Wife: "So before we decided on a natural birth, I had actually thought I wanted to have a Cesarean. You know, to save my precious vagina. Some women get such bad tearing."
Husband: "Well... I think your precious vagina came through with flying colours."
I have something to confess. When I first found out I was pregnant, I considered having an elective Caesarean. Since there are no negative side effects for the baby, my thoughts went (and of course C-sections wouldn't be so common if there were!), I might as well save my precious vagina.
But as I looked into it, I found out that there are potential side effects for the baby – higher risk of respiratory problems (because the water in the baby's lungs is not expelled by uterine contractions), and low but significant chances of the baby being cut by the knife. There is also a risk of complications in future pregnancies, though those rates vary according to the type of incision made.
And of course, planned Caesarean birth just isn't really the Svea way; I soon booked myself an appointment at the Maison de Naissance (birthing centre) in Montreal. We were followed by three midwives and I got on the natural birth bandwagon, reading some great books like Erica Lyon's Big Book of Birth and Une Naissance Heureuse by Isabelle Brabant (her article, Ne Touchez Pas a Ma Doleur, outlines the purpose and beauty of labour pain and is available for free, French download here). As the due date approached (and passed...), I began to worry more about the chance that I might have to have a C-section.
Whereas before I had thought of a C-section as a way to gain control over the situation (get the upper hand of the birthing process, if you will), now I knew that if I ended up having a Caesarean, it would essentially be a matter outside my control. It was not something I chose or would choose, unless the survival of the baby were at stake. It's in this switch, from a person with agency to choose to a patient without choice at all, that a great chasm of pain resides.
Helen Dunn is a recent graduate of Simon Fraser University's Counselling Psychology programme. In her research she interviewed women who had undergone both unplanned Caesareans and regular vaginal births. Her thesis, Someone Else's Child: Women's experiences of disconnection and birth distress is a heartbreaking look into their post-Caesarean feelings of loss and alienation. When I read about her work in the Georgia Straight newspaper I realized there was a whole side of the debate I had been missing: the effect of the Caesarean on the mother.
There are obvious physical side effects – a C-section is not a 'procedure', it is a major surgery, with all the risks of infection and complication that surgeries entail – but mothers' emotional and cognitive effects have been swept under the rug. Our attitude that the baby's health is the only important thing has blinded us. The reality is that the mother's sense of well-being is closely interwoven with the baby's. And it is important in its own right. Of course, not every Caesarean turns out badly -- for some women this is an important and empowering choice. But for some, their unplanned Caesarean has ramifications that affect them for the rest of their lives.
I contacted Helen Dunn to find out more about these issues and how women like myself could be better informed. In the following interview she describes her personal experience as well as the implications of her research. Helen is a warm person full of vitality and insight. She conducts phone therapy with new mothers, so if you're dealing with any of these issues I recommend you contact her (her website is helendunncounselling.com -- she also does in-person sessions at the Grant Street Wellness Clinic in Vancouver). Her very readable thesis can be downloaded for free from the SFU website.
-- Svea Boyda-Vikander
SV: I guess the first thing I want to know is how you came to choose this topic for your thesis. It's a personal one, and I think it's very courageous for you to have opened up your personal trauma to academic study. What prompted you to take that step?
HD: The biggest thing for me was trying to make sense of my experience – which I also put a focus on in the research, making sense of the participants' experiences. I thought to myself, This can't be an isolated incident, this can't just be me.
I had the impression as I was going about my daily life and recovery from my Caesarean birth trauma that there were women at that very moment somewhere right now, isolated with no one they could tell... I wanted to do this work not just for myself but for them as well. When I put my call out for participants this whole underground network of women miraculously appeared. All these women who are on the front lines of birth trauma and obstetrical violence against women started to appear in my life. Gloria Lemay, Myrta Marten... I felt very encouraged. Myrta said to me, "You're doing very important work." Also, my supervisor is a trauma specialist herself and she was very encouraging.
SV: Could you tell us a little bit about your experience?
HD: I was alone for the birth of my first child – my family was in Ontario, and my husband wasn't there for the predominant part of the labour. We were in the hospital where I had been induced, and had been told to expect a long labour, so I had sent him home to look after our dogs. He came back but he had gone to get some breakfast when the fetal heart monitor started indicating the baby was in distress. I underwent an emergency Caesarean right away.
Also postpartum it was difficult for us in that I had the eight and a half months' preparation for the baby coming. He wasn't as prepared and so he wasn't as supportive as I wanted him to be. It was also a lack of community – you know, not having the village (for me, my family) around to help.
But my mom came two weeks post-partum...She stayed for a month and then I went back to Ontario for four months while my husband stayed here. I needed her. I could not function or cope, so she took time off work, slept with the baby and brought him to me to nurse. Her intervention probably buffered the effects of my not being available to bond with him like I wanted to.
SV: Four months is a long time when you're post-partum. How did you manage to reintegrate your husband into your life when you came back?
HD: We went to therapy, and we went to an information session on Post-Partum Depression. When he gained more of an understanding that what I was going through was out of my control and it wasn't something that I was doing on purpose or could snap out of, he was able to be a lot more compassionate and understanding.
SV: What has been the most significant challenge for you in doing this research?
HD: I think the main thing was trying to do justice to the stories that the women told me. Trying to represent them accurately and give them the voice that I intended to... While there were commonalities there were also differences, and I wanted to communicate this to professionals. So that they have some understanding about the issue but don't presume to know too much.
SV: What advice would you give women who are expecting?
