The story of the line: celebrating c-section mamas and exploring the prevalence of caesarean birth

April marks Caesarean Awareness Month and we Golden Month folk celebrate any chance to honour each powerful caesarean mother and the crooked ‘smile’ on her abdomen – a permanent reminder of her courage, pain, heartache, elation, and devotion to meeting her babe, by any means necessary.

Caesareans stir complicated feelings. There is joy, of course, at having brought a beautiful soul into this world, enriching her heart and life, beyond measure. But there may also be disappointment, if baby’s birth didn’t eventuate as planned; and even trauma, if birth morphed from what she hoped would be a beautiful, natural experience, to a medicalised event that stole her power. The sting of missing out on physiologic birth can be as real as the twinges at her incision site, whether her caesarean was scheduled or an emergency procedure.

These feelings are perfectly natural and may linger for years after caesarean birth, but if, at any time, they become too much to bear or begin impacting your daily life, please speak to a health professional. You are important, you deserve to be well and happy, and you are an integral part of your family and community, so please mama, reach out and take those brave first steps to getting the care you deserve.

Compounding this cauldron of complex emotions are the physical impacts of caesarean surgery, and that others may minimise her experience because ‘at least her vagina was spared’. There exist many misconceptions around caesarean surgery, and Caesarean Awareness Month provides the ideal opportunity to unpack these falsehoods and reaffirm the courage it takes for a woman to go under the knife to bring her baby earthside.

Caesarean birth is birth

Birth is defined as ‘the emergence of a baby from the body of its mother; the start of life as a physically separate being.’ By this very definition, mothers who give birth via caesarean have no less birthed their children than any other mum. While the surgical theatre is cold and sterile, where the delivery suite can be fiery and raw, the c-section mama has brought life into this world just the same, and she is a warrior.

She sat, nervously furled upon herself, afraid to err a millimetre, as an anaesthetist plunged a large needle into her spine, placing her at risk of infection and nerve damage. She steeled herself once more, numb below the waist but surging with emotion, as an obstetrician cut through six layers of her tissue and muscle to reach her baby, risking blood clots and postpartum haemorrhage. Despite being groggy from anaesthesia and exhausted, perhaps having already weathered several hours of labour, she pulled her baby close, awash with pure love and relief, bravely entering the miracle and the mayhem that is motherhood. Recovery is drawn out; she will do too much before she is ready, and for several weeks, every cough, sneeze and trip to the bathroom will serve as a reminder that her body is still healing.

Contrary to popular belief, caesarean mums don’t ‘get off easy’. A caesarean section is major surgery, five times more dangerous to women than vaginal birth, and carrying inherent risks to both mum and baby. Caesareans are intimidating and intense, whether scheduled or performed in an emergency. A raw, battered uterus and abdomen is no more enjoyable than feeling broken apart after vaginal birth. All mothers perform awe-inspiring feats to meet their babies. All mothers deserve for their birth stories to be met with care and respect.

 

She is not a failure for having had a caesarean

Australia’s caesarean rate is exceptionally high, at around 34% of births, where the World Health Organisation prescribes an ideal caesarean rate of 10-15%. Looking at Iceland, a country with similar population demographics, a caesarean rate of 15%, and among the lowest maternal and infant mortality in the world, it’s clear that something is amiss here and it does not rest on the shoulders of Aussie mothers.

Obstetrics has transformed labour and birth from a primal, natural event, into a medicalised procedure that is timed, measured, and manipulated, often for the comfort and convenience of health professionals. While the specialist knowledge and sanitation inherent to modern obstetrics are a blessing, there seems to be difficulty in striking the correct balance between nature and science – providing the highest level of care and safety for mother and baby, while respecting the body’s innate wisdom and empowering pregnant women to trust their bodies.

Birth education is woefully lacking in our healthcare system. The pregnant woman is not told how, when allowed to go into labour spontaneously, multiple systems in her body work in perfect synergy to bring baby down the birth canal without extreme effort; or, that having caregivers who allow her choice and agency, and support her in creating a calming, comfortable space to labour in, can eliminate stress and reduce her perception of pain. As a result, we often approach birth with trepidation and inadequate knowledge and must reassemble the wreckage when our bodies don’t respond to being strong-armed into labour.

Women are routinely induced before their due dates, with no medical justification; or frightened into inducing as soon as their due date has passed, with no acknowledgement that healthy full term birth can be anywhere up to 40 weeks and 10 days, and regular monitoring is all that is needed to ensure that mum and baby continue to do well.

Synthetic induction opens women up to a cascade of medical interventions that are often traumatic and can increase the likelihood of caesarean birth. Syntocinon is a drug given to induce or enhance labour and results in suddenly more frequent and painful contractions. Unprepared for this sharp rise in pain intensity, many women request epidural anaesthesia, forcing them onto their backs for the remainder of labour, and necessitating constant electronic foetal monitoring. This can diminish contractions and decelerate labour, sometimes resulting in episiotomy, forceps or vacuum delivery, or caesarean section, if mother or baby are showing signs of distress.

