The saying ‘we are our own worst enemies’ has never been truer than when applied to conversations about birth.
There’s a lot of unnecessary g uilt and blame surrounding birth. Every time a new piece of research hits the press, a war of words ensues between polarised stakeholders—obstetricians, midwives, researchers, paediatricians, mothers, fathers, and even people who don’t desire to ‘breed’ at all.
Women who’ve had elective caesareans feel defensive because a compelling body of evidence has revealed that elective caesareans for no medical reason are more harmful to babies and mothers than vaginal birth. In addition, recent evidence showing the compounded risks for the mother and any future babies she might have has rocked the obstetrical world.
Women who have had good outcomes from caesareans get hot under their maternity bra straps because negative reports about the operation translate as ‘you’ve made a bad choice,’ instead of ‘you were given bad advice and/or poor support.’ So, women take on more guilt because they feel like they’ve been labelled as bad mothers for agreeing to an operation they thought was best for them and their babies.
On the other end of the spectrum, the diminishing number of women who manage to come out of birth unscathed by medical interventions feel defensive too. Their beef is with those pesky too-posh-to-push Lexus drivers and their obstetricians who declare that anyone who has a vaginal birth is either lucky, stupid, selfish, or downright dangerous.
And it doesn’t end there. Women who give birth in hospital feel criticised by women who choose to birth at home. Women who thank their lucky stars their emergency caesarean saved their baby, feel it is their duty to give other women some perspective. Forums are filled with women telling those who come out of a caesarean birth feeling mugged, raped, and left for dead, they should just be thankful for a live baby and get over it.
What is missing here? In my six years as an advocate for informed choice in birth, I have seen very little empathy from people in general—whether they be mothers, fathers, doctors, or midwives. They all have different personal perspectives on birth but there seems to be very little understanding of what makes birth good or bad and why it matters at all.
If a woman is brave enough to admit that she feels like a train wreck after a caesarean birth, she is told to suck it up and get on with looking after her new baby. She is lectured about how lucky she is to live in a first world country where medical intervention saves lives. Yet, how can a woman get over it, if she is never allowed to process something she obviously feels is significant to her? Why should she bottle up her grief and live with the incredible guilt that comes when you feel bad about a life-event that is supposed to bring such joy? It all adds up to more guilt and a ticket to poor mental health, with all its repercussions.
Conversely, why is it that we accuse women of being cowards because they are fearful of childbirth. These women need to be listened to, acknowledged and helped. Recent research has shown that more than 43 percent of women who choose elective caesarean have a clinically significant fear of childbirth. The sad truth is that surgery won’t heal the emotional wounds that underlie childbirth fear. It can’t be cut around[WCEMC1] . It needs to be explored. But how often does this happen when the expert listening is a surgeon and not a counsellor or psychologist, let alone one who understands the impact of birth?
Perhaps we need to redirect our angst, not at each other, but at a healthcare system that has put birth into hospitals with sick people and turned it into a disease that needs to be contained with machines that go ‘ping,’ time limits, drugs, and surgery.
As someone who was born by caesarean, I know that birth matters. My mother was deeply affected by her experience and I was never allowed to forget it. I’ve also been the train wreck after a nasty caesarean experience, had a good elective caesarean experience and felt the amazing power of normal natural birth. Subsequently, when discussing birth, I often feel like the teenager stuck in the middle of arguing parents. It is true I probably wouldn’t be here if my mother hadn’t had her emergency caesarean but I nearly didn’t make it after my eldest son’s avoidable caesarean-gone-wrong left me traumatised and unable to cope. Should I now feel guilty because I’m not grateful for that?
When I did finally give birth normally with my last child, I realised how important birth was to me as a woman and a mother. Whether it was that surge of hormones as I drank in my little one’s eyes, or the high from finishing the marathon-like labour, I don’t know. But I do know it made me stronger to face the challenges mothering has brought and I refuse to feel guilty for wanting every birthing woman to feel like that.
Only a system-wide rethink about how birth is funded and managed can bring about a change in women’s and practitioners’ thinking about birth. When women (and their babies) are at the centre of care rather than passive recipients, when they are clients rather than patients, our predominant conversations about birth might just change from being about how dangerous birth is, to how great it should be. And maybe we’ll stop taking the blame for a system that has set us up to feel like it is all our fault. It is time to remove the guilt from birth.
NOTE: see Caroline McCullough’s other related article
Wiklund, I., G. Edman, et al. (2008). Expectation and experiences of childbirth in primiparae with caesarean section. BJOG. 115: 324-331.
[WCEMC1]I would leave this as “away” as the point was to show that surgery can’t take away the underlying problems behind fear of childbirth. Perhaps another word that could substiture is “out”.