Caesarean Section: A Positive Birth Experience
Around 25% of NCT members deliver their babies by caesarean section. Many of
these women feel that their birth has somehow been taken out of their control.
Fiona Barlow an NCT antenatal teacher, suggests ways in which antenatal class
leaders can help parents who are faced with a caesarean section to feel positive
and in control of their birth experience.
'Caesarean section? Oh, as soon as I mention sections to a class they all
switch off; they never think it will happen to them.' Maybe not our most popular
topic...but perhaps when we slip it in at the end of a session or simply offer a
handout we are the ones at fault of 'switching off'.
What follows is a brief account of how I deal with the subject of caesarean
section during my general antenatal classes. (I also occasionally facilitate
small group, or one-to-one sessions, for parents who know for sure that they are
to give birth by caesarean section.)
So much of what we discuss in our general antenatal classes is actually
highly relevant to women faced with the possibility of having their babies by
caesarean; we just need to help them make the connections, for example:
- postural exercises to encourage optimal fetal positioning during pregnancy
- coping with a breech presentation and finding a way through the available
- relaxation techniques throughout labour while spinal anaesthesia is
initiated or surgery is imminent
- the links between induction of labour, epidural anaesthesia, electronic
fetal monitoring and caesarean section
- optimising the chances of vaginal delivery; the effect of birth place,
attendants, movement during labour
During my classes, I focus for some time on the reasons why a caesarean
section may be required. I describe situations when caesarean is the most likely
outcome (cord prolapse or placenta abruptio) and compare these with
circumstances when management is more open to debate - breech presentation, for
example, or 'failure to progress'. I usually find that, far from 'switching
off', couples are keen to explore their fears and feelings in these situations;
to become aware of the difference between the drama and inevitability of the
emergency scenario and other occasions when informed choice and, perhaps,
assertiveness play a part. I find the use of BRAN - a discussion of the
Benefits, Risks, Alternatives, Nothing - a useful tool for exploring the options
available to couples who may find themselves in these situations.
Having considered ways of avoiding a caesarean birth, I then guide the group
through ways of improving the caesarean experience, preparing them for an
alternative - but perfectly valid - way of giving birth.
I describe what it may be like in the operating theatre, the number of people
present and their roles. The sheer numbers involved often comes as a
considerable shock to couples, especially if they have been planning a quiet and
private birth. I find the 'Playmobile' operating theatre set a useful tool for
this exercise - although you do need to buy more people!
We move on to explore the choices available to a woman and her labour
partner, antenatally, during the birth and posnatally. People are often
surprised at the range of options open to them in the face of a caesarean birth;
the little things that can, with a bit of forethought, be done to create a
memorable and pleasant birth experience. I suggest that couples may wish to
write a birth plan, although I emphasise that this document, like all birth
plans, should be flexible. A birth plan does not need to be very detailed; I see
it as a way of increasing awareness about choices. I consolidate our discussion
with a handout, detailing the questions a couple may wish to ask their midwife
or obstetrician in order to gain a thorough understanding of their particular
circumstances and management (Figure 1).
I usually use a separate session to talk about the potential problems of
recovery from a caesarean section (and other assisted deliveries) - the need to
anticipate a slower physical recovery, the possible emotional impact. I stress
the need for practical help and suggest ways in which this can be organised. My
emphasis is on identifying problems, finding ways to cope and enabling parents
to be positively involved in their care. I conclude by offering a handout of
practical coping tips for mothers faced with a caesarean birth, compiled by
other women in the same situation. I invite the new parents to contribute their
own ideas after the birth of their own babies (Figure 2).
Caesarean birth can be a very positive experience. I firmly believe that, as
antenatal teachers, we should do all we can to give choice and control back to
women faced with a caesarean section. This is not done with the intention of
disempowering obstetricians; it is done in the hope that we can encourage all
involved to strive to ensure that the birth of a baby by caesarean section is as
special and as memorable as any other.
QUESTIONS TO ASK WHEN PLANNING A CAESAREAN BIRTH
BEFORE THE BIRTH
- Could you explain to me and my partner exactly why I need to have a
- Could you explain in detail the various procedures, terminology and
- What are the advantages to me or my baby of an elective caesarean?
- What are the risks?
- Will I be allowed to go into labour spontaneously before the operation is
performed? - If not, why not?
- Can we wait until my baby is full term? - If not, why not?
- Can my partner stay with me throughout the operation? In what circumstances
might he/she be asked to leave, and why?
- Will I need to be shaved? If so, by whom and when?
- Will I be catheterised? If so, can it be done after I have been
- Will I be given suppositories or an enema before the operation?
- Could somebody tell me about the different kinds of anaesthesia - spinal,
epidural and general?
