The simple truth is, during a caesarean the woman has no control over what is being doneto her. She is incapacitated and sometimes unable to move at all depending onthe strength of the epidural. In rare cases the epidural may not workeffectively to block the pain of the operation and the mother may be renderedunconscious with general anesthetic. Some mothers feel ignored while medicalstaff are deep in conversation at the operating table and some mothers feeltheir need to bond with their baby is usurped by common hospital policies tosend babies to special care nursery for several hours after surgery.

Jo, amother from Adelaidesaid this of her caesarean: "They were discussing football results and didn'tnotice the epidural wasn't working until the anaesthetist noticed that whenthey touched me my screams were coinciding!"

After thebirth, the mother is dependent on pain killing drugs, may have difficulty inpicking up, caring for or feeding her newborn and moving about unassisted. Postoperative infections, which are reasonably common, may cause severe crampingand fever for several days after the birth.

For severalweeks after the birth a mother is not supposed to drive or lift anything heavyincluding emotionally distraught toddlers who are trying to adjust to a newbrother or sister in the house.

All this is a lot to go through for anyone having surgerylet alone a woman making the transition to motherhood with sleepless nights andthe demands of newborns and toddlers to deal with. Most women who have had acaesarean would agree that a caesarean birth is not the easiest way to have ababy and many feel insulted when someone suggests they took the easy way out.

There areways in which women can take more of an active role in how their caesareans areperformed. For those women who feel they need to have a caesarean birth it canbe helpful to negotiate a caesarean birth plan with the attending obstetricianand pediatrician. In this way you can ensure your needs are met and theoperation is carried out in a respectful manner. It can also help you implementstrategies to kick-in your natural hormonal response to help you bond with yourbaby after the operation and establish breastfeeding. Skin-to-skin contact withthe baby on your chest straight after he or she has been taken out can be veryhelpful for the mother and baby. A blanket can be placed over the baby to keephim or her warm while you say "hello" to each other for the first time. Delayedchord clamping can be helpful in providing more oxygen to the newborn after theshock of being taken out of the womb so suddenly. It also helps to have aprofessional birth support person there for you and your partner, someone whocan make sure that your needs are met and your wishes respected, someone whocan help you establish breastfeeding in recovery if you desire to or get holdof your placenta if you want to see it.

Caesarean risks

So if caesareans are so safe what is risky about themChildbirthConnection (2004) provides the following list of increased risks of caesareans(as opposed to vaginal birth) from their comprehensive systematic review of theresearch on caesareans.

Physical Risks forthe mother:

• maternal death as a direct result of caesareansurgery.


• emergency hysterectomy:


• blood clots and stroke


• injuries from surgery to the uterus and otherorgans such as bladder and bowel


• injuries from anaesthesia


• longer time in hospital


• going back into the hospital


• post-operative infection


• longer-lasting and more intense pain


• ongoing pelvic pain due to scarring and/oradhesions


• bowel obstruction and twisted intestines in theyears after surgery as a result of scarring and/or adhesions

Psychological Risks:

• negative feelings about the birth


• less early contact with her baby


• unfavorable early reaction to her baby


• depression


• psychological trauma including Post-TraumaticStress Disorder (PTSD).


• poor overall mental health and self-esteem


• poor overall functioning in daily life in theearly weeks after birth.

Risks for the baby:

• Cut by scalpel (usually in the face) during thesurgery


• Breathing problems


• Intensive care admission


• Breast feeding problems which may result inincreased allergies


• Asthma in childhood or adulthood

Many of the longer-term impacts of caesareans are littleunderstood but the effect on future pregnancies is beginning to gain morerecognition.

In future pregnancies there is greater risk of unexplainedstill birth, greater risk of all of the above complications if a repeatcaesarean is performed and greater risk of life-threatening placenta-relatedcomplications, infertility, ectopic pregnancy and uterine rupture. The risks ofpremature birth, low birth weight and respiratory problems also increases.

You may be thinking these risks are highly unlikely. Some ofthem are rare (and some like surgical injury to the baby are not) but it isimportant to understand that with the increase in our caesarean rate the incidenceof death or injury related to caesareans also increases. This fact has beenconfirmed by recent research by the World Health Organisation (2006). Everywoman should be fully aware of the risks before deciding what is best for themand their babies.

VBAC realities

Once you've had a caesarean it is harder to gain support fora natural birth after caesarean. In their Listening to Mothers survey oncaesareans (2006), Childbirth Connection found that only 12 percent of women inthe survey had a vaginal birth after caesarean (VBAC) and of the 45 percent ofwomen who were interested in VBAC, more than half were denied this option, notbecause of their individual circumstances but because the care provider orhospital was unwilling to support VBAC under any circumstance.