More and more I am seeing comments and stories about women choosing caesareans as a way of avoiding birth trauma.
I’m by no means suggesting that this isn’t a valid consideration when deciding on birth options. And I know many women who have had very healing planned caesareans following traumatic labours and traumatic vaginal births.
But I definitely have a couple of big concerns about this recommendation.
Concern #1: That women are led to believe that a planned caesarean is a guarantee of a positive, safe, and beautiful birth.
An elective caesarean is still major surgery. It still comes with some pretty huge physical risks. And women don’t seem to be made aware of these risks before they agree to a caesarean. While many women do have beautiful, safe and positive planned caesareans I also see the other side a lot.
Women who have significant issues with having the spinal placed and end up bruised, battered, and traumatised before the surgery has even taken place. Women whose epidurals or spinals don't work effectively. Women whose babies need to be whisked from the operating room because they are struggling to breathe. Women who experience significant blood loss and struggle to recover.
Many of these women were promised that a caesarean would be far less traumatic than a vaginal birth and they are left feeling betrayed and let down. They are left wondering “what if”. And they are left with increased risk factors and less options for their next birth.
Imagine how traumatised someone might feel if they planned a caesarean on the basis of it being promoted as a “more positive way to birth” and ended up with a general anaesthetic because they could feel the incision? Or if they developed placenta accreta in their next pregnancy and lost their uterus (and baby) as a result? Or if they ended up in intensive care due to excessive blood loss?
Planning a caesarean guarantees nothing other than having a caesarean.
Concern #2: The vast majority of the birth trauma that I see reported has very little to do with birth physiology and a lot to do with hospital and care provider policies and how women are treated.
Yes – some birth trauma is caused by physiology. Women can and do definitely experience trauma due to having their lives threatened by pre-eclampsia / eclampsia / HELLP syndrome. They can experience trauma during a physiological homebirth. They can be traumatised by the experience of a post-partum haemorrhage. Sometimes physiology doesn’t work and can leave women feeling traumatised.
But for the majority of birth trauma cases that I hear about, the cause of the emotional trauma has more to do with how the woman was treated and the physical traumas are often iatrogenic in nature. For example: Women will often feel traumatised if they feel like they have no control over their body, feel humiliated, bullied or coerced by their care provider, have been frightened into a procedure or have been left alone, in pain, with no explanation of what is going on.
Or they are left terrified because they are experiencing complications as a result of an induction…and they had been told that induction was perfectly safe. Or they have just passed out as a result of the epidural causing their blood pressure to drop. Or they are experiencing extended prodromal labour as a result of a stretch and sweep. Or they experience a postpartum haemorrhage after a long, induced labour – and they didn’t know that syntocinon can increase the chance of a haemorrhage occurring.
A really common comment made by women who have experienced trauma is: “I didn’t know that could happen. If I had known this was a possible outcome I might have made a different decision.”
Rather than seeing hospitals automatically offering caesareans as a way of avoiding birth trauma, I would love to see hospitals working to make vaginal births less traumatic for mothers. I’m not saying that caesareans should not be available at all – they are a completely valid choice and even with all the information some women will still choose caesarean. But should major surgery be the first, and often only, option offered to women who have previously experienced traumatic births?
Maybe we need to look at making sure women planning a vaginal birth feel safe, supported, confident and capable.
Empower women with knowledge and with actual power.
Make sure women know their rights and feel confident in asserting themselves.
Put more effort into reducing trauma during vaginal births and less into pressuring women into caesareans next time around.
And make the emotional health of mothers a priority.
PS: If you are ready to explore VBAC preparation in a way that will help you find your power, prioritise your mental health, and get clear on how birth works for you please click HERE to book in a sales call where we will work out what you need from this journey and the support that you need. You can also email me at email@example.com.
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