Caesarean mothers receive such comments as: 'A caesarean is a small price to pay for a healthy baby...It's only a short time in your life and the baby is a good consolation prize...Most mothers are able to put difficult births behind them and get on with their lives.'
But is it fair or realistic to expect a woman to be able to put the experience of a caesarean behind her so easily? The confidence of a woman in her ability to give birth has a profound effect on her feelings towards herself as a woman. Although the act of 'giving birth' is indeed less important to every mother than the health of her baby, the act is still a fundamental one. A caesarean section, even one that has undoubtedly saved a life, does not negate the importance of 'giving birth' for a woman, nor should it be expected to do so. The woman should be allowed to express feelings of grief.
Those mothers who do voice their feelings are often considered 'ungrateful'. Some are even accused of putting their wish for a natural delivery above their concern for the welfare of their baby.
We now have an average caesarean rate of 15.3% - that is, one in every 6.5 mothers. Recent increases have been attributed to 'fear of litigation' and to 'maternal request'. This means that many caesareans are not being carried out on health grounds. Indeed, it has been shown that outcome statistics do not improve once the caesarean section rate rises above 7. Statistically over half the caesareans now carried out do not save life or improve health.
Mothers who suspect that the operation may have been unnecessary are those who are most likely to have difficulty coming to terms with the experience, and to express negative feelings. Many mothers, however, need to believe that their, caesarean was absolutely necessary - whether it was or not - since that is the only way they can cope with it emotionally. Any suggestion that their caesarean might have been avoided constitutes a threat to the beliefs which are underpinning their coping mechanisms.
Whilst all mothers have a right to have their beliefs respected and their means of coping left intact, we need to be able to offer support to those mothers who are ready to confront, or express a need to confront, these difficult personal issues. These are issues that encompass both physical and emotional consequences. For while the way a baby is born is important for the physical health of both baby and mother, the way the events of the birth are perceived also has implications for the pair's emotional health.
A significant proportion of women who have undergone a first caesarean express the sense that the baby doesn't feel like theirs, or doesn't really belong to them. They may know without intellectual doubt that the baby is theirs - but what we know does not always control what we feel. 'It's almost as though someone has said, "Never mind, dear, have this one. It's better than the one you would have had anyway."....'lt feels a bit like I picked him up in Sainsbury's somehow - but I can't take him back.'
Such deep-rooted emotional trauma, together with the accompanying feelings of failure and grief, deserve to be treated with understanding and respect. However, the general lack of understanding of the emotional aftermath that a caesarean section can cause, and how to deal with it, are great. It is vital for all those supporting a woman through this aftermath to acknowledge both her need to feel a continuous link between her pregnancy and the baby in her arms, and her personal need to have her fundamental womanhood respected.
Caesarean sections are by no means always negative experiences, but the first step towards true understanding is to remove the taboos and allow women to express their confusion as well as their gratitude.
First published in the National Childbirth Trust's journal New Generation September 1995