Emotional Recovery From A Cesarean

by KMom

Copyright 1998-2001 KMom@Vireday.Com. All rights reserved.


DISCLAIMER: The information on this website is not intended and should not be construed as medical advice. Consult your health provider.

CONTENTS

 

Introduction

"Your pain matters, it is your guide to healing."  Lynn Madsen, Rebounding From Childbirth

Women who experience a cesarean respond in different ways.  For some women, the experience is no big deal, and they quickly move on with their lives.  Some women even experience a cesarean as a relief, as freedom from a long difficult labor, a 'rescue' from a life-threatening situation, or an emotional 'escape-hatch' when the idea of normal labor pain and/or vaginal birth is extremely distressing for some reason. 

Other women find a cesarean difficult to deal with emotionally.  They are happy to have their children with them, but just can't see the method of their birth as 'no big deal'.  For some, the lost dream of the way they had wanted to birth takes real grieving, and for others, the pain of the physical recovery (from what is after all MAJOR surgery) is difficult emotionally too.  Still other women experience their birth and cesarean as a deeply traumatic event, even akin to rape.  

A woman's response to a cesarean depends on a great number of factors, including how she was treated by medical staff, the respect and dignity she was accorded, factors involved in the actual surgery, how labor went, the response of her loved ones, the fantasy birth she had dreamed of beforehand, the fears and emotions she brought to labor and birth, prior experiences with the medical establishment, and her own emotional background and personal history.  Because of all of these variables, it is only logical that different women would experience and interpret a similar event----surgical birth----differently.  This is completely normal.

This particular FAQ is about the emotional recovery after a c-section.  It discusses what women may experience emotionally, the wide range of responses that can happen, the validity of these responses, and ideas that other women have used to help themselves heal and grow after a cesarean.  Because many women find that their future choices about birth and parenthood can be affected by their cesareans, this FAQ also briefly addresses the emotional aspects of choosing more children and birth choices in future pregnancies.  

Since women who 'love' their cesareans or have no problems recovering emotionally from them tend not to need a great deal of validation of that experience in our society, this FAQ does emphasize those women who found their cesarean emotionally disappointing or traumatic.  However, this is not meant as a judgment of those who were not distressed by their cesarean.  It is simply a validation to those who found the experience difficult and distressing, and a way to share steps that other women have found to be emotionally healing afterwards. 

It is important that women who read this FAQ not judge women whose experience of cesarean was different from theirs.  No response is 'right' or 'wrong', and no one's experience is 'more valid' than anyone else's.  Emotions are just that-----simply EMOTIONS.  They don't need to be justified, they just are.  This is not the place for judgment of other people's choices or responses.  Instead, this is the place to try and understand where someone else is coming from and why they feel that way, to empathize with those feelings, and to find validation for your own feelings, whether they are the same or different from others' feelings here.

If you would like to share your own experience about emotional recovery from a cesarean, feel free to email Kmom about that experience.  If you would like it shared here, please keep it reasonably brief, send it by email (no attachments please), and give permission for your story to be published.  See below for more information.  

Ideas for emotional healing and recovery in this FAQ are drawn from many resources.   Rebounding From Childbirth: Toward Emotional Recovery by Lynn Madsen is a primary source, and Kmom highly recommends this book.  Other useful books included Birth As A Healing Experience by Lois Halzel Freedman, Transformation Through Birth by Claudia Panuthos, Silent Knife by Nancy Wainer Cohen and Lois Estner, Trust Your Body! Trust Your Baby! Childbirth Wisdom and Cesarean Prevention edited by Andrea Frank Henkart, and Ended Beginnings: Healing Childbearing Losses by Cathy Romeo and Claudia Panuthos.  Further information on these books and where to find them can be found in the references section.

Other resources include Healing and Grieving Workshops given by Nancy Wainer, grieving exercises from the Birth Works childbirth education program, an ICAN workshop on "The Emotional Scars of Cesarean Birth" by Nicette Jukelevics, workshops by Penny Simkin, the writings of Gloria Lemay and Leilah McCracken, and suggestions from the ICAN mailing list.  

Enormous thanks are due to the women who have dealt with these issues and shared what worked for them, and especially to those who have actively worked towards helping other women heal their birthing experiences.  Bless you for breaking the silence and talking about an issue that few people took seriously. And bless you for lighting a candle for others to use as a guide towards healing.   You will never know how many women you have helped.   

 

Note: Since most women will not read this FAQ in its entirety at one time, a number of important points are repeated throughout the text to make the FAQ more user-friendly.  

 

Emotional Recovery After Cesarean: A Variety of Responses

Women have a wide range of emotional responses after a cesarean.  Some are devastated by it, some love it, some are disappointed but okay with it, some feel 'rescued' by it, and some seem fine at first only to experience delayed grieving later.  There are many factors that can influence how a woman experiences and interprets a cesarean emotionally.

Planned Cesarean vs. Unplanned Cesarean

Whether or not the cesarean was planned is often (but not always) a factor in how a woman experiences her cesarean.  

Women whose cesareans were planned ahead of time usually have the easiest time recovering emotionally, since they knew ahead of time that it would happen and more or less what to expect.  They had time to grieve their lost ideal birth ahead of time, and were able to prepare themselves mentally for the rigors of surgery and recovery.   They did not have to go through the pain of labor and the pain of surgery too.  

However, not all women who have planned cesareans have an easy time emotionally; some have planned cesareans because of unavoidable physical factors and/or unenlightened medical policies.  Because they did not want the cesarean but were forced to have one anyway, the emotional recovery in these cases can be difficult and painful.  

Women who do not plan to have a cesarean but who go through labor and still end up with a cesarean anyway generally have a hard time adjusting emotionally too.   To go through the intensity of labor and then have to endure the pain of surgical recovery too is a double physical burden.  To give up your fantasy of how you wanted your birth to go and face a totally unexpected outcome is a difficult emotional adjustment for many.  

Those who unconsciously believed that 'this won't happen to me' (and conversely, those who were especially afraid of having a cesarean) often face the most difficult emotional adjustments of all.  Rigid expectations of birth, denial of the unpredictable nature of birth, or extreme avoidance fears of possible surgery make a cesarean that much harder to deal with if it does occur.   

Experience of Labor

Another factor that strongly influences a woman's experience of cesarean birth is how her labor went.  

If a woman experienced a relatively easy labor but a situation suddenly occurred where a cesarean became necessary, some women feel bereft and robbed of the culmination of what they had been working towards.  These women tend to adjust fairly quickly and are often able to navigate recovery easily enough. They usually do not face future pregnancies or births with much fear of labor, just the fear of the recurrence of the complication recurring.  Once they get past the stage where the complication occurred, they generally do very well.  Sometimes they do experience the complication recurring, but with a more favorable resolution, and then they are fine.  

On the other hand, sometimes women who have had a sudden cesarean due to an emergency during labor are traumatized by the suddenness of how things changed, the unpredictable nature of labor, and a sense of fear over this volatility.  The quick action that sometimes must be taken because of complications often does not leave time for women to adjust emotionally; they may feel like their bodies and emotions have been hijacked.  In subsequent labors, even if everything is going well, they may fear another sudden 'hijacking' by a complication, and often need a lot of reassurance that all is going well.  Again, once they are past the point where the previous complication occurred, they can often relax a bit more.  

Women who experienced a very difficult and painful labor before their cesarean occurred often see the cesarean as a welcome release from the pain they experienced.  These are often the women who 'loved' their cesareans, as to them it was a release or a rescue from a difficult situation.  To go from an immense amount of pain with little or no progress to the numbness of cesarean anesthesia may feel like a real blessing, and to have the immediate gratification of having it all over and holding that precious little one in their arms sooner rather than later is an understandable joy. 

Many women in this position logically therefore see their anesthesiologist or OB as rescuer and hero.  Ironically, many of these difficult labors were actually caused by the labor management policies of the doctors, who were then able to ride in on their white horse to 'rescue' the woman from the problem the doctors had created in the first place!   Women in this situation usually divide into two camps---those who staunchly keep seeing their doctors as white knight rescuers, and those whose heroes get knocked from the pedestals when they find out that the actions of their doctors may have caused their cesareans in the first place.  

This is a particularly difficult emotional transition.  A woman may be 'fine' with her cesarean at first because she saw it as a rescue from a difficult situation or a lifesaving measure for herself or her baby.  If she finds out later that the doctor actually caused or greatly added to the problem that she had to be rescued from (or even worse, put her baby's life in danger through his actions), that transition from loving the cesarean to feeling betrayed by it can be particularly bumpy.  If she idolized her doctor/hero only to have him fall from the pedestal in a big way later on, then all of her beliefs about medicine and childbirth get shaken to their core.  These women often start out 'fine' with their cesarean but have a very difficult time healing emotionally once they truly understand their prior labor and birth.  

Women who are induced, have a long and painful labor, and end in an unanticipated cesarean can also have a particularly hard emotional recovery.  A cesarean after a long difficult induction can be particularly challenging physically, and induction drugs often have long-term physical effects too.  Pitocin, for example, can cause significant swelling and edema in the mother, which may impact breastfeeding supply, make it difficult and painful to walk, and be very uncomfortable to deal with.  Women who have been induced with Cytotec (misoprostol) often report that their labors were extremely painful and difficult to deal with.  Babies who have experienced labors with lots of drugs and pain medications often are jaundiced, drowsy, and 'out of it' at first, then fussy later on.  All of these physical factors tend to make emotional recovery much more difficult as well.  

Adding to the difficulty of physical and emotional recovery after a difficult induction is the fear factor.  Some inductions are so difficult that women develop a tremendous fear about labor.  They can feel traumatized by how hard it was and how much pain they went through. Many have great anxiety about going through labor again because their only experience of labor was such an unnaturally strong and painful one.  As a result, many choose an elective cesarean for their next birth in order to avoid a recurrence of such a difficult labor, not knowing (or not being able to trust) that labor doesn't have to be that painful and hard.   

Experience of Surgery and Recovery

What happens during surgery and recovery also influences a woman's perception about her cesarean.  

If the surgery was experienced as a blessed relief after a long and very difficult labor, many women feel 'rescued' by it, and may always want to have a cesarean in the future.  If they have never experienced an uncomplicated vaginal birth and have no comparison of how much easier a vaginal birth is to recover from, then they have no standard by which to measure a surgical recovery.  Therefore, if their surgical recovery was unremarkable, these women are inclined to think of a cesarean as 'no big deal'. 

On the other hand, if surgery was difficult or traumatic in any way, a woman's perception of her cesarean is understandably going to be more negative, and her emotional recovery afterwards more difficult. For example, some women have experienced a lack of complete anesthesia coverage during their cesareans, which can be absolutely devastating emotionally and physically.  This type of experience has long-term effects on feelings and fears about birth and surgery, and is a very difficult issue to heal from.  It also can involve Post-Traumatic Stress Disorder.  True recovery often involves going back and revisiting and reprocessing the experience, and the difficulty of doing that can keep women from healing for a long time. However, emotional recovery is possible, and the experience can often be a potent healing influence.   

If a woman's physical recovery is difficult or involved after a cesarean, then her emotional recovery will also likely be affected.  Since larger women are more at risk for infections and wound separations after a cesarean, this can be an issue for them (although it should be noted that average-sized women can encounter problems too!).  If a woman's incision site will not close, develops an infection or pockets of fluid, then she may need long-term nursing care.  Sometimes women even need to be re-admitted to the hospital for additional surgery on the site.  Cesareans also increase the risk for postpartum health problems like gallstones, appendicitis, ectopic pregnancy, painful scar adhesions, and possibly infertility.  If you experienced problems like this, it's understandable not appreciating the cesarean, or having difficulty recovering emotionally afterwards!

Treatment by Staff

How a woman was treated by the medical staff during her labor, during her cesarean, and during her recovery also influences her opinions about cesareans and her emotional recovery from them.  

If the staff were consistently helpful, nurturing, empathetic and considerate towards her feelings, this goes a long way towards helping a woman towards physical and emotional healing.  She may still experience disappointment over her cesarean but probably won't be as deeply traumatized by it.  

On the other hand, if staff were uncaring, cold, distant, judgmental, or abusive during labor, the cesarean, or recovery, then a woman is highly likely to find her cesarean traumatic and have great difficulty recovering emotionally.  Although we would like to think that all hospital staff is caring and considerate, some staff can be chillingly cruel or even sadistic.  This may be particularly true if the staff is fat-phobic.  

If you read a few of the stories in the BBW Cesarean Birth Stories, you will understand better how some women can find their cesareans deeply traumatic, and carry long-term emotional wounds from them.  Emotional healing is of course still possible; often these terrible experiences are a call to action and create great empowerment for these women if they are able to marshal their anger and channel it into action and reform.  

Necessity of Surgery

How necessary the surgery was is also a very important factor in how women perceive a cesarean.  

If the surgery truly saved the life of the mother or the baby, her feelings about it will be different from a woman who was bullied into surgery unnecessarily.  For some women, knowing their surgery was necessary helps them recover emotionally without a great deal of regret.  Their disappointment about the cesarean may be overshadowed by gratitude that surgery was possible and available, and that they and their child are alive to tell about the experience.

However, even when surgery is truly necessary or life-saving, some women still mourn the loss of their ideal birth and the changes that had to occur due to circumstances.  These women are often told "at least you have a healthy baby" and that they should be thankful for the life-saving surgery, but often find this an extremely frustrating and disempowering statement.  Guest columnist Gretchen Humphries writes about this statement in her powerful essay, "You Should Be Grateful." 

Of course it is true that a healthy baby is the top priority, and if the c-section was truly necessary, then we can be grateful intellectually for the procedure.  It is insulting to suggest otherwise.  However, even when the surgery was necessary, a woman often needs to mourn the birth she wished she could have or was not allowed to have, and to acknowledge the difficulty of having major surgery.  Having major abdominal surgery right before taking care of a needy and high-maintenance newborn is not easy!  Most women would not choose to adopt a baby and bring it home on the day they had their gallbladders out, yet people routinely dismiss the physical impact of cesarean surgery on the mother. And for some women, to be told that they have no right to mourn the loss of their ideal birth in addition to the physical invasiveness and burden of surgery is insult added to injury.  

If women who truly needed a cesarean can still find it distressing, imagine the bitterness and intensity of mourning in women who find out that their cesarean was unnecessary!  About half of all cesareans in this country have been estimated to be 'unnecessary', and as previously noted, are often caused by the management policies of the doctors themselves.  When a woman realizes this difficult and invasive experience could have been avoided, the anger and bitterness she experiences often makes it emotional healing difficult.  On the other hand, if she is able to channel this anger into empowerment, this may also propel her into great action and healing in birth issues and in life.

Beliefs, Dreams, and Fears About Birth

A lot of how a woman experiences a cesarean emotionally has to do with her own beliefs about birth, the fears and dreams and beliefs she brings to labor and birth.  

If a woman believes that birth is high-risk, if she doesn't trust her body to 'work right', if she uses technology as a talisman to ward off bad luck or bad outcomes, then she is much more likely to fear birth and see a cesarean as a rescue.   Women who 'love' their cesareans are often those who prefer a high-tech approach to birth, those who have prior miscarriages or stillbirths and feel 'safer' with a cesarean, or those who have deeply rooted fears of birth that cause them to view a cesarean with relief and anticipation. 

Women who prefer cesareans can also include those who fear labor pain very strongly, those who dislike the messiness and unpredictability of birth, and those who prefer the convenience and predictability of scheduled elective cesareans.  Women who are uncomfortable with their bodies because of past abuse also sometimes prefer cesareans because it allows them  to circumvent "that" part of their bodies, to avoid uncomfortable feelings and procedures that may remind them of the abuse, or to prevent themselves from 'losing control' or feeling too much during labor.  It offers them a feeling of control over the process, and control is often an important issue to these women.  

There are also women who really don't care how their babies arrive in the world, who see cesarean birth and vaginal birth as truly interchangeable, and simply do not see a cesarean as any big deal.  They are often able to adapt and 'go with the flow' easily and don't care how they give birth, or just don't see a birth experience as important and would just as soon get it over with.  Some of these women have had a difficult time imagining themselves actually giving birth vaginally, and so are not disappointed if it does not happen.  To them, it doesn't really make much difference either way.  

On the other hand, if a woman strongly believes that birth is a natural occurrence and dreams of a birth that is totally natural and medication-free, a complication that ends in a cesarean often shakes her belief in the safety and naturalness of birth, and shakes her trust in her body.  Women who strongly desire a totally natural birth yet experience a cesarean often have a difficult time integrating that experience.

Women who had a strong ideal of birth beforehand that was not fulfilled in reality also often have a hard time mourning the birth that they wanted and didn't get.  There is nothing wrong with a strong vision of birth, but it is important to be able to be flexible and adapt because birth is not always predictable. These women have to find a way to maintain their vision of birth but be able to 'go with the flow' if things happen differently, and to encompass into their vision a way to have a good birth if a problem makes different choices necessary.  Mourning their cesarean often helps these women find that compromise of vision with flexibility. 

Some women see birth as a pass/fail test.  They are often perfectionists and high achievers who place a high priority on 'doing things right' and doing a good job at all times.  Being 'out of control' during the most intense part of labor may frighten them, and the thought of 'failing' at labor may have them petrified.  Experiencing a cesarean is often devastating to these women, but if they let it, the experience can help them find the ability to release control and embrace the uncertainty of life.  

Women who have co-dependency issues also often have a strong need for control, and the unpredictability of birth is often difficult for them too.   They may have highly detailed birth plans that specify what is to happen under what circumstances, and may encounter difficulties with providers that are impatient or inflexible about hospital policies.  The uncontrollable, roller coaster nature of labor (especially one that leads to an unplanned cesarean)  is often very difficult for these women to deal with.  They frequently find their cesareans very threatening, and may carefully research and analyze things for their next birth in an attempt to control it better.  Their emotional healing from a cesarean often involves nurturing the ability to 'let go' of trying to control the outcome.   

Women who have been abused sometimes experience a cesarean as a rescue as noted above, but can also experience it instead as a terrible  violation, as almost akin to another rape.  A cesarean is by its nature a very intrusive procedure, and it is only natural for a woman to want to protect her body and her baby.  To be laid bare in front of room of strangers, placed in a position that resembles a crucifixion, and tied down while being 'violated' often triggers memories of abuse, and can be extremely traumatic for some.   These women often become very determined to find a different way of birthing next time, and the trauma of their cesarean can create a very powerful impulse towards healing of their unresolved trauma.  These women also often become birth pioneers if  they can actively transform their trauma into a force for healing in the world.

Conclusion   

Women experience their cesareans in vastly different ways, depending on the beliefs and fears they brought to the birth, how well they were treated during labor and birth, how the surgery and recovery went for them, and how necessary the surgery really was.  Although these generalizations about women's experiences are obviously a bit over-simplified, they do contain many truths about how and why women respond so differently to what seems on the surface to be the same experience.  Remember, no judgments are implied here; these are simply observations that may help explain why different people experience the same incident so differently. 

Did you find yourself, your beliefs, or your situation described at all above?  Did you recognize Kmom in any of the entries?  [She's there in a lot of them!]   Many women who read these observations will see themselves, perhaps in multiple ways.  Other women may not see themselves at all. 

Take some time to consider to yourself how you have responded to your cesarean, and what factors might have influenced that response.  Don't be judgmental; simply observe your influences and reflect on them.  This may contain some of the keys to help you towards healing.

