Sunday, May 22, 2011

"Natural Cesarean" Why the Controversy?

This tissue has been brewing for me for the last year.

The issue is this; in most hospitals cesarean protocol is antiquated in a number of ways. Routine separation of mother and baby is the norm. Often baby is sent to the nursery, or at best is sent with dad(or partner) to wait for the mama to come out of recovery.

Even at the hospital I birthed at that allowed skin to skin in the OR, and babies in recovery, my perfectly healthy newborn was not shown to me for around ten minutes while he was weighed and measured and tagged, and a medical student practiced a newborn exam on him.
The atmosphere in the OR was "business as usual", cold impersonal, lacking in any "warm fuzzy" feeling at all. I was told my son had been born by having one of the docs declare "1:25" loudly at my face. When I didn't respond he clarified "That's the time of birth". The doctors talked to each other as if I wasn't there, discussing my "bladder dissection" as a example of how to avoid nicking a bladder. The operating doctor didn't say anything to me in the OR at all, in fact I didn't even know who had operated on me until three weeks later.

This was on top of numerous experiences in the lead up to the surgery that led me to file a formal complaint. And to suffer p.t.s.d. I still struggle to deal with symptoms.

As part of my healing process I started researching better cesarean techniques. I was sure that there had to be a way cesareans could be done in a more holistic and psychologically sound manner. I was thrilled to find this article:

J Smith,a F Plaat,b and NM Fiskac

It describes a more holistic cesarean experience, keeping the focus on the family, early contact with mother and baby, allowing the parents to watch the birth and more. The result is much happier mothers. Less trauma more satisfaction.

I was so happy. A team of wise care providers had pioneered the exact type of technique I was thinking about.

And then I started talking about it on the "natural birth" type forums I was frequenting. Instead of embracing this "woman centred" cesarean the idea was attacked. And I was attacked for championing the idea. I was accused of promoting elective cesareans, being complacent to the cesarean epidemic, and told I lacked integrity. Let me tell you it was a shock, especially as a new cesarean mother suffering greatly due to the non woman centred protocols I endured.

Two concepts seem to really offend. First, the term "natural cesarean" that just gets so many folks nickers in a twist. "Cesarean aren't natural" they proclaim. One blogger says

The other is that the article describes a technique for elective cesarean surgery. Apparently this is an evil that haunts many birth advocates. The fact that the article clearly states that these techniques can be modified for the emergency situation. Obviously a emergency section mother is not going to tour the OR before hand, but they could still have the screen lowered to view their babies birth. Makes sense to me.

When I saw this post at Lamaze's Science and Sensibility by Kimmelin Hull got me all bothered all over again. I would summarize the authors stance as this: Doing cesareans in a more woman centred way is too risky as it might further increase an all ready unhealthy cesarean rate. The author quotes a doctor as calling gentle cesarean techniques "window dressing".

Are you freaking kidding me!

These are harm reduction techniques not fluffy inconsequential stuff.

I wrote the following response:

I believe that ALL cesarean should be done in a better, more human way. To imply that making them more “natural” will result in more women picking them I think is not giving women enough credit. As you point out no matter how humanly a cesarean is done it is still major surgery with potentially life long implications.

I also believe that one of the reasons that woman choose repeat sections is that their first section was not the experience the wanted and they believe, and are often told, that a planned section is much better then a emergent one. Perhaps if the initial sections were not so trauma inducing women would be emotionally more ready to choose a vaginal birth next time.

It seems wrong to not do what ever we can to promote emotional health of the mothers and babies, and I firmly believe that every care provider should be striving for the most holistic birth possible, even if that ends up being a “natural cesarean”. Emotional health is a part of birth that is often an after thought,but it shouldn't be. I believe doing woman friendly cesarean can help avoid the increasing cases of p.t.s.d., a debilitation and potentially long term health issue.

One of the saving graces of my sons emergency c.s. is that he was placed skin to skin in the OR with me. It a moment that I use to help balance the rest of my experience which was very non “natural cesarean”.

Many other woman agreed with these sentiments and many adding their our outrage. Still the author didn't back down defending her position by referring to a fictitious woman who is exhausted and not progressing, who given more support and time could have had a vaginal delivery but is convinced by a doctor to let them do the c.s. by promising low lighting and music.
Sorry but I think this is total B.S. Woman are convinced by doctors to have cesareans because they are told their babies could be in danger. I haven't met one unplanned cesarean mother who wasn't told some version of "it's better for the baby" to have surgery.

I followed up with this post:

@Jane “Failing to fully get behind efforts to make c-sections less traumatizing and unpleasant for mothers and babies is just disappointing and wrong” I totally agree! Thank you for your post.

If this topic were a way to make cesareans physically safer there would be no debate.

A technique to prevent maternal deaths from cesareans would be embraced. I really can’t see how can any birth advocate justify denying “gentle” or “natural” cesarean techniques . I recently read that p.p.d. and p.s.t.d. can result in suicide. It is also reported that cesarean mothers are at greater risk for these disorders. I feel it’s not too far fetched to infer that:

protocols that lessen the trauma experienced during a cesarean is life or death matter.

