Unplanned Cesarean Birth. A warrior’s path.

Caesarean birth may not be everyone’s first choice when planning the type of birth we’d like. For many women and people who give birth it would be the very last type of birth they’d opt for. So when you are faced with your least favourite choice, the thing you’ve worked so hard to avoid, your worst fear, what can you do? How can we cope with the disappointment of a birth that’s so far from the birth you’d dreamed of that it can resemble a nightmare? What went so dreadfully wrong, and who can we blame for this travesty?
As a midwife and mother who’s first baby was born by unplanned caesarean I’d like to explore these questions further.

A less than ideal birth?

Does a less than ideal birth have to mean less-than? Might a less than ideal birth leave you feeling that you didn’t get to complete? Do you feel that your body apparently failed to give birth, or that you didn’t get to do the things you’d planned to do when greeting your baby? Some may feel a sense of failure or regret. I certainly remember feeling that my body had failed to birth my first child, and that I’d somehow failed to be there for my baby immediately after birth. These are very common but totally irrational thoughts as we try to make sense of how our plans went so wrong. There must be someone to blame, and that someone must be us. But we must be so confused after an unplanned caesarean, as I was obviously not slacking by needing a life-saving caesarean, then haemorrhaging and being unconscious for hours after. Where does all that self-blame come from? Wherever it comes from it is severely misplaced after unplanned caesarean birth.

How can we even think that we are to blame for things going wrong? I can joke about it now, as it’s over 30 years since my baby and I nearly died. I can see rationally that my caesarean was a life-saving measure, and that my now grown up child shows no signs of potential early neglectsuffered. But do you know what? It still hurts to think of those lost hours when we were not together.

Best laid plans

Like many women I’d prepared for a homebirth, but of course I knew as a midwife that anything could happen. It just wouldn’t happen to me, as I was so well prepared. I watched all my plans evaporate when labour didn’t progress and I transferred to hospital for analgesia and augmentation. A catalogue of nightmarish scenarios ensued, and my baby was found to be presenting by the brow (forehead, instead of the back of the head coming down first). Of course trying to force a mal-positioned baby through a pelvis for hours is never a good idea, so my body haemorrhaged after my caesarean and I was returned to surgery. Postnatal depression inevitably ensued, marring a majority of our first year together. It just didn’t make sense. I’d done everything so right. How could it go so wrong?

 Are birth plans worth the paper they’re written on?

I’m sure we can’t actually plan a birth, knowing that birth is inherently unpredictable. but I do think writing a birth plan is a good exercise in looking at and discussing your birth preferences with your birth partner. It can also be a useful communication aid for your midwife to read whilst you are busy birthing and not able to fully express your wishes. It can also help you and your partner plan for unexpected outcomes if you make a plan for all common birth outcomes, and not just the one you want. If you do write your birth preferences down please write each on just one side of A4 paper, use bullet points, and try not to be too outcome orientated. What I mean by this is do not write “I am having a homebirth, vaginal birth” etc as these are never guaranteed. Its fine to write “I hope to have a homebirth” or “I’d prefer x to y if I require pain relief” or how you’d like to spend the first moments with your baby if possible. Please do keep it short though, as I’ve heard doctors joke that women with long, inflexible birthplans are bound to need medical interventions! So plan all you like, but your baby may have an entirely different plan of course. I do believe that all babies do their best to come out the way we have planned, but some get stuck, some run out of energy or become unwell, and if left to a natural conclusion, some babies and women would not survive the pregnancy or birth process. Nature doesn’t always get it right despite our best efforts, and timely caesarean surgery can save lives.

Less of a birth=less than a woman/person?

Why should you feel “less than” if you’ve accepted life saving surgery, albeit unwillingly? As a midwife I see so many different types of birth, and not one has more worth than another. All women and birthing people are strong, beautiful and powerful in their birthing efforts. This transformational portal has equal value whether it is long or short, painful or ecstatic, vaginal or abdominal, surgical or physiological. Each birth brings forth a baby as well as the birth of new parents who need to start their parenting journey in an empowered way. It is a true rite of passage, where you are presented with obstacles and challenges, so that you can discover how courageous and strong you really are. When women and birthing people are well supported in their births they get to see their own strengths and triumphs, and can start their journey to parenthood in a peaceful way. Without support and explanation they may be left feeling disappointed or even traumatised by such an unplanned outcome.

So how can we lessen the impact of unplanned caesareans and enable people to feel strong and empowered in their birthing? It’s important to have continuity of midwife, or a doula if possible. Research has shown that continuity of carer leads to better outcomes. Families can empower themselves by learning assertiveness phrases and asking for everything to be explained, so they are in charge of the decision making. They can organise 2 good birth supporters, who will support their choices, and be able to help practically as well as emotionally after an unplanned outcome. family members will need opportunity to debrief their birth with their care provider after unplanned caesarean. Andcare providers have a duty to help mothers and fathers to understand and integrate their birth experiences. Unfortunately most people don’t have continuity of midwifery care, but all midwives and doulas can help a woman after unplanned caesarean birth. We can do this by listening, by witnessing their story without interrupting, and by answering their questions. We can believe them and validate their experiences, letting them know they made the best choices possible (being a professional means putting aside our personal opinions). We can congratulate them on their intuition, bravery, endurance etc, for giving it everything they had and then some, because of course every woman and birthing person does. Don’t forget to mention their beauty and dignity in birthing, their graceful acceptance of the inevitable, and big up their support team too ifthey helped.

That person is a birth warrior, they have done battle with nature and maybe their worst fears, they have bravely laid their body down on the theatre table and has said “cut me open for the sake of my child’ risking their own life to save their unborn baby. They then return from battle triumphantly holding their reward, their baby,! and should be welcomed home as a returning Hero. How can this warrior’s birth ever be seen as less than?

Conclusion

As a birthkeeper and former midwife I’ve had the pleasure to see empowering and ecstatic, planned and unplanned caesareans. I have personally had a vbac so also know the joy of vaginal birthing too. All births are great opportunities to grow and become more than we ever thought possible. This is a process of growth not of diminishing, so let’s treat it as such, and celebrate all birthing women, fathers or non-binary people as the birthing Warriors they are.

Further information

Of course the story doesn’t end there for many families as any trauma experienced can affect people in their daily lives. I suggest talking things over with your care provider, GP or health visitor if possible as there is some support and treatment available on the NHS. I also offer many services including Birth story listening, Investgation of your maternity notes, Rewind therapy, and Re-birthing and Closing the bones ceremonies.