 

The Response of Friends and Relatives To Our Grief

"A woman faces everyone else's denial when she attempts to say how a traumatic birth has affected her.  An uncomfortable sense of isolation and a fear of being crazy results, as loved ones, friends, and co-workers do not acknowledge her pain or how her world has changed.  This separation from others in viewpoint and experience is often more difficult to heal than the physical wounds of birth."  Lynn Madsen, Rebounding From Childbirth

Women who have had cesareans often find that their providers, spouses, siblings, friends, and parents are less than sympathetic to their grief over their cesarean. People surrounding the mother may dismiss her disappointment at having a surgical 'birth,' be cavalier about her physical pain, or even be derisive about the trauma she may have suffered.  This lack of understanding from friends and family is often very painful, and women may feel isolated and depressed because no one seems to understand her suffering or value her experience of birth.  She may begin to question the validity of her own feelings and even her own sanity.

Years later, as women plan further children, they may be further disparaged for wanting a Vaginal Birth After Cesarean next time; the mother may be told she is being selfish and putting her own self-centered need for a 'good birth experience' ahead of her baby's health (completely ignoring the data that shows that cesareans are actually more risky than vaginal birth!).  Or friends and family may otherwise criticize and deride the plans the woman has made to make a better birth experience for herself, denying that how a woman experiences birth matters at all.  As long as you get a healthy baby out of it, they say, who cares?

It can be very difficult to deal with friends, relatives, and even spouses who "don't get" why we are upset over our birth experiences, don't agree with our assessment of what happened, or find the birth plans we have made for  future children threatening to their belief systems.   

Dealing With Relatives and Friends

Friends and relatives can be difficult to deal with after a cesarean in many ways.  Although the majority of problems are due to dismissal of a mother's emotional pain over her cesarean, in a few cases women are disparaged for having had a cesarean instead of a vaginal birth.  In some cultures, for example, a woman may be looked down on for needing a cesarean.  She may be viewed as 'defective' because some health concern necessitated the cesarean, or seen as 'less' of a woman.  Some are disparaged for 'taking the easy way out.'  This is nonsense, of course; vaginal birth is not a requirement for being a 'real' mother, and needing a cesarean does not mean you are 'defective.'   And certainly, having major surgery is NOT the 'easy' way out of birth!

However, this scenario is unusual in our society.  Instead, most of the problems cesarean mothers have with friends and relatives is caused by denial of the mother's grief over her cesarean.  Many people today believe that a cesarean is basically interchangeable with vaginal birth, that an elective cesarean is great because then the mom doesn't have to go through labor, or that a cesarean is 'easier' on mother and baby.   There is a lack of understanding about the true scope of cesarean surgery; some people seem to think it's kind of like unzipping a zipper and taking the baby out----maybe a little more complicated, but not that difficult.  They do not fully understand just how invasive it is and do not equate it with other similar major abdominal surgeries.  Nowadays, most people just see it as 'no big deal,' and so they find it hard to understand why the mother is upset about it. 

Some relatives may be less-than-sympathetic because they come from an age of extreme intervention in childbirth and may have little interest in more natural childbirth.  Many older women come from a time when they were completely unconscious during the birth of their child, suffered through huge episiotomies that often left long-term damage, and were routinely separated from their children for long periods after birth.  To them, unconsciousness or semi-consciousness at birth, pain, suffering, and separation may seem totally normal and unremarkable.  Even women who gave birth in less interventive times often have unresolved birth grief to deal with, legacies of still-potent drugs, 'purple pushing', episiotomies, and routine separations from their babies.

It should be noted that some relatives may be less than attentive to the mother's grief because they are concentrating on their joy in the new baby.  Perhaps they cannot bear to acknowledge any shadows from such a wondrous blessing as a baby, and so brush aside any mention of problems.  Oftentimes, friends and relatives may simply be swept up in the thrill of getting to know their new grandchild/godchild, and in their happiness they may be unable to understand less-than-total joy at its birth. 

Friends and siblings may also find it difficult to relate to your pain because they often have unresolved grief from the births of their own children to deal with, even with seemingly normal births.  Because they have their own birth beliefs and fears, they may impose these beliefs on your experience too.  If they fear labor pain greatly, they may not emotionally be able to see that epidurals can bring risks and intervention along with pain relief.  If they had a cesarean and felt 'rescued' by that experience, this may not allow them to understand that someone else could feel traumatized by their cesarean. 

Conversely, others may have had such easy and uncomplicated births that they 'don't see what the big deal is' and simply cannot understand that someone else's birth might not have been as simple and easy as theirs was.  More than one grieving woman has been brushed off by women who birth easily and can't understand that not every birth is like that.   

Some therapists feel that many people are unconsciously dealing with grief over the way they were born so many years ago. If a baby really is a fully feeling, sentient being at birth, how must he or she feel at some of the more violent interventions of birth, from forceps or vacuum extractors dragging them out, being taken away from the mother and isolated, to all the routine shots, blood tests, circumcisions, and other interventions that babies are subjected to immediately upon entering a new world?  There are therapists who feel that those who experienced particularly difficult births were traumatized by the experience and carry that trauma with them into life.

Many women feel acute pain when they are not able to share their grief over their birth experience with their mothers.  Here is the one person in the world who should be able to empathize with you, yet she is often the person who has the least understanding.  The reasons are often complex.  For her, the joy of becoming a grandmother may supercede her ability to hear your emotional pain, or the unacknowledged grief of her own birthing experiences may keep her from being able acknowledge yours.  Perhaps the difficulty of seeing her beloved daughter in pain may have caused her to see the medical system as having 'rescued ' you from terrible pain or even from danger.  Or she may have boundary issues with you that makes her want to control your life, to discount your feelings and desires, and to 'fix' things for you.  

The often-strained relationship between many mothers and daughters makes communication about basic issues difficult enough, let alone emotion-laden issues such as birthing experiences.  And communication may be hampered by unresolved tensions in the relationship, such as control or co-dependence issues.  Often, the mother's reaction to her daughter's birth grief reflects her own life issues, and the underlying issues of tension in their relationship.  

Summary

The sad truth is that many women are never able to find sufficient understanding about birth grief with their own mothers, friends, or relatives, and must learn to find the support they need elsewhere.  It's possible that eventually you may be able to get them to understand or at least acknowledge your pain, but it may also be that you need to concentrate on the things you do have in common and learn to accept that this may never include sharing your birth grief.   This is a significant loss and you should mourn it, but eventually try to find a way to move on and honor the things that you can share.   

The people in our lives that have the most violent and denying reactions against our grief may be those who have the most birth grief themselves, either from their own births or from the births of their children.  How other people react may not really be a reflection of your experience but of their own fears and beliefs that get imposed on your situation.  The only way to deal with such people is to realize that their reaction is not really about you, but about their own needs.  

With less extreme reactions, the answer often lies in our culture's inability to deal with grief. People in our society have a difficult time dealing with another person's pain and grief, whatever the source, and tend to avoid or minimize it rather than acknowledge it.  We are trained to avoid other people's grief, to look away from pain, to deny illness and death, and leave people to deal with these things in private.  Sharing another person's pain is simply not a skill many of us have developed or are comfortable with, and grief is still taboo in our society.  Grieving death is hard enough; grieving anything less than a death is often seen as indulgent, self-involved, and neurotic. 

But birth is a major rite of passage in a woman's life, and a woman's experience of this does matter.  It is normal to grieve if this rite of passage was difficult or traumatic or even 'just' less-than-ideal.  It is part of our devaluing of women and their experiences in our society for people to imply that only the end product matters, and that how a woman experiences birth does not matter.  It DOES matter, and it is normal to grieve and need to work through that grief.  

You are not wrong or crazy or neurotic or wimpy or selfish for feeling the way that you feel.  As Madsen writes, "It is important to realize that other have their own reactions to a birth; a woman's personal reaction is right for her regardless of others'."  Your feelings are simply your feelings, and they are neither right nor wrong----they just ARE.  If you look closely at them, they are your clues to why this birth has such meaning for you, what life issues they are resonating with, and what you can do to help heal yourself.  If others have a problem with your feelings, then that is THEIR problem.  You have every right to your feeling, and you need to tell people so. Madsen writes further: 

Each time a woman is confronted with someone else's minimization, placation, or denial, she is tempted to take this craziness into herself rather than acknowledge that the situation is crazy.  She becomes stronger as she learns to trust herself and name what is going on inside, to separate out which thoughts are her responsibility and which are others', and to rebuild bridges with people she cares about.

You cannot expect every person around you to understand your feelings completely, but you can ask them to acknowledge and respect the fact that you have these feelings.  You can't expect everyone around you to be in constant mourning with you over your birth, but you should be able to expect them to acknowledge that you were hurt, that you have the right to your feelings, and to give you space for the mourning and healing that you need to do.  

Sometimes, you simply have to tell friends that they may not fully understand why you are so upset over your birth experience, but they do need to understand that you ARE upset by it, and that they need to respect that.  Sometimes, you have to instruct them on what you need----a listening but non-judgmental ear, someone to bounce ideas off of, a helper to take the baby for an hour or two so you can take time to really grieve, or whatever.  Sometimes, strong or repeated conflict is an indication that you are having boundary issues with someone, and that you need to become more assertive and set more strict limits with that person.  Occasionally, you simply have to declare the subject off-limits with certain people, and if necessary get up and leave.  

On the other hand, it's important to understand and respect that other people have different views of birth. You don't need to convert everyone around you into your point of view about birth; if you want them to respect your point of view, you have to respect that they may completely disagree with you.  As Madsen notes, "With the emotionally loaded subject of birth, differences in philosophy and practice make for volatile encounters.  Without the agreement to disagree with respect, primary relationships such as marriage, parent-daughter, and friendships can be torn apart."  Remember, their beliefs in different birth values than yours does NOT invalidate your beliefs.  Don't be threatened by someone else's beliefs, just agree to disagree.

Don't randomly seek support from people around you; seek out the people you can get support from and find a way to deal with the rest without denying your feelings or going crazy.  When you encounter a person who simply cannot acknowledge your grief or empathize with your birth choices, you may need to minimize contact with that person, or if you value their place in your life, you may need to honor the relationship by concentrating on the things that you do share and agreeing to disagree on the others.  

You may be able to help some friends to understand your feelings better by giving them a copy of one of the following essays:

Sometimes, reading essays such as these can help people 'get' our pain, or at least acknowledge that we are having pain, whether they fully understand it or not.  You may have been saying the same things all along, but hearing it in another person's voice may be the key to getting a friend or loved one to be more empathetic.  

However, some people may never 'get it.'  They may have too much of their own 'stuff' in the way, they may have their own agendas about birth, or they may not be willing or able to really acknowledge and deal with someone else's pain.  Madsen urges women to seek support for their healing journey from sources where they will get it.  Don't keep looking for understanding from people who are not capable of giving it; instead seek out sources where you are more likely to find understanding or a sympathetic ear.  Seek out many different types of resources, as one may not be able to provide you with all the support you need. Combine resources as needed in order to meet all of your various requirements.  As Madsen states:

Support will come from a variety of places and people, not just one or two sources.  Some sources will provide emotional understanding, others will offer practical advice [on the baby], and other may offer financial support.  The challenge is to accept what is offered and to piece together within oneself a coherent and loving sense of self. 

And of course, don't forget that your primary resource is yourself; you are the key to your own healing.

Dealing With Spouses

"Spouses' birth experiences and expectations are intrinsically different from a birthing woman's...Yet often spouses are the ones women first turn to for support, and the kind of understanding sought may be unrealistic.  Spouses give support, but it won't be totally what a woman needs.  They are too close to the situation, and have their own reactions and investments...Having witnessed the birth, spouses have their own trauma to heal.  Because of this, their ability to listen to and support the birthing woman is conceivable, but not always possible."   Lynn Madsen, Rebounding from Childbirth

Many women also have great difficulty in dealing with their spouses after a traumatic birth.  Spouses in particular tend to pressure a woman to "just get over it already" because of their own difficulty dealing with emotional issues, their own birth beliefs and birth issues, their difficulty in questioning medical authority, their distaste for dealing with women's intimate issues, and a reluctance to revisit the difficult emotions and memories of the birth itself.  

Reluctance to validate a wife's grief over her birth may reflect the husband's discomfort with how the birth progressed. Supporting a woman through a difficult labor and subsequent surgical birth is extremely trying emotionally, and many spouses feel inadequate, frightened, and powerless in the process. It is very hard to watch someone you love be in pain, and most men are trained culturally to want 'to do something;'  Therefore, having the surgeon take over and 'get it all over with' is frequently a relief to them.  Thus, to them, the cesarean may actually have seemed like a really good thing to them.

Men also have their own birth beliefs and issues that interfere with their ability to support the mother emotionally.  Men may need to resolve their own difficult births, or they may have issues with their own parents that tend to resurface as they become parents themselves.  Dealing with the reality of their wife's pregnancy and birth of their child may remind men of these issues and make them uncomfortable if they are not ready to deal with them yet.  

Furthermore, men are trained to be very uncomfortable with 'women's stuff'; frank talk about body fluids and their partner's anatomy tends to make most men ill at ease, so they avoid it whenever possible.  In addition, seeing their intimate partner during birth in a such a clinical way can make men uneasy; they may prefer to return to their perception of their partner as a sexual intimate instead.  Men's profound discomfort with 'women's stuff' is often a powerful barrier to helping their partners heal.

Issues of response to authority may also arise.  Many men are very reluctant to question doctors, and want to simply assume that 'doctors always know best.'  Many men become co-opted into the medical model of childbirth by the doctors, and doctors often talk past the mother and to the father during labor, forming a male coalition to 'handle' the woman during birth.  Other men would prefer to keep birth on an intellectual level, easily analyzed with data charts and dealt with through black-and-white decisions made by an all-knowing authority figure.  To be forced into questioning whether this authority figure actually made the right decisions is very threatening to some men.  Madsen notes that, "Spouses may need to hang onto their faith with the medical practitioners for their own various reasons."  

Furthermore, fathers may not be very responsive to the mother's birth grief because they may be working through their own emotional issues about becoming a parent about the time the mother is most in need of support.  While mothers start dealing with parenthood issues earlier because of the physical reality of pregnancy, fathers often are dealing with it more during the first few months after birth.  They may be so overwhelmed by the new baby in the house and the realities of their new role as parent that they just do not want to discuss the birth or wish to simply put it in the past.  Thus the mother may feel abandoned at the time when she needs support the most, and the father may feel put-upon trying to deal with all of the mother's issues while simultaneously trying to grapple with his own issues.  

Fathers go through a grieving process, too, but they may show it differently, or they may be in a different stage at a different time than their wives.  Nancy Wainer Cohen writes in Silent Knife, "Often, the father and mother are at different stages of grieving.  This is understandable and appropriate, considering that their experiences and perceptions about the baby and birth are different.  However, the difference can complicate matters, especially if understanding, patience, and acceptance are scarce.  The character of the marital relationship and the degree of communication and support present will influence the patterns and expediency of grieving."

Witnessing your loved one being cut open while you are present can also be deeply distressing.  Cesareans are the only surgery where your loved ones are permitted to be present and watch the surgery.  While men generally want to be present to support their wives and see their babies right away, many are unnerved by the surgery part.  It is far too real a lesson in anatomy for most people, let alone a disturbing reminder of the mortality of their partners, and many men would prefer not to be reminded of that experience afterwards.  If the surgery was in any way especially traumatic, men tend to especially shut down and not want to deal with remembering it at all because it may be so disturbing to recall. 

On the other hand, it must also be noted that often-times, a cesarean is more father-friendly than mother-friendly.  The baby is often given to Dad to bond with while the mother is still being operated on, and he may even get to give the baby its first feeding.  So while the mother may get a glance at her baby or a kiss or two, the father usually gets extended access in those precious newborn minutes.  Many mothers are deeply envious of this time------this was supposed to have been their bonding time with baby after all!-----while fathers naturally enjoy this private time.  Because cesareans can be very rewarding in this way for fathers, and because an elective cesarean does not require the father to go through the emotional pressure of trying to coach and support the mom through labor, some men prefer elective cesareans and pressure their wives to have them for all future births.

Because many spouses are distressed by the feelings of helplessness they felt during the birth, disturbed at the idea of questioning medical authority, out of their comfort zone in dealing with intimate anatomical processes, dealing with their own emotional issues, and may be overwhelmed with the reality of a new baby and their new role as a father, they are often just relieved that it's all over with and don't want to deal with it anymore afterwards.   As a result, many fathers find it difficult to empathize or deal with the mother's emotional needs after a cesarean and simply want to move on.  

This conflicts deeply with the mothers' need to deal with the reality of what happened to them, to integrate and understand the experience, and find a way to live with the wild array of emotions the birth has brought to them.  If other friends and relatives are less than supportive of her need to grieve, the mother may also unrealistically place all her need for support and healing upon her partner, adding even more pressure to their relationship.  

One of the most common areas of tension with spouses is the mother's need to re-tell the birth.  Most postpartum women feel the need to go over and over the birth, especially if the birth was traumatic in any way. This need to discuss the birth repeatedly can create a great deal of tension with the spouse, who generally wants to forget the experience or is ready to move on sooner than the mother is.  It is completely normal for mothers to need to re-live the births of their babies however it went, but this need is often markedly stronger in women who had difficult or traumatic births.

It is your job to emphasize to your partner that it is a very important (and normal) part of the healing process to need to review the birth again and again. He needs to understand that his job is to listen, help you recall, sympathize, comfort, and hold you, but it is not to help you solve anything or get you to move on. Men tend to be programmed to do this when trying to help, and it's the opposite of what most women need after birth. 

Many men tend to listen, offer a course of action to solve the problem, and then move on. That's fine; it works for them. However, they need to understand that YOUR course of healing may be different, and that what most women usually need is a sympathetic ear, one who will listen nonjudgmentally over and over again, as long as is needed. He needs to know that his healing is important (and many spouses have a lot of buried emotions after a c-section) but that your healing is very important too, and that you need his support to heal in your way, not his. 

One suggestion that works for many women is to schedule specific times to focus on birth issues and discussion of birth-related feelings with their husbands.  The husband has to promise that during this time he will really listen to the woman's feelings and try to understand them, and that he will not judge them or dismiss them.  The wife has to promise that she will try to limit her birth discussions with him to these times, so that he can have the relief of  'birth-free' times when the subject is tucked away and the two of you can focus on your relationship, your family, or other issues in your lives.  Scheduling specific times can provide the outlet the woman needs, an opportunity for discussion of important birth issues between partners, yet contain the grieving into more manageable chunks so that the couple doesn't spend all its time being dominated by this issue.  

Another difficult issue impeding communication with husbands after a cesarean is that deep-down, many women are angry with their husbands for not protecting them from the cesarean or the interventions that led to the cesarean.  This anger may not be on a conscious level.  Many women do not think they are angry with their partner, only to find later that when they really explored their feelings deeply, they were angry.   Sometimes men perceive this intuitively, and so they avoid the whole subject.

The anger women feel towards their partners may have a real basis, or it may not be rational.  Many women know that it was unfair to expect their husbands to protect them from interventions or to stop the cesarean from happening, yet they are still angry anyhow.  This is a very common feeling!  It may not be fair, but those feelings are there.  If they are not acknowledged, they fester and poison your relationship.  Getting them out is important.  

