Sunday, 31 January 2016

To c or not to c: thoughts on a section

When I agreed to speak to the Observer for a piece on the ‘incessant increase’ in caesarean rates among first time mothers in the UK, I knew from the get-go that this wasn’t going to be a straightforward, ‘cut and shut’ story, but that it would spark reams of comments from readers outlining their own birth experiences or debating mothers’ rights and mindsets, the adequacy of antenatal information and the state of the NHS.

When the photographer arrived to take a (lovely!) picture of little miss and me, his first question was: ‘So, are you one of the good or bad case studies?’  I didn’t want to be the poster girl for either – my operation was unwanted but medically necessary, and while it ran smoothly the recovery was brutal.

I was relieved when, in the resulting article, the journalist had managed to make good sense of what I babbled at her and my case study seemed relatively balanced.  Unfortunately, I can’t say the same for some of the rest of the piece or, predictably, the comments underneath.  Do calls to action such as ‘stop first-time mothers having caesareans’ and phrases like (shudder) ‘too posh to push’ really help in any way when we are talking about mothers undergoing major abdominal surgery, in most cases on medically necessary, sometimes life or death, grounds?  Even the usual terminology, ‘elective’, is a complete misnomer, suggesting that choosy new mums opt for a caesarean in the way that they might pick out curtains or a Pret wrap.

Few people who have been adequately informed about the process, risks and recovery period want to have a caesarean over a natural birth.  For me, however, the knowledge that I might need one was never far away in the late stages of pregnancy, even as I pored over the pros and cons of water births and weighed up the merits of hypnobirthing. 

At 33 weeks, I was told that I would have to have a planned caesarean if my baby, who was using my uterus like a hammock, blissfully unaware of the complications she was causing, didn’t turn from a transverse position to head down by week 37.

Four weeks of frenzied bouncing on a birthing ball and uncomfortable moves from the Spinning Babies website and we’d nearly got there – I had a head down albeit slightly diagonal baby but she hadn’t engaged yet.  I thought I had plenty of time before I needed to start worrying about it.  Sod’s law had other ideas; my waters broke at 37 weeks and my tiny (4 lb 11) girl was pulled screaming into the world through an emergency c section after things didn’t get going after a day and a half and her heart rate went sky high mere minutes into induction.

I’d be lying if I said that the recovery period was a walk in the park – just walking up the stairs was an ordeal in those early weeks, and trying to sleep for the short stretches my new baby allowed propped up in an armchair was a fitful, excruciating affair.  The whole area surrounding the scar was black, purple and swollen for several weeks, the curse of someone who bruises like a peach.

Do I wish I didn’t have to have a c section?  Of course.  Do I regret that I said ‘yes’ when a concerned team of consultants scurried into the delivery room and gently recommended that it was the safest course of action for me and my distressed, low birth weight baby?  Not for a moment. 

However, I do recall a brief, pre-spinal, moment of weakness, where I said to my scrubbed-up husband and the midwives, ‘I’m sorry if I’ve failed.’  This comment was probably mainly fuelled by tiredness, nerves and nausea, but I think it’s a sorry state of affairs where pregnant mothers, especially anxious first-timers, are conditioned into thinking that they have not given birth in ‘the right way’, or that having a c section is in any way something that they or an obstetrician have decided to go through on a whim, for convenience or on cosmetic grounds.

There probably is a small percentage of pre-parenthood people who think a c section is a less painful, more straightforward option, or who prefer the idea because they are legitimately anxious about natural delivery.  Rather than slamming this group as selfish or weak, surely we need to be giving them the tools to make informed choices about how they give birth, and not stigmatising c sections when we are talking about saving the lives of the mother, the baby, or both?  In the lead-up to my op, I was equipped with advice from friends who’d already had c sections and what I’d learned in antenatal classes – that isn’t the case for everyone by any means.

As I say in the Observer, a caesarean is by no means an easy way out. But the most important thing is the baby’s safe arrival, whatever method it might be by.  I have the amazing efforts of the NHS to thank for that, and it’s something I am grateful for every day.