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 might 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, and maybe your worst fear, what do you do?

How can you cope with the disappointment of a birth that’s so far from the birth you’d dreamed of that it can resemble a nightmare? Questioning what went so dreadfully wrong, and who can we blame for this disaster? Often turning that blame towards ourselves and the choices we made or didn’t make.
As a former midwife and mother whose first baby was born by unplanned caesarean under general anaesthetic, 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? Many people experience feelings 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 (when i was unconscious). These are very common but usually totally irrational thoughts as we try to make sense of how our plans went so awry. There must be someone to blame, and that someone must be us. But we can often be in a state of shock and confusion 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 anyway? Wherever it comes from it is severely misplaced after an 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 neglect suffered. But do you know what? Despite having tried many healing modalities, it still hurts to think of those 15 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 with a syntocinon infusion for many 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 prepared so well and done everything so right. How could it go so wrong?

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

I know that 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 partners. It can 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 (see my online guide ) 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. Whereas it’s fine to write “I plan 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 be aware that your baby may have an entirely different plan. 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.

Can unplanned caesarean lead to feeling less than?

Why should women and birthing people feel “less than” if they’ve accepted life-saving surgery, albeit unwillingly? As a former midwife I’ve seen 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 feeling empowered. It is a true rite of passage, where families are presented with obstacles and challenges, through which they discover how courageous and strong they 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 an empowered way. Without support and explanation, they may be left feeling disappointed or even traumatised by such an unexpected outcome.

How can we lessen the potential negative impact of unplanned caesareans?

It’s important to have continuity of midwife, birthkeeper 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 know their options and can make truly informed decisions. They can prepare by having 2 good birth supporters, who will advocate for their choices, and help practically as well as emotionally during and after an unplanned outcome.

After birth families may benefit from an opportunity to debrief their birth with their care provider after unplanned caesarean. And care providers have a duty to help mothers, fathers and non-binary parents to understand and integrate their birth experiences. Unfortunately, most people don’t have continuity of midwifery care in the UK, but all midwives and doulas can help people 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 labouring, their graceful acceptance of the inevitable, and big up their support team too if they helped.

That person is a birth warrior, they have done battle with nature and perhaps their worst fears too, they have bravely laid their body down on the theatre table and have said “cut me open for the sake of my child’ – risking their own life to save their unborn baby. They then return from battle, often bearing scars, but triumphantly holding their reward – their baby, and should be welcomed home as a returning (S)Hero!

How can this warrior’s birth ever be be viewed in any way as less than?

Conclusion

As a birthkeeper and former midwife I’ve had the pleasure of seeing many empowering and ecstatic, planned and unplanned caesareans. I have personally had a VBAC so also know the joy of vaginal birthing. 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 with ongoing problems which affect 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, Investigation of your maternity notes, Rewind therapy, and Re-birthing and Closing the bones ceremonies.