Have you recently found out that your baby will need to be born by caesarean? Did you labour for hours or days only to have a surgical birth in the end? Do you have concerns about the decision? Perhaps you are even angry or depressed? Do you feel as if somehow you failed as a mother and a woman?
A mild form of depression, called the baby blues effects as many as 70% to 80% of new mums. Usually beginning on the third or fourth day after the birth, the baby blues are a reaction to hormonal changes in the body following the birth.
Less common, but still effecting as many as 20% of new mothers is the more serious Post Natal Depression (PND). Unlike the baby blues, PND usually has a gradual onset over several days or weeks. For some women, PND can resolve itself in a few weeks, but for many others it requires months of professional assistance and perhaps even medications. The symptoms of PND are similar to depression. There are no studies which show that caesarean mothers are more likely to suffer from PND.
Birth trauma or Postpartum Post Traumatic Stress Disorder (PTSD) on the other hand does show a dramatic increase following a caesarean birth when compared with a vaginal delivery. One study (PTSD and cesareans, Childbirth Resource Network) reported as many as 28% of the mothers had PTSD following a caesarean birth. According to the Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders says:
"The essential feature of Posttraumatic Stress Disorder is the development of characteristic symptoms following exposure to an extreme traumatic stressor involving direct personal experience of an event that involves actual or threatened death or serious injury, or other threat to one's physical integrity; or witnessing an event that involves death, injury, or a threat to the physical integrity of another person; or learning about unexpected or violent death, serious harm, or threat of death or injury experienced by a family member or other close associate (Criterion A1). The person's response to the event must involve intense fear, helplessness, or horror (or in children, the response must involve disorganized or agitated behaviour) (Criterion A2). The characteristic symptoms resulting from the exposure to the extreme trauma include persistent reexperiencing of the traumatic event (Criterion B), persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (Criterion C), and persistent symptoms of increased arousal (Criterion D). The full symptom picture must be present for more than 1 month (Criterion E), and the disturbance must cause clinically significant distress or impairment in social, occupational, or other important areas of functioning (Criterion F).
In other words:
- There must be a traumatic birth experience that involves intense fear, helplessness or horror.
- There are flash backs or re-living the birth.
- There may be avoidance of anything associated with the experience such as hospitals, doctors, the baby or pregnancy.
- There may be anxiety or panic attacks following the event.
These symptoms must last for more than one month and result in an impairment of function to meet the definition of PTSD.
So what can you do if you are having or have had a caesarean birth to minimise the impact of PTSD?
As a mother who has had three caesarean births, the first of which resulted in PTSD that lasted almost five years, I believe that the most important thing you can do is to prepare for your birth and actively participate in the decision-making process. The defining characteristics are intense fear and helplessness. If you have prepared for the birth by reading about caesarean procedures, talking about them with your doctor and even taking special childbirth education classes that focus upon caesarean births and recovery, then you will minimise fear of the unknown by educating yourself. Likewise if you discuss your concerns with your doctor, research the issues and then compromise on the issues that concern you most then you will be an active participant in your birth and minimise the sense of helplessness.
My oldest son was born in 1986 via emergency caesarean after over nine hours of natural labour. I was hugely disappointed. I felt as if I had failed. And I was angry with my doctor, blaming him somehow. I was frustrated too because every time I tried to talk with someone about my feelings the answer was always...but you have a healthy baby, move on. Eventually I moved on emotionally or so I thought. I realized the truth though when over eighteen months later I found out that I was pregnant once again. All of my old fears and feelings re-surfaced. I sat and cried for hours; not because pregnancy was unplanned or the additional strain that another child would place upon our finances or troubled relationship, but because I would have to endure another caesarean. I began to look for alternatives and eventually found a midwife that would consider a homebirth. Our first pre-natal visit lasted almost three hours and was more about debriefing from the trauma of my first birth than my physical condition.
But even the successful VBAC homebirth of my 7 lb. 14 oz. daughter did not lessen my anger at what I thought was an unnecessary intervention. In fact, a casual comment by my midwife that my pelvis was more than adequate caused my anger to intensify. In a classic Post Traumatic Shock Disorder experience, that comment re-ignited all the feelings that I had experienced right after the surgery. I tried to channel my anger in a constructive manner. I became a crusader for natural birth; taking a lay midwifery course. I tried to find an attorney to sue my doctor, but the statute of limitations had expired.
In stark contrast is my second caesarean birth some fifteen years later. I had planned a midwife assisted hospital birth. I was confident that I would have no difficulty with another VBAC. I stayed home during early labour and went to the hospital only once labour was well established the contractions close together and so intense that I was having difficulty managing them. I was sure based upon my earlier labours that the baby's birth was imminent, but when checked I was only 2 cm dilated.
The baby was posterior and my intense back labour was not effectively dilating my cervix. I tried labour upright in the shower. I tried walking. I tried lying on my side. Nothing worked. The pain was more intense than any of my previous labours. I knew that if I choose to have an epidural I would significantly increase my chances of having another c-section, but the pain was so intense that I made the decision to have it anyway. Several hours and several interventions later, I did indeed have another caesarean. This time though rather than anger and resentment, I owned my decision. I was confident that I had done the best I could for me and my baby.
I believe that the two differing perspectives of my caesarean births illustrate the power of educating yourself about your options and actively participating in the decision-making process. After my first birth, I felt powerless and the result was anger, depression and PTSD that lasted five years. With my second caesarean, I had educated myself about labour and birth. I knew with each decision I made what the pro's and con's were and I made the decision with my midwives and doctors. The result was a birth that left me contented and fulfilled as a mother and woman with no regrets.
So if you are facing a caesarean, determine today that you will learn all you can about your condition, the baby's and the procedures involved. If you discover something that concerns you, discuss those concerns with your doctor. Bring research with you. And together make compromise that you can both agree with. Or perhaps change doctors.
But even if you have already had a caesarean birth, you can still apply these principles. Begin by talking openly and honestly with your doctor or hospital. Not in an accusatory way, but just tell him how you are feeling and ask for his side of the situation. Then do more research, realising that rarely is the old adage once a caesarean always a caesarean true anymore. You may be able through education and empowering yourself to have a different type of birth next time, whether that be a Vaginal Birth After Caesarean (VBAC) or a family-centred caesarean.
In either case, by educating ourselves we can reduce the fear of the unknown and by actively participating in decisions we can eliminate the sense of helplessness. Without the fear and helplessness, the catalysts for birth trauma or Postpartum Post Traumatic Stress Disorder are removed, thus minimising or eliminating your chances of developing this functionally impairing mental disorder.