how do c-sections fit into a natural birth framework?

[PlayaMama]

i've had this thought several times on reading recent threads and it's an issue i'd like to explore. i can EASILY see it getting heated so please remember to be respectful of other's views.

as we are on mdc, i think most of us feel "natural is better" and that birthing with less unnecessary interventions is better. obviously, a c-section is the ultimate intervention in birth and they are sometimes performed unnecessarily. how can the issues be untangled so that unnecessary c-sections can be discussed without casting such a wide net that anyone that has had a c-section is met with the underlying suspicion that their c-section was not necessary?

there is also an idea that women should "trust their bodies" and that their birth will go as nature intended. the consequences of this can be that when birth does not go well, these women's bodies are failures. i have seen it expressed on here several times that this can cause great amounts of anguish and guilt.

so, my questions:
is there a way that natural birth advocates can include c-section mothers?
if not, then what does this mean for those women that have had c-sections?
is the bigger goal to support mothers or to support natural birth?
what do you do when supporting natural birth gets in the way of supporting mothers?
how can the idea of trusting your body be reconciled when your body doesn't do what everyone has been telling you it is natural for your body to do? _is_ that woman's body a failure?

[KaylaBeanie]

Originally Posted by PlayaMama

is there a way that natural birth advocates can include c-section mothers?

Absolutely. The whole point of natural family living is to do what comes instinctively. If a woman has been in labor for many, many hours and instinctively feels she needs an epidural to rest, that needs to be respected If a woman has suffered abuse or another experience that has led to an intense fear of vaginal birth, she should be offered therapy, but should she decide that a c-section is least traumatic and will allow her to better bond/breastfeed/parent, that needs to be respected. If a woman is bullied or feared into a c-section/induction by a doctor who had claimed to be a natural birth advocate, she needs to be included and her birth respected. Last of all, sometimes c-sections are necessary. A natural birth is no good if it kills or damages mom/baby. There needs to be understanding and encouragement.

To sum it up, natural family living is a holistic approach, with birth being only one part of the equation. If a woman legitimately couldn't breastfeed (or was misled by doctors/LCs), wouldn't we encourage her to still do everything else (nurse, co-sleep, etc)? While not very vocal, there are parents here who do circ, but does that mean they shouldn't homebirth/nurse/co-sleep/not vax/eat healthily? We have many members who follow everything on the long list of "crunchy things" save for one thing. Birth, while a HUGE part of the equation, is just one more thing, and assumptions should never be made without all the details.

if not, then what does this mean for those women that have had c-sections?

See above. I think it is terrible that women might feel excluded because of a c-section.

is the bigger goal to support mothers or to support natural birth?

To support mothers, hands down. Birth is not a one size fits all formula. If a woman reads all the risks of different interventions but still feels comfortable with it, that is her prerogative and I respect it 100% even though i might not agree with it.

what do you do when supporting natural birth gets in the way of supporting mothers?

It never should. I think 99% of us here would agree that the issue is not women, the issue is the system. Doctors are not educating women and are not allowing them true autonomy when it comes to delivery. I would bet my life that if we transformed the birth industry to where women were legitimately informed of the risks of medical birth and given the proper support for natural birth (freedom of movement, do away with lithotomy position, no induction/c-section unless medically necessary, institutionalization of doulas, no IV, the list goes on), we would see c-section rates and epidural rates absolutely plummet. The key to obtaining more natural births has little to do with supporting natural birth itself, and everything to do with informing and supporting women.

how can the idea of trusting your body be reconciled when your body doesn't do what everyone has been telling you it is natural for your body to do? _is_ that woman's body a failure?

Every birth has a risk of c-section. I believe recalling that out of home birthing women, only 8% will end up with a c-section. So, given the different types of birthing environment, you have a 8%-33% chance of a section with each birth, more or less depending on the woman and her history. Not everyone is low risk. Sometimes c-sections are necessary. Does that mean the woman's body has completely and utterly failed? Well, if you look at it from a pretty harsh point of view, yes.

