International Cesarean Awareness Network

 

By Ibone Olza - Psychiatrist
Article originally published in Ser Padres February 2002

 

It is estimated that approximately one out of every 4 or 5 women in Spain will give birth by cesarean. In the majority of the cases, the decision is made urgently in response to problems that occur during labor. This may result in a stressful atmosphere in which there is fear for the well-being of either mother or baby. Because of this, the recuperation may be slow and will depend on more than physical healing. The emotional aspect has to be given consideration too. Some mothers accept the surgical intervention well and recuperate without problems. For other mothers the impact can be very strong but they will not share their negative feelings because they feel they should just be happy for their child’s birth.

 

"I never imagined that there could be problems in birthing. After 6 hours of labor, they told me that my baby’s life was in danger. I experienced so much fear, even thinking that I might die. My husband had to wait outside (of surgery). As soon as my son was born, they took my baby and I only saw him for seconds. While they sutured me, I felt tremendously sad and alone, the caregivers hardly said a word to me." M.P.

 

The circumstances that surround a cesarean birth can be very stressful for the woman and her partner. Every situation that implies a life threat carries with it a serious psychological stress. Sometimes the health care providers are not aware of the psychological suffering that these situations generate. Many women who have experienced the urgent need for a cesarean relate that in the weeks and months following the birth that they have relived the birth in their heads as though it were a film. While they may often experience sadness or rage, they may not demonstrate their emotions openly because those around them suppose that they are happy in their motherhood. Expressing one’s sadness is the first step towards recuperation. In those cases in which the pregnant woman knew in advance that her child was going to born by cesarean the intervention probably was perceived less traumatically.

 

"I thought that it would be the happiest day of my life and instead it was one of the worst. When they brought me to my room, I didn’t even want to see my daughter. I think that I am a bad mother since I am not happy even though I have a precious daughter." M.C.

 

Having to give birth by cesarean can imply a loss; the birth one has dreamed about has not occurred as one thought it would. (Likewise, this can occur even with a vaginal birth if it has been a traumatic one). Even if the cesarean has provided a safe arrival for the baby, the mother may feel sadness for not having had a natural birth. This sadness does not signify that she doesn’t love her child like other mothers! In fact her sadness may be increased by her post operative weakness. A cesarean is major abdominal surgery —-and mothers just recently anesthetized are expected to engage in the care of their newborns. If, on top of all that the mother has lost blood during the surgery or has not rested well afterwards, the exhaustion can contribute to further sadness and may even cause depression.

 

"I feel failure and frustration because I didn’t have a vaginal birth. As ridiculous as it seems I also think that I disappointed my husband. I think that it is my fault because I didn’t prepare well for the birth."

 

The birth is much more that the arrival of a child. It is also a crucial moment in the life of many women. Ever since our first menstruation, we have been told about our innate ability to conceive and birth children. That the woman needs to birth by cesarean may give rise to feelings that her body has failed her or even a sense of guilt to not have taken good care of the baby she has been carrying. These thoughts can become obsessive: the woman can constantly dwell on this theme thinking of what she could have done so that the birth would have occurred differently. One way to alleviate these feelings is to discuss the birth with the professionals who attended the birth or with other doctors or midwives who can help the mother better understand what occurred. Many times the father of the baby has also suffered great fear and may be concerned about his wife’s recuperation or her future pregnancies. Alternatively, he might not understand her sadness if the child is perfectly healthy. Sharing these feelings intimately may relieve the feelings of guilt and blame. They may come to accept that being a father or a mother is much more complicated in real life than they anticipated in their dreams, but also much more enriching than they expected too.

 

"We want more children, but I don’t feel capable of experiencing what I did all over again. Just seeing the hospital gives me goose flesh. I don’t know if I will be able to overcome this problem."

 

Talking about all the feelings that surround a cesarean or a traumatic vaginal birth will improve the emotional recuperation. The reasons that precipitated the first cesarean don’t have to repeat themselves. With time, support of one’s partner, and with adequate information, the experience can be put into perspective. Breastfeeding the baby and watching his/her growth is of tremendous help in overcoming the initial birth trauma. Although the next pregnancy may be shadowed by the fear that the same pattern will repeat itself, talking about it and getting the support of a midwife or an obstetrician can help confront the next birth without fear. If the health care providers don’t demonstrate their support, it is beneficial to look for a second opinion or a change in caregiver altogether.

 

Aspects that help one overcome the cesarean:

Rest and tranquil surroundings. When a woman is convalescing from her surgery, she doesn’t need to be concerned with picking up the house or receiving visitors. It is advisable to postpone the visits until the baby is one month for example, and dedicate time towards getting rest.

 

Speak with your healthcare providers and express all your doubts and concerns about the operation. Even if the mother was locally anesthetized and "awake" for the birth, she may not remember many of the events that occurred. Even if it is difficult to speak personally with the professional who attended the birth, you can request a report a medical report.

 

Recognize, honor and accept the feelings of loss or sadness if they are present. "The most important thing is that the baby is healthy" is one of the most oft repeated sentiments after a cesarean. Of course it is, but it is also important to comfort the mother and acknowledge her frustration if this is what she is feeling.

 

Talk with other women who have had similar experiences and you will sense great relief. The Internet has discussion/support forums that help women overcome their cesarean experiences. A Spanish language resource is: http://www.elistas.net/lista/apoyocesareas

 

Face your future pregnancies knowing that the events don’t have to repeat themselves. Is it estimated that 80% of the women who have had a cesarean can still experience a vaginal birth. In the United States, there are women who have had VBAC after two or more cesareans. The research shows that the birth centers where natural birth is most respected have the lowest incident of cesarean without incrementing risks to either mother or baby. Becoming informed is the best way to avoid an unnecessary cesarean!

 

If a repeat cesarean does become inevitable, you can make requests that will help your physical and emotional recuperation. Ask that the father be present and that he hold the baby, explain the importance of the mother receiving feedback throughout the birth and immediate postpartum period, and emphasize the need for an atmosphere of silence during the surgery in order to maintain the respect and sanctity that should surround all birth.

 

translated by Joni Nichols CCE, CD(DONA) ICAN representative of Guadalajara

 

 

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