Thursday, November 18, 2010

Change #12: Prepare Mothers and Fathers for Cesarean Birth

Dear Peeps,

One way to change the experience women have giving birth in our culture is to warmly, honestly prepare them for all kinds of birth in our culture. That includes cesarean birth.

Have you noticed how many times the mother who is in birth shock or shame after a cesarean is the mother who did not read or ask about it, because she truly believed it would not happen to her? (With the rising cesarean rate, even if it "shouldn't" happen to her, it might.)

If you were to ask her (or the father) what would have helped, she (or he) might say--"I wish I had known what to expect. It was such a shock."

We must not put the onus of holistic preparation on uniniated mothers or fathers, i.e., "if they don't ask, we won't talk about it." Mothers and fathers who are not prepared suffer terrible emotional shock, not from the surgery itself, but from their own innocence, cluelessness, self-judgment, and being so overwhelmed, that they disconnect to get through it.

Even when the tide of unnecessary cesareans turns back, some women will have cesareans. So, cesarean preparation must become part of holistic preparation. All mothers, fathers, other mothers and their birth partners need to be prepared to give birth-in-awareness by cesarean.

In the birth trauma work I do, story after story, is not about the cesarean itself, but the shock of not knowing what to expect, or what to do, or what it means about her as a mother. On the other hand, BFW mentors have often heard thanks from parents who, because of the sensitive role-play class on cesarean birth-in-awareness, were prepared and much less traumatized.

Parents who see midwives, doulas, and take classes--and hear not a word about what to do during cesarean birth--often feel betrayed. Oddly, not talking about cesarean preparation prenatally adds to their feeling of shame because the people they trusted (i.e., the people who 'trust birth') did not talk about it. Silence sends a meta-message something like, "cesareans are something that happens to unprepared, uncommitted women, or women who don't have protection from information and doulas."

When birth peeps (or even friends) talk, straighforwardly and warmly, about giving birth by cesarean in-awareness, we model acceptance and strength. If we have rapport with the parents, they embody our acceptance and strength. Think of this as an emotional homeopathic dose of Medicine against shame, withdrawal, the pervasive feeling of failure. And, if she does have a cesarean birth, she knows she has an ally in us: we dared to talk about it!

If you are one of the people she trusts (one of the people who 'trust birth') and you talked about giving birth by cesarean, even if you are not with her in the operating room, she knows you are "with her." She knows she can come talk to you later.

Not all birth peeps can talk about cesarean birth warmly and without bias. Some need to first go through a period of healing their own birth trauma or agreements against cesareans or cesarean parents. Then, it can be done.

There are many ways of teaching about cesarean. Some send tacit or overt messages of judgment, with reasons and ways to avoid cesarean at all costs. The positive intention is to scare or motivate a woman not to "choose" a cesarean, but in labor, we all know that "choice"and informed consent are nebulous,gray areas.

When I teach couples about cesarean birth, I feel it is a ceremony, an initiation into self-acceptance and envisioning themselves coping--even with an unwished-for cesarean. The teaching is about embracing oneself, not about avoiding and regretting.

Fathers and other mothers experience cesarean birth from an entirely different perspective. They too need support and preparation; they too, can be traumatized by lack of preparation. If we don't tell them, they will be so overwhelmed by the surgery environment. This week I worked with a lovely couple who was unprepared for cesarean birth, but had one. The baby was born healthy, taken to the baby table for the baby dry and wrap ritual... then given to the father and escorted out of the room to the nursery. The mother never saw her baby. ... not until hours later in the recovery room. This father had no idea he could take it to his wife, the mother.... and help her see him, hold him, on the operating table. He was utterly overwhelmed and shepherded out of the operating room without a clue of the options. Their experience would be so different if ...if only.... they had been prepared for cesarean birth-in-awareness.

Some of you may already be doing this. And for some, it is so counter-intuitive, you can't imagine how to talk about cesarean birth without sounding like you are "approving" it or hypnotizing them to give birth by cesarean. These are important considerations. It can be done though. If you want to learn one way to do this, take an introduction to mentoring workshop, or contact Birthing From Within for a phone class.

There are many ways to change birth in our culture. It's not only about changing the medical protocols and rituals, but in preparing parents to birth in the culture they are actually birthing in, and not the one we wish they were birthing in.