However, I am an optimistic person and if I ever had a medically necessary c-section, I would be thankful that I lived in a time where I did have options to make up for when my body just couldn't do it. Birth is a natural process that usually goes just fine. In low-risk women, it almost always goes right. However, sometimes it doesn't and the choice is either severe harm/death or medical intervention, and there is no shame in that. If you took a population of people who ate very healthily and exercised frequently, most of them would make it through life just fine. However, sometimes nature screws up and people get sick. Just like sometimes, something goes wrong with birth, nature screws up.

[Snapdragon]

I think it has to, having just had one a month ago. I was the most natural homebirthy type of person I knew! I thought birth would be easy- ha! It just wasn't in my case- I know it is for some!
I ended up with a c section. big adjustment.

NOw- I see lots of anti c section stuff- like even in mothering magazine- and it gives me a little grief because it is something I did- felt I had to do. I don't know- for those of us who have had them I think having a place to be at peace with it is helpful somehow, rather than feeling wrong or ashamed or less than. I like how the woman from the girlfriends guide to pregnancy talks about her experience of it.

[Geigerin]

So glad you started this thread! Our little girl was born 4 1/2 weeks ago via c-section. We had planned a homebirth (waterbirth). We had the birthing tub set-up in our living room for 2 weeks. I'd hang out in it every night, practicing my hypnobabies and imagining our amazing birth.

Very long story, but after 5 1/2 hours pushing at home, I was transferred and had a non-emergency c-section. Before this, I will admit that every time I heard 'c-section', I immediately assumed 'unnecessary intervention.' I'm still not certain if mine was 'necessary' or if I had just tried a little longer... We then spent 3 weeks and 4 days trying to get Maddy to latch. It was heartbreaking. Thankfully, she's nursing like a champ now.

I will never again judge women for their choices in birth or parenting. I dont know their circumstances or why they make those choices. This has been the most humbling experience. I think the key to the natural birthing perspective is to make the right choices for ourselves and reserve judgment of others.

[Snapdragon]

Originally Posted by Geigerin

So glad you started this thread! Our little girl was born 4 1/2 weeks ago via c-section. We had planned a homebirth (waterbirth). We had the birthing tub set-up in our living room for 2 weeks.

me too! Both the 4 and a 1/2 wks ago c section and having the tub set up long in advance!
And also I think birthing and parenting is SO much harder than I thought it would be!! And I used to judge c sections too. Not anymore! Now I just know that we do what we have to do and all choices take great strength and courage.

[FireWithin]

My second was a section and our surgery fell into the gray area of was it really necessary. I know in mainstream society it was deemed totally necessary. Where here I am frequently reminded that I could have said no. I think this is partially why it has been hard for me to heal emotionally.

My son was breech and I truly, truly wished that I could have had a trial of labor in a hospital with an experienced OB. That wasn't possible where I am so I decided to have a section as peacefully as possible.

I discussed a home birth with my awesome hospy mw, and she even slipped me contact info about birthing at The Farm in TN. I already knew that The Farm wouldn't accept us because he was so big, and my first child was also big (9.6 lbs). With this info I was not comfortable doing a trial of labor at home, although I know many other woman would have been.

So my 2nd was born via section. He was 10.3 lbs. Most of the time I think it was the right decision, but there are times I have felt unsupported.

My mw acted like a doula and she did her best to keep it as natural as possible within the hospital guidelines. I think this is one way that natural birth advocates could help section mothers. Advocating and giving information about how to keep separation of mom and baby as short as possible. (My son was never more that 10 feet from me, and I could see him the entire time. He was put in my arms even before I was put in my gurney bed and he transferred with me in my arms to the recovery room - very wonderful natural birthy)
Another way is to teach the surgeons to keep their mouths shut during surgery. I got to hear about their golf experiences. In this way I felt demeaned. So I think surgeon education would be another way birth advocates could support section mamas.

[Snapdragon]

yes, I think the way the surgeons and other people attending the birth treat the situation can add or take away a lot from the experience. I had very kind and respectful doctors and midwives and nurses at my c section and that made a big difference in a good way.

[Drummer's Wife]

c-sections fit into natural birth b/c, well, they happen! Many, many women (myself included) went into it wanting nothing more than that peaceful, magical, rainbows and butterlies perfect birth and never dreamed they would be included in the 'statistics' of c-sections performed.