- What are the risks and benefits to both me and my baby of each procedure?
- What about the effect on breastfeeding?
- Can I choose the type of anaesthetic?
- If I need to have a general anaesthetic, can my partner star with me so he/she can hold our baby
immediately after birth?
- Will I be given any other medication before or during the operation?
- Will this effect my baby in any way?
- What about the effect on breastfeeding?
- Are there any alternative therapies, such as homeopathic remedies, which may help me or my baby?
- Do you object to me contacting an alternative therapy practitioner?
DURING THE BIRTH
- Will a familiar midwife be able to stay with me throughout the birth?
- I would like to know exactly what is happening; could someone give me a commentary?
- I wear glasses/use a hearing aid; will I be able to use them in the theatre so I can see/hear my
- Will we be able to see what is going on?
- Can I see a reflection in the theatre lights?
- Could a mirror be used to let me see what is happening?
- Could the screen be lowered so we can see our baby being born?
- Will our baby be born into bright lights or can this be avoided?
- Will the theatre be quiet at the moment of birth?
- Can music be played during the birth?
- Can our baby be turned to face me as he/she is born?
- Could somebody take photographs of the birth?
- Could my partner or I be left to discover the sex of our baby?
- Will we be able to hold our baby as soon as he/she is born?
- Could the paediatrician check our baby after we have had a cuddle?
- Will the baby be able to stay in the theatre with us?
- If I am not able to hold him/her, could somebody tell me what is happening and make sure that
I can see my baby all the time?
- Can I breastfeed while the operation is in progress?
- Can my partner and baby come with me into the recovery room?
- If I have a general anaesthetic, when wilI I meet my baby?
- Can my partner care for him/her until I wake up?
- If our baby needs to go to the Special Care Nursery, can my partner go with him/her?
AFTER THE BIRTH
- What pain relief will I be offered?
- Will this have an effect on breastfeeding?
- Will the drugs make me drowsy or sick?
- Can the administration of the drugs be timed to minimise their effect on breastfeeding?
- Will I need to have an intravenous infusion?
- When will l be able to drink and eat normally?
- Will I need to have suppositories?
- Can my baby be with me all the time?
- Will somebody be available to help me breastfeed on demand?
- In what ways will breastfeeding be different or difficult?
- If my baby is in special care, can you assure me that he/she will not be given any water or
artificial baby milk without my permission?
- Can you assure me that I will be fetched to feed my baby, even if am asleep?
- How long will it be before I can care for my baby unaided?
- Will my partner be able to stay with me, so that he/she can care for our baby?
- How soon can my other children come to visit me and our new baby?
- Do I have any say in deciding how long I stay in hospital?
- Will I have chance to talk through the caesarean with a midwife or obstetrician present at the
- How soon will I be able to lift and drive after the surgery?
PART OF THE HANDOUT OF PRACTICAL TIPS FROM OTHER PARENTS
DEALING WITH EMOTIONS
- A caesarean section could happen to you. Accept that it might and consider a caesarean when
writing your birth plan.
- Fear of the unknown is the worst. Read lots, talk to caesarean mothers, contact a caesarean
birth group, talk to midwives, doctors, antenatal teachers. Get your questions answered. Write
your questions and answers down. Make sure that you get answers you can understand. You may need
to go back more than once.
- Accept your feelings. Although you know a caesarean is necessary, you may nevertheless feel
very negative, let down or guilty. Find somebody to listen to you who recognises that it matters
to you and who will not judge you.
- Deal with loss. You may feel quite a sense of loss that your baby's birth is not to be as you
planned. Feel free to grieve this loss.
- Deal with guilt. You may feel guilty, continually asking yourself: 'what am I doing/did I do
wrong?' Seek to understand why your caesarean is necessary and, afterwards, tell yourself that you
have succeeded in having your baby against the odds. A TRIUMPH, NOT A FAILURE!
- Be ready for pain. During vaginal birth the pain felt is often described as being 'positive'.
The pain following a caesarean birth may, by contrast, feel quite 'negative'.
- Prepare for breastfeeding. Many mothers who have given birth by caesarean feel passionately that
they need to breastfeed. 'This is one thing I can get right' is a common sentiment. Prepare mentally
for the fact that breastfeeding may be taking longer to establish than following a vaginal birth.
Realise that in the early days, you will find movement slow and painful and may not be able to get
to your baby as quickly as you would wish.
- Be ready for feelings. Some women feel truly 'awful' at the moment of the birth or for some time
afterwards. This need not affect you long term. If you feel low, unhappy, depressed, ask for help from
your midwife, health visitor, doctor or NCT postnatal supporter.
First Published in the National Childbirth Trust's journal 'New Generation' December 1997