Caesarean Birth: A positive approach – goes to 2nd Edition

The 2nd edition of Caesarean Birth: A positive approach to preparation and recovery is now published and available globally via Amazon.

The update came about because conversations with many women in the 7 years since this book was first published reveals little has changed in terms of a woman’s experience of a caesarean or the extent to which it is included in antenatal education and the need for up-to-date information is as vital as ever.

That said, once a caesarean is agreed, ideas about how to improve the experience are being more readily accepted by some practitioners and the ‘natural caesarean’ approach is now more commonly discussed. However, the barriers faced by women wanting to discuss their options in the first instance are still many. Hospitals and individual practitioners, driven by economics and/or professional bias, continue to make things difficult for some women wanting more say their birth options.

Despite the World Health Organisation’s retraction of their recommended target levels (retracted in 2009), which clarified that the “optimum rate is unknown”, hospitals continue to be threatened with unachievable targets and women labelled ‘too posh to push, are blamed for driving the caesarean rate up.

This update:

  • Adds new research
  • Updates facts and figures pertinent to both caesarean and vaginal birth
  • Adds learning from women and birth partners who have shared their experiences with the author
  • Highlights the needs and issues of same sex birth partners – in this last case the needs of this group are frequently over looked and while much of their experience of birth is the same as for male birth partners, research suggests that these co-parents actually have a significant number of additional emotional factors to deal with and the impact of this is only just beginning to be researched and understood

AIMs review Caesarean Birth: A positive approach to preparation and recovery

Chloe Bayfield an AIMS midwife recently reviewed Caesarean Birth: A positive approach to preparation and recovery.

“The book is easy to follow and explores almost every aspect of the thought processes you are likely to go through when making decisions about your birth…Using this chapter, [“How Can I Improve My Recovery”] along with Appendix A (“The caesarean procedure”), will go a long way towards preparing you for your operation.”

Thank you for your supportive words.

(AIMS -Association for Improvements in the Maternity Services objectives are: working towards normal birth, providing independent support and information about maternity choices, raising awareness of current research on childbirth and related issues.)

Dads struggle through birth too!

Professor Marian Knight from Oxford University speaking about her new research reveals that “pregnancy complications…can have long-term effects on mental and physical health, as well as on family relationships.”

Of course Mum experiences the pain and worry of childbirth, but it would be incredibly naive to assume that it is a walk in the park for the partner. The birth partner (often the father to be) witnesses the person they love in pain and are powerless to stop it. Yes they may be given ideas of how to help during labour but they cannot stop the pain and they have to watch hour upon hour of it without any idea of when it will end or indeed how it will end … and those are just the straightforward births.

Add to this those practitioners who treat partners with impatience, indifference and/or a general lack of respect and you have individuals feeling totally inadequate and traumatised by the whole experience. For those suddenly excluded from theatre if an emergency arises requiring a caesarean (it is not uncommon for the partner to be left in the corridor alone with no news of mum and baby for considerable time periods) there is a particular risk of trauma and flashbacks.

When I interviewed dads for the book Caesarean Birth: A positive approach to preparation and recovery I repeatedly came across descriptions of events where they felt completely out of control, horrified and unprepared. Some described months of nightmares afterwards, others confessed they hoped not to have more children and still others revealed that they were relieved their wife had a caesarean. One father contacted me begging me to convince his wife to have a caesarean as he could not face a third natural birth.

It is wonderful that partners are encouraged to participate in birth but they too require support and understanding in order to remain effective during the birth and beyond.

While I believe that it is entirely reasonable for Mum to be focused inward during pregnancy and particularly birth this should not be to the total exclusion of the partner and their feelings.

In an ideal world antenatal education would encourage families to recognise the needs of everyone involved in the birth. For the sake of family relationships going forward it is crucial both parties are helped to recognise the long term effect on relationships where partners have been excluded, emasculated and traumatised. For these families far greater support is needed postnatally than is currently available.

Special requests when planning a caesarean

With any request  you make about how a planned caesarean proceeds it is worth discussing these well in advance. Some requests can be accommodated, others cannot but the hospital may be able to suggest alternatives for you.

Examples of things you may want to request (there are lots of others and I discuss many more in my book):

  • Partner present during set up (e.g. insertion of anaesthesia needles etc.) – This is permitted in some hospitals but unfortunately tends to be down to the practicalities of the size of the room. If you are to be fully ‘prepped’ in the actual theatre (and not everyone is) there should be sufficient space for your partner
  • Delayed cord clamping – Delaying for 2 minutes is thought to enable valuable oxygen and nutrients (e.g. iron) to continue to reach your baby until breathing has been properly established, (also reducing the risk of anaemia). This is an on-going debate but if you have a particular view, state your preference in advance as it can be quite difficult to gain agreement for this
  • Skin to skin contact ASAP – Unless there is a medical emergency which has led to your caesarean there is absolutely no reason why you should not be able to hold your baby within seconds of her being born. Many hospitals prefer to have a quick check of her condition but if this is a straightforward planned caesarean with no complications predicted then there is no reason why you shouldn’t ask to hold her immediately. You can actually go one step further and hold her skin-to-skin if you make sure your gown is free of the screen prior to surgery commencing. Indeed it is possible to attempt breastfeeding in theatre but you really do need to agree this in advance as your gown will need to go on backwards (e.g. open at the front) and your partner will need to be next to you to assist you in holding and positioning (you are flat on your back and it will be quite tricky to hold her safely). Breastfeeding in theatre is not common practise and you will need the support and encouragement of the team and prior agreement for it. Women have reported that they were refused the option of turning their gown around being told it would “compromise the sterile field”. I have checked this with medical professionals and there is absolutely no truth in this – the screen protects the sterile field not your gown