I still consider myself a natural birth advocate - and this after I've had 4 unwanted cesareans. My mom is most definitely a natural birth advocate, as a practicing midwife, and she herself had 2 sections after a vaginal birth. In her situation, she went into pre-term labor at 31 weeks with twins, and had to have an emergency c-section. It might have saved her and my life (sadly, my twin was stillborn). The other c-section was b/c she had a T-incision, and in 1981 vbac'ing was rare, much less with a vertical cut like that.

I guess the thing is that it's perfectly okay to discuss our countries current c-section 'epidemic', and try to somewhat get to the bottom of it, b/c I know there are people who have the desire to save the world one vaginal birth at a time - but the key is doing so in a non-judgmental way. I know it's hard not to judge - I'm guilty of it myself - especially when you feel so passionate about something, but the bottom line is that while yes, we can assume that about half of the c-sections performed are likely unnecessary, there's no way to know for sure which ones are included in that number. No one has a magical crystal ball. I can say I feel like my c-sections were not needed (or I can say they were) and regardless of what I think, there is no way of knowing what the outcomes would have been if I had refused the sections in the end. Comfort can be had in knowing that about half of all c-sections (as high as the statistics may be) *are* in fact necessary.

I mean, heck, compared to what horrors used to occur before c-sections existed, we can be grateful that those medical and technological advances exist. And back in those days, who knows how many of those awful endings to births were necessary, either. The thing is, they (whoever was attending the births), did the best they could at the time with the information they had available - as well as using their gut instinct. If they feared mom's life was in danger and birth wasn't progressing normally, they had to find a way to get baby out, and quick. While there are not-so-natural birth advocates of OB's practicing nowadays, I would be willing to give them the benefit of the doubt and say that they are doing what they feel is best when making most decisions regarding whether or not to section or not. Now, a big part of that is due to their medical training, as flawed as some aspects of it are - so I'm not saying they are in the right the majority of the time, but that they truly believe they are, most of the time.

Women who have had c-sections should be supported unconditionally among the natural birth community - regardless of why the c/s was performed. We can still advocate for change, and better information and education, etc., without alienating other mothers. I don't mean to come off harshly, but I really get annoyed when women who have not had a c-section themselves make somewhat judge-y statements regarding c-sections or how women should be feeling after having had one. Because, really, you have no way at all to determine what exactly went down the day they were cut open, and you have no way at all of understanding how exactly they feel about it.

I think the only thing others can do is be supportive and understanding, regardless of how strongly they feel about the ideal natural birth - b/c even if the number of c-sections were to ever go down - the fact is they are still going to happen.

FWIW, personally, while I wish I never had c-sections, I can't relate to some of the feelings other have b/c I was never separated from my babies, or treated badly, etc., I know I am lucky in this regards when I hear of the horror stories - and w/o my mom there as my advocate and hand-picked nurses and my wonderful OB, I may not have had such positive experiences. Which leads me to think that part of the advocacy needs to be for still meeting mom and baby's needs in the event a c-section occurs. It is possible, to nurse right away, to keep baby in the recovery room, and promote bonding - I really think that right there would alleviate at least a portion of the trauma many women feel.

[Altair]

Having been a HB doula for 10 years prior to getting pregnant, I had *no* doubt I'd have a blissed out waterbirth in my living room. We even filmed our trial runs and made a blog/documentary about how excited and unafraid we were of our birth.

And then it started... and it was all the huge amounts of pain I knew it would be, but I was so grateful to be doing it. One of the most poignant, and heartbreaking moments of my life came over 60 hours later, after 15 hours of pushing a big headed stuck baby, when I just stood up naked in the tub and grabbed on to my partner's neck and sobbed sobbed sobbed. He knew at that moment what I meant by those cries. My dream of a homebirth was dying. Baby was healthy, I was healthy, but he just simply wasn't being born. Slipping in and out of life and death I felt in the last of those hours of pushing... and I just stood up and made the decision to live. But at that same moment I was giving up the moment I had been dreaming and dreaming about, feeling my boy push out and slide up my body to my breasts. I ached for that sensation my entire pregnancy.

