Why prepare for the possibility of caesarean birth?

Like it or not, whatever your birth plan says, the fact is a third of UK births will be caesareans. As I have worked with practitioners and women preparing for birth over the years, it has become very apparent that fear and stigma can still be very much a part of caesarean experience for many. Unfortunately, in being unprepared for a caesarean outcome, when it happens some women in their sleep deprived, stressed and postnatal hormonal state, are unable to rationalise the experience describing it as “disappointing” or worse “highly traumatic”.

Understandably, many women take their adventure into motherhood very seriously, attending antenatal classes, buying book after book or, if neither of these, at least talking to family and friends about their options. Sadly in many cases despite the best of intentions many can remain quite in the dark about caesarean birth, inadvertently taking on board the negative opinions and media hype surrounding this mode of birth. And while some practitioners do try to talk about caesareans in a positive way, women often reflect they found it difficult to find the positive messages and that preparation advice was typically woefully insufficient.

One woman once wrote to me:

“I was actually on the table and surgery had started when it occurred to me to ask what the difference was between an epidural and a spinal anaesthetic,¦I should have known and it was too late to participate in any discussion.”

In the UK nearly 1 in 3 births are caesarean, and over 1 in 3 in the US with similar rates in many countries. Yet all too often the two phrases heard in connection are:

“major surgery” and

“it will affect your ability to bond with your baby”

While both can have an element of truth to them (for some women), the tone in which they are typically delivered and the total absence of any explanation, support or clarification makes them two of the most irresponsible phrases used in antenatal discussions.

That said it is becoming more acceptable to ask questions and a quick Google search will produce websites talking about how to improve your caesarean experience. But incredibly in 2021, the number of books which treat caesarean delivery as a valid and incredibly positive birth experience can still be counted on one hand.

I wrote the first edition of Caesarean Birth: A positive approach to preparation and recovery to redress this imbalance back in 2011 and it has since gone to a second edition (2018). As a complete caesarean ‘manual’ it covers:

  • Why one might be suggested
  • Why we should prepare
  • How to make the most of a caesarean (preparation and recovery guidance)
  • A detailed risk / benefit comparison with vaginal delivery
  • Implications for future births
  • A description of procedure itself and crucially how women can participate in and influence that process

The book blows apart the myths we hear about caesareans and women have reported feeling more confident and able to make informed decisions about their births as a result. Crucially it gives lots of ideas on how to prepare for and express preferences about the experience, radically improving the chances of perceiving it positively should a caesarean become necessary.

For example, knowing to ask to put your gown on backwards (opening at the front) prior to surgery means, assuming there is no emergency, you can easily hold your baby skin-to-skin and possibly even breastfeed while still in theatre. Such a seemingly simple thing is so incredibly important to so many and is actually totally achievable in many caesareans.

Asking questions and being better informed places us in a far stronger position to negotiate and actively manage the direction and experience of our birth whether it is a vaginal or a caesarean outcome, why leave out knowledge of a whole birth experience and risk being disappointed or traumatised unnecessarily.

“I am so glad I read this book before my birth. I didn’t intend having a caesarean but when it happened I wasn’t at all frightened and I fed ‘S’ in the recovery room. This book thoroughly demystified caesarean birth for me.” Vicki (35)