Many women find that they can deal with it by journaling about it, working through their feelings on paper before discussing them with their spouses.  Or they can talk them over with a neutral person, in a cesarean support group or online.  They can acknowledge that the feelings may not be fair, but that really feeling and acknowledging them anyhow can lessen their toxicity and help the woman move beyond them.

Each woman must decide for herself whether or not to share those feelings of anger or disappointment with her spouse; whether it is important to share depends on the relationship you have, what occurred, and what tensions you share for the future.  If you are afraid that the same problem will recur, if you want to hire additional labor support and he finds that threatening, or if you need more support or a different kind of support from him next time, sharing the feelings may be important to help you clear the air and change things for next time.  On the other hand, some women find that if they really deal with it on paper or in therapy, they do not have to share those feelings fully, or can concentrate instead on expressing clearly how they need their husband to support them in their next birth.  

Conflicts Over a New Pregnancy

When the subject of a new baby comes up, new tensions in the relationship may well arise.  Although both spouses may strongly desire to have another baby, going through pregnancy and birth again brings up all those difficult memories and issues from the prior birth to deal with again.  The wife may re-experience all the emotional upheaval and disappointment of that birth over again, and she may need to start to re-tell and re-hash her birth experience, which can be very frustrating for the husband to have to deal with all over again.  And the husband may have his own issues to deal with again.  

The husband may be reluctant to commit to having another baby because of how difficult it was to deal with before, because he saw what happened to the mother emotionally afterwards and is afraid it may happen again, and because he may be afraid for the mother's physical health as well.  The wife may be reluctant to commit to another baby because she is filled with fear of complications recurring, ambivalent about the discomforts of pregnancy and birth, or may not feel like she has enough birth choices to avoid another birth like that again.  

Frequently, spouses disagree about pregnancy and birth decisions for next time.  The husband may have a strong desire to push for an elective cesarean to just get it all over with; facing the uncertainty of birth and the pressure to support the woman through labor again may be too much for him to deal with emotionally.  On the other hand, the wife may have a strong desire for a Vaginal Birth After Cesarean, which may put her in conflict with her family members, her husband or even her provider.  Having to fight for this chance can be exhausting at a time when a woman most needs support, yet frequently encouragement and assistance is at its lowest during this time.  

Sometimes, the woman has done a lot of research and may choose birth options that a husband is not prepared to deal with.  For example, many husbands are threatened by the idea of hiring additional labor support, avoiding pain medications, seeing a midwife, having the baby in the water, or birthing outside of the hospital, yet these options are often very helpful in achieving a VBAC.  The husband may find his wife's newfound independence very threatening, the idea of questioning medical authority unthinkable, or he may simply be overcome with fear for her physical safety.  These are often issues that take time to work through, and usually reflect deeper issues between the couple, or his own underlying individual issues crying out for healing.  

There is no one easy way to work through these issues.  Oftentimes, it is useful to have each partner reflect on their own time what they want out of the next birth and why, and then consider what deeper issues might be behind these desires.  Then they can schedule time to come together and listen to each other's points of views neutrally and without having to decide anything yet.  Nicette Jukelevics suggests that the following format can help partners communicate more effectively:

Sometimes it is helpful to restate the other person's opinions and issues to show your understanding, to clarify any questions or confusion, and to share and emphasize your common priorities.  Then take time to go away and reflect on each person's point of view, and to do research on any issues that arise.  Return later on to discuss what you have found out, to work through your issues, and to see if there is room for compromise.  

Counseling with a childbirth educator or birth issues therapist can also be helpful in finding out more about birth care controversies, uncovering the real emotional issues behind any conflicts, finding ways to work through fears, and to come to some understandings about these issues.  Journaling exercises and birth art are often particularly powerful ways to work through such concerns.

Sometimes, the woman is more ready to deal with these issues than her husband is.  Many husbands carry such fears and emotional baggage from the previous birth that they refuse to discuss the issue at all, refuse to do any reading about birth issues, refuse to consider alternative arrangements for birth, and emotionally wall themselves off.   Many couples who have experienced traumatic birth find themselves at an emotional impasse at some point in the next pregnancy.   

This is a very difficult situation.  The mother has to respect that the father is dealing with his own issues, beliefs, and fears, and that they may be so strong that they do not allow him to be empathetic or consider alternatives. Usually, in time, most fathers are able to eventually start working through their feelings and deal with the upcoming birth, and the couple is able to reach some type of compromise.  However, on rare occasions, sometimes the mother has to understand and respect that the father simply cannot deal with this issue for whatever reason, and make arrangements for other support.  She may need to realize that this problem is not really about her but about his own issues that simply are too difficult to deal with right now.  

Although the mother should make every effort to connect with her partner and try to work through problems, she cannot let his issues keep her from doing her own birth work and processing.  This is her body, her baby, and her life, and her pregnancy will proceed whether or not her partner decides to work on his own issues.  Even if the father is absolutely obstinate, she should not put dealing with her own feelings and issues on hold.  Go to counseling alone, do your own journaling, read lots of books on your own, experiment with birth art anyhow.  Do what YOU have to do in order to grieve your last birth and help make space for the next birth to be more empowering and healing.  

Oftentimes, the mother proceeding with her own work and issues helps the father past his reluctance and he becomes involved anyhow.  Many mothers also find subtle ways to involve the father more, such as leaving a birth book open to a certain chapter in the bathroom for the dad to look at if he chooses, or leaving a pamphlet in the father's briefcase for him to read on a trip.  Scheduling time away from the other children to relax and reconnect as a couple can be helpful in re-opening the lines of communication.  Writing a formal letter about your feelings and mailing it to him often 'reaches' him when normal spoken communication has been closed off emotionally.  Other moms find getting the father to another childbirth education class (preferably a non-hospital, non-traditional class series) is key in getting him to open up and consider difficult issues.  Although many men have to be nearly dragged to class initially, most eventually feel that it was very useful in working through birth issues.  The process of getting a reluctant partner to deal with birth issues and grief is often a long and difficult one, but most women do find that eventually some progress does come.  

Ideally, a woman and her husband should find a way to come to agreement about birthing issues for next time.  The husband has to remember that although the baby is from both of them, the birth is from the WOMAN'S body and ultimately the choices about how to birth are hers.  He may have to learn to question all of his assumptions about the 'proper management' of birth, the infallibility of doctors, and the ability to control the process of birth.  A woman may have to find the strength to stand up for herself and her baby, to assert herself in her care, and to research and advocate for birth issues.  She will have to reach down and find out what is truly important for her in birth, and what it is possible to compromise on.  Together, they must make priorities and important choices, and find a way to come together as a family for a better birth.  

Summary

Some women get over a cesarean very quickly, and some women take years to get over it. It is the husband's responsibility to be responsive to his wife as she goes through her healing process, but it is the woman's responsibility to help her husband understand what he needs to do to support her while she heals.  She should not feel guilty for asking for his help, but neither should she expect him to read her mind or do her healing for her. 

It's important to recognize how hard it is for the partner of a c-section mother to watch his partner go through the labor, surgery and recovery; re-examining that can be very scary for the spouse. And dads have their own emotional issues to deal with; moms need to understand and give them space to deal with their issues too.  However, recovery is about personal AND mutual healing, and it can actually greatly aid the communication in your marriage to pursue discussing these issues carefully.

Remember that healing proceeds in stages, and that every couple's journey is different.  Expect that there will be bumps along the road, the most difficult of which is often dealing with subsequent pregnancies and choices about these.  Given time, these can be a path to tremendous growth and healing, however difficult they are to deal with at first.  

Don't expect your spouse to be your only support; the care and understanding of other women in a personal support group or an email mailing list is also a crucial part of recovery.  Also consider a personal journal to vent in, or a birth issues counselor who can help uncover and work through difficult issues in a safe space.   Childbirth education classes that specialize in emotional preparation for pregnancy can also be a vital part of personal recovery and preparation for future births.

Be sure to have room for other meaningful conversations and contact with your spouse; don't let your whole relationship be about the birth!  Spend time with and rediscover your partner; he needs nurturing and healing after a difficult birth, too.   Together, with time and care, you can both find your way to healing.   

 

Timing of Grieving

Different women have different timelines for grieving after a cesarean.  There is no right or wrong course for grieving; women need to grieve in their own way and their own time.  

Some women need to grieve their cesarean right away.  The experience of the labor and delivery may be so immediate in their minds that it is an emotional necessity to deal with it right away.  Some women also need to deal with their grief quickly in order to bond more closely with their babies.  

For other women, however, the experience may have been so traumatic that it is impossible to integrate psychologically right away, and they may need to create more emotional distance from the birth in order to function. For these women it may be healthier to put the experience 'away' for some time so that they can concentrate on the new baby and the intensive demands of new parenthood.  This is often especially true for women whose labor or cesarean was particularly traumatic.  

The woman who is 'fine' with her c-section at first often experiences delayed grief later on.  Frequently this occurs as the baby gets a little older and less demanding, around the anniversary of the baby's birth, when the woman is ready to start conceiving another child, or when a friend/relative that is close to them has a baby. This is very common and is a natural time to work on integrating the previous birth into herself.

Sometimes a mother may feels like she is 'fine' with her cesarean and has moved on.  It may only be later that she becomes aware of a deep and searching need to relive, discuss, and second-guess the birth, especially if she later suspects that the cesarean may not have been strictly necessary.  She may feel betrayed by her providers, overwhelmed with a sudden need to learn all about birth issues, and obsessed with discovering what really happened to her.

On the other hand, some women never do experience a need to re-live or second-guess their c-section, which is also fine. Not every woman is stressed by her c-section!  Although many who feel 'fine' about it at first do go on to question or mourn it later, some do not. Women who are 'okay' with their c-sections should not feel guilty or pressured into angst. Each woman is unique in her process of accepting her birth experience, and no response is 'right' or 'wrong'.

However, if grief is a part of your response, it is important not to rush it.  Oftentimes, women face a lot of pressure from friends and family to "just get over it," to deal with it quickly and then move on.  Sometimes, the pressure is from the woman herself.  In response, Madsen suggests:

Recovering from birth trauma or a related event is consuming; it can take up every waking and sleeping moment.  Consider taking breaks.  Commit to a conversation with a friend where birth is not mentioned.  Go to a silly movie...Take a bath and keep the mind empty. It's natural to want to move through the healing journey as fast as possible; after all, who wants to be in pain or identify big feelings?  'Let's get this over with,' a woman says, and then is challenged by a much slower timetable which her healing requires...An affirmation to use is:  a woman remembers and finds her feelings and memories as she is ready to remember and find them.

Don't rush your grieving; accept that your healing process will come and go in layers.  You will work on mourning certain aspects of the birth intensely for a while, then things will ease off for a while, only to return in force again later.  Again and again this cycle will probably happen, but each time the grieving is slightly different, the healing stronger, the burden lighter.  Some authors compare grieving to a spiral, but one which moves UP and into the light.  Work at your grief, but give yourself time and space to do it in your own way, and remember that while you may revisit the process periodically, your circle is a spiral that goes UP and moves into the light.   It does get better.

 

Bonding with Babies

"The urge to hold, cuddle, and touch a newborn is very strong in many parents.  To be denied that urge by some life-threatening emergency, or, worse, by some routine hospital policy, can be deeply painful.  The sorrow over not being able to have one's baby when the heart aches to parent and love is painful indeed.  The long-range effects may be great unless the sorrow is released and the heart healed."  Claudia Panuthos, Transformation Through Birth

For many women, one of the most difficult parts of cesarean birth is the lack of bonding time with their newborn.  Many women worry deeply about the newborn while separated because they usually cannot physically see and touch the baby for some time.  Many also deeply grieve that while they should have been the first to hold their babies, they were actually among the last to snuggle their baby; that virtually every staff member and family member got to hold and know their baby intimately before they did.  This is a deep and very primal loss, and should not be underestimated by others.  Biologically and emotionally, women are strongly programmed to interact with their children right after birth, to make sure baby is all right, and to cement their prenatal bond in a new and special way.  Losing this period after birth is a deep emotional wound, one which is difficult to heal.  Bonding can of course take place later, but that doesn't replace the precious time right after birth that can never be restored.  

Even after the surgery is over, cesarean mothers often miss out on bonding time.  Anesthesiologists regularly add drugs after the baby is born to make the mother drowsy and relaxed for the rest of surgery, but this makes many women feel completely drugged and 'out of it' for hours afterward, not just during the surgery.  Many cesarean mothers mention how frustrating and deeply disappointing it was to be too groggy to really remember this time or to be in too much pain to enjoy their baby fully.   

Women often also grieve lost breastfeeding opportunities.  Hospital staff often give a cesarean baby a bottle of formula 'just as a precaution' or 'so the baby won't get hungry while you are waking up.'  Therefore, many women are not only deprived of the first moments of baby's out-of-utero existence, she is also often denied the joy of giving baby his/her first meal, first bath, first diaper change----all those sentimental but oh-so-important firsts.   And research does show that those 'innocent' bottles of formula and delays of first nursing does tend to make a cesarean mother's milk come in later, may impact milk supply negatively, and may create nipple confusion. Research shows that cesareans do negatively impact breastfeeding rates, and the loss of this connection can be yet another loss a woman has to assimilate.  

Some women also feel disconnected from their cesarean babies, which often causes great guilt.  Since most c-section moms do not get to see the baby emerging from their bodies, to some the baby may seem unreal or as if it's the wrong baby. The lack of that primal knowledge of feeling and seeing that baby emerge from your body, of holding it right away afterwards, of knowing that this is your baby, can be devastating to the bonding process.  

Lois Halzel Freedman in Birth As A Healing Experience notes that one study that compared vaginal and cesarean deliveries found that 88% of women having a vaginal birth held their babies within the first hour after birth, whereas only 9% of cesarean mothers held their babies within the first two hours of birth.  She writes:

When women tell me that they did not hold their babies for a few hours after birth, or even for as much as twenty-four hours after their cesarean section, they express grief and feelings of loss about this.  Sometimes women feel unsure whether the baby is definitely theirs and may experience guilt over their doubts.  Some say they had not cared about holding the baby because they had felt so physically uncomfortable.  Many women stated that they grieved over the memory of not seeing their babies and not caring about seeing them.  This indicates the importance of the emotional need for mothers and their newborns to have physical contact soon after a cesarean section.  

Sometimes, those who experienced particularly traumatic births may subconsciously blame the baby for the experience.  Although this sounds terrible to outsiders, what is usually going on is that these mothers are just too pre-occupied with what has happened to them to be able to open their hearts fully to the baby.  They are overwhelmed by their experience, and because of the nature of birth, in their minds the baby is part of the source of the pain.  Subconsciously, even the most loving and attentive mother sometimes is a little angry with her baby for being malpositioned, for getting 'stuck,' for developing distress, etc.  It doesn't mean that these mothers don't love their babies or are poor mothers, just that what has happened to them is overwhelming and difficult to deal with, and they are human in their responses. 

Because of delayed access to the baby, less than ideal bonding time, interference from pain medications, delayed access to nursing, or inability to see the baby emerging from their bodies, some cesarean mothers can have difficulty bonding with their babies at first.  This state does not persist forever.  Most moms who have trouble bonding eventually experience a breakthrough and bond just fine-----but they may mourn forever the time lost to them. Sometimes the process takes days, sometimes weeks or months or longer, but usually at some point, most mothers find the opportunity to 'fall in love' with their babies after all.  

On the other hand, some women who experience traumatic births bond fiercely and immediately with their children. Trauma and difficulty do not always impede bonding; sometimes it has just the opposite effect. These women may be intensely connected with their children, and the level of bonding can be quite fierce. The trauma in these cases only helps to focus the mother's attention on her child, and the effect may be so strong that other concerns may drop away.  Recovery in the more extreme cases may involve relaxing enough to loosen vigilance or to include others within their tight world of focus and concern. However, fierce bonding can also be just another legitimate response to a tremendously challenging situation----another way of coping. 

Women who experience cesareans may have bonding issues with their children.  Although bonding eventually occurs, some women find it delayed by the experience of surgical birth, or mourn deeply the time lost to them immediately after birth. Each woman needs to deal with the trauma in her own way, accepting her response as normal and human, and move beyond it into healing and closure as time goes on.

 

Breastfeeding Issues and Impact

Breastfeeding can be the source for additional trauma after a cesarean, or it can be a source of great emotional healing.  Studies show that breastfeeding initiation rates are lower after a cesarean, and not nursing can make a mother feel even more disconnected from her baby.  If mothers experience difficulty breastfeeding after a cesarean, many report that it made them feel even more like a 'failure' than before.   Of course they are not 'failures' at all, but the feeling is not unusual.

On the other hand, if women are able to breastfeed successfully after a cesarean, they often find that they are able to 'reconnect' with their baby through this experience, to firmly cement their missed bonding, and to feel like finally, their bodies "were able to do something right."  Many cesarean moms report that breastfeeding was a source of significant emotional healing after their cesarean.  

Cesareans can make the physical act of breastfeeding more difficult or more painful, but there are techniques that can help make the transition easier.  Unfortunately, not all hospitals are very good about helping post-cesarean moms very well.  You may need to actively seek out help, preferably from a professionally certified lactation consultant (identified as "IBCLC").  

How a Cesarean Can Interfere with Breastfeeding

Breastfeeding is more difficult after a cesarean for many reasons.  Nursing your baby as soon as possible after birth ensures the jumpstarting of hormonal processes designed to ensure milk supply, and aids in the woman's physical recovery afterwards.  Although a few women are able to nurse their babies right on the table during surgery, most have to wait until they are in the recovery room.  A few misguided hospitals still have the outdated practice that forbids breastfeeding during the mother's time in the recovery room, so their babies must wait even longer to nurse for the first time.  In addition, many women are so groggy from drugs after the surgery that they are not able to nurse for many hours afterwards.  This delay in first nursing definitely impacts milk supply, often delays the appearance of mature milk, and undermines a woman's confidence and desire to breastfeed.  

Many cesarean babies are given bottles of formula routinely, which research clearly shows also lowers the rate of successful breastfeeding (Blomquist 1994). Because cesarean mothers' milk may be delayed in coming in, the baby may be at more risk for excessive weight loss after birth, which usually means more bottles of formula.  If the mother had pitocin during the labor, jaundice rates are higher, which may erroneously mean even more bottles of formula. The more bottles are given, the less the baby is nursing, and the less the mother's supply is stimulated.  Between the delayed access for first nursing and the bottles of formula routinely given, many cesarean mothers experience a delay in their milk coming in, low milk supply at first, and difficulty nursing due to nipple confusion from bottles.  Indeed, Perez-Escamilla et al. (1996) found that cesarean mothers were much less likely to initiate breastfeeding or to breastfeed for less than one month.   

Physical factors that accompany cesareans can also interfere with breastfeeding.  If a woman experiences excessive blood loss during surgery, she may experience anemia afterwards, which can interfere with milk supply significantly (Willis and Livingstone 1995).  If you experience dizziness, weakness, and extreme fatigue after your cesarean, strongly request that your iron levels be checked; early treatment can prevent or minimize problems with milk supply, and speed your recovery significantly.

Positioning can also be more difficult after a cesarean.  The usual 'cradle' nursing position can be painful after a cesarean, since this places baby against an abdomen that has just been traumatized.  Many women can still use the 'cradle' position after a cesarean by putting a pillow over their incision and putting baby on top of that pillow.   Other women prefer to nurse lying down after a cesarean; women who are well-endowed or who find it difficult to nurse lying down usually find the 'football hold' the best position.  For more information on breastfeeding after a cesarean and illustrations of all these various nursing positions, read The Nursing Mother's Companion, The Womanly Art of Breastfeeding, or So That's What They're For! Breastfeeding Basics.  You can also find more information and illustrations online at www.promom.org, www.breastfeeding.com, or www.lalecheleague.org.   

