Judged for having an elective caesarean

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"I didn’t think you were the type to have an elective caesarean," said an acquaintance when I told her of my plans.

Once I stopped choking on the judgment I got to wondering: What exactly is the ‘type’?

Is it the heartless ambitious career woman who has her PA schedule the birth of her child between client meetings? Or perhaps it’s the vain yummy-mummy who needs to plan around her pedicure and her plastic surgeon’s availability to give her a simultaneous ‘mummy tuck’? Or maybe some other cardboard cut-out mother who only exists in Hollywood scripts?

Whatever the cliché, the clear implication is that women who opt for a caesarean are immoral, lazy and self-indulgent and probably going to Hell.

Luckily, I avoid this fate once I supply the reason for the elective caesarean: that my first daughter got stuck and could have died and there is a reasonable chance this baby could get stuck too. I am then redeemed and the judgment about my poor morality is reversed.

Having a c-section is not the problem. The sin is CHOOSING it.

In the ultimate in disempowerment, modern medicine has given women the option of a legitimate medical procedure but they are only allowed to have it if they would prefer not to.

My obstetrician, who fully supports my decision to have an elective c-section, says that she rarely recommends c-sections for first-time mothers. Not because they are unsafe or inferior but because women are often traumatised by the sense of failure and shame.  

"There is so much social pressure for women to deliver naturally. It’s crazy the pressure women put on other women," she said.

But according to Dr Hans Peter Dietz, Professor in Obstetrics and Gynaecology at Sydney Medical School Nepean, this is not just a problem of peer-pressure in the sisterhood.

"We seem to be obsessed with how a baby is born, and we don’t seem to give a toss about what happens to women in the process. Tears to the pelvic floor muscle and anal sphincter can have an impact on the next 50 years of a woman’s life," he says. "We’ve got it the wrong way around. And it’s not just the public. It’s policy makers as well."

For example in 2010 the then NSW Labor government released the policy directive ‘Towards Normal Birth’ instructing public maternity wards to reduce the number of c-sections from about 30 to 20 per cent by 2015.

While there has been a change of government since, and the target is no longer being pushed, neither has it been revoked or revised. And, as NSW Health’s website still makes clear, ‘Compliance with this policy directive is mandatory.’

Interesting that women’s bodies are being used to achieve someone’s Key Performance Indicators.

Dr Dietz is not against natural births. He feels that for many it’s the better option. What he objects to is the pressure women face to attempt a normal birth, especially after having a first child by casesarean.

He also says that most women are not fully informed of the risks, such as anal sphincter tears and pelvic floor muscles being overstretched or torn. This can lead to fecal incontinence, problems with sex, or female organ prolapse later in life.

"I deal with the damage women suffer in childbirth every day,’ he says. ‘Only about 25 per cent of women get what they want and expect — a non-traumatic normal vaginal delivery that does not do serious damage to their pelvic floor or their anal sphincter," says Dr Dietz.

"And this is first time mothers. If we did this kind of analysis on women who try for a VBAC (vaginal birth after caesarean) it would probably be as few as 10 to 15 per cent."

"We push women in a certain direction and make them feel bad if they require any intervention, and we tell them very little about the things that can go wrong. It’s the biggest event in a woman’s life. We need to do better," he says.

What I don’t often reveal when discussing my elective caesarean, because I don’t want to deal with the ‘too posh to push’ judgment, is that I want to do it. I’ve done 14 hours of labour in my life, and every second of it sucked. I don’t want to, or feel I need to, ever do it again.

And I’ve heard too many stories of women who wet themselves every time they laugh or have to have a couple of glasses of wine before having sex so it doesn’t hurt.

I’m not suggesting that one birthing method is better than the other. I respect women’s right to choose a vaginal birth without judgment. It would be nice if the same courtesy was afforded to the women who choose a caesarean.

 

Kasey Edwards is the author of Thirty-Something and The Clock is Ticking: What happens when you can no longer ignore the baby issue. www.kaseyedwards.com

 

25 comments

  • When the time comes for me I am going to do my best to stick my fingers in my ears and go LALALA while having either ALL THE DRUGS or ALL THE CAESERIANS.