I think it’s terribly harmful to try to prevent the dissemination of good information in suppressing “natural cesarean” techniques simply because of fear and a misguided attempt to influence the cesarean epidemic this way.

To me the natural, woman friendly, family centred, or gentle cesarean is a topic that should be addressed outside of the debate as to how to reverse the tide of the dramatic overuse of cesarean sections in the developed world.

Empowered women make good choices, not women living in fear of outdated protocols.

Think of how ridiculous it would seem if home birth advocates were calling for routine separation of mothers and babies in hospital to try to convince woman to home birth.

It is misguided to defend leaving cesarean protocols as they are as woman are being harmed.

I’m ashamed to hear otherwise wise birth advocates(both here and in other forums) bowing to fear and trying to prevent harm reduction techniques

I didn't get a direct response from the author to either of my posts, but feel so glad to see the number of women who also stood up for this very necessary dissemination of information.

Okay, I feel a little less bothered now. I guess that's what's really great about blogging is you get to say your piece.

Here's hoping that we can come together to better the treatment of families during cesareans.


  1. Thank you for writing this and for all it took to come to this blog post.

    It's upsetting when women's investment in a particular belief prevents them from a compassionate understanding of other women's experiences.

    C-sections happen - lots of them and no doubt many are 'unnecessary' that is no reason to argue for the denial of creating the best possible situation for both mother and baby when they occur. To say this will increase c-section rates is unfounded and frankly silly.

  2. Thank for your kind comments.

    I visited your blog too, great scar care info and more.

    I'm glad you understand that we so need to pull together to better maternity care. It's issue like these that keep us fighting each other instead of working hard to change maternity care for the emotional and physical well being of all women.

  3. I'm always a fence sitter. I can empathize with 'their' underlying concerns but find it unethical to 'cover up' or prevent access to better cesarean birth.

    My first cesarean really was no big deal. In fact, the spinal immediately took the horrible pain away, and I was just excited to meet my little girl. I didn't fully understand the consequences of my consent. I didn't 'bond' particularly strongly to my daughter, but everything else went smoothly.

    My second cesarean was pretty terrifying. I can't explain it, really. And the OB and his surgical assistant (his CNM, actually) were very pleasant. He showed me each baby before giving them to the nursery staff. I was able to nurse the twins in recovery. Yada yada. But the recovery was not so easy peasy that time.

    I had suffered PPD and PTSD previously (associated with pregnancy losses), but this did not affect me with c/s #2.

    If as c/s were to become necessary, I'd hope that a few additional preferences would be observed. I haven't yet made out that letter, perhaps because I don't want to consider having a c/s this time.

    I wish women didn't choose elective cesareans. I wish women weren't scared into electing repeat cesareans, but I can't wish away the fact that c/s birth is here and here to stay. I think a woman stating her preferences for a cesarean IS NOT the battle we should be fighting, especially amongst ourselves.

    Women need to find opportunities to come together, to work together to improve health care and improve patient education and truly informed consent. Pointing fingers and name calling don't get us anywhere.

    I've researched cesarean birth plans for friends who needed them, not because I was excited to help them plan their major abdominal surgery, but because I love and respect them and want to support them in their experiences no matter if they don't resonate with me personally.

  4. Thank you for your comments and for sharing your story.

    The more we share stories the more we can understand that we are all different, and each birth is different, but the overall goal should be health and safety of the family involved.

    I also completely agree we should not be fighting amongst ourselves.

    I think that to achieve this about the topic of natural cesareans is to separate the issues of the very real cesarean epidemic (in the developed world) and humanizing protocols during surgery.

    I'm so glad to hear that you are willing to assist your friends. I too have assisted a number of women to prepare for cesarean births. Each time I have carefully and gently given them as much info as I can to make sure they know that they have options-none of the cesareans have been unquestionably unavoidable, but what do I know?
    Once that is done, I give myself over to teaching them about gentler, "natural cesarean" type info. I tell them over and over that if they want those types of protocols they are going to have to be firm and advocate for them with a great degree of conviction.

    We are so far away from natural cesareans from being the norm.

    Thanks again for taking the time to comment.

    Many blessing for your next birth!

  5. Mieke! I wonder if you would consider writing a post about this as a guest on our site? This and birth trauma PTSD in general are issues which need more attention... Let me know if you are interested! It's Melissa~remember we met at Gloria's place last year?! email me at melissa at mothers of change dot com if you think you could do a post for us. You are articulate and your blog is so important!!

  6. p.s. I also had a cesarean, as you know, and had similar experiences to yours: cold, sterile, clinical, and routine separation from my baby.... I have wanted to write about the natural cesarean topic for awhile. If you are able to write a post sometime soon, I could do a series and we could really blow those natural birthers out of the water =)