When Breastfeeding 'Fails'

Mothers who experienced great difficulty in breastfeeding and gave up (or who had to supplement because their supply was impaired) often feel great guilt, frustration, or anger. The reasons for their difficulties may vary widely. Some may not have been adequately prepared emotionally or physically for breastfeeding, or may have lacked adequate instruction and support about starting or preserving breastfeeding. Some were very likely sabotaged by medical mismanagement (i.e. supplementary bottles), and some may have experienced a lack of support at home or from family members. Others may have undiagnosed physical causes, such as maternal hemorrhage, anemia, retained placental fragments, hypothyroid levels, or birth control pill prescriptions that cause their milk supply problems. These women are quite likely to be able to succeed at breastfeeding again with another child, given adequate information, care, and support, but still need to grieve and vent about their difficult experience this time.

Although most breastfeeding 'failure' after cesareans is due to medical mismanagement, it is important to note that there are a few women who are not able to breastfeed fully even when extremely well-prepared and supported. These dedicated women do everything possible to ensure success, get timely professional help, pump religiously to increase supply, etc., yet are never able to produce enough milk to fully sustain their child. No one knows exactly how many are truly unable to breastfeed since medical mismanagement is so common, but. there is a very small percentage of women whose breasts never change during pregnancy and  never get any milk, and there is a slightly larger group who get some milk but not enough to fully support their baby without supplementation. This is probably due to hormone imbalances, but no one quite understands what really happens in these cases.

Among these mothers are some women with Poly Cystic Ovarian Syndrome. Although no one has documented exact numbers, lactation consultants have observed that some women with PCOS have trouble breastfeeding and need to partially or fully supplement.  Although most women with PCOS are able to breastfeed fully (and up to 20% even overproduce milk due to very high prolactin levels), there are some women with PCOS who must partially or fully supplement, despite doing their utmost to nurse.  This is NOT a failure of these women to be proactive about breastfeeding; it is a physiological imbalance

Unfortunately, nearly all research into PCOS in the past has covered reproductive issues; PCOS medical researchers are generally very uninterested in lactation issues, and there is little funding for it. In the lactation research community, there is beginning to be some acknowledgement of the problem, but the information is mostly anecdotal and speculative. Some women are beginning to experiment with herbs or insulin-sensitizing agents, but formal data on the safety of this approach for infants is not readily available yet.  Therefore, help for this difficult problem at this time is significantly lacking.

PCOS mothers should be strongly encouraged to breastfeed, since most of them do so successfully and it has many potential benefits for mother and child.  However, they should be extremely well-educated and proactive about breastfeeding, and receive careful help and monitoring from lactation experts.  

Remember that any amount of breastmilk a baby gets is greatly beneficial for its antibodies and protective immunological properties. Even if a mother is not able to fully nurse her child, the baby benefits greatly from any amount of breastmilk it does get.  How long to sustain this must be left up to the mother involved; it is not always an easy process and the benefit to baby must be balanced against the stress that is placed on the mother. Kmom would encourage these mothers to nurse their babies as much as they can for as long as they can, but if the process becomes too stressful, each mother must be encouraged to do what is best for the mother-child pair as a unit, and this decision must be respected.

Summary

In conclusion, it's true that the success rate of breastfeeding after c-sections and traumatic births is lower than after normal birth (Perez-Escamilla, 1996) since conditions that surround these deliveries often interfere with breastfeeding, there may be less support from the staff, or the mother may be separated from baby more. But it's worth pointing out that many women who experience traumatic births or c-sections are able to preserve breastfeeding anyhow, and report the experience of breastfeeding to be one of their best acts of self-healing.

It does seem that women who are able to breastfeed successfully experience less severe levels of Post-Partum Depression and quicker bonding after a traumatic birth, while those who find breastfeeding difficult or give up quickly may find it more severe (Laufer, AB, Journal of Nurse-Midwifery, 1990). This may be related to hormone levels (since women who do not breastfeed tend to 'crash' more quickly and do not get the moderating benefits of prolactin and other hormones), or it may simply be emotional. 

Emotional support for women after birth is sorely lacking, even for those who end up with a relatively normal birth experience. For those who endure a traumatic labor, c-section, and also have trouble breastfeeding, the emotional devastation can be particularly difficult. The sense of betrayal by one's body can be acute, and there may be little support and even blame from medical personnel and family. These women's difficulties need to be acknowledged and supported, and a safe place to vent is important. 

Unfortunately, resources for this are few and far-between at this time. One online resource, however, is available for those who have had great difficulty breastfeeding, MOBI (Mothers Overcoming Breastfeeding Issues). A web page with more information can be found at www.internetbabies.com/mobi/.   By all reports this is an excellent resource, and Kmom highly recommends it.  

To have the great frustration of having to deal with a cesarean and then not be able to fully breastfeed afterwards can magnify the grief and frustration intensely.   It is important to fully grieve all the losses involved with birth, including those involved with breastfeeding.  Find the emotional supports and groups that understand what you've been through, who will listen to your grief and disappointment, who can give you valuable information and help, and who can help you move on positively no matter what happens.  But rest assured, whether or not you were able to breastfeed, you can go on to emotional healing.  

 

Birth Envy

Many women who have experienced a difficult birth report afterwards that hearing about other women's births is very hard for them.  It's very common to feel envy, anger, sadness, or depression.  All the old feelings about your own birth experience may resurface again too.   Even when you have done a great deal of work processing your feelings, it's still not unusual to be broadsided by the intensity of your feelings about someone else's birth story. 

Sometimes, when you hear someone else's difficult birth story, it can bring back bad memories in a very visceral way. Confronting these memories yet again can be daunting, and you may wonder if you will ever get to a place where you won't be surprised and devastated by these memories again. Or you may take on the other person's grief so strongly that you make it your own.  

Many women experience the opposite problem-------becoming upset by other women's good birth experiences.   If your own birth experience was long, painful, and traumatic, it can be very hard to listen to the experience of someone who gave birth in two hours and found labor to be 'no big deal.'  It's often especially difficult for women who experienced problems from interventions like epidurals or inductions to listen to the stories of women who chose these interventions without thought and sailed through without problems.  It's hard to hear someone else rave about how fabulous their epidural was when complications from your own epidural is what led to your cesarean.  

Finding it difficult to listen to other women's easy birth experiences is only human. It's certainly not that we want our neighbor or our sister-in-law to have a difficult birth---of course we don't wish them any ill!  But it's hard when the thing we want most, some women have so easily and treat so carelessly.  And to add insult to injury, these are often the very women who find it so difficult to empathize with our feelings, as they cannot seem to understand how traumatic birth can be sometimes.  Although we don't actively wish ill will on anyone else, it is only natural to want for other people to truly understand our pain and what we have gone through.  When they can't or won't, it's only natural to feel isolated, sad, and burdened by our feelings.  

Many women who have gone through difficult births also find that they want to 'save' other women from difficult births too.  There is nothing wrong with this; our obstetrics system is greatly in need of change and it takes people with passion to do this.  It's wonderful if you can take your grief and turn it into passion for a worthy cause!  We need more women to speak out about childbirth issues and become activists for reform.   Only when enough women agitate for change will it happen. 

But there's a fine line between passion for a cause and trying to control others.  If you find yourself accosting every pregnant woman you meet and 'witnessing' to them in a way that makes them uncomfortable, then you may be projecting your own issues onto someone else and falling into the co-dependent's trap of trying to make other people's choices for them.  There is nothing wrong with offering information about choices to those who are interested in hearing, but beware of trying to control them. You cannot re-do your own choices through them, and you cannot reform a whole system of birth by making someone choose the way you would.  The decisions have to be theirs, whatever the consequences.

Ultimately, childbirth decisions are up to each individual, and while we can (and should!) advocate and educate, we cannot control others.  If we do, we become guilty of the same kind of paternalism that we object to in mainstream obstetrics.  Remember, another person's childbirth decisions don't really reflect on you, only on their own beliefs and priorities.  Choosing differently than you does not invalidate your opinions or your choices.  Put the information and your passion out there to the universe, and then let go of trying to control the outcome.  

Finding other people's birth stories hard to hear and trying to influence other people's birth choices are natural responses to grieving a difficult birth experience, and seems to be a normal stage of the grief process.  Don't feel guilty for a perfectly normal response!  However, an extremely strong reaction to a birth story or the need to control other people's choices may indicate that you have issues of your own that you still need to deal with. 

Eventually, you will progress to a point where every birth story you hear is not devastating to you, and every person's birth choice is not a reflection of you as a birth activist.  Try to get to a place where other people's birth stories are simply their stories, and other people's birth choices are simply their choices, not threatening to the validity of your choices or experiences.  Don't be hard on yourself if the process is not always easy; progress will come with time and healing.   Eventually, you will find the balance between activism and loving detachment that is right for your life.   

 

Grieving Stages and Post-Partum Depression

Grieving Stages

Emotionally, many women who have a cesarean experience a grieving process. Grieving stages are not usually experienced in a clear linear progression and many people experience them in periodic cycles. Most c/s mothers experience these in one degree or another. Though it is distressing and stressful, most are able to deal with it in a mentally healthy way in spite of the circumstances.  

Grieving stages are NORMAL responses to the stress of loss, and reactions like these are not unusual at all.  These responses are healthy responses, allowing women to gradually integrate a distressing experience rather than having to assimilate it all at once and become overwhelmed.  Examining typical responses does not imply that they are unhealthy, just that they are not unusual.  Given time, responses do change as a woman integrates her experience more fully.

Denial is the response that some women have initially.  Some women need to justify that their cesarean was necessary, no matter what.  Many believe their OB's dictate that, "A 6-pounder couldn't get through that pelvis" or that "Your babies are just too big," or are unwilling to see that interventions may actually have caused the fetal distress that necessitated her cesarean.  This is not to say that all cesareans are unnecessary; some actually are life-saving and necessary.  But the fact that many are preventable is a difficult conclusion to come to soon after your own cesarean.  For their own sanity and immediate recovery, most women need to believe at first that their cesarean was absolutely necessary, and only later are able to consider the circumstances more objectively. 

In addition, culturally our society has a hard time dealing with strong negative emotions in general, and generally teaches us to suppress or medicate them.  In Rebounding From Childbirth, Lynn Madsen writes:

Our society encourages...denial of any pain...Emotional pain is either medicated or disregarded completely.  When a woman wants to acknowledge pain or view it positively, she stems a strong tide of denial.  Also acknowledging current pain may unleash past personal wounds formerly suppressed and now accessible.  She fights uncountable messages to avoid, medicate, and eradicate pain instead...She avoids the depth and impact of her birth experience, avoids what her body is trying to tell her.  Fear of strong emotions is a primary cause of denial.  

Many women initially deny that their cesarean was distressing, or minimize the pain it brought them. This is very functional.  They may need to concentrate instead on the fact that their beloved baby is here, they may need to get on with concentrating on baby's needs and their own physical recovery, or they may simply not be ready to deal with the full psychological impact of everything that has happened to them.  For some, a cesarean really is no big deal and never will be.  But for others, the psychological and physical pain of their cesarean has to be minimized at first in order to move on with their life and deal with the immediately important tasks of bonding with their baby and dealing with all the other emotional upheavals of becoming a new parent.

Denial is a very normal stage, and can be a very healthy response to an overwhelming situation or reactivation of old wounds.  In time, the woman will come to grieve her experience in the way that she needs to.  Acknowledging the pain will help her move through it.

Anger is also a perfectly reasonable response to unexpected or undesired cesareans. A c/s mother may blame a provider or common medical policies for the problem that caused the c/s, or she may even feel angry at her child for 'causing' the problem.  More commonly, she directs her anger inwards towards herself. This is especially prevalent in large women or those with fertility problems, who often feel like their bodies have failed them yet again and weren't capable of birthing normally. The prevalence of size bias and harassment by many medical providers can add to the post-surgery burden a larger woman may feel, too. 

Again, these feelings are normal and healthy; they should not be suppressed but freely expressed and gotten out of the body.  Suppressed anger can be very harmful and often reveals itself as disease later on; but channeled anger can transform your own life and the lives of others.  When the mother is ready, it helps to express the anger and channel it into a positive direction, whatever seems most appropriate to you.  Many women who have had the most traumatic births take their anger and transform it into helping other women, into becoming birth activists and professionals, into reforming birth protocols to be more humane. Use the gift of anger.

Bargaining or negotiation is often interwoven with denial issues.  For some women, acknowledging the possibility that her cesarean might have been unnecessary or that her doctor's actions might have put her child or herself at risk is too difficult to face.  They may only be willing to see being 'saved' by the cesarean or 'rescued' from a difficult situation; rationalizing the difficulties of cesarean birth by seeing it as an exchange for the life of their child or a 'rescue' from pain.  Their ability to accept their cesarean and move on emotionally is based on this bargaining, and if something happens that makes them question this bargain, then their world is often shaken in a major and very disturbing way.  

Bargaining often also takes place in the next pregnancy, as the mother faces her fears of the complications or birth trauma repeating.  The mother may unconsciously negotiate past the problem----'please God, just let me get past 6 cm'----or negotiate for the safety or health of her child.  Again, this is not an unusual process and may be very helpful to the mother.

Depression often happens as a woman begins to truly integrate her birth for the first time.  The full scope of what happened to her finally registers, she mourns the loss of time with her newborn, and she starts to reconcile her ideal birth with what actually happened.   In most cases, this process is not usually severe, and is the beginning of acceptance.  

A more difficult depression can result if a woman realizes that her cesarean (and all her suffering) was unnecessary.  Even when a cesarean is necessary depression happens, but it can be especially strong when a woman realizes it all might have been prevented.  How she responds to that knowledge and uses it can help her out of the depression stage, but sometimes reconciling the full scope of her birth with the knowledge that it might have been prevented tips women into full Post-Partum Depression. 

For many women, depression also ties into underlying issues in their life, such as feeling that their bodies 'don't work right' or 'betray them,' of feelings of invasion and intrusiveness from the surgery that may be related to past issues of abuse, etc.  Depression can also have a biochemical basis; women who have had a past episode of depression tend to be more prone to developing it after childbirth too, when hormonal fluxes may contribute to the problem.  

Acceptance is the so-called final stage of grieving, where a woman can come to accept her cesarean as a part of her life.  As Madsen writes:

The universe is great enough to include both the loss and the gain...Healing does not mean that the past and related feelings are buried and gone.  They are not forever out of a woman's mind, never to bother her again.  Healing is feeling the presence of the traumatic experience at its own place at the banquet table, amongst all the other guests.  It is amongst the good times, the other children, friends, accomplishments, and even the wonderful births.  Another leaf is placed in the table to accommodate all the guests, for no one is banished...Imagine setting a place at the table for the birth a woman wishes had happened differently.  Let that image in.  

After a difficult birth experience, a mother may never love the experience or be glad it happened to her, but she can accept that it did happen, and although painful, that it may have brought many important lessons into her life.  Acceptance does not mean being glad to have gone through the experience; it simply means accepting that it has happened, permitting it to be a part of your life, and recognizing that good things, too, can come as a result of transformative pain.

Stages of grieving rarely come and go in nice, neat little parcels of sorrow.  They do not follow a linear progression; women can jump from one stage to another and back again for some time.  Often they are cyclical in nature, a spiral progression of healing that proceeds upwards, towards the light.  Over time, healing does occur, grieving progresses, and little by little things DO get better.   

The key is to let yourself experience your feelings fully, to express those feelings completely, to consider what underlying issues may be reflected in your grief, and to find ways to work through your grief issues and release them.  It is when we resist feeling things and working on them that we tend to get 'stuck' and unable to move on.  As the old saying goes, "What we resist, persists."

Post-Partum Depression

Lois Halzel Freedman in Birth as a Healing Experience notes that several studies have found that women who had cesarean births were more likely to experience depression afterwards, and sometimes this depression or 'baby blues' can progress to the more serious Post-Partum Depression.  Many new mothers experience some degree of 'baby blues' (often as a function of changing hormone levels), while others go on to experience the more severe PPD.  Usually women who experience PPD are the women who are most at-risk for depression because of biochemical problems, hormonal imbalances or unresolved childhood issues, but women who have had traumatic, unsatisfying, or unexpected birth experiences can also experience PPD.   In fact, some cases of what is called "PPD" may actually be birth trauma instead, or the two may go hand in hand.

It is unknown how many women who have had cesareans go on to experience PPD, but anecdotal observation indicates that  the rates are probably higher than in women who had easy vaginal births.  A lot has to do with whether the cesarean was expected or unexpected, welcome or unwelcome, traumatic or easy, how your physical recovery goes, how much sleep you are able to get, and how much support you have post-partum.  

Some women are more at-risk for post-partum depression than others.  Women who have a history of depression or other problems are probably the most at-risk for PPD.  Women with Poly Cystic Ovarian Syndrome (PCOS) are often also prone to depression as a result of hormonal imbalances from PCOS.  Women who have experienced a major recent loss in their life (such as divorce, family death, or other emotional crisis) may also be more vulnerable.  Women who have a history of addiction, women who have been abused in their past, or women who have co-dependency issues should also be more alert to the possibility of PPD.  However, it is also VERY important to note that many women who have 'risk factors' for PPD never experience any at all.   Just because you have a risk factor for PPD doesn't mean that you will experience it!  

Even among Post-Partum Depression literature, very little attention is paid to the role that cesareans and traumatic birth experiences may play. Doctors often tend to ignore these  issues as irrelevant; they have been trained to think that the only thing that really matters is a live, healthy baby at the end, and that the process of achieving that is basically irrelevant.  The importance of the mother's experience or the child's experience is very foreign to their training, and the idea that a difficult experience might result in long-lasting psychic trauma seems ridiculous to most. 

Doctors are trained to think of the person in the mechanical model, and so usually treat any manifestation of PPD as simply a hormonal or biochemical imbalance.  Therefore, they most often respond by prescribing drugs for it.  This can be helpful in some cases, as hormonal and chemical imbalances can cause or add to depression.  However, their training and world view usually prevent them from recognizing the impact a traumatic birth experience can have, the importance of grieving a traumatic birth, and the importance of counseling and support in recovery.  All of these can be important in helping women recover.

Most women with PPD recover with the help of a support group, a therapist, understanding friends, and time.  If a traumatic birth has occurred, it is very important to work through that with a support group or therapist that understands this issue well and can facilitate healing techniques specific to the woman's needs. For a few women, though, drugs can be extremely helpful and should be considered if other measures do not help sufficiently.  Some herbs are also helpful and can be tried in lieu of traditional drugs (with careful consultation of an herbal expert and your provider).  

Women who have a past history of depression (especially depression needing medication) are the most likely to need chemical help to recover from PPD.  However, it is important that drugs or herbs not be the only approach to helping women with PPD; grieving a traumatic birth IS also an important part of helping many women with PPD.  Often the PPD issues are tied up with other life issues that need healing as well; an integrated approach is very important in these women.  

It is controversial whether PPD drugs should be used during breastfeeding, and there is not a great deal of research on the subject.  The choice depends on the type of drug used, how old the baby is, how much the mom needs it, the dosage, and many other factors.  The possible risk to baby must be weighed against the possible benefit to the mother (and therefore to the baby and its care), and this is a complex question, not easily quantified.  