    Commenter
    CBR
    Date and time
    January 29, 2014, 9:19AM
    • It's brave of you to share your story, thank you. I only hope you're not subjected to a tirade of criticism in these comments.

      I've not yet had a baby, but have already decided that if I do, my choice would be for a c-section. This choice has nothing to do with not having the time, or being 'too posh to push', etc. The idea of birth freaks me out completely. I have lived with terrible panic attacks all my life; I live with all kinds of fears and phobias, some of which are hard to manage, and I know myself - I know that, for me, going through the anxiety and trauma of childbirth would not be worth it - for me or my baby. I don't have a burning need to "experience childbirth" as the most important thing is for me to retain a calm mental state during and after the birth, have as much control as possible throughout, and be the best mother I can be. If that is a birth by c-section, and my baby is healthy, and I am in a good place mentally, how is that wrong?

      Commenter
      Mave
      Date and time
      January 29, 2014, 9:54AM
      • +1

        I can empathise with this. As a child with a disability, I was subjected to a number of very painful and intrusive medical tests and procedures that left me feeling totally humiliated, ashamed and powerless. I remember once asking a doctor (politely) for an anaesthetic during a very painful procedure, and being sneered at and told I was "being ridiculous" (though in fact, anaesthesia is routinely given for this procedure, particularly for children).

        As a result, I have a terrible fear of being placed in a medical situation that is out of my control, especially one in which I will be shamed for admitting pain or distress, or denied available help just on principle. Before having children, I'll be doing some careful research and finding an OB/GYN who respects my position and is willing to provide me with pain relief etc. if I should ask for it. I absolutely refuse to contribute my pain, agony, physical or mental trauma to achieve someone else's KPIs, when these are based on politics rather than outcomes.

        Also, in the course of my work, I've met far too many women who suffered extremely traumatic births - many resulting in permanent injury - to forget that birth is inherently risky. Talk to a woman who has suffered a fourth degree tear and suddenly a C section looks like a positively wonderful experience.

        Commenter
        Red Pony
        Date and time
        January 29, 2014, 1:48PM
      • Hi Mave. I experience panic and anxiety too. It's a long journey. I think it's great that you "know yourself" - that awareness makes it a lot easier to manage day to day life in this state.

        I'm childbearing age too, and I've decided to wait until I'm finished sorting the causes of my anxiety before I bring a child into this world. As you said, trauma during childbirth wouldn't be good for you or the baby. My concern is that my body in its current state isn't really a fit place to raise a child throughout the rest of the pregnancy also. For me, if I'm worried about panic affecting the birth, I should be worried about it affecting everything from conception to birth and beyond. Just my thoughts, it's up to you how you feel about it.

        Regarding the anxiety, can I please encourage you, and anyone else reading this who feels the call, to never give up trying to get help. I'm not out of the woods yet, but I have reached a point where I can see that this is something I can definitely recover from. For me, meds were not an option, psychology has fallen flat, and it's through finding a network of supportive people and practicing yoga (as in the lifestyle, not just the class at the gym) that I'm starting to see the light at the end of the tunnel. It's hard in our judgemental society, but we have to persevere with healing because other people's petty judgement shouldn't determine how we live on the inside. At the end of the day, it's only yourself that you have to answer to :)

        All the best,
        GI

        Commenter
        Good Intent
        Location
        from the heart
        Date and time
        January 29, 2014, 1:51PM
    • I also had an elective C-section. I had a medical reason to do so having suffered a pulmonary embolism a couple of years earlier, but to be honest I probably would have chosen to do so anyway. I have had a few raised eyebrows at my choice and a few implied criticisms but these definitely toned down when I explained about the PE. But, I had to pretty much go head to head with the hospital to get my C-section and it was only when they discussed my case at the medical review meeting they agreed it would be more beneficial for me to have a C-section than to attempt to labour naturally. I still don't think I should have had to push that hard (no pun intended) to get a medical procedure that ensured the safety of me and my baby, considering my age and history (I was 39). As it was, I still haemorraghed during the birth and had I attempted a natural birth, things might not have ended so well. However, the biggest shock I had was after agreeing to do the C-section, at about 32 weeks my hospital changed my Obstetrician and at the first consultation with the new doctor, she reduced me to tears with her judgements and comment about me having a caesar. Despite the notes in my file setting out why that course had been chosen, she still saw fit to pass judgement on me about my 'refusal to labour'. When that is the attitude of an informed professional, is it any wonder women face judgement from others as well? My view is that who cares how baby is born, as long as both of you emerge from the experience healthy.