I chose to get a c-section at that moment because I believed 100% his chances and my chances of health and life were stronger with that choice. But in that choice I had to give up my coveted place in the natural birth community. I was so *bitter* about all my friend's homebirths happening in the same few weeks. I was so sensitive to ANY questioning of mothers who had never had c-sections going on and on about how horrible they are.

A year later my scar is so dark and prominent and much higher than any other I've seen. Every day when I look at it I feel slightly less bitter, but it's a long, hard process. My son is worth any ideal being broken, he's worth any pain on my part. If it takes ripping my body to shreds to get this big and beautiful guy out of me, sign me up.

But you're exactly right, OP, it's so hard to see where you fit in the NB community anymore.

[Geigerin]

Altair- You have so much courage and strength. I'm so glad you have a healthy babe.

Originally Posted by Katie34

me too! Both the 4 and a 1/2 wks ago c section and having the tub set up long in advance!
And also I think birthing and parenting is SO much harder than I thought it would be!! And I used to judge c sections too. Not anymore! Now I just know that we do what we have to do and all choices take great strength and courage.

So glad to know I'm not alone in this. We had our homebirth support group meeting last week, and it broke my heart being the only one to have to say our birth ended in a transfer and c-section. I felt like a failure and an outcast. No one in my group made me feel that way- that's how I made myself feel. Seeing there are other women in the same boat is healing.

[Storm Bride]

hmm...my perspective is probably a little different, because I didn't even know there was a natural birth community until after I'd had two unwanted c-sections, and was pregnant with ds2...and having nightmares.

I don't have any answers, except that I think there has be respect for how the mother feels about her experience...in either direction. I see the post-cesarean "armchair quarterbacking" and it bugs me. I also see the "you have to look at it the right way" thing and it bugs me, too.

I'm not in any other woman's shoes. I can't say what was right or wrong in her particular situation, and I sure can't say she's right or wrong for feeling a particular way. I'm never going to say "you shouldn't have had the epi, then everything would be great". However, I'm also never going to use the term "natural cesarean" or even "empowered cesarean", because I think the first is nonsensical and the second is simply not my reality. There are very few things that I find less empowering than lying on an OR table while somebody cuts my numb, unmoving body open. (And, I say this as someone who walked into a new OB's office about 15-16 months ago and said, "I'm pregnant with my fifth baby, and I'll be having a c-section", and who asked for several things, and got most of them.) So, those terms just aren't in my book at all.

I think supporting moms is the most important things. Gentle birth is great. Having a non-gentle birth and then being emotionally beat up by people is not so great. I personally don't care if people tell me the mistakes I made, because I know they're right in my case. I just kept caving, even though I knew it wasn't in my best interests, or the best interest of my baby/babies. That doesn't mean I'm going to beat up some other mom who's having trouble processing things. It sucks to be beaten up by people when you need support. In my case, that "beating up" has been mostly from the "mainstream", so this issue has been very slow to show up on my radar...but it's there.

We need to stop reframing and redefining other people's experiences. That's the bottom line, at least to me.

[GuildJenn]

I think people forget that death is natural too.

Mother nature does not care about you or your child. Yes, in the natural world in order for an entire species to survive, many members of that species need to survive (although obviously for some species, very few do to adulthood).

But mother nature does not care if ONE baby or ONE mother survives. Or if there is damage.

My baby died because we were not able to have a c-section in time for various complicated reasons. There is no question that had we had a section at the critical point, she would have been fine. Instead I watched the very natural process of her oxygen-starved 4 days of life culminating in death.

It was biology at its most dictatorial, really. Natural does not necessarily mean safe or risk-free. People who think that are enjoying a luxury in their experience.

So - basically I think that unless people are ready to return to losing babies at delivery at the same rates that they would die naturally, yes, absolutely there is room for intervention including c-sections.

[PlayaMama]

mamas! thank you so much for your responses and sharing your stories.

i have a couple of ideas to address but my dd is sick and needs mama right now. so, quickly, it seems like natural birth was a goal for many of you and the subsequent loss of that dream was very painful.

do you think that you could have been prepared to view your experience positively? do you think that your reaction and healing is a matter of personality? are you generally an optimist or a pessimist in other areas of your life?

i guess, i want all women to be at peace with their births and i feel sometimes that the constant questioning of c-sections can hinder that. i fear that the more strident natural birth advocates can cause emotional damage to otherwise healthy women and i'd like to figure out a way for everyone to get on the "don't judge until you've been there" boat with me.