Information about use of PPD drugs during breastfeeding can be found on some of the various breastfeeding websites such as www.promom.org, www.breastfeeding.com, or www.lalecheleague.org.  Dr. Thomas Hale also puts out a book (revised every year) with information on various medications and their suitability during breastfeeding.  This book is called Hale's Medications and Mother's Milk and is often available from various medical libraries or lactation consultants.  Information about this book and where to purchase it can be found at http://neonatal.ttuhsc.edu/lact/index.html.  

Post-Partum Depression is a serious and real problem for many women.  Although chemical and hormonal imbalances can be a significant part of the problem, an under-recognized cause of PPD can also be unresolved life issues or grief over traumatic birth experiences.  Often, the most severe cases are a combination of the three of these, and treatment must start to incorporate all three components instead of just giving medications. How a woman gives birth CAN matter, and discussing this issue should be a part of all PPD counseling.  

 

Post-Traumatic Stress Disorder

Some women have such difficult births that they even experience Post-Traumatic Stress Disorder (PTSD). A sudden emergency/'crash' c-section, one where the surgery was especially difficult or painful, one that required a great deal of drugs or general anesthesia, or one where the baby was in danger or died often involves higher rates of PTSD. This Post-Traumatic Stress Disorder often manifests itself in flashbacks and dreams, physical sensations or stimuli causing intense anxiety or recollection, jumpiness, and increased incidences of Post-Partum Depression. Some cases of PPD may actually be unrecognized cases of PTSD.

Traditionally, Post-Traumatic Stress Disorder (PTSD) is usually associated with soldiers who experience flashbacks of a war, victims of terrible abuse, or victims of accidents and crimes who experience flashbacks too.  However, women who have had an extremely difficult birth may also experience PTSD, something that mental health providers are only now beginning to realize.  As Madsen says, "Trauma is trauma, and its identification is one more way of acknowledging the power and importance of the birth experience."  

In the past, in an unconscious sexism, few had thought that the common experience of childbirth might be equated with the terrible occurrences that can happen in war, abuse, accidents, or crime.  However, now some are beginning to realize that childbirth by its nature is an extremely intimate and vulnerable time, and that birthing women may experience just as valid a sense of threat.  Most women who have had a difficult birth will not experience PTSD, but a few will.  It is important for them to realize that they are not crazy, that their feelings are real and valid, and that healing is possible.

What Is PTSD?

PTSD can occur when a person has experienced "an event that is outside the range of usual human experience and that would be markedly distressing to almost anyone, e.g., serious threat to one's life or physical integrity; serious threat or harm to one's children...." etc.  (from the Diagnostic and Statistical Manual, DSM-III-R, as recounted by Lynn Madsen in Rebounding From Childbirth).   The traumatic event may be reexperienced in at least one of the following ways:

People with PTSD often persistently try to avoid stimuli associated with the trauma, or experience numbing of general responsiveness, possibly including:

Many women also experience persistent symptoms of increased 'arousal' around things associated with the event.  (The arousal they refer to here is not sexual, simply emotional or physical expressions of distress at being reminded of the event.)  In other words, simply thinking or talking about the event (or even driving by the hospital where it happened) is enough to make a woman's pulse race, her heart jump to her throat, her stomach to flutter, or to have an anxiety attack.    Other symptoms can include:

Another common feature of PTSD is a very strong fear of the traumatic event recurring. All of these symptoms and disturbances are usually ongoing, lasting for weeks, months, and sometimes longer.  Women who suppress their response at first can also have a delayed onset of PTSD.   

An Example of PTSD: Kmom's Story

To give an example of PTSD after childbirth, Kmom experienced surgery without complete anesthesia in her first cesarean. This was not just feeling 'a little bit of tugging and pressure,' this was feeling the surgery intensely.  Surgery with inadequate anesthesia certainly qualifies as being 'outside the range of usual experience,' and it was certainly a 'threat to physical integrity!'  Although not the classic experience of trauma that causes PTSD, being cut open with full feeling meets the definition of "an event that is outside the range of usual human experience and that would be markedly distressing to almost anyone, e.g., serious threat to one's life or physical integrity; serious threat or harm to one's children...."

Afterwards, Kmom experienced typical PTSD symptoms of nightmares, difficulty sleeping, extreme distress and fear about the event, avoidance of dealing with it at first, feelings of detachment, hypervigilance, irritability, and physiologic reactivity to reminders of the event.  For many years, she avoided dealing fully with the experience because it was so traumatic; suppressing it probably contributed to her second cesarean (a 'failed' VBAC). Fear of recurrence of the "surgical awareness" problem was very strong in that cesarean, but fortunately using a different type of anesthesia helped things go much better.

Eventually, Kmom concluded that she really needed to work through the first experience in order to heal it.  It took several tries to be able to face it fully and it was a very intense experience when it finally happened, but it did finally clear the path for healing to start to take place, and was probably a factor in working towards the VBAC Kmom experienced in her third pregnancy.  

The full story of Kmom's PTSD experience and healing is found in the "Women's Stories" section below.  Kmom's experience with PTSD shows many of the classic symptoms of the syndrome.  Although her case was fairly mild compared to some PTSD, it was real and it did have long-lasting effects.  PTSD after childbirth does exist, and does need dealing with in order to move on constructively.  Trauma is trauma, and needs to be acknowledged and approached as such.

Other Issues in PTSD

For many women, a really traumatic birth that leaves a woman with PTSD may also reflect earlier disturbing incidents she may have experienced.  For example, in Kmom's story, feeling the surgery, being held down against her will while being hurt, and not being believed also made her flash back to a prior memory of abuse, so that the two events became symbolic of each other.  If you experience PTSD, you might want to explore whether your birth experience was traumatic not only for itself but also as a reminder of other issues or incidents in your life.  There may not be such a connection for you, but there often is; being aware of this possibility can be helpful.

One controversy with PTSD is whether or not to use medication.  (Kmom did not.) Again, as with Post-Partum Depression, this will depend on a each person's history and circumstances.  Madsen cautions that medication can be a crutch, a help, or a hindrance to a woman trying to recover from PTSD.  She notes that, "Medication for emotional pain can give a woman a break from the intensity of her situation and free her to look at the situation more clearly.  For some, medication prolongs denial and suppression of images and emotions that need to emerge."   Basically, whether or not to use medication becomes an individual decision, based on a woman 's needs and personal circumstances.

Is it really important to go back and relive the birth, to really uncover the exact feelings and sensations that occurred during the trauma?  If at all possible, yes, this is an extremely powerful healing tool. It is very difficult to let yourself re-experience what happened, but it seems to be a vital part of the healing process.  Madsen writes:

Uncovering strong emotions, acknowledging trauma, and integrating the events into a woman's life aid her healing...It is natural to want to avoid unpleasant emotions and memories...Feelings and memories seem to have lives of their own; they emerge when a person is ready to experience them.  The job is to meet them halfway. If [PTSD] symptoms are experienced, with or without specific memories, this path of healing is a necessary one.  There is no effective shortcut."  

Remember that if you choose to use this method of healing, you need to have a supportive and well-trained person with you, and they should remind you that you are not actually re-experiencing the trauma first-hand, you are just remembering.  A good therapist will help you keep that 'separateness' to help you integrate the experience without becoming overwhelmed by it.   

If you are not yet ready to go back and face the trauma, it is okay to put it off until you are more able to deal with it.  It's not a good idea to put it off forever, since facing it does help unblock the emotions and the body (which would be extremely helpful before your next birth!), but if you really are not ready to deal with it yet, don't force it too soon.  Listen to your intuition on this.  If your inner voice is telling you that you are absolutely not capable of dealing with this yet, honor that.  If you listen to your inner cues, your intuition will let you know when it is time.  Periodically take time to try and explore this issue, and then listen to what your gut is telling you that you need to do next.  When you are ready, cues and signs will start to present themselves. 

Although Madsen feels that it's possible for the PTSD label to be negative if a woman uses it as a way to remain a victim or stay stuck in the trauma long-term, usually PTSD is a very freeing diagnosis.  It reminds a woman that she is not crazy, that what happened to her was terrible, and that her pain is real and important.  Madsen writes:

The PTSD diagnosis is most useful as a tool of recovery, one of many that guides a woman through difficult times.  When doubts occur that what happened to her was traumatic, recalling the characteristics of PTSD is helpful.  If a woman has nightmares about the birth, or terrifying thoughts come into her mind unbidden, this tool will help her know that she is not crazy, but she is recovering from trauma.

Most women who have a cesarean do not experience PTSD, but for those who do, it can an amazing relief to know that these symptoms are normal, that she is not crazy, and that help can be had.  It can help her to know what to expect, what some common techniques are that may help in her healing, and that things will get better.  Although women with mild PTSD can get better on their own, many women with PTSD strongly benefit from counseling with therapists experienced in dealing with birth trauma, or from childbirth professionals who are familiar with healing and grieving techniques for birth experiences. 

In Trust Your Body! Trust Your Baby!, Jeannine Parvati Baker reminds us:

Healing the trauma of cesarean will facilitate deeper bonding to the baby, cleanse the old wounds and provide the new ground from which to transform a horrific experience into one of great power.  Wherever there is fear, there is power...The more trauma involved, the greater the opportunity for transformational healing.

Remember, the sooner you start acknowledging and working on the trauma, the sooner the healing begins.  

 

Emotional Issues That May Influence Cesarean Recovery

Claudia Panuthos in her book, Transformation Through Birth, notes that oftentimes, some cesarean moms have certain characteristics in common.  They often have certain beliefs, emotional issues, or past history that influences their birthing.  Although these should not be overgeneralized or overemphasized, some examination of a woman's emotional issues, beliefs, and history may be useful in facilitating emotional healing after a difficult birth.  

For example, Panuthos notes:

Over the past several years, we have noticed that Cesarean mothers more often report, as part of their personal history, beliefs that mentally define birth as dangerous or unsafe.  They are more likely to have been the product of a difficult delivery or the focus of a family birth story that describes birth in negative and frightening ways.  These thought patterns result in an instinctive urge to hold on in order to protect the child from harm...

Cesarean mothers are less likely to have faith in their bodies and more likely to have felt critical and disapproving toward their bodies as children.  These feelings are sometimes further validated by a Cesarean delivery...our ongoing survey...shows that women with previous miscarriages and infertility problems were more likely to be surgically delivered than women who had not.  Again, these experiences point to a possible loss of faith in the physical body, and, again, a Cesarean only further confirms this psychological situation...

According to other studies, couple  who received the most childbirth education were most likely to have Cesareans...These findings point to the possibility that Cesarean women place greater inner demand on themselves to  be informed, well prepared, and in control...It has also been our experience that Cesarean mothers tended to seek perfectionism in themselves in many areas of their lives and had been extremely hard on themselves when goals were not achieved...

Lastly, there are women who believe they deserve to have a Cesarean.  For example, on several occasions, sectioned mothers have shared their belief that they somehow deserved to be cut open in order to make up for something they felt they had done wrong...Other women felt that they had to bargain with God for a live child by allowing themselves to be surgically delivered.

Other factors not mentioned by Panuthos may include abuse issues from the past, and addiction or co-dependency/control issues.  Although these issues may not seem to impact a birth on the surface, many women who explore their life issues in depth can also see how their life issues intertwined with their birthing beliefs and influenced their births.

As you can see, the factors that can influence a woman's recovery are many and varied.  Exploring your own influences can be useful in recovery, but it should not be used as a tool of judgment of self-condemnation.  Everyone has emotional issues that affect them; exploring these can be useful for healing, but should not be yet another method of self-criticism.  

Birth Beliefs

Start by asking yourself what your own beliefs about birth are. Do you believe that birth is safe or risky?  Why?  Take a minute and explore your feelings about this; don't censor yourself and consider what you 'ought' to be feeling, but really access what you DO feel, rational or not.   How safe do you think birth is in general, and how safe do you think YOU are in birthing?

Along this vein, do you think that the hospital is the only 'safe' place for birth, and that people are crazy to consider birthing anywhere else?  Are you constantly afraid that something is going to happen to your baby or to you?  Have you experienced pregnancy losses like miscarriage or stillbirth?  If so, how have these experiences influenced your beliefs about birth?  

Do you believe the more technology the better?  Did you want the maximum possible number of ultrasounds and other tests while pregnant?  Do you think that technology will protect you from a bad outcome?   If you were somehow cut off from civilization and away from all help and machines, do you think you could give birth anyway?   

Do you trust your body to work 'right' for you?  Do you think you are reasonably healthy?  Did you take good care of yourself in pregnancy?  Did you expect your birth to go well or were you full of fear that something would go wrong, or that somehow your body would 'fail' you or maybe even harm your baby?  Do you feel 'on trial' in birthing and worry that your body won't 'perform' successfully?  Do you worry about measuring up to somebody else's standards?  

Is it important to you to control things?  Does uncertainty and unpredictability bother you a lot?  Does being able to schedule your birth at a set time appeal greatly to you, and if so, why?  Do you feel bothered by the messiness of birth, or the unpredictability of it all?  Are you afraid of losing control in front of others, or annoyed at having to go through labor in order to get your baby?  Do you want a normal birth but are afraid of the possibility of 'failing?'  Do you try to control things by having a 10-page long birth plan and micromanaging every detail?  Do you find it difficult to release control and just let things happen as they will?  Do you wish you could jump forward and see how things turn out in your next pregnancy ahead of time?  

How do you feel about labor pain?  Do you have normal anxiety about it, or are you terrified by the thought of it?  Is going through labor pain more threatening to you than the thought of cesarean surgery? If so, why?  Did you experience normal labor or was it augmented by drugs?  (Remember that induced or augmented labor is much more painful than normal labor.) How were you able to cope----did you feel panicked by labor, did you interpret it as suffering, or did you see it as healthy pain moving your baby towards you?  Would you have given anything to get away from the pain, or did you feel able to cope and handle things most of the time?  How do you feel about going through labor in the future?

Do you think that you 'deserve' to have a good birth experience?  Do you have something in your background that makes you feel unworthy, like you don't deserve to have a child, or that you should suffer because of something you have done?  Do you have a history of abortion, of giving a baby up for adoption, or losing a child?  Do you struggle with feelings of unexplained shame or overwhelming guilt at times, without reason? 

Examine how you handle other issues in your life too.  Do you feel like you often have to struggle to have anything go right for you, that you don't deserve to have success, that life is unfair?  Do you feel that you can only depend on yourself and cannot trust others? Or do you tend to feel like a victim, looking to others to come and rescue you from a bad situation?   What are your greatest fears in life, and your most difficult issues?

Pay attention to the way you speak about birth.  Do you sometimes say things like, "Why do things always have to be so hard for me?" or "My babies tend to be malpositioned" or "Why can't my body work right?"  Although you may simply be trying to express and work through your disappointment about past births, you must be careful not to reinforce patterns for the future.  When you can step back and observe the messages you tend to reinforce about birth, you have made the first step towards breaking the chain and starting to make NEW messages for yourself.   

There is an old midwives' saying that, "As a woman lives, so does she birth."  In other words, a woman's life struggles and life patterns tend to be reflected in her birthing too, and inner beliefs can have a great deal of influence on outcomes.  Take time to really examine your own life issues, your beliefs and concerns about birth, how these things may be connected and reflective of each other, and how they may have influenced your birth.  Then you can work towards healing and change.

There are tools that can assist you in this process.  There is a "Birth Inventory" available in both Transformation Through Birth and Silent Knife, and some childbirth education classes like Birth Works have worksheets and activities designed to help people uncover their underlying belief systems about birth.  Journaling, dream work, and birth art are also methods of accessing deep personal beliefs and fears to examine them more closely.  After birth beliefs are identified, there are exercises that can help women work on addressing their fears and changing their beliefs.  Affirmations, visualization, art therapy, and active dreaming can often help women start to change their personal patterns and transform their beliefs.  

Family Birthing History and Messages

Finding out about your own birth and the births of those around you is often also helpful in identifying the inadvertent messages and fears you may have picked up and brought to your birth.  Many women who have had traumatic birth experiences find upon examination that the birth messages they have received life-long have been negative. Madsen writes:

How a woman was born into the world, physically and emotionally, contributes to how she will give birth to her own baby.  When the birthing history between generations is known, information is available to learn from, and then patterns can change.  Significant life events can also impact how a baby is born...Beliefs handed down from mothers or from society to pregnant women that birth is dangerous, unsafe, or undesirable hold power to thwart labor and birth.  Though family history and beliefs often appear more solid than stone, they can change, and a woman can break a pattern of family legacy.

Perhaps you have heard about how hard your own birth was.  Some therapists believe that people can be unconsciously influenced by what happened to them during their own prenatal time and especially during their own birth. Few people have conscious memories of their births, but even so, the memory may be held within the body without words or images, through feelings or kinesthetic memories.  Since most of us were born during an era of extreme intervention in birth and routine separation afterwards, those who may have experienced especially difficult births may have been influenced life-long by the experience.  Claudia Panuthos notes in Transformation Through Birth

There may [be] a tendency to relieve some aspect of [our] own birth experience for the sake of resolving the event.  Although we tend to relive our life scripts or dramas with similar roles, scenes, and characters, we do so out of an inner urge toward well-being.  The psychological tendency to repeat past scenes that carry unresolved hurt or conflict is always an attempt to create an opportunity for personal healing.

Not all women have access to their birth stories, however.  Sometimes a parent is unwilling to discuss this issue, has passed away or is otherwise no longer available for questions, or the birth parent gave up the child for adoption and there is no way to obtain birth information.  Women in these situations often have strong issues to work through; issues of abandonment, issues of anger over not being able to obtain the most basic of information of how they arrived in the world, issues of grief.  Although lack of knowledge about your own birth story can be limiting, there are exercises that can help. You do not have to be blocked off from healing simply because you do not have all the information you would like to have.   

Family messages about childbirth also have an influence on the unconscious baggage a woman brings to labor and birth.  Perhaps there is a history of cesareans in your family, and you have been trained to expect that this might happen to you too.  Perhaps because of your size or some other factor, your family gave you negative messages or expectations of problems.  Perhaps your family did not support your pregnancy because of single parenthood, teen pregnancy, or disapproval of the father.  Perhaps they gave you subtle messages that you deserved to have problems or could not possibly have a healthy pregnancy or normal birth.   

Or perhaps there was grief associated with birth in your family (as in giving up a child for adoption, abortion, miscarriage, stillbirth, or other pregnancy losses).  Women who strongly associate grief or loss with birth may unconsciously hold back from giving birth in order to avoid this loss or protect their baby.   Expectations of negative outcomes or associations with loss can influence a woman to subtly repeat the family's prior experiences (thus reinforcing them yet again), but the cycle of repetition can be broken.  

Panuthos notes that, "As children, we even tend to absorb the feelings of our mothers, internalizing them as our own, in an attempt to help or relieve our mother's pain.  Or, if we hear stories....childbearing may become an expression of fear or a tradition of loyalty to a past that need not be repeated." 

Pay special attention to the way your own mother speaks about birth, and the way your other relatives speak about it too.  What kind of messages have you been hearing?  Some cesarean moms report messages such as "All the women in our family have trouble," "We tend to have breech babies," "She nearly died in childbirth," or "The women in our family have small pelvises." Does your family tend to emphasize the 'danger' of birth, the suffering of labor, or a family tradition of problems? 

