The simple truth is, during a caesarean the woman has no control over what is being done to her. She is incapacitated and sometimes unable to move at all depending on the strength of the epidural. In rare cases the epidural may not work effectively to block the pain of the operation and the mother may be rendered unconscious with general anesthetic. Some mothers feel ignored while medical staff are deep in conversation at the operating table and some mothers feel their need to bond with their baby is usurped by common hospital policies to send babies to special care nursery for several hours after surgery.
Jo, a mother from Adelaide said this of her caesarean: “They were discussing football results and didn’t notice the epidural wasn’t working until the anaesthetist noticed that when they touched me my screams were coinciding!”
After the birth, the mother is dependent on pain killing drugs, may have difficulty in picking up, caring for or feeding her newborn and moving about unassisted. Postoperative infections, which are reasonably common, may cause severe cramping and fever for several days after the birth.
For several weeks after the birth a mother is not supposed to drive or lift anything heavy including emotionally distraught toddlers who are trying to adjust to a new brother or sister in the house.
All this is a lot to go through for anyone having surgery let alone a woman making the transition to motherhood with sleepless nights and the demands of newborns and toddlers to deal with. Most women who have had a caesarean would agree that a caesarean birth is not the easiest way to have baby and many feel insulted when someone suggests they took the easy way out.
There are ways in which women can take more of an active role in how their caesareans are performed. For those women who feel they need to have a caesarean birth it can be helpful to negotiate a caesarean birth plan with the attending obstetrician and pediatrician. In this way you can ensure your needs are met and the operation is carried out in a respectful manner. It can also help you implement strategies to kick-in your natural hormonal response to help you bond with your baby after the operation and establish breast feeding. Skin-to-skin contact with the baby on your chest straight after he or she has been taken out can be very helpful for the mother and baby. A blanket can be placed over the baby to keep him or her warm while you say “hello” to each other for the first time. Delayed chord clamping can be helpful in providing more oxygen to the newborn after the shock of being taken out of the womb so suddenly. It also helps to have professional birth support person there for you and your partner, someone who can make sure that your needs are met and your wishes respected, someone who can help you establish breast feeding in recovery if you desire to or get hold of your placenta if you want to see it.
So if caesareans are so safe what is risky about them Childbirth Connection (2004) provides the following list of increased risks of caesareans(as opposed to vaginal birth) from their comprehensive systematic review of there search on caesareans.
Physical Risks for the mother:
- maternal death as a direct result of caesarean surgery
- emergency hysterectomy:
- blood clots and stroke
- injuries from surgery to the uterus and other organs 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/or adhesions
- bowel obstruction and twisted intestines in the years after surgery as a result of scarring and/or adhesions
- negative feelings about the birth
- less early contact with her baby
- unfavorable early reaction to her baby
- psychological trauma including Post-traumatic Stress Disorder (PTSD).
- poor overall mental health and self-esteem
- poor overall functioning in daily life in the early weeks after birth.
Risks for the baby:
- Cut by scalpel (usually in the face) during the surgery
- Breathing problems
- Intensive care admission
- Breast feeding problems which may result in increased allergies
- Asthma in childhood or adulthood
Many of the longer-term impacts of caesareans are little understood but the effect on future pregnancies is beginning to gain more recognition.
In future pregnancies there is greater risk of unexplained still birth, greater risk of all of the above complications if a repeat caesarean is performed and greater risk of life-threatening placenta-related complications, infertility, ectopic pregnancy and uterine rupture. The risks of premature birth, low birth weight and respiratory problems also increases.
You may be thinking these risks are highly unlikely. Some of them are rare (and some like surgical injury to the baby are not) but it is important to understand that with the increase in our caesarean rate the incidence of death or injury related to caesareans also increases. This fact has been confirmed by recent research by the World Health Organisation (2006). Every woman should be fully aware of the risks before deciding what is best for them and their babies.
Once you’ve had a caesarean it is harder to gain support fora natural birth after caesarean. In their Listening to Mothers survey on caesareans (2006), Childbirth Connection found that only 12 percent of women in the survey had a vaginal birth after caesarean (VBAC) and of the 45 percent of women who were interested in VBAC, more than half were denied this option, not because of their individual circumstances but because the care provider or hospital was unwilling to support VBAC under any circumstance.