HD: I would have a doula, somebody to advocate for you, certainly. Ask your medical providers what their C-section rate is – not just doctors, ask your midwife as well. And I would absolutely advocate in a normal pregnancy to have a homebirth. I think that medical professionals are geared and trained to believe that whoever they have coming in the door is having an emergency... So I would recommend to go in with a clear plan and to go in being assertive. To not be afraid of what other people are going to think about you in that moment. It might affect you for the rest of your own and the rest of your child's life. Prepare yourself mentally, think of how you might handle a C-section, what you would want that to look like, and what resources and help you might seek out afterwards.
SV: What about partners? How can they be supportive?
HD: I think to be a mediator between any kind of medical staff or intervention. Knowing what the woman wants, and being willing to advocate for her and act on her behalf. It's difficult if you're in pain and somebody's telling you your baby is at risk. It's easy to just go along.
In the case of surgery under general anaesthetic, it's helpful to have somebody there who can explain what happened. There's evidence to suggest that trauma takes place when dissociation takes place. I think trying to have a woman maintain as much control as possible, even in small ways, goes a long way in terms of allowing her to feel active and empowered. Also, a partner can interrupt any small-talk that's going on over her [One of the participants in Helen's thesis describes doctors conversing about golf over her supine body, just before conducting the Caesarean – Ed.]. And simply having someone validating your experience after the fact can help you work through it.
SV: Several of the women you interviewed describe violent visualizations in the weeks (and perhaps months) after their Caesareans. In a poem published in the 1970s, Sharon Olds describes these violent dreams and fantasies, "It is true that the young woman, a mother for three days, would die for her child, and dreams every night of murder." Women I've met online talk about being kept up at night by graphic imagery of their babies' death. I personally was much relieved when we left our fourth-floor apartment in Montreal – for months I'd been terrified I would accidentally (but somehow casually) drop the baby over the balcony. What kind of attention has the medical establishment paid to these kinds of fantasies? What do you, as a therapist, make of them? When do they become a problem?
HD: I went through treatment for that myself. It was Cognitive-Behavioural Therapy for Primary Obsessions (intrusive thoughts). Mostly, the way that it was dealt with for me was that it was normalized. We framed it in this way: when you have something very precious, vulnerable, and small, the most conscientious people will have alarming thoughts of losing that 'thing'. It's different from psychosis. It needs to be talked about more and brought out into the open because some women don't feel disturbed by these thoughts, but many do. I myself wondered, How do I know I'm not psychotic? I had a social worker come to my house and evaluate me and I said to her, "Am I going to hurt my baby?" and she said, "No." It was a great relief.
SV: What do you make of one of your participant's hypothesis that there is an evolutionary mechanism that tells a mother that her baby has died if she isn't placed in close proximity to it in the first few minutes after birth? This makes perfect sense to me (and is perhaps a better explanation for the need for immediate contact than the critical bonding period theory). I'm reminded of the LeBoyer bathing technique, where newborns are placed into a warm bath immediately. It's not popular now but it was trendy in the 1970s. Many infants didn't cry – but their mothers did, saying "My baby is dead, I know it is, just tell me."
HD: Having the actual experience of seeing the baby born and birthing the baby... It's such a huge experience, and it makes sense from an evolutionary standpoint that you would feel a real disconnect if you didn't have that. But, then again, not all women who have C-sections are traumatized or feel disconnected. There is also evidence to suggest that even if women do feel disconnected or not as bonded with their baby as they would have liked, they will deny it. I believe this is due to societal and cultural pressure.
SV: One of your participants mentions the disappearance of the placenta after her C-section. Is this common? I recently interviewed a doula who does placenta encapsulation so women can consume it post-partum. But it can also play roles in ritual, art and other empowering actions. What role do you think the placenta might play in recovery?
HD: I believe it is common. Mine specifically went for testing to see what had happened because of the prenatal complications. They wanted to know why the placenta had "failed" to nourish him. The exact wording I was told was that he was "thriving in a hostile environment". Could it be helpful? I'm sure... The second time around I chose to have the placenta encapsulated so I could consume it for the health benefits. More women should be aware of this option.
SV: Epidural also inhibits beta-endorphin production and therefore has been hypothesized to interfere with mother-infant bonding, though of course most hospital births use it and mothers report bonding well with their babies. What do you think about this?
HD: I think hormones play a role, but I don't know about the research around that. I think that inductions are a dangerous thing. When you have those kind of artificial synthetic hormones, drugs, taking over your body, it often doesn't end up well. Inductions lead to much higher rates of C-sections. First-time mothers have a higher rate of induction than anyone else. Why? Who knows.
Part of my trauma was the induction, because I couldn't get up and walk around. I continue to have difficulty in situations where I feel confined – agoraphobia. That has taken a huge toll on my life.
In my second pregnancy I had the same 'problem' (my baby didn't seem to be gaining weight at the normal rate). My midwife advised me to drink lots of water, and otherwise not to worry about it. I had to go into my regular doctor, who had been my OB/GYN for my first baby, to get a prescription filled. And she looked at me and said, “You're so small, are they monitoring you properly?” At birth, my second baby was seven pounds... Totally healthy. I wonder if I had been followed my a mid-wife and received that same advice for my first baby, the outcome would have been different.
I still feel disconnected from my first child, but it makes me try harder. I have that extra push to connect with him. And I don't wish a traumatic C-section birth on anyone but there's been a lot of positive things to come out of it. I tell him all the time that his birth is a blessing to so many other people, because it will help them. Women everywhere can benefit from my experience, and from his experience. It's so painful not to connect deeply with your newborn but we need to talk about it.