Similarly, what kind of messages did you hear from your family and friends about sexuality, especially when you were an adolescent?  Did you receive accurate information, freely given?  Were you made to feel ashamed?  Was discussing sexual issues uncomfortable in your family?  How was pregnancy viewed within this context of sexual attitudes?   A family's attitudes about birth and sexuality are subtle but powerful influences on our internal messages or expectations for birth.

When the women of your family discuss birth, do they tell horror stories of suffering or loving stories of blessings and empowerment?  First-time moms are often subjected to women swapping horror stories of their births; this may be a subconscious attempt by those women to work through unresolved grief from those births, even when on the surface they seem to take pride in their suffering. Unfortunately, although they are trying to heal themselves by re-telling and working through their own difficult births, they may also be subconsciously programming the new mother towards negative experiences too.  You need to find a way to acknowledge their suffering yet still change the subject so you don't need to be subjected to this negative programming.   

Many women find it very helpful to discover these types of family and environmental messages and work through them before or during their next pregnancy.  The Birth Inventory in Transformation Through Birth can also help participants identify their family's attitudes about pregnancy, sexuality, and birth.  Panuthos reminds us that we do not need to be loyal to our childhood or family beliefs about birth in order to be loyal or loving to our parents.  The more we release our past messages and perceived obligations, "the more free we are to love in the present with respect for what has passed."   But the first step is to identify those subtle messages and recognize their influence on us.

Another very powerful but sometimes difficult exercise comes from Birth Works childbirth education classes.  They often use a writing exercise where a woman imagines herself to be her own mother in labor.  Writing as if she is her mother giving birth, participants explore their perceptions of what their mothers might have felt like, her emotions, her sensations, and the possible stories of their births. Even if a woman does not know all of her own birth story or what her mother was like, just using imagination and writing speculatively can be very helpful in tapping into her own emotions, gaining empathy, and examining her own beliefs. These stories can be very revealing of your own fears and issues, and what you may have been taught about birth.

Even if this exercise seems threatening, silly, or useless to you, push your boundaries and try it anyway.  This is a very powerful exercise that tends to bring up a lot of extremely strong emotional responses, not all of them comfortable.  In fact, many women have VERY strong reactions to doing this exercise; the very fact that it brings up such strong emotional responses shows how powerful it can be for working towards healing.  Although the initial feelings around the exercise may be negative, ultimately bringing up those emotions and starting to release those strong emotional charges helps the woman really start to access her feelings and process her emotions and beliefs.  From there, healing can proceed.  Don't be afraid to try exercises and activities that challenge your comfort level; the more strongly you react to something, the more of a clue it has for you towards ultimate healing.  

Also, find a way to surround yourself with only positive birthing images and messages, both from friends and family, and from media sources too.  Don't watch birth videos or programs filled with images of intervention, helpless women strapped down on their backs, or bad outcomes.  Ban negative birth talk and swapping of horror stories around you.  Assert yourself around others, and be ready to detach temporarily from people who have a hard time being positive about your birth and your plans.  Just as you should only surround yourself with people who give you positive energy during birth, so should you work towards this before birth as well.  Keep the energy around you positive.

Finally, identify how your birth beliefs may have been influenced by your friends and family, and use affirmations to start creating new ones.  Give yourself permission to periodically explore birth fears and worries, but don't spend all your time dwelling on them.  Spend most of your time, power, and energy on reinforcing positive birth messages, visualizing positive birth outcomes, and promoting feelings of bonding and nurturing towards your child.  When you change the messages around you while simultaneously working on your own birth beliefs, amazing changes can happen.

Body Image and Body Trust

Body Image is often an issue intricately tied up in birthing.  Many women who have had cesareans do not trust their bodies to 'work right' for them, think of their bodies as ugly or defective, are uncomfortable with natural body processes, or are simply not comfortable in their skin.  They may be surrounded by negative messages from the media about their particular body shape or size, bombarded with negative messages from friends and family about their body's ability to nurture and birth a baby, and harassed by medical personnel about nutrition and weight gain.

Several authors have noted that women who have had cesareans are often women with body image or body trust issues, and that working towards healing these issues can go a long way towards healing a traumatic birth.  Lynn Madsen writes: 

"Acceptance and appreciation for one's body helps it heal.  A woman with a positive body image is more than halfway toward a healthy, normal birth.  She embraces her body's power and ability to birth a baby, appreciates how miraculous body functions are, and the birth connects her with her body like nothing else.  After trauma, a positive body image enables a woman to better appreciate her body's potential and ability to heal, and its power to fight back as needed throughout recovery." 

There are many books (available from www.naafa.org) that can help you work on body image issues , including:

Many holistic health practitioners believe that having had a cesarean can actually lead you towards healing body image.  It can become a wake-up call to dealing with self-love and self-acceptance issues, towards concentrating on healthy habits, and towards making peace with your body.  Lynn Madsen writes:  

Pregnancy requires a rootedness in the physical body.  This makes it imperative for a woman to enter her body, acknowledge its pain and strength, and allow it to do the work and creation of baby making.  Pregnancy can be a powerful opportunity for healing body image.  Without healing, pregnancy can be a powerful force for a woman to further separate from her body or to further deny abuse, putting her at risk for perpetuating the same abuse and an even worse body image.  Body image is a powerful component of birth.  If a woman integrates herself so that she can be in and appreciate her body and use its power, she will participate in an empowering birth experience.

Love your body.  Find a way to come to peace with the things that didn't go 'right', and practice self-love and self-forgiveness.   Find a way to appreciate all the good things your body has done for you.  Embrace its curviness, its lumpiness, its scar.  Appreciate the tremendous task your body had in creating and sustaining your baby inside you.  Value all the things that did go 'right' in your pregnancy, and thank your body for them.  Work towards accepting your body the way that it is NOW, lumps, bumps, folds, sags and all.  Understand and forgive your body and yourself for not being perfect, and appreciate all the wondrous things it DOES do.  Use affirmations to help begin moving towards greater understanding and acceptance.

Scar Issues

Closely tied in with body image problems are a woman's feelings about her cesarean scar.  Many women feel repulsed by it.  For some it is a mark of shame, a symbol of failure, or a marker of abuse and violation.  It may represent a physical touchstone to all the issues she may need to deal with in her life but may not be able to face yet. For many women, negativity about their scars is about the scar's emotional implications in their lives. 

Other women simply find the scar difficult to deal with physically.  Some women experience significant scar tissue, adhesions that pull and twinge painfully during recovery, or nerve damage that can either create pain or make things disturbingly numb.  These  pains that can last for months and even years. 

Many women have found that professional attention to the scar can help it feel better, although it may feel worse at first before improving.   Some types of massage therapy specialize in breaking up scar adhesions, improving blood supply to the area, and easing pain.  Some resources list myofascial massage as being very helpful for resolving scar tissue problems.  Some midwives have used ultrasound on the scar, or simply used essential oils such as Evening Primrose Oil or Vitamin E on the scar area.  Discuss with your providers what types of therapy might be helpful to you.

Even if you don't get specialist treatment, just the act of 'making friends' with your scar may help you towards emotional and physical recovery.  Although many women find it difficult to touch their scars (let alone rub them or massage them with oil), many report that if they can bring themselves to do this regularly, over time they achieve a sort of 'detente' with their scar, and eventually do make a sort of peace with it.  They may not ever be glad they have the scar, but they can be more accepting of its presence and of its role in their past.  One woman wrote: "My scar repulsed me, if possible I would have obliterated it.  Touching and rubbing healing oils into the scar helped, then I knew my child entered the world through my stomach."

Many cesarean moms have reported that taking time to do a visualization of the uterus from the inside is often healing, especially as they approach their VBAC.  They envision soft white or golden energy sinking into the uterus and permeating it, and especially surrounding the scar with warmth and healing strength, reinforcing its integrity while retaining its flexibility.  Then they picture this glowing energy also surrounding their new baby, caressing it with their love.  They picture themselves, lit from within, glowing with strength and loving power.  When they are ready and the energy starts to fade, it leaves behind a permanent little 'afterglow' for the baby and for the scar, like a guardian angel watching over them. 

Madsen recommends using the following affirmation: "I value my scars as evidence of my life and willingness to know myself." In Trust Your Body! Trust Your Baby!, Jeannine Parvati Baker recommends asking the scar what lessons or messages it has for us.  She says, "The wound reveals the cure.  Invite a message from the old scar and listen for the word medicine which comes.  Ponder these things in the mother's heart."  

Making peace with your scar, if possible, can be another stepping stone on your way to healing and acceptance.  There are many ways to approach this, and each woman must find what works for her personally.  This work is certainly not easy and is not absolutely required for emotional healing, but many women do find it helpful.  

Past Losses

A recent loss or a history of many past losses makes emotional recovery from a cesarean more difficult, and may also impact the next pregnancy as well.  Losses can take many forms, from the recent death of a loved one, to miscarriage or stillbirth and many others.  If the losses have not yet been fully grieved, many times the losses pile up and become entangled with each other.  

It is interesting to note that many women who have a cesarean report having lost close friends or relatives shortly before or right around the time of the cesarean.  Some birth advocates believe that unresolved grief like this can get in the way of birth for some women, and that working through grief issues can make a difference for the woman's next birth.  Other cesarean moms report having a friend who lost a child or baby recently.  With a recent death like this on their minds, perhaps some moms unconsciously withhold their babies to try to keep them safe, or alternately, may unconsciously consider cesarean birth to be 'safer.' This, too, is grief that needs to be worked through.

If there is a prior history of miscarriage or stillbirth, issues of prior losses may get all mixed up with ambivalent feelings about a cesarean and fears for present and future babies. Oftentimes, a woman has not fully grieved the loss of the prior baby (or babies), and needs to work through this grief, as well as the cesarean and her fears of a recurrence of problems.  

A very hard situation occurs when a woman has a cesarean and the pregnancy results in loss.  This double blow can be so immense that women are overwhelmed at first.  Any woman would of course trade a cesarean in an attempt to save her child's life, but when this doesn't work and the baby dies anyhow, the grief can be doubly hard.  Naturally, the loss of the baby is foremost and takes the focus of the grieving process for a long time, but eventually the mother must also face her grief over her cesarean as well.   For some women the grief of the cesarean part is no big deal, but for some women it is an additional tremendous burden.  

Lynn Madsen reminds us that "Healing from both birth trauma and infant or fetal death can happen concurrently; the two aspects of birth dovetail one another, yet they are not always one and the same...Speaking out and grieving openly will alleviate her pain and allow more room for life to take its place." 

Some women report that in their subsequent pregnancy, they felt as if they were birthing both the baby who died and the new baby as well, or they report feeling like the baby who died was present, helping to 'midwife' the new baby into the world safely.   Many women find this imagery helpful and comforting, but of course each woman must grieve in her own way, and prepare for the next birth after loss in her own way as well.

Madsen had a miscarriage between her first and second births. She writes eloquently about how this impacted her next birth:

Past loss of a baby pre- or postterm is part of history to be reckoned with.  Fear of another death can be present every moment of a pregnancy, and affect a woman's willingness to abandon herself to labor and her baby's emergence...

As a woman journeys on the path of her...other pregnancies and births, she benefits by using each memory.  Each association can be used to recall a past birth or pregnancy.  Give it its due.  Grieve as needed.  Know one's fears whenever possible.  Be amazed at the similarities and intensity of recalled feelings that one fervently had hoped were gone for good.  Affirm this new pregnancy at the same time; there is room for both memories and the present.  This is especially true when there has been the death of an infant.  If loss of a baby was also experienced, then acknowledge the fear of another loss, another death--it will be a companion through a subsequent pregnancy.  Appropriately, a mother will be reminded of the baby who died no matter what, particularly as another baby grows and is born.  Expand awareness to include anticipation of the future as well as memories of the past.

There are many organizations that can help parents with grief, including Compassionate Friends, www.compassionatefriends.org, and SANDS (Stillbirth and Neonatal Death Support), www.sandsvic.org.au.  Tangible symbols of the baby can be especially helpful for grieving or creating ceremonies, especially if the baby was lost very early.  One such resource is called 'Grieving Bags,' each representing the lost baby (see below for more information), available at www.midwiferytoday.com/loves/alliealden.html. There is also an email list for women going through a pregnancy after a prior loss, called SPALS (Subsequent Pregnancy After Loss Support), and information on this valuable mailing list can be found at www.inforamp.net/~bfo/spals/index.html.  

A past history of infertility is another type of loss that often impacts birthing.  Many women who have been through infertility have lost faith in their own bodies, and this can make it difficult for them to envision birthing normally.  If they got pregnant with the help of high-tech techniques, they often put all their faith into a high-tech approach to birth, with all its attendant risks and interventions, and which tends to increase the cesarean rate.  

Although some women with past infertility are fine with a cesarean, not all are.  Many grieve their cesarean strongly.   They are of course thrilled and grateful to have a baby, but the invasiveness of the cesarean may remind them of the invasiveness of the conception, or it may make them feel like their body has failed them yet again.  They may have missed time immediately after the birth with the baby, or breastfeeding may have been problematic for them.  These things can become yet another loss on top of so much prior grief.  Although women with a history of infertility often have a lot of emotional issues to work through, many of these women are able to go on to have a better birth, oftentimes including a VBAC.   

Other reproductive losses can include prematurity, birth of a seriously ill baby, and losing a baby to SIDS.  Releasing a baby for adoption is another type of loss that often impacts later birthing, and so is abortion.  All of these losses are difficult to deal with in their own way, and all require grieving and working through difficult feelings.  

Non-reproductive losses can also impact birthing, too.  Lois Halzel Freedman points out in Birth as a Healing Experience that many women who have experienced a recent death in the family, have experienced abuse, have grown up in a family with a substance abuser, who grew up in loveless families, or who have experienced an early death of a mother, father, or sibling may also be in need of specialized support during pregnancy or postpartum. In particular, she counsels many women whose mother died at an early age, whose mothers abandoned them, or who otherwise were somehow unavailable to them. She writes:

Early mother loss has a tremendous impact on a woman's life as she reaches the developmental milestone of becoming a mother herself.  She may feel sorrow for the loss of her mother especially keenly during pregnancy or after giving birth.  Her grief may resurface in disturbing and painful ways. It is very important for a woman who has suffered the premature death of her mother to connect with and gain specialized support from other women during pregnancy and the postpartum period...For women who feel that they were not mothered in the way they needed or would have wished, issues of unresolved loss can arise similar to those of women whose mothers have died...

Motherless women may miss the love and support of their own mothers acutely as they become mothers themselves.  It does not matter if the loss occurred during the past year or thirty years ago; it is important for a woman to know she has the opportunity to process her feelings of grief at this time.  The grieving process is just that, a process.  Her feelings may not surface all at once, but as they do it helps to know that there is someone with whom she can share them, and that she need not be afraid to feel them.  There is a relief that comes with allowing the sadness to emerge.  Many of my clients have felt some resolution after doing this important work.

Death and other losses are difficult in and of themselves, but when combined with pregnancy and birth, can often be extra-hard.  Although some of the hardest involve the loss of a baby, there are many types of losses around pregnancy.  Loss is loss, and it all needs to be grieved, each type in its own way.  Acknowledging and working through the impact of these losses can help emotional recovery after a cesarean.

Death and loss can also impact future pregnancies and births if not grieved and released.  The book, Ended Beginnings by Cathy Romeo and Claudia Panuthos, is an excellent resource for starting to work through these feelings; Kmom highly recommends it.   It deals with all types of pregnancy losses, and has very practical short-term as well as long-term suggestions for starting to get better and working through the grief.  The authors stress the importance of grieving, stating, "It is our task to heal ourselves so that these losses and this mourning process can become a rich source of blessings rather than unproductive suffering."  

Past Abuse

Many women who have had cesareans have a past history of abuse, whether emotional, physical, and/or sexual.  Although many women who have been abused have normal and happy births, there is also a substantial number who experience difficulties with birth.  As Madsen writes:

Because birth is a powerful life-affirming event, a history of abuse----the opposite of life affirmation, creates a complex situation.  After abuse, a woman constricts and insulates herself for protection.  Yet birthing requires her to be open and vulnerable.  Sexual abuse, in particular, elicits a closed, protective, mute, distrustful stance.  If the abuse happened in childhood, this stance is a longtime pattern, so ingrained a woman might not be consciously aware of it.  She has body memories that contribute to her pushing away life, but once memories are unlocked, her energy is able to flow through her.  Acknowledging abuse in her background and finding ways to protect herself other than shutting down are fundamental tools she can use to heal herself and to increase her potential to give birth without intervention.

Many women with a past history of abuse experience labor dystocia, or difficulty with labor progressing normally.  This usually gets attributed to a "big baby" or "small pelvis" (a.k.a. 'CPD' or cephalo-pelvic disproportion) but instead may be because a woman finds a way to shut down her labor if it becomes too threatening or the sensations become too strong.  Madsen continues: 

When abuse has occurred and is unacknowledged, any way to give birth without opening, without giving up the protection and shell the woman desperately needs, will be sought on an unconscious level.  A cesarean is a way out in this case----a way for the baby to leave the woman's body without her becoming sexually vulnerable.  The woman still faces the healing challenge of finding the inner power that will allow her to learn to open and be vulnerable.  In unlocking her anger, fear, grief, and rage, she ultimately leads herself to effective self-protection and joy.

Many women with abuse in their backgrounds coped by losing touch with their bodies.  Sometimes this is referred to as 'living from the neck up.'   When labor sensations get overwhelming, women may panic, disassociate completely, resort to an epidural in order to deaden the feelings, or unconsciously create a situation where a cesarean becomes necessary in order to find a way out. Once a woman can acknowledge her abuse and start to release the emotional charge associated with it, she can learn to stay in her body and not be so overwhelmed by physical sensations, to release and let go physically as well as emotionally.  

Women who have experienced sexual abuse often feel more comfortable going to a female provider.  However, they should be sure that they carefully investigate their female providers too; many a woman has gone to a female OB on the assumption that they will be more birth-friendly, only to find out to their sorrow that their woman doctor was even more interventive than her male colleagues!  Similarly, although midwives tend to be a much better choice for birthing women in general and especially for women with special concerns like abuse, not all midwives are truly birth-friendly either.  In other words, choose whomever you are most comfortable with, but be sure to ask plenty of questions to be sure that this is the right one for you.  Don't just make your decision on surface qualifications like gender or title.  Better a male doctor that is gentle and respectful than a woman OB (or midwife) who is cold, unreasonable, or abusive.  

Difficulty with setting boundaries can be a problem common to women who have abuse in their pasts.  They may find it hard to say no to having people at their births that they don't want, or to declining interventions they don't want.  They often see providers who are very controlling and uncaring, or who seem caring but turn around and betray their trust later on.  They may also find it difficult to leave these providers, even when they are dissatisfied with their care.  If they are angry about the care they received, they may deny it to themselves, or acknowledge it to others but find it very hard to confront the provider about it.  

Standing up for yourself and the type of care you want is often a difficult skill, but it is a skill that can be learned.  Sometimes, it's easier to think of the issue as standing up for your BABY instead of yourself.  In this way, you can put aside passivity and be more assertive for the sake of your baby.  However, don't wait and do it just for the baby----do it for you too.  You deserve to be well-treated, and you deserve loving and respectful care too.

