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Why the experience of childbirth also matters

02 June 2014, 14:33
In a recent edition of Drum Magazine the following question was received and answered by Sis Dolly...

Question: I was pregnant in 2007 and everything went well until the day of my delivery. I was induced because my doctor was going away and I was not comfortable with the replacement doctor on call. I ended up having a Caesarean and I was very disappointed and depressed by the experience so I have bad memories about it every December. How can I forget about my experience? 

ANSWER: What does having a Caesarean mean to you and why does it have bad associations? You seem to think it makes you less of a woman. Your first choice was a natural birth but the outcome was different for the sake of the baby's wellbeing and yours. The way you can forget everything is to start by being grateful for what you have - your health and the gift of the child. You are unnecessarily holding onto the negative. Let it go, appreciate what you have and look to the future.

As someone who works with pregnant women, and assists them during childbirth, I was quite shocked by the lack of compassion or understanding in the answer. What shocked me even more was the number of people who didn't understand why I felt the answer given by Sis Dolly was a problem.

So let me unpack my perspective as someone who deals with the aftermath of bad birth experiences on a regular basis.
Just get over it
The problem with the perception of bad birth experiences is that the majority of people feel that the only outcome a mother should be worried about is that she has a healthy baby. Of course that is everyone's primary concern (although for most Doctors the most important thing is the mothers health, followed closely by the babys) but the experience itself is a separate and important issue in its own right.

Any mother who dares to voice any disappointment in how her healthy baby arrived earth-side is immediately met with a barrage of comments telling her she is ungrateful and should just "get over it". She is told that both her experience and feelings about the birth experience are completely null and void "because, healthy baby". Sis Dolly's answer is the perfect embodiment of this.

This attitude reminds be of people who turn to a mother who has just suffered a miscarriage and tell her to pull herself together because she can always have another baby. This totally disregards the hurt, pain and disappointment of losing THAT baby.

Let me also just point out that this is not just another attack on having a c-section. You can have a good c-section experience and bad c-section experiences. My own child was born by c-section and the surgery was a good experience, but I have spoken with women whose planned elective c-sections became very complicated and to the point of being life-threatening (leaving them with deep trauma and PTSD). You can also have good vaginal birth experiences and bad vaginal birth experiences. I've spoken to women with all kinds of bad experiences, and no matter how their baby arrived they still face the same "just get over it" attitude if the baby was born healthy.

So lets look at this specific case and what a much better answer would have been.
Cascade of Interventions
The mother was given the choice to give birth while being monitored by someone she didn't trust, or to have her body forced to go into labour before either she or her baby was ready. Neither of those two options were what she really wanted: a natural birth, which includes going into labour on her own.

In order to make the best of a bad situation she chose to have an induction, which she most likely believed would give her the best chance of the desired outcome with her chosen care provider. As her doctor would know (and was unlikely to inform her), less than 50% of inductions will result in spontaneous labour. Lets also just remember that this induction was not done in the best interests of the health of mother and baby, it was for convenience. The c-section was a necessary intervention when the induction failed.

If Sis Dolly had truly understood the problem, she would have realised that the surgery itself is not what the mother is feeling bad about. The real cause of the bad experience was a mother being left with some rather sh*tty choices which made her feel like her control, and any power for autonomy over her body and baby, was slowly taken away.

A mother wanting a natural birth is someone who wants to be involved with the process; to actively find ways to cope and work with her body during an intense physical process to bring a new life into the world. She is anything but passive during the whole experience and that's how she wants it. An induction hands over that power and control to someone else. The birth experience changes from one that she actively participates in to one that is done to her.
All experiences are valid
The right answer to this question would be to remind the mother that she made the best decisions that she could, based on the situation she was in. It is also totally normal and understandable that she would have felt negatively about what happened because she went from being involved with the process of birth to just having it happen to her. It is also normal to grieve after a big disappointment, and she should find a safe space to explore her feelings about it all. She can also be grateful for a healthy baby, but sad about her own, separate experience, at the same time. These two things are closely connected, but they are not one in the same.

The c-section was done as the result of a failed induction, because it wouldn't have been safe to just leave her once it was started. She can't change the past, but she can use this experience to make different choices in future. Perhaps having private midwifery care would be a choice for future births? Or even exploring birth in a government facility where it is midwife-led and all intervention is strictly done based on what is best for mother & baby (and not for convenience).
Experience matters
A bad experience during birth is linked to increased chances of Postnatal Depression, Postnatal Psychosis and Post Traumatic Stress Disorder (PTSD). With all the challenges that new motherhood brings, surely the least we can do for mothers is ensure that not only is the baby healthy, but the mother herself is psychologically healthy in order to cope with what lies ahead? Having a mother that is depressed or anxious has a direct impact on the health and development of a baby. This means that ensuring the mother is treated with kindness and respect, that she feels involved in the decision making process and that her autonomy is respected is almost as important is her clinical treatment.

Any bad experience needs to be treated with compassion, no matter how minor it may seem to someone else. I really hope that this mother looks elsewhere for advice and finds a empathetic ear to share her sadness with so that the negative feels can be overcome and the more precious memories of meeting her child will rise above them.
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