  1. Birthing From Within has articles on our website with more in-depth ways of preparing parents holistically for a cesarean. Many of our Mentors (childbirth teachers) have found that this preparation isn't just helpful for women who have cesareans, but also in reducing the anxiety and tension that many expectant moms and dads have BEFORE birth. By having a demonstration that includes not just what can happen, but also, more importantly, what they can DO (physically, mentally, spiritually), their bodies release some tension. What better preparation for labor than helping that fear drain out. This is true empowerment.

    ~Virginia Bobro
    Managing Director & Workshop Facilitator

  2. Here is the link to our cesarean article. Please share with your birth peeps and pregnant folks!

  3. Thank you so much for this blog! With my first child I had to have an emergency C-Section -- I was not prepared for it, it happened after hours and hours of labor and even 2 hours of pushing... and I kept refusing because I thought I was less of a woman if I did, if I chose the pain meds, or an epidural. It is very difficult for those of us who do need the surgery to actually live -- and to make sure our babies live and are safe. I have no regrets about laboring so much and trying so hard, I do regret not being prepared for the cesarean, for what came after, for the emotions I would feel about it, for the disappointment. Pam, thank you.

  4. Pam,

    Thank you for this blog and for the work you do in teaching doulas and childbirth educators how to address cesarean (and to address it at all)!

    Having never had a cesarean myself nor ever seeing one, there was a huge gap in my approach with clients as a doula until I took your workshop.

    Thank you!

  5. While a cesarean is not a probability for women planning home births, doesn't mean it should not be explored as a possibility. My students learn that education prior to the birth is 90% of their work.
    Carla Hartley

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  7. Carla - I don't undestand what you mean in your comment. What do Trust Birth students learn about when it comes to supporting women who may have a cesarean?

  8. Thank you everyone for your enthusiastic and warm responses to this topic. Let's keep talking and changing birth in our culture,

  9. Pam,
    What do you think about giving a copy of the BFW article that Virginia and Donna wrote to parents after an un-wished-for cesearean? I recently supported a woman who worked very hard for a natural birth but ended up with a cesarean after many hours of labor. The cesearean happend in the middle of the night, after my nursing shift was over. I'm not really sure how she is feeling about it now, but I do recall in labor her reluctance to use medications or an epidural because she hoped for that post birth oxytocin/endorphin high. These parents did not take any birth preparation classes, but I do know that she read your book as part of her perparation. Do you think reading the article after the fact could help a new mother reframe her cesarean and see it in a new light?

  10. Thank you so much for posting this. I had a c-section and felt totally unprepared and only knew of ways to avoid one. In return I was left feeling embarrassed and feeling the need to justify my birth to others. I felt alone and guilty. My doula did no follow up with me and I felt abandoned. I was disconnected from my baby and did not know why. I wish my birth class taught ways to accept outcomes. I spoke with you on the phone during labor and just that small amount helped a bit when challenged with a c-section. When I read this article I felt empowered again and more at peace as to what happened. Thank You!!!

  11. This is beautiful! everything well said.
    I am a hospital-based childbirth educator, NICU RN, and mama of four under four. My twins were born via emergent section for VASA previa rupture (at home!!). We beat the odds, thanks to the professional staff and the very interventional birth. He is one of 5 known cases of servival of a vasa previa rupture outside of the hospital. I was only 29weeks, so not admitted to the hospital for the duration yet.
    I am so very grateful for their birth. And, yet I don't think of it as a birth at all. I was put to sleep, and felt terror like I'd never felt before as I was trying to breath the gas to go to sleep.
    I've just given birth via "natural" VBAC.
    Both births (and my first birth, also natural) have brought me the best gifts ever--my sweet babies! In the end...healthy mama, healthy baby/ies!

  12. Excellent. This is SO important...if only by preparing women for the possibility of a cesarean so that it isn't something that they have to fear during labor. I am SO glad that I had talked to my birth team about our options in the case of a section birth even though we were planning to proceed with an unmedicated delivery. When there was talk of a section as a possibility, I remained totally calm and relaxed because I knew that my team was aware of my fears and wishes and that they would ensure that i remained empowered throughout. Had we not prepared for that possibility I would have flipped out when it was brought up. In the end I delivered vaginally, but tell all my friends that they should prepare for the possibility of a section birth, just in case.

  13. Not only is it important for families to be prepared with knowledge about what to expect if they find themselves facing cesarean, but also to know that they have rights and choices even in the OR. I help my clients to create a family centered cesarean birth plan so that in the event of cesarean they can have a birth that is as close to their original plan as possible.