On the other hand, some women who have experienced abuse have difficulty bonding with their babies.  Madsen observes, "Lack of bonding may be the result of traumatic birth.  It may also reflect a history of abuse; with the baby's arrival, the mother's own childhood history is more easily accessed." Having the powerful sensations of labor and the invasive treatments may bring back long-buried disturbing memories. And taking care of a helpless infant may raise strong self-doubts about parenting abilities and memories of your own feelings of lovelessness.   All of this can combine to make women detach from their own children, or at least regard them with ambivalence.  

Women who have experienced sexual abuse may have particularly ambivalent feelings about their babies if they are boys.  They may feel guilty because it's not rational to blame an innocent for something someone else did, but feelings aren't rational, they just are.  You can love your son and still have deeply ambivalent feelings about having a boy.  Working on your abuse issues clears a way for your present little boy to be fully accepted into your heart, and often clears the way for future little boys to be born normally.   Your little boys need you; open your heart and start clearing your past for their sake as well as your own.

Penny Simkin, a doula, author, and childbirth educator from Seattle, has researched  the impact of childhood sexual abuse on childbearing women.  She and coauthor Phyllis Klaus have written a book called, When Survivors Give Birth, but so far have been unable to find a publisher.   However, in her workshop on "The Impact of Childhood Sexual Abuse on Childbearing Women and Their Caregivers," she details a number of ways in which sexual or physical abuse can affect women in birth, and strategies these women and their caregivers can use to help diffuse the influence of this history.  

For example, many procedures common to obstetric care can feel very invasive or threatening to Survivors.  In particular, they may fear exposure or nakedness, or may strongly dislike invasive tests and procedures like blood tests, IVs, vaginal exams, or vaginal ultrasounds.  Simkin recommends that care providers reduce or eliminate as many painful or stressful procedures as possible, and that women be up front with their providers about what bothers them and why, so they can find a way to compromise.  She recommends eliminating any possibility of surprise about procedures, to keep the woman informed and involved about care decisions, and to discuss and negotiate the care plan as they go.  Women can keep their own clothes on as much as they wish during labor, and the importance of privacy can be emphasized to the staff.  

Self-image and empowerment is also often an issue for Survivors.  They may see themselves as 'bad,' or 'dirty,' or 'defective.'  They may believe deep-down that they do not deserve to be treated well, or unconsciously go to providers that will treat them badly.   They may fear pain to an extreme, or be afraid of dependency and helplessness during the birth.  They may have difficulty envisioning giving birth 'down there' and will do anything to deaden or avoid dealing with that area.  Although it is most helpful in birth to be able to 'go into' the pain and 'tune into' your body and this is a goal for women to work towards, for some women at certain stages it may be more helpful if they can just disassociate with their body and tune out instead of in.  If that's what works for a woman in order to birth more normally, then her coping style needs to be respected too.

Some Survivors are extremely passive, avoiding decision-making at any cost, and often seeing very controlling and abusive providers.  Once they start to process and grieve their birth experiences, though, they may finally find their anger not only for the birth but also for the earlier experiences of abuse.  In this way, a traumatic birth can actually be the key for finally unlocking the anger and the sadness and the grief that may have been hidden away for so long.  

One result of this may be that they transfer some of their anger against the abuser onto the provider.  Of course, many providers deserve every bit of anger women can have for them, but they may also serve as a lightning rod or 'safe' outlet for the anger until the women is ready to deal with the anger towards the abuser as a separate issue.  In this way, again, a traumatic birth can actually be a springboard to healing.

Although it is very difficult to deal with abusive providers, it is also  an incredible opportunity to finally find your anger, give it voice, and to stand up for yourself and start fighting back.  As awful as these providers can be, the anger they create can also be the key to finally taking back your power, both then and now. 

Survivors may also have very strong control and power issues, too.  Some become very demanding patients, with lengthy birth plans, extreme preparation, and a need for very long appointments.  Their need for control and power takes the opposite tack from passiveness, and they may try to micromanage everything.  This can actually be quite helpful in many ways, as long as during labor, the woman is able to release and work with it instead of trying to control it.  The key is to find a provider who is compatible with these needs, who is able to understand and accommodate more detailed involvement than they may be used to, and for the woman to communicate her history, fears and concerns to help the provider be able to better address those concerns.   

Simkin feels that Survivors strongly benefit by hiring an experienced doula to help out during their labor, and that the doula should be aware of procedures and situations that seem most threatening to their clients.  They also need to be aware of the type of language they use during birth; Simkin recommends avoiding the terms, "letting go," "yielding," and "surrender" if this is  associated with victimization to Survivors.  She also reminds doulas that some women cope best by tuning out of their body instead of into it, and that childbirth professionals need to respect that some women may need a different method of coping.  Taking their cue from the woman's responses may help them know how best to respond.  

Simkin also recommends preparing visualizations and coping strategies with the woman ahead of time, and that these may differ during different parts of labor.  In early labor, she recommends techniques to aid relaxation and promote confidence, including a short visualization of a peaceful happy time.  She suggests each mini-visualization have a beginning, middle and end so that it can be used with each contraction if that seems to help the woman.  For the powerful sensations of active labor, she suggests a visualization to help a woman deal with the pain as well as any fears that may arise, one that incorporates a woman's own experience of meeting a challenge and overcoming it.  Using positive imagery from a woman's own life may be especially helpful in helping them remember their own power and abilities.

Woman who have been sexually abused may find transition and pushing contractions the most challenging of all, and may tend to want to 'hold back.'  The pain of birth may remind her of the pain of the abuse, so she suggests emphasizing that birth involves pain leaving the body, not coming in.  She emphasizes messages such as "Push the pain right out," and "Meet the pain and press it out of your body."  

She emphasizes to women that the baby is their ally in healing.  The baby can help take the pain away 'because the pain comes out with the baby; the baby is going to help push the pain away.'  Thinking of the baby as an ally in healing can make a lot of difference to an abused woman.  It emphasizes bonding and a woman's connection to her baby, and it puts the baby on the side of the mother, working with her to help finish the process of birth and to help in her healing.   

Simkin suggests that women with abuse issues often benefit from one-on-one counseling specific to her concerns.  Women should see a qualified therapist who specializes in abuse about the abuse issues themselves.  However, seeing a therapist trained in counseling birth matters can also help address the issue of keeping the abuse from negatively affecting the birth.  In these sessions, they can address what kind of fears she has, what kind of sensory input makes her feel uneasy, how she can discuss these issues with her provider, and what kind of plan they can make to help handle the issue proactively.  They can also spend quite a bit of time on relaxation exercises, exercises for bonding with the baby, and visualizations of a normal, healthy birth.  Creating the emotional experience of a normal birth ahead of time through hypnosis and visualization exercises can help the woman envision this possibility for herself, and she will be able to access this emotional memory when she is in labor.  Gayle Peterson's work indicates that this can be a particularly powerful tool for women. 

One question many women with a background of abuse have is whether they really have to confront these issues during pregnancy.  The answer, of course, is no.  Many women with past abuse have managed to give birth just fine without fully dealing with their abuse.  If you are not ready to deal with everything, you certainly don't have to, or you can take your grieving in small stages instead of all at once. For many women, simply acknowledging the fact of abuse and making a plan for tough moments (should any arise) is enough.  Growth along the healing curve is all that's required; what kind of growth is important for you is what you need to determine and pursue. 

Listen to your inner intuition; it will tell you when you are ready to work on these issues and when it is too soon to take care of them fully.  For some women, they are best approached in layers instead of all at once.  For others, doing a lot of healing work all at once is an important part of working towards a better birth.  Understand that working through these issues can really be helpful in your life and your child's life too, but let your inner voice guide you in your healing.   

Birth can be a time of tremendous emotional discomfort because such strong physical processes can bring up so many memories of abuse, but it can also be a powerful time for healing.  Even long after the fact, birth can still be a touchstone for healing of abuse issues. Madsen urges women to use the opportunity:

Any birth is powerful.  Even with unforeseen medical interventions, planned medical interventions, or unexpected loss, potential for healing is present.  Days, months, or many years after a birth, a woman can tap into this power and weave her own tapestry of healing  from abuse.  Her personal cycle of repeating the abuse pattern within herself or with her family will be transformed.  

Remember that healing from abuse issues can take place at ANY time.  If you are not ready to heal now, you can do it whenever you are ready.  The lessons from your birth can guide you when you are ready, and your baby will be your ally in healing.  

Success/Failure Issues (Perfectionism)

Many women who experience cesareans have success/failure issues.  They are often caught up in perfectionism, in judging themselves according to their own strict (and rarely reachable) standards.  Usually, there are strong life issues behind this.

There are a number of women who feel like failures because they had a cesarean. They second-guess their decisions, feel like they 'wimped out', feel like their bodies failed them, or that if they'd just 'toughed it out a little longer,' they could have made it.  Nancy Wainer Cohen debunks the 'failure' syndrome in Silent Knife.  She asserts:

Many women 'beat themselves up' after a poor birth experience.  They need not do that!  They made the very best decisions they could...Our selflessness and survival instincts are...strong.  If we perceive that our child is in danger, we will do anything to protect her...We will permit ourselves TO BE CUT OPEN to save the life of our baby...Cesarean mothers are not weak failures; they are courageous women who are willing to be cut apart for the lives of their infants!  Perhaps it is time to congratulate yourself for your strength and your courage.  It is time to love yourself for what you did.  What you did was AN ACT OF LOVE...

Look at yourself with respect...you did your best.  You acted out of love.  You don't have to get down on yourself because you had a cesarean.  You can forgive yourself...you can also begin to forgive your body, your baby, and your mate, if necessary.  They did the very best they could at the time, too.  

For many women  with success/failure and perfectionism issues, a cesarean can, in the long run, be a healing experience because it helps you confront those issues and quit trying to control everything.  It is often a very difficult thing to deal with at first because it hits so strongly at the most vulnerable part of you----the feeling of being 'not being good enough'.  

Many women never get past this----the deciding factor many women cite in choosing an elective repeat cesarean is 'what if I go through all that and fail again?'  Rather than risk 'failure' (who says it's failure?), they choose the known outcome of an elective cesarean, which is more comfortable to them than the uncertainty of not knowing what will happen, or risking 'failure' in their own eyes again.  But a cesarean after a 'trial of labor' is NOT a 'failure!'   Andrea Frank Henkart points out, "'There are no failures, only lessons.'  This concept gives women permission to accept life's experiences in a very positive way. We need to find ways to be accepting of ourselves and our experiences and gain insight into what lessons we need to learn in life."

Women can use a VBAC for perfectionism, too.  They may feel that if they can learn enough, read enough, do enough, then they can protect themselves against 'failing' and control the outcome.  And of course, there is some truth in that; knowledge about childbirth issues can often help protect against unnecessary cesareans.  But in the long run, life cannot be controlled.  There are no guarantees, no shortcuts to avoid failure or unpredictable variables.  

Choosing to go for a VBAC can help women learn this.  You prepare the best you can, do your physical and emotional homework, find a really supportive provider and labor team, and then let go control.  There are always variables that cannot be controlled for; after a certain point, you just have to go forward and let things happen as they will.  In this way, a woman's past cesarean (and her VBAC labor) can help her work through some of her perfectionism and 'failure' issues.  

Not all women are ready for this release of control, or they may have other pressing reasons why they choose repeat cesarean. Although choosing a VBAC labor can be very liberating in terms of control issues, don't let which option you choose become yet another issue you are 'judged' over!  Choose the option that is best for you, be clear on why you are choosing it, and then move forward with that choice.  

Delving into your own life issues to get to the bottom of why success/failure/perfectionism is such an important issue in your life  can be very helpful in resolving your past birth and working towards a better birth next time, whatever your choices are.   

Parenting Fears

Another issue that is closely tied into abuse or codependency issues is that of parenting.  Many women face parenthood with trepidation, conflicted about work and career issues, unsure if they will be a 'good-enough' parent, afraid they will repeat the mistakes their parents made with them---some even afraid they will abuse their own children.

Many women are conflicted to some extent about work and career issues, but this issue hits some women particularly hard.  If the woman has a flourishing career, the thought of giving that all up is very difficult, especially if much of her self-worth has been defined by her career.  Yet once the baby arrives and she sees how much he needs her daily presence, the idea of leaving is generally much harder than anticipated.  Financial straits may also require that she work outside the home, whether or not she wishes to, and that is its own stresses too. 

Whatever work/home combo they choose, most women find there are bumps along the way.  But when work issues are piled on top of birth trauma issues, oftentimes the path is even bumpier.  The key may lie in trying to understand the larger underlying issues instead of getting tied up in the minutiae of work arrangements. 

Nearly all women wonder if they'll be good mothers.  This fear is nearly universal, but some women do worry more than others.  Usually this is rooted in their own upbringing; women who are parented lovingly and appropriately may experience self-doubt and questioning at times but generally have a solid core of self-acceptance and basic confidence.  On the other hand, women who have been raised in families with abuse, chemical dependency, mental illness or other problems tend to be more insecure about their mothering potential because they were not raised with good parenting themselves. 

Many of these women fear repeating the mistakes their parents made with them, and while perfectly understandable, sometimes this fear can be so paralyzingly strong that it does end up interfering with their parenting.  Women with histories of unhappy and dysfunctional families often benefit strongly from therapy.  This can help them differentiate their own mothering styles from their parents' styles, work through their parenting fears, reinforce good parenting skills, and reassure them that "progress, not perfection" is the goal.  

Although it is true that some children who have been abused go on to abuse others, the majority do not.  Many actually become excellent parents.  They may suffer more than the usual share of self-doubt and struggle at times, but if they get help to deal with their feelings and insecurities, most do just fine.  A past history of abuse does NOT have to perpetuate itself, and the best way to assure that this does not happen is to get professional help and/or attend a self-help group.  You can parent differently than you were parented.

An Opportunity for Healing

Claudia Panuthos writes in Transformation Through Birth

Childbirth is a time of great learning and emotional growth.  Hopefully, it will be used as such...It seems increasingly clear to us that parents who have the consciousness to use childbearing as a growth opportunity seem to gain in personal strength, resources, and depth of relationship.  They often alter many other areas of their lives, such as their relationships with their own parents, children, and friends, as a result of their learning through emotionally conscious childbearing.  These parents exhibit great emotional resources, strength, and health.

Pregnancy and birth are not isolated incidents in our lives; they are intimately connected with all the other beliefs and fears and issues we have in our lives.  They reflect our own personal history, but they can also be the key to healing and changing destructive patterns that we may have in our lives. 

Although you certainly don't have to look more deeply at your life issues and birth beliefs in order to move on with your life after a cesarean, it IS a golden opportunity for healing.  Holistic mind-body therapists might suggest that the cesarean happened in order to help you face these issues; sometimes it takes a shock to shake us out of our old patterns and make us work towards new growth and healthier patterns. 

Perhaps this is true and perhaps it isn't, but if some good can come out of your cesarean, why not embrace it?  Uncover your beliefs and work through your issues so that you can grieve the birth, find greater healing in your life, and move towards peace.  You already had to go through the bad parts of the cesarean, why not reach out and take the gifts it may be offering you as well?

 

Healing From a Traumatic Birth Experience

"What does healing mean?  It means identifying and listening to the messages within a woman's pain, including her feelings." Lynn Madsen, Rebounding From Childbirth

There are many things you can do to help yourself recover emotionally from a c-section or traumatic birth experience. What helps you personally may differ from what helps someone else, and it may also change over time. Be open to many different types of experiences and resources; something you may never have considered as being helpful might end up being the very thing you find most healing.  

Some women need time and space to concentrate on baby before dealing with their c-sections; others may need to heal emotionally in order to connect with their babies. Many women don't really begin fully grieving their previous birth until they are pregnant with their next child, having to face old fears and make difficult birthing choices.  Be gentle with yourself; accept your healing process as being the one that YOU need.  Let it happen in its own space and time.  

Finding Resources

Many women benefit from support groups such as International Cesarean Awareness Network (ICAN), www.ican-online.org. As stated on its website, ICAN's goals are:

  1. To lower the rising cesarean rate through education,
  2. To provide a forum where women and men can express their thoughts and concerns about birth, and
  3. To provide a support network for women who are healing from past birth experiences and for those who are preparing for births.

ICAN has local support groups in many cities, and many women find the one-on-one support with a group of other women who understand and who have 'been there, done that' very healing.  ICAN has a list of these groups and contact numbers for their leaders at www.ican-online.org/chapter.htm.  ICAN also has a terrific online email support group, which offers a place to vent, ask questions, worry, obsess, heal, and grow. It can be joined by sending an email consisting solely of the word 'subscribe' (no punctuation) to ican-request@fensende.com.

Other websites that may be helpful include: 

Email lists that are specifically about recovering from a traumatic birth include: 

Some women may prefer to do individual work with a therapist specializing in birth issues.  It is often not easy to find therapists who specialize in birth issues, but although other therapists might be helpful, they might also be hurtful as well.  Many women have reported seeing therapists that just didn't 'get' birth issues, told them that the method of birth was unimportant, and that they needed to just get over it and move on with their lives.  

It is important to have a therapist who understands fully that pregnancy and birth is a very important rite of passage in a woman's life, and that what happens during birth is not trivial or less important than other life issues. Therefore, it is probably very important to find a therapist who specializes in birth issues and healing from traumatic births if at all possible.

One way to do this may be to call all the childbirth professionals in the area and see if they can recommend someone.  Try calling  local childbirth educators who work independently from hospital programs.   For example, see if there are Bradley method  (www.bradleybirth.com ), Birth Works ( www.birthworks.org ), and Birthing From Within ( www.birthingfromwithin.com ) childbirth educators in your area, and ask them if they know of anyone who specializes in this type of work.   Contact local homebirth midwives (direct-entry midwives, licensed midwives, or certified professional midwives) to see if they know of anyone.  Go to a La Leche League meeting ( www.lalecheleague.org ) and ask around; this organization does not make any recommendations officially, but if you ask around informally at a meeting, many women there can often direct you to the best community resources.  

Self-help books are a great way to do individual work on your own at home.  Obviously, one outstanding resource that Kmom highly recommends is Rebounding from Childbirth by Lynn Madsen.  The author is a psychologist who underwent a true emergency cesarean, then had a miscarriage, and then had a VBAC. She speaks about healing both as a psychologist and as a woman who has gone through a traumatic birth herself.  It can be ordered from www.amazon.com, www.1cascade.com, or other online book sources. It is truly excellent.   Kmom recommends reading it in small doses and coming back to it from time to time to refresh your healing. 

Another outstanding book is Transformation Through Birth by Claudia Panuthos. Unfortunately, it is out-of-print now and hard to find, although Cascade Books (Birth and Life Bookstore, www.1cascade.com, [503] 371-4445 or 800-443-9942) has a limited supply available for sale. Kmom also highly recommends this book.

Other good books include Birth As a Healing Experience by Lois Halzel Freedman, Ended Beginnings: Healing Childbearing Losses by Cathy Romeo and Claudia Panuthos, and Silent Knife by Nancy Wainer Cohen and Lois Estner, the classic in the childbirth field that started the whole cesarean prevention and VBAC movement.

 

Tools For Healing

There are many activities that can help you uncover your feelings and help you towards healing.  Different people find different things useful; don't feel you have to try everything below.  Start with what feels most comfortable and go from there.  

However, don't limit yourself too much; some women find that the activities they find most uncomfortable or silly are often the most useful to them.  For example, highly logical and 'left-brained' people often disdain art therapy or journal writing in the non-dominant hand.  Yet if they can get past their reluctance or disdain for these techniques, many of these people report that these were the most powerful healing tools of all for them.  Work with what is comfortable for you, but don't be afraid to try something new or to push your comfort zone in your pursuit of healing.  

