Compassionate Preparation for Cesarean Birth
In 2010, Pam England wrote a series of pieces about ways in which we can change birth in our culture. We hope you enjoy this wonderful material, both the archival treasure and the new, innovative insights!
One way to change the experience of giving birth in our culture is to prepare parents for all kinds of birth, including cesarean birth, with warmth and honesty.
Have you noticed how many times the parent who is feeling shock or shame after a cesarean is often the same one who did not read or ask about it, because they truly believed that it would not happen - or because they were afraid to think that it might? They may have directed all of their attention towards unmedicated birth in the belief that doing so would guarantee that outcome. But ignoring something does not make it less likely to happen. What it does do is increase the likelihood of feeling lost and overwhelmed by the experience if it does happen, as well as the likelihood of having a tough time processing it afterwards. If you were to ask such parents what would have helped, they might say, ”I wish I had known what to expect. It was such a shock!" If our approach to teaching about cesarean birth (or other unexpected or unwished-for events in birth) is "If they don't ask about it, we won't talk about it,” we are putting the onus of preparation on the uninitiated - in other words, we are asking people to initiate themselves. The task of self-initiation is extremely difficult, maybe even impossible. Parents who have received no guided preparation may suffer emotional shock, sometimes from the events of the surgery itself, but more frequently from their own innocence and self-judgment, and from being so overwhelmed by the experience that they disconnect in order to get through it. Even when the tide of unnecessary cesareans turns back, some parents will still have cesarean births. As long as cesarean birth remains a potential outcome, cesarean preparation must become part of holistic birth preparation.
All parents and birth partners need to be prepared to give birth in awareness via cesarean.
Birthing from Within mentors working with postpartum parents hear story after story of trauma generated not by the cesarean procedure itself, but by the shock of not having known what to expect or what to do, or by the belief that having to have a cesarean birth reveals something negative about the parent as a human being. In contrast, Birthing from Within mentors have often heard thanks from parents who, because of sensitive discussions of cesarean birth, were emotionally and practically prepared, and therefore much less traumatized. Parents who see midwives, hire doulas, and take classes, but hear not a word about what to do during cesarean birth, often feel ashamed if cesarean birth becomes necessary. Silence on the topic sends a meta-message along the lines of, "Cesareans happen to unprepared, uncommitted parents who don't have the protection of midwives/doulas/correct information; they don’t happen to parents like you.”
On the other hand, when birth professionals talk about cesarean birth with warmth and honesty, we model acceptance and strength, which parents can then embody. Think of this as an emotional homeopathic dose of medicine against shame, withdrawal, or the pervasive feeling of failure. And, if a cesarean birth becomes necessary, the parent knows that they have an ally in us; we are the ones who dared to talk about it! Even if we are not with the parents in the operating room, they know that we are “with them,” and that they can talk to us about their experience with no fear or shame. There are many ways of teaching about cesarean birth. Some methods send tacit or overt messages of judgment, with reasons and ways to avoid cesarean birth at all costs. The understandable positive intention of such approaches is to motivate parents not to "choose" cesarean birth.
But as birth professionals, we also understand that in labor, “choice,” “informed consent,” and “medical necessity” can become nebulous gray areas, impossible to navigate by black-and-white approaches to what “should” or “should not” be happening.
Truly holistic teaching about cesarean birth might feel less like holding up a bunch of warning signs and more like a ceremony, an initiation into self-acceptance and and an invitation to parents to envision themselves coping with the experience, including unwished-for events. This way of teaching is about embracing oneself, not about avoiding and regretting. It is about inviting birthing people to step into a place where they are safe to face their fears and familiarize themselves with all possibilities related to birth. Not all birth professionals may be able to talk about cesarean birth warmly and without bias right away. Some may need to first go through a period of healing their own birth trauma, or their (sometimes unconscious) negative beliefs about cesarean births or parents who give birth that way. Others may feel unable to imagine how to talk gently about cesarean birth without sounding like they are “approving" of it, or somehow hypnotizing parents into giving birth that way. These are important considerations. It can be done, though, and all birth professionals are capable of learning how to do it.
If you are interested in learning how to do this as a professional, we invite you to explore the Birthing from Within trainings (Doula, Childbirth Educator, and continuing education courses). If you are interested in experiencing this type of preparation as a parent, connect with Birthing from Within birth professional - even if there isn’t one in your immediate community, there are mentors who offer remote classes and consultations. There are many paths that can lead to the goal of changing birth in our culture. Some of us may feel the call to put on our activist hats and agitate for changes in medical protocols and rituals. There are definitely times and places for that.
As mentors, though, part of making healthy change is guiding parents to examine what they might encounter in the culture in which they actually live, rather than the one they wish for, and to consider what they will need in order to cope, remain connected, and give birth in awareness, no matter how that birth may occur.