A 2021 study[i] found that the top two reasons for caesarean section in Queensland public hospitals were abnormal foetal heart rate, accounting for 23% of caesareans, and inadequate contractions, accounting for a further 23%. In both scenarios, artificial rupture of membranes, syntocinon administration, and epidural anaesthesia were predictive factors for caesarean section.

Australia’s exorbitantly high caesarean rate is not the fault of mothers, but of a health system butting heads with nature, and a culture of fear surrounding birth. Watch any birth scene in a movie or television show and what do you see? Is it a woman lying on her back, legs in the air, screaming in agony? Paints a lovely picture, doesn’t it? We need more positive and empowered birth stories and open knowledge sharing and we need them now – not to shame women who couldn’t or didn’t birth vaginally, but to pave the way for a better reality for our daughters and granddaughters.

 

She is not precious for choosing a scheduled caesarean

Perhaps most symptomatic of how the dominant culture and conventional obstetric care fails pregnant women is that some are so fearful of vaginal birth that they would elect major surgery, which carries significantly higher risks.

Some of the most common reasons given for elective caesarean include fear of childbirth, safety concerns related to perceived health risks, previous negative birth experiences, positive attitudes toward caesarean birth, and access to biased information. Many of these reasons can be attributed to inadequate birth education and the failure of care providers to inform of the risks of caesarean birth, or to encourage vaginal birth.

The reasons a woman opts for caesarean birth may not be obvious, but in her eyes (the only eyes that matter, here) they are valid and profound and no one else’s business. We mothers need to lean on each other and hold space for each other’s birth stories, without judgement. Where one c-section mama might be devastated by her experience, and another might be perfectly okay with her choice, we all deserve to be heard and embraced.

Caesarean birth does not mean that she can’t experience a successful vaginal birth in future

Some obstetricians can be quick to resign their patients to repeat caesareans, rather than encouraging vaginal birth after caesarean, or VBAC. Despite the fact that 70%-80% of women who attempt a VBAC are successful, only a small percentage of women opt to do so. Again, this is down to the failure of care providers to promote the benefits of vaginal birth.

While a VBAC presents a slightly increased risk of uterine rupture, this risk is very low at 0.5%, or one in two hundred births. Barring any medical concerns, such as placenta praevia, previous uterine rupture or a complicated uterine scar, a successful VBAC is much safer than repeat elective caesarean surgery.

If you hope to achieve a VBAC, it’s best to wait at least 18 months after a caesarean before becoming pregnant again, allowing your body time to heal. Use this time to heal mentally as well as physically, processing any grief or disappointment over your previous caesarean, so that you feel strong and capable to achieve the birth you desire. Eat well, exercise, and take care of your scar with castor oil packs.

Knowledge is power and will help you to avoid unnecessary interventions, make informed decisions and appreciate when intervention really is necessary. Vaginal Birth after Caesarean, by Helen Churchill and Wendy Savage, Obstetric Myths vs Research Realities, by Henci Goer, and the VBAC Companion, by Diana Korte, provide a great jumping off point for your research. The Caesarean Awareness Network Australia and International Caesarean Awareness Network websites are also full of excellent resources.

Seek out a caregiver and birthing centre that will support you in your VBAC. Meet with as many as you need to and ask as many questions as you need to, until you find the right fit.

Parting thoughts…

There is no doubt that a caesarean section can be a life-saving procedure, when medically necessary, and we are fortunate to have access to largely safe, sterile, and painless caesarean surgery (our foremothers weren’t so lucky).

Frustratingly, though, some women are needlessly enduring major surgery, due to inadequate birth education, lack of advocacy for vaginal birth, and the scheduling of inductions and caesareans for convenience, rather than necessity.

Conventional healthcare is failing women in this regard, and we needn’t wait for a broken system to fix itself. We, as a sisterhood, can share our experiences, hold each other up, and educate one another, so that we may reclaim our power and advocate for ourselves, to achieve the birth experiences we desire.

Whether we strive for vaginal birth, choose induction, or elect a caesarean, let our choices rest on complete information around the risks and benefits of each option, and not feelings of coercion or fear.

Whether a caesarean is planned or not, it is a feat of courage and sacrifice. In each case, women risk their physical wellbeing to meet their precious babes and they, like all mums, deserve compassion and support.

 

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[i] Fox, H, Topp, S, M, Lindsay, D & Callander, E 2021, ‘A cascade of interventions: A classification tree analysis of the determinants of primary caesareans in Australian public hospitals’, Birth: Issues in Perinatal Care, 00, 1-12, <https://doi.org/10.1111/birt.12530>.