believe mine was necessary but I believe it only happened because of several elements that I felt I had not control over.

My overriding feeling afterwards was ‘why does everyone keep looking at me with pity?!, I have a beautiful baby! It’s all fine! Stop pitying me!’

I remember thinking that society was wrong as I shouldn’t be made to feel bad about not having had a vaginal birth. That I wouldn’t have to feel bad about it if others didn’t. I felt like I hadn’t done it, I couldn’t do it. I didn’t work. I didn’t consider that actually what should and could change was the maternity system that I had my baby within.

Over the next 2 years I spent time being disappointed, took a long time to recover physically with an infection and anaemia. I coped with the emotional side by pushing it aside. When my son was 14 months old I fell pregnant for a second time. I told the midwife I wanted to go for a vaginal birth and not opt for an elective Ceasarean. I knew this was an option but I didn’t look into it too much as I was absolutely terrified of being disappointed again.

However, I did start to read some things when I got to around 30 weeks. I wanted to go with the flow, but I realised that just going with the flow may have not been enough last time around. I could have said no to being induced, I hadn’t even been aware of the risks to baby of being induced. I hadn’t known how alone I would feel and afraid on a ward alone in labour without anyone supporting me as I wasn’t considered to be labouring. I had also not been aware of the risks of the epidural and the Caesarean in relation to me and my baby. The risks of not doing these things were made clear at the time but not the risks of doing them. Having more knowledge and support may not have changed the mode of birth but it would certainly have changed how I was able to view the birth itself afterwards.

I sought out support from other women who had decided on a vaginal birth, I looked up the current research on the subject which all pointed to a vaginal birth still being safer all round than a caesarean. What seemed important in archiving a vaginal birth and avoiding unnecessary risky interventions was to have as minimal interventions to start with as possible. This was a battle, having had a previous caesarean the hospital protocol was to recommend (tell me) to have electronic fetal heart monitoring, a cannula sited on admission, restricted access to water for labour and time limits to prevent long labour. The research that these recommendations were based on was either limited or didn’t exist, it appears to have all come about the wrong way around. The technology was introduced and then they couldn’t take it away even though it never seems to have been proved to improve outcomes and there are many associated links to further interventions and  other risks to mother and baby.

So….. I thought being informed was enough this time. I wanted to birth in hospital with the NHS rather than at home and I had to fight my corner to request to be treated normally and not have the interventions unless needed.  The previous caesarean not only affected my birth first time around but it was a major factor this time around also. I felt I had to change my community midwife to one who knew my rights and was supportive of me rather than telling what I wasn’t ‘allowed’ and  I even found myself and hubby having a debate with staff in hospital during labour as to why I was wanting to have a mobile and active labour without straps and machines attached to me. I did have a VBAC, it was amazing and wonderful to birth my baby. But the support I had in labour was shocking, I was seen as someone who may or may not be able to do it. The hospital midwife was still doubting it 30 min before my babies head appeared. This is not good enough. The support we get in labour and birth is vital. However our babies are born Kirsty is right, we should not feel guilty about it, but quite frankly I feel that often those working within the maternity system should!

Birth has no guarantees, and for some women it can be truly traumatic, no matter the mode of birth. Sometimes a birth is traumatic because of what happens to the baby or mother. What also often makes a birth traumatic is the support or lack of support a woman receives before during and after her labour and birth. This is what the focus should be, not the mode of birth or trying to control it.

Instead of campaigning that we should stop focusing on natural birth I support that we should be focusing on how to protect women in labour and how to reduce the amount of births that are unnecessarily traumatic. If women automatically had a named midwife whom they knew and trusted (and could change if they wished) throughout pregnancy, labour and birth then this would automatically reduce so much intervention and importantly fear and guilt. Women would feel safer, the midwives would know the women and their history, midwives would be less dependent on machines and more dependent on their knowledge, skills and experience. This is what the M4M campaign is about, and you can read more here www.m4m.org.uk

Currently in the UK we don’t usually have access to one to one care of this nature on the NHS. It has been called  the ‘gold standard of care’ and has been proven to improve outcomes for women and babies but it is a long way from our centralised labour wards in busy hospitals. What we do have in the UK, are Independent midwives, who we hope will continue to provide care for women from October when new insurance regulations come in. Independent midwives may not be available to all (they are paid for by the client except in special circumstances where they have waived fees or been paid for by an NHS trust)
But they are an amazing group of practitioners who not only have the right to practice independently but whom women have the right to access. To find out more and support the continued practice of IMs please visit here www.independentmidwives.org.uk

For those who support the idea of having a one to one midwife, can’t afford or access an IM there are also other regional changes taking place. In the north there is a group called one2one midwives who are supporting women via the NHS in a one to one capacity. However they too are facing constant challenges as the GP commissioning groups are not currently seeing women’s one to one care as a priority. As centralised maternity care has become the norm, birth centres, access to midwives for one to one care and home births seem to have become seen as expensive and unnecessary.

Well, I urge any pregnant women to seek information. Disappointment does not come from that. I’m not asking that we have huge expectations about birth and motherhood – what happens and how each of us experience it is so different. But what we can have is expectations with regards to the level of care we should receive.  What is available to you locally? What are the intervention rates of where you plan to give birth and how do you feel about them? How are you treated? What do other women say about their care? Are you spoken to with respect?

No, we cannot know how a birth will turn out. But, we can expect support, appropriate care (for normal birth as well as for when intervention is truly necessary – which is more confidently ascertained when one to one midwifery is used) And all of this from a midwife who knows us, who is confident in normal birth not just machines and who is available to us when we have our baby.

This is not preparing for disappointment as I originally thought, it is not trying to ‘get an experience’. It is trying to reduce the likelihood of risky interventions, a traumatic birth or surgery and ultimately trying to ensure the safest birth for your baby which without other medical indications is still vaginally. For me it is about trying to ‘not’ have an experience rather than trying to ‘get’ one.

Background reading
Tew, Marjorie, Safer Childbirth? A critical history of maternity care. 1998
NICE guidelines – Caesarean Section 2011 www.nice.org.uk/cg132
RCM Practice guidelines 2012

Susan x