[PlayaMama]

i just want to each and every one of you that has shared their story. thank you.

[Storm Bride]

Originally Posted by PlayaMama

i have a couple of ideas to address but my dd is sick and needs mama right now. so, quickly, it seems like natural birth was a goal for many of you and the subsequent loss of that dream was very painful.

Yes.

do you think that you could have been prepared to view your experience positively?

No. To this day - 17 years after my first c-section - I still struggle to understand that there actually are women who don't have the same feelings I have. I know there are, but it's so alien to me that I can't grasp it.

do you think that your reaction and healing is a matter of personality?

Partly, I'm sure. Partly, it's from growing up knowing that my mom's belly was torn up (she had a vertical skin incision, classical uterine incision, and bad keloids) to get me out. I had a gut level aversion to the idea from the time I was a child.

are you generally an optimist or a pessimist in other areas of your life?

I used to be more of an optimist. My "birth" experiences have spilled over into my worldview in a big way, and I struggle every day with it.

i guess, i want all women to be at peace with their births and i feel sometimes that the constant questioning of c-sections can hinder that. i fear that the more strident natural birth advocates can cause emotional damage to otherwise healthy women and i'd like to figure out a way for everyone to get on the "don't judge until you've been there" boat with me.

This may be the case. I hear it a lot. IME, it was the "you're so lucky you didn't have to push out a baby" and "you cheated" comments that made it harder to heal...oh, and that long bout of secondary infertility, and the three miscarriages, all of which seemed linked to my c-section. (In retropsect, they probably weren't. I think they had a lot to do with my ex's drug use...but "that c-section wrecked my uterus" was my emotional reality for almost 10 years.) I do realize that being told you're a failure, when you don't think so (or even if you do?), would be very hard to cope with, emotionally. Being told I caught all the breaks when I didn't think I did was hard to cope with, too.

I guess it really does come down to simply accepting and honouring where the mother is within herself.

[PlayaMama]

storm bride- i could see that too.

the mainstream world is much more accepting (and even advocating) of c-sections. so, there really is a disconnect where people don't see that it can be an issue about loss and grieving the natural birth you didn't have.

at the same time, i feel like there is a LOT of emphasis on having a natural birth in the first place that can cause a marginalization of women that do have c-sections.

i'd like there to be a happy medium and i guess that since i can only control myself and my thoughts, i'll have to be more of an advocate of respect either way.

[CoBabyMaker]

I have to agree with a lot of what has already been said.
I wanted to add...To me, much of the reason I value natural birth is because it is part of motherhood. It is part of my deep-seated need to protect my child because I am her mother. (I'm not saying I don't have an issue with surgical risks to moms but it's not been my biggest emotional hurdle personally.) I so badly wanted a natural birth because I believe (in most cases) it is the best way to prepare to care for your child. THAT was my biggest personal struggle, not that my body had failed me but that I had failed to protect my child.
I completely agree with previous poster that there needs to be a change in the system to support mothers after birth. There NEEDS to be contact, no removal of the baby, BF initiation. To me, that is why natural birth is important, it promotes those things.
I know that some women mentioned that they feel fine about their c/s most of the time but feel shamed on these boards. (I am no way saying that those feelings are wrong.) For me, however, I appreciate that I am "allowed" to be angry/hurt/etc. about it here with other women. I guess I am trying to say that one of the things I appreciate about the natural birth community is that they understand why I'm not ok with my c/s.

[Storm Bride]

Originally Posted by CoBabyMaker

I wanted to add...To me, much of the reason I value natural birth is because it is part of motherhood. It is part of my deep-seated need to protect my child because I am her mother. (I'm not saying I don't have an issue with surgical risks to moms but it's not been my biggest emotional hurdle personally.) I so badly wanted a natural birth because I believe (in most cases) it is the best way to prepare to care for your child. THAT was my biggest personal struggle, not that my body had failed me but that I had failed to protect my child.

