Giving birth by cesarean is a worry of many pregnant women. Different women may want to avoid a cesarean for different reasons, including risks to the mother or baby, increased healing time, postsurgical pain, scars, fear of separation from the baby, fear of the unknown or not being in control. Cesarean sections have risen dramatically in the United States in the past 20 years. Two years ago the American College of Obstetricians and Gynecologists (ACOG), and the Society for Maternal Fetal Medicine, published an Obstetric Care Consensus on the Safe Prevention of Primary Cesarean Delivery. The intention of the document is to identify areas of practice that can be examined and changed to decrease the incidence of a first cesarean delivery. The focus on preventing a woman’s first cesarean delivery is because after having one cesarean, the likelihood of further cesareans increases.
As a society there are four essential questions we must ask about cesarean birth.
The first two are discussed often in health care settings, among childbearing women, and increasingly in research:
1) why are there so many cesarean births?
2) what can we do to decrease the rates of cesarean births? These are important questions considering cesarean birth increases the risk for negative outcomes for both mother and baby.
The next two are often left out of the conversation surrounding cesarean birth but are just as essential:
3) how can women and their partners’ best prepare for cesarean birth?
4) how can cesarean birth be transformed into a process of birth by which the mother, partner, and baby are active participants and that respects the experience of the human beings involved?
What are the steps to cesarean awareness?
Although there is more understanding and commitment now than in the previous two decades of ways to prevent cesarean, the fact remains, in our culture today, about 1/3 of births are cesarean births. When women are preparing for birth therefore, comprehensive preparation includes learning about cesarean birth. Women can take time to be self – reflective in their learning and understand their own beliefs about cesarean birth, and also learn practical information about cesarean birth in the culture in which they will be birthing.
Here are some suggestions to guide discovery and awareness:
The movement towards family-centered cesareans:
There has been a movement toward natural, gentle or family-centered cesareans in the past few years. Health care is a rapidly changing industry. Consumers are demanding more choice and payers are demanding investment in value. This is leading health care organizations to recognize the importance and benefits of patient or consumer input in all processes, including the birth experience. However, even when it is known that certain practices are beneficial for the patient, it can take years to put the changes into practice.
This is why the consumer voice is so important. When women want change and demand it from their providers and health care systems, it starts to happen.
For example, first just one mother has skin-to-skin after a cesarean, then another, after a few months it may become the new normal in a particular setting with more and more women asking and more nurses and providers witnessing the benefits. It takes all participants in the health care process to create a change in practice; the consumer, the providers, nurses at the bedside, nurse leaders and health care administrators. In family-centered or gentle cesarean births, women are requesting skin-to-skin, two support people (instead of one so that a doula can also be with the mother), clear drapes to be used toward the end of the surgery so that the mother, who is lying flat on the operating table, can see the baby right away. Other ways to make the experience more personalized and gentle are music, massage or reiki before or after the birth, arriving early before a scheduled cesarean to have time to relax, take a bath, settle in and connect with the baby and the birth experience. At the moment of birth, inviting the mother to be fully present by picturing her baby being born, or by giving a gentle “push” can create an experience in which the mother is an active participant.
Changing health care practices to help prevent cesarean births is certainly valuable and effective. But health care professionals and parents-to-be must also remember that even if change is occurring for the better, some women will have cesarean births.
Women and infants do benefit from cesarean births time and time again. We must practice prevention as well as comprehensive preparation. Birth is one event in life that is arguably 90% mystery. Preparing for the many ways of birthing honors and recognizes both the mystery of birth, and your power and intention for readiness and self-love in all experiences.
Exercise to enhance your cesarean awareness:
For a quick and interesting exercise on how our words impact our thoughts, get some paper and pen. Now, take a moment to say the word C-section out loud to yourself and notice the image that comes to your mind. Quickly, draw it on the paper (don’t think, just draw). Notice what you drew. Pause. Now flip the paper over. Say “Cesarean Birth” out loud and draw the image that comes to your mind when you say this.
Notice what you drew. How are the images different? Try this with a friend or two. Do you see any patterns?
Most of the time in our culture we see and hear “C-section”, “cesarean”, “section”, or “cesarean section”. The image that comes to mind is an incision, a knife or scalpel, a scar, a belly with an opening, a person lying on a table alone. The word birth is rarely used in association with cesarean, and yet it is a birth. When we say “cesarean birth” many people draw a baby, a baby and a mother, a family. There is a human being involved in the image and a feeling that the mother is participating in the birth. In her book, Birthing From Within, Pam England refers to cesareans as cesarean births. When we use the word birth, we can begin to think about and prepare for cesarean in a very different way while we also work to prevent them.