      Commenter
      Pink Peril
      Location
      Melbourne
      Date and time
      January 29, 2014, 9:58AM
      • I hope you made a formal complaint about that doctor. Whatever her medical advice, a bedside manner that reduces pregnant patients to tears is never helpful.

        Commenter
        Red Pony
        Date and time
        January 29, 2014, 1:54PM
    • Thank you for this. Before I had my first child I was very keen on natural birth and did as much preparation for it as humanly possible. I did 26 hours of drug-free labour including over 2 hours of pushing ending in a vacuum extraction. Certainly not as traumatic as a lot of people's experiences and the recovery was ok. But we are starting to think about having a second and the idea of going through that again is making me very anxious. I am starting to think about what other options I have, from different pain relief options all the way to a planned c-section (I like the terms "planned" and "unplanned" rather than "elective" and "emergency", which I don't think truly reflects most circumstances). Anyway, thanks for sharing your thoughts (and the sorts of comments one can expect with a planned c-section) and all the best for your birth!

      Commenter
      Dee
      Date and time
      January 29, 2014, 10:01AM
      • Great article, I was in labour for 20 hrs after being induced 20 days after my due date when I had my daughter 7yrs ago. After complications, an emergency caesar was performed, and the repercussions of going through that useless labour are myriad. I was so exhausted and sick afterward that my milk did not come in, I went into somekind of PTSD situation which led to PND and the ultimate decision by my husband and I to only have one child as a result. Our small family was too precious to risk me going off the deep end again. Had I had my baby quickly and effeciently, our outcome may have been totally different.

        Commenter
        kyzmet
        Date and time
        January 29, 2014, 10:34AM
        • I'm a first time mum and I'm not ashamed to admit that I would like an elective caesarean for a couple of reasons: (1) I have chronic lower back problems; and (2) I had a bout of Group B Strep early in my pregnancy.

          I have never, ever been under the illusion that a vaginal delivery makes me more of a woman or is the only way to go. I think many women wouldn't opt for a caesar if they didn't have to. I will strongly be pushing (pardon the pun) for a c-section because first and foremost I want my baby to arrive safely and secondly, I'm very worried about the long-term damage a vaginal delivery could do to my lower back.

          Commenter
          I'm With The Band
          Location
          Backstage
          Date and time
          January 29, 2014, 10:52AM
          • Yes, yes yes!! Every caesar outside an 'emergency' caesar is called an 'elective caesar'. The majority of the time women elect because they're sensible enough not to put themselves or their unborn child at unnecessary risk & willing to take the advice of people who've spent their adult lives studying the field of obstetrics.

            I am grateful for my scar because if caesars didn't exist I wouldn't have a child. If a woman elects to have a caesar because she's terrified of natural birth or god forbid she is a career woman and needs to fit the birth in with a schedule, then what, we're to say she cannot have a child??

            A woman's body is hers, no one elses and she has the right to decide how it's treated and when it happens!

            When I was about 35 weeks pregnant I had a complete stranger tell me (in a park!), after I told her I could not have a natural birth, that I should wait until I go into labour then have an emergency caesarean because it would be better for the baby. I was flabbergasted, stuttering to justify a decision that was none of her business. I have relived that scenario many times, my favourite is that I slap her...I know very wrong but her reaction to my decision was even more so.

            Good luck with the remainder of your pregnancy and enjoy the birth of your new baby!

            Commenter
            Anonymous
            Date and time
            January 29, 2014, 11:04AM

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