Emotional Impact of Cesareans

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Every 30 seconds in the US, a cesarean is performed.This overuse of cesarean surgery puts moms and babies at risk—not just physically, but emotionally ... A cesarean can reach far beneath the bogus smile on mom‘s face. It can scar her heart, as well as her uterus.

A baby girl is born. She grows and begins menstruating. She becomes sexually active and becomes pregnant. She births her baby. She breastfeeds her baby. This is life—normal and natural, yet exciting and important. In the continuum of life, pregnancy, birth and the postpartum period are milestone events. These experiences profoundly affect women, babies, fathers and families ...

When a woman gives birth, she has to reach down inside herself and give more than she thought she had ... There is a moment when every woman thinks, “I can‘t do this.” If she is lucky, she has a midwife ... to whisper in her ear, “You are doing it.” As she does it, she becomes someone new: a mother. If the birthing process is skipped or occurs in a hostile situation, or if the interventions become overwhelming, she becomes a different mother than she would have been if she had only had a supportive, midwifery model of care.

... A woman‘s confidence and ability to give birth and to care for her baby are enhanced or diminished by every person who gives her care and by the environment in which she gives birth.

To control and actively manage a woman‘s labor and delivery, modern obstetrical practice relies on conformity. A woman is “subject” to rules, restrictions and protocols ... Physicians and the hospital staff have authority—there is an unbalance of power ... I say: You can only consent to that which you are capable of refusing. If you can‘t refuse the test, the drug, the procedure or the surgery, then you did not consent to it. This is coercion and it leads to disempowerment of women ...

Many women who have cesareans suffer in silence because society expects them to “just be happy about their baby.” ...

... Research has shown that when we stray from evidence-based maternity care, we have a high degree of obstetric intervention that is associated with acute trauma symptoms ... how a woman perceives the event, not the event itself, plays a vitally important role in whether she has trauma symptoms.

Women report experiences that fall into the following categories:

* A sense of loss: birth didn‘t turn out like expected, loss of the experience of participating in the birth experience, not being there when the baby enters the world * Interrupted relationship with baby: feelings of detachment from her baby * Altered identity: sense of failure, feminine identity altered; lowered confidence in her body * Intimations of mortality: surgery gives “rise to fears about mortality” * Feelings of violation: from surgery where the body boundaries are violated, feeling “mutilated” or “butchered” * Anger at caregivers: particularly regarding “what was perceived to be an unnecessary cesarean, lack of involvement in medical decisions, feeling unsupported by hospital staff before, during and after the cesarean” * Dissociation: feeling that the surgery was taking place on someone else or from a distance * Humiliation: being scolded * Helplessness: not being able to take care of herself or her baby * Posttraumatic Stress Disorder symptoms: anxiety, trouble sleeping, panic attacks

Let‘s consider that a moment. What if we went to a wedding today and while waving the couple off in the limo, we see it get hit by a truck before it turns the corner. If the bride were to spend her honeymoon in the hospital, no one would tell her, “Well, at least you have a healthy husband.” ...

... Some women have such a traumatic experience, they close themselves off to the possibility of more children. They never consider the idea that it doesn‘t have to happen that way ...

... Women who have had cesareans have higher rates of voluntary ... infertility ... This is often due to their determination that the trauma, whether physical or emotional, was too much to repeat.

Men are in a unique place during labor. They have been asked to be the support person and the labor coach. Now they are asked to be the protector. While historically men have taken the role of protector, I submit that the labor room is not the place men want to be trying to protect their wives.

Is it fair to expect this of partners? How are partners to be effective protectors / advocates when it is their partner and baby going through the experience? Is it fair to expect this role on anyoen who does not have the qualifications and experience to advocate?

Husbands of women who had had cesareans responded ... mainly with fear and anger ... “The pall that the experience placed over our entire relationship was stronger than a death in the family, because we both feel that we should have been able to do better. She has an alibi and can say she did all she could. I have no such explanation.”

Another husband expressed ... he was “ashamed that I let them hurt my wife as I stood by.”

What is a husband protecting his wife from? We trust our obstetricians to provide care that is safe and effective for women and their babies. Yet, in the US, the norm in maternity care that is provided is technology-intensive and not consistent with the best available research.

This is the norm in Australia too.

Healthy women often are given ... interventions that could have been avoided. In the hospital, some procedures or interventions are done freely and routinely, whether or not the mother or baby has shown a clear need. These interventions are disruptive, uncomfortable, can cause serious side effects and often lead to the use of other procedures ...

... Birth has become extremely interventive and this includes everything from the seemingly minor ... to the most invasive—the cesarean. It has become so interventive that it takes something away from what the experience should be. As a result, many women find themselves grieving.

... Partners witnessing birth trauma are also at risk of developing depression, caused by feelings of helplessness during the traumatic event. Men are more likely to express their feelings of depression through anger and abusive behavior. Truman stated, “The cesarean completely destroyed my faith in the medical community ... ”

... Tim stated: “I‘m mad and bitter—disillusioned. That likely won‘t change with time. Recovery is not a term I would use. I‘m not recovering. I have learned a lesson.”

How the couple process their experience can determine whether the marriage survives. Chris said, “... It put us at the brink of divorce. I didn‘t understand fully what happened and my wife thought I didn‘t care.”

The cesarean may be difficult for the father. A husband may have seen his wife rushed to the OR. He saw her uterus taken out of her body. He was worried about her. He may not have words to describe the experience, but he needs to process it.

When I broached the subject of intimacy after cesareans to husbands, some asserted, “Everything‘s fine there, thank you.”

Others report having to work hard to restore intimacy to their marriages: “It took more than a year for intimacy to start returning. More than a year.”

One husband, when asked, snorted, “Hah, are we seriously going there? Personally, it has left ’intimacy‘ out in the dark. She is embarrassed about her scar and she thinks it makes her less sexy. I guess it‘s more of an emotional hardship for her and she just doesn‘t feel sexy anymore.”

The cesarean recovery has an impact on the couple‘s ability to resume intimate relationships. The immediate problem is healing of the incision and recovery from the surgery itself. There also is long-term impact that is rarely noted by the medical community. Some women report a loss of feeling around the scar. Others are hypersensitive to any touch or pressure in the scar area—which may be psychological as well as physical. They report pain and discomfort.

Intimacy is an emotional connection. After a cesarean a number of things may interfere with this connection. The husband may have been frightened by the sight and sounds of—or the scenario that lead to—the cesarean. He may be hesitant to resume relations, worrying that he might hurt her. What if she gets pregnant again? He certainly doesn‘t want to do that again. His wife might feel the same way. She has to focus on her own recovery, which takes away from what she can give to their relationship.

... Stephanie‘s cesarean changed her husband‘s view of the medical community. He said, “... To know that people we trust with our lives and the lives of our children are so careless and insensitive about our lives and the little ones they savagely bring into this world.”

The veil has been removed—even doctors no longer believe in the Hippocratic Oath. They cite liability as the main reason they do many things, including unnecessary surgeries and banning VBACs. Since they are more concerned with money than with the health and safety of women and babies, we must now claim the right to have full and complete information about the risks and benefits of, and alternatives to, every test, drug, procedure and surgery. We must claim the right to make medical decisions for ourselves and in behalf of our babies.

Melissa Maimann, Essential Birth Consulting 0400 418 448