This is related to my issues, as well. I don't exactly feel that I failed to protect my child (except for poor little Aaron) with respect to the birth. But, I went through hell being unable to care for him properly afterwards. (This was particularly true of my first one, because of the drugs they gave me, and the lack of food, on top of the labour and surgery.) I had this tiny little person I was supposed to be totally responsible for, and I couldn't even take care of myself. It was an absolutely horrible initiation into motherhood. And, honestly...if I hadn't been so bloody-minded about breastfeeding - and so incredibly broke - I don't think I'd have managed that, either. It just hurt so much, and it was so much work to get him positioned, latched, etc.

That's one area I have occasionally felt shamed here. It's been a while, but I'd say something about being unable to get out of bed, and get a response like, "having a c-section doesn't mean you can't stand up - I know, because I've had one" (no apparently understanding that they're not all the same) or "I had to get out of bed - I was too concerned about my baby in the NICU to even be aware of my pain" (strong implication that any mom who couldn't get up must not care that much about the baby - or at least that's how it felt). Those comments were really hard to take. I had very little trouble (comparatively) getting up and mobile after ds2 or dd2. I had a ton of trouble after ds1.

[KaylaBeanie]

I think that we on MDC see women who react more negatively to c-sections because of the universal thought here that natural is the ideal. I know that more mainstream women generally aren't as attached to their birth process, with many of them thinking that they'd like to shoot for natural, but at the end of the day the doctor is going to do a c-section if that's what is perceived as "best."

In fact, reading many of the stories here of women who suffer negative feelings following c-sections, there is usually some variation of the woman saying "I never thought I'd have a c-section, I did everything right to avoid it, but still ended up with one." With home birth and women who plan (actually plan, not just hope for) natural births, few seem to realize that a c-section might be the outcome, even if they do everything perfectly. The shock of the unexpected probably has a lot to do with the trouble coping.

Once again, I'm only speculating, as I have yet to have children. I hope that I never have to have a c-section. If I do though, I imagine I would thank god that I had access to the technology I needed to survive, go forth with my AP self and aim for a HBAC if I decided on a second. It's been pointed out though that we're all boxed in by our own perspective, and different people think differently.

[mama de dos]

First off, enormous hugs and wishes for peace for all the mamas who have shared their stories here. I am moved and inspired by what you've shared and I wish peace for all of you.

I hope it's ok for me to post here... I've not had a c-section, but I am a childbirth educator and I'm always looking for ways to encourage and support *all* the moms I work with, which of course includes moms who will end up with a cesarean birth.

One thing that I try to talk about with my classes, which may speak to some of you here, is that I firmly believe that there are many cases in which the mom's body/intuition *protects* the baby by making a cesarean necessary. Often, a mom will have a cesarean and the cause of the surgery won't be obvious. However, I believe that there are reasons for c-section we don't and can't understand. Just as intuition can guide a mom through a safe natural, vaginal delivery, it can also ensure that the baby is NOT born vaginally, b/c for that baby, it wouldn't be safe. Does that make sense??

For example, perhaps a particular baby has a very short cord, or one that is in danger of being severely compressed (due to baby's position, mom's pelvic shape, whatever). That baby may never descend enough to be born vaginally, despite mom's, midwife's, doula's best efforts, many different positions, walking, pushing upright, faith, belief, time, patience, etc... That baby just won't come. A c-section becomes necessary. The OB may or may not recognize the short cord, but the mama's body KNEW and PROTECTED that baby by ensuring a surgical birth, b/c that was the safest (only?) way for that baby to be born. Her body didn't fail her baby, it protected it.

I think it's important that we recognize that sometimes a mother's willingness to surrender to a cesarean birth IS her intuition and her body protecting her baby. It is her body's wisdom doing the best for her baby.

Of course this isn't always the case, and women do get coerced or forced into c-sections for a thousand different reasons, but to answer the ? of the OP, yes, there is room to recognize that ONE way a woman can honor her baby's and body's wisdom is to have a c-section to protect one or both of them. Women deserve to hear that, too.

I know this won't necessarily mean that women won't or "shouldn't" still have a difficult time accepting or processing a c-section, that's not the case at all. There is still much to process and women need tremendous support for that. However, I hope it does give some women a different angle to view it from that maybe they've never heard or considered.

With all best wishes,
Jennifer