Tell Your Birth Story

"It is the remembering and telling of [the birth] stories that begins the healing process."  Lois Halzel Freedman

The first step in moving on is to tell your birth story or stories.  This is one of the most difficult steps for some women, but it really is very important in getting the healing started.  If you can't name what happened to you, then you can't fully understand it or begin to make it different next time.  Name the problem, talk about what happened, then retell your story over and over and over.  

Madsen notes, "The act of recording a birthing story is difficult to begin; it may feel like an act of betrayal to all those voices who minimized the heartbreak, depression, pain, or disappointment...To write about what happened may act as a catalyst, as a key that unlocks and releases her voice and power.  It is also scary, because saying or writing the truth means movement and change.  Power can be scary.  At times like this it is helpful to remember that any effort deserves affirmation, and the words will come as fast or as slow as a woman is ready for them."

Tell the story to an impartial listener, write it down to share online, or write it down just for yourself.  Put it in a journal where no one else can see it except for yourself, or shout it from the rooftops, whichever feels right to you. Find a safe space to work on your story, and a safe space to keep it away from the prying eyes of others.  Only share what you feel like sharing.   

If you are having trouble getting started, try writing small parts of it first.  Deal with what happened after the baby was born, or how your recovery went, or how your pregnancy went before labor started.  Work your way up to writing about the surgery or whatever was the hardest part for you personally. Try writing a bare bones version of the story first, then go back in time and flesh it out more.  Or start out by journaling about why you think you are having such trouble writing the story down.  Just find a way to GET THE STORY OUT.  

Usually, it's not enough to tell your story only once.  Often the story needs to be retold many times, with different focuses, in order to really start processing it.  Many women start out telling only the basic bones of the story, but with retelling they often remember more details, access more feelings, and get to the root of their distress more effectively.  Madsen suggests writing the story in two layers, resting between layers as needed.  First, she suggests writing down all the concrete details you can remember----sensory detail, who, what, where, when, etc.  Then she suggests describing the "inner space of birth."  Where was your mind, were you aware of the baby, what did you say to yourself, how were you feeling, etc.   

Then find as many different mediums to tell your birth story as you can; write poetry about it, do a painting of it, write music about it, retell it in the third person, tell it from the point of view of your baby, etc.  The more you tell the story, the more you process the birth.  

Explore Your Feelings

Some of the hardest work you will do is accessing your deepest feelings about your child's birth.  Often, it is very difficult to do this.  People don't like to go through pain, and facing unpleasant or difficult feelings is painful.  Feelings about birth tend to be very intense, especially the deeper you go.  Often they bring up life issues which can be even more intense.  

It is completely normal to wish to avoid pain, but if you suppress your feelings and don't really feel them fully, they become stronger.  Often they will present in your life again and again, each time stronger and more insistent, and sometimes in more destructive ways.  Although facing the feelings may be very difficult or feel very threatening, in the long run it is what frees you. 

Some women feel like their feelings aren't important enough to bother with, or that they are in the past and that they have 'moved on' now.  Madsen reiterates that ALL feelings matter:

Every feeling about birth matters, no matter how long that feelings lasts, no matter how unreasonable, irrational, or out of proportion it seems.  Any feeling, no matter how strong, is easier to live with once it is named.  Naming creates edges so the feeling is only as big as the room or the city or the sky, and not bigger than the entire universe.  But to experience this kind of relief requires a leap of faith, an abandonment into feelings, an embracement that goes against many creeds.  Now that the pain is recognized, a woman can take this leap and begin to voice her feelings about how her birth occurred...

Yet to let feelings follow their course, wind their ways out of her, can feel as threatening as a loaded gun at her head...To sit with a big feeling, no matter what it is---anger, sadness, fear---can feel lethal...A woman may believe she is going to die as the feeling rolls through her, but she won't.  The trick is to sit with the feeling until this intensity, this sensation of death passes, and light is perceived at the end of the tunnel.  

Dealing with your deepest feelings, fears, and emotions are the emotional homework of pregnancy.  If you have leftover feelings and fears from your last pregnancy, you need to work through them eventually so you can "clear a space" for your next baby and your next birth.  Find your feelings, name them, find their edges, define them, feel them fully and completely, and release them.  This will help you clear a space for next time.  If you have finished childbearing, it will help you find closure from the past and clear a space for the future.  

Keep a Journal

Many women find that keeping a journal is extremely useful in working through emotional issues and dealing with fears.  Although most of us find it difficult to take the time to do a journal, women who commit to doing this find it is amazingly revealing.  Simply the act of writing down fears often leads to new insight into emotional issues, or a significant lessening of pain and anxiety.  

If you have trouble knowing what to write about, start with the story of your cesarean.  Start by describing labor, and use your senses to help remember the situation more vividly.  What did the room look like, what did you smell, what did you hear, etc?  Also concentrate on the emotions you were feeling, what you felt about your doctors, nurses, midwives, and even your partner.  Let it all out; don't censor yourself or try to be 'nice.'  You can recreate a more edited version of it another time if you wish; for now don't censor yourself in any way.  

You can try writing a letter to the people who were there at your birth, or to your spouse or baby.  You can also try describing your feelings around the birth as specifically as you can.  Remember, don't pretty anything up!  No one's going to read this but you. This is your space to let it all hang out.   Quit worrying about spelling, grammar, being reasonable, or saying it in a way that others would understand.  Just let your emotions be as raw as possible; lance the wound and get it all out. Be as emotional, inflammatory, enraged, unreasonable, sad, or as bitchy as you want. This is YOUR space; use it!

You can also try some of the writing and art exercises in the book, Creating a Joyful Birth Experience by Cappachione and Bardsley.  They have a technique that utilizes non-dominant handwriting that often helps unlock lots of feelings and fears.  It really seems quite ridiculous at first, and some women find it so nonsensical that they refuse to even try it.  However, women who try it often remark how powerful a tool it is, and although they do feel silly using it at first, they are surprised at how revealing it can be.  Sometimes the women who find it the most revealing are the women who are most derisive of it in the first place, especially those who tend to be very 'left-brain' oriented.  What's to lose by trying it, after all?  Worst-case scenario is that you might feel silly and learn nothing from the experience.  Best-case scenario is that you might find it releases some anxiety and maybe even clarifies a difficult issue for you.  

Journaling is a very powerful healing tool, and can really be revealing if you are only willing to risk pushing your comfort levels and try it.  Throw aside your inhibitions and your excuses; make some time for doing some journaling, and keep at it.  Your intensity may increase for a while, but after a while, you will probably find that if you are open enough, the intensity starts to decrease, and healing begins.  

Dream Work

Madsen says, "Dreams are the most easily accessible source of one's unconscious.  For [you] to know [your] dreams is to know [yourself]...When birth trauma has occurred, dreams are actively involved with its clearing."

Everybody dreams.  Some people do not remember their dreams, but often if you keep paper or a tape recorder right beside your bed and make a practice of immediately recording whatever you remember as soon as you awake (before getting out of bed!), you will find that you start to remember fragments and retain them longer.  Slowly, you will recover more of your dreams---but only if you do it consistently.  Don't neglect this; dreams are often a very powerful tool for healing.

Interpreting dreams is not always easy, though.  Don't worry about interpreting them at first; just get them down.  Many may be bizarre or sometimes even disturbing; this is very common and they usually should not be interpreted literally.  There are many books available for helping to interpret the meaning of dreams.  Madsen recommends the following books:

Some people believe that in some dreams, many of the different characters/things that appear actually represent you, or different aspects of you.  Try looking at some of your dreams in that way, and see what it could mean.  For example, Madsen gives the example of a woman who dreamed that she had a repeat cesarean instead of a VBAC, and she couldn't love or attach to the baby as a result.  She felt terribly guilty about this dream, and was worried that if she had a repeat cesarean she wouldn't be able to love the baby.  Her midwife pointed out that the abandoned baby might actually be her, and might represent her fear that if she had a repeat cesarean she wouldn't be able to love or forgive herself.  Her dream was telling her that she had success/failure issues she needed to address, and that if she had a repeat cesarean, she still deserved love and comfort and nurturing from others and from herself.  

If a woman has had a particularly traumatic birth, dreams are quite often part of the postpartum experience.  If they are not paid attention to, sometimes they can last for years, repeating themselves in order to get across their urgent messages, trying to be heard by the conscious mind.  

This is particularly difficult if you have nightmares as part of Post-Traumatic Stress Syndrome.  The dreams can be so difficult that the last thing you want to do is to really pay attention to them and listen for their message.  Madsen notes:

If a woman is having dreams of an unpleasant or terrifying experience, it helps to view the dream as a message or as a way for the trauma both to become integrated and to leave her.  Just like a demanding child, if attention is paid, the child eventually happily wanders off to play on its own.  So will a dream stop returning during sleep once its message is heard...If a woman tries to deny her dream, it will become stronger until she says what needs to be said, acknowledges what is demanding to be known, and lets her feelings surface."  

If your dreams are particularly troubling, you may want to get the assistance of a therapist who specializes in dream work.  Art therapy may also be helpful in finding the message in the dream that you need to hear or express.  If you have trouble getting to sleep because of unpleasant dreams or 'mental tapes' that play over and over in your mind, a relaxation induction audiotape may be useful to you, or a hypnotherapy session in which a suggestion is given to dream your dream but from a safe distance and with the ability to see its meaning more clearly.  

Affirmations as a Tool For Change

All of us have messages that we send to ourselves on a regular basis.  For many of us, these messages are largely negative, self-critical, and ultimately destructive.  Using affirmations changes our self-messages from negative to positive, and helps clear a space for new behaviors, new beliefs, and new outcomes.  Almost everybody feels very silly using positive affirmations at first, but those who use them consistently usually report that they have been powerful tools for change in their lives.  

Melody Beattie discusses affirmations in Beyond Codependency.  She writes:

Most of us have spent much of our lives asserting and emphasizing certain ideas about ourselves, others, and life.  The issue in recovery is choosing what we want to affirm...Affirmations create space for reality to happen in.  The concept of using affirmations in recovery means replacing negative messages with positive ones: we change what we say so we can change what we see...

To empower means to give power to.  What have we been giving power to?  The terrible way we look?  How bad we feel?  Our problems?  Another person's problem?  Our lack of money, time, and talent?  The awfulness of life?  Next question: Do we really want to feed and nurture negative ideas---knowing those attitudes will likely create more negative ideas and negative reality?  Do we want to empower the problem or the solution?...

To discover what you need to work on, spend a day or two listening to your thoughts.  Listen to what you say.  Listen to the problems and negative qualities you empower in yourself and others.  Look in the mirror and notice what you think and say...Hold your special person in your arms and listen to your thoughts.  Listen to how you react to your problems.  Listen to what you say to and about your children.  

What are you giving power to?  What are you creating space for?  Are you feeding what you want to grow?  

Pay attention to the messages you give yourself, both in general and about birthing.  What are you giving power to?  What negative messages have you been telling yourself?  How can you clear a space from these old messages for new ones to take their place?  

When you first start using affirmations, it's probably going to feel very strange and very awkward.  Using affirmations seems like a very 'crunchy granola' thing to do, and you will probably feel stupid at first.  That's okay, it's very normal.  As Beattie notes, "It's normal to resist affirmations and positive thoughts.  If you've been feeding yourself negative ideas for ten, twenty, or thirty years, of course the positive will feel strange for a while...Be patient.  Don't give up."  

Sometimes things seem worse before they start getting better.  Beattie notes this too, saying:

Things may temporarily get worse.  Our old ways of thinking surface into conscious awareness.  That's good.  It's clearing out of our subconscious and making room for the new.  A room always looks dirtier when we start to clean it...Cleaning intensifies the disorder, until a new order can be created...You'll probably be tested when you turn negative beliefs into positive ones.  Often, when I change a belief, a big tidal wave sweeps into my life to try to wash away my new belief...Let the storm roar.  Hold fast to your new affirmations.  Let them be your anchor.  When the storm passes, you'll see you're on solid ground with new beliefs.

People use affirmations in different ways.  Try chanting them over and over to yourself as you go for a walk, a run, or a swim.  Make them rhythmic, short, and catchy, so they will catch and stay in your mind more easily.  Say them quietly to yourself 10 or 25 times before you go to sleep, and when you wake up in the morning.  When you catch yourself repeating one of your old negative messages, say your positive affirmation 10 times to yourself instead.  Find some private time when you are alone in the house or in a room and say your affirmations out loud, or sing them to yourself, even.  

Take time to actually write them down, too.  Written affirmations are even more powerful than spoken or mental affirmations.  Write down your most important affirmations ten times each day.  Visualize writing them inside your head.  Make a poster of your most powerful affirmation, written in calligraphy or strong bold letters and then decorated up to be striking and powerful visually.  Post your affirmations where you can see them daily.   

Or transform your most important affirmations into artwork.  Assemble a collage.  Cut pictures and sayings out of old magazines and newspapers and paste them onto a large piece of posterboard.  Make them represent the new, positive messages you are giving yourself.  Pick out some pictures or objects that symbolically represent your new changes, your new attitudes about yourself, your hope for the future.   Post your artwork in your bedroom or your bathroom.  Some women even make sure they have it with them while they are laboring, using it as a focal point for their concentration or a reminder of their goals.  

Many of the books excerpted for this FAQ have lists of sample affirmations.  Here are a few of the many available:

 

Other Ideas For Healing

Understand Exactly What Is Involved in a Cesarean

Although it seems counterintuitive, some women find relief afterwards in understanding exactly what a cesarean section entails physically.  Finding a description of a cesarean, seeing photos, or watching a video describing exactly how it happens can sometimes be a stress reliever for some women.  

There are written descriptions of a cesarean operation in A Woman in Residence by Michelle Harrison or in Silent Knife by Nancy Wainer Cohen and Lois Estner.  Photos of cesareans are available online at various sites, including:

There is also a video of an elective cesarean with very complete explanations and footage from "The Operation" series on the Learning Channel, and it is available for purchase.  It is around $45-50 and can be purchased by calling 1-800-257-5126.   

Be ready for some sadness or feelings of invasiveness as you begin to understand exactly what was involved in your surgery.  Not all women find this step healing; some women find it very distressing at first as they begin to confront exactly what they went through, or as it brings flashbacks to an unpleasant experience back to them.  However, confronting the reality of the surgery in a very visceral way can be one step in really accessing your deepest feelings about the whole experience.   

Although your first feelings may be ones of revulsion and feeling threatened, eventually there may also be feelings of healing and relief at knowing exactly what happened.  Listen to your intuition on this; if you are horrified at the very thought of dealing with the reality of the operation, then perhaps you are simply not ready to face this yet.  Or perhaps your strong reaction is telling you that this is precisely what you need to confront in order to really start to heal.  You decide, and let your intuition be your guide.  

There is one caution, however.  Don't watch a video of a cesarean or look at cesarean photos if you are pregnant with another child (unless you are positive about planning an elective repeat cesarean).  Birth images are very powerful and can imprint expectations on our minds.  If you are planning a VBAC, don't imprint the image of a cesarean.   Fill your mind with images of empowering natural birth instead.  It really can make a difference.

Find Out What Really Happened in Your Last Birth

It is extremely important to find out exactly what happened in your last birth, to try to understand the complexities of the situation, and to figure out how you could prevent the same thing from happening again.  This is often a very emotional step, but a very important one.  Try to look at things with fresh eyes; treat everything you were previously told about why you had the cesarean with a lot of skepticism, and be ready to question the reasoning.  It may well turn out that everything you were told was right, but you shouldn't just accept that automatically.  Many women are surprised at the answers they find.

Order your medical records from the hospital and/or your provider.  Call the hospital you were at and request the medical records department.  Ask them what you need to do in order to request your medical records.  In most cases, all you need to do is send a letter giving the pertinent information about who/what/where, giving permission to copy your records for you, and then sign the letter.  You will have to pay for reasonable photocopying costs, but these should not be too exorbitant if you do not ask for copies of the external fetal monitoring strips.  Typically, most people get the surgical report and the doctor's summary, but the nursing notes are often very revealing and should be requested too.  If there are other pertinent pages, you can also ask for those.   If there were questions about your child's health or care after birth, you may also request the records under your child's name.   

Although the fee for copying your records is usually not exorbitant (omit those fetal monitor strips unless pertinent!), if you are told the charge will be high or are really pressed for money there are other options.  You can go down to the hospital and look at your records in person to flag the specific pages that you need; reducing the number of pages to be copied will reduce costs and often they will charge fewer overhead fees as well.  

Other options may even help you get your records for free.  You can find another provider that is sympathetic and ask them to request a copy of your records.  This is provided free from provider to provider as a professional courtesy, and because another provider is requesting the records, it is sent without question.  Your provider can then make you a copy as well.  Many midwives (especially homebirth midwives) are very sympathetic to requests such as these and will help you out like this.   

Most women need only see the records from their hospital stay, but a few may need records from their prenatal care.  Although most hospitals are very straightforward about providing records without hassle, requesting records from a private provider can be met with more resistance.  Because of concerns about litigation, some office staff tend to strongly discourage requests for records, and may try to tell you that you cannot have this information, or that it can only be sent to another doctor.  Baloney.  

You have a legal right to see your medical records.  Legally, the information in those records BELONGS TO YOU.  The physical copies of the records belong to the hospital or provider, but the information in them is legally yours.  By law they cannot keep this information from you, although they may try to convince you otherwise.  If you request your records formally, they probably will not hassle you. However, if you do experience problems, you can ask a friendly midwife to request your records for you [see above], or you can remind them that you have a legal right to your records and will pursue that right as needed.  When reminded politely but firmly about your legal rights, most staff will back down.  

Once you have your birth records, grit your teeth, read them, and then start asking questions.  Many women find that when they look more carefully at their birth, there were factors their doctors missed, misinterpreted, or may have even caused themselves.  This is not to blame your prior provider, just to try to clarify what happened so that you can find a way to change things for the future.  If you need help understanding your records or clarifying some questions, go online and ask your questions on the ICAN email list [see below], where other women who have been through this process themselves can help women interpret their records.  Or you can check what some medical abbreviations mean at www.birthlove.com/pages/gloria/records.html.  

Read what your provider says happened at your birth, but treat the information with a 'grain of salt'; don't automatically accept it as gospel, nor automatically condemn it either.  Keep an open mind; remember that there is a great deal of room for interpretation of medical events, and that someone else might have come to different conclusions and actions from the same information.  Try to piece together your information as objectively as you can.  See the books and websites recommended elsewhere for more information about various interventions and protocols and their risk/benefit tradeoffs.  

Be prepared---reading your records may not be an easy process.  There are often errors in these records----sometimes egregious ones.  Some are typos or transcription errors, but some are outrageous errors made by the medical staff.  Some women find there are unkind comments or even outright lies in their records.  You may be depressed, sad, or even enraged over what you read in your records.   But remember that the rage or sadness you might feel in reading your records is an important part of reconnecting you to your feelings from the birth, to really accessing your deepest feelings, and to uncovering the truth about what really happened in your birth.  You may not like everything you see in your records, but it will eventually help you towards great insight about your birth.  

Although getting your records may seem intimidating or too painful at first, remind yourself that this is the first step on your road to an empowering birth next time!  Think of it as an exercise in assertiveness.  Although this task is certainly not an absolute requirement for healing, most moms find that it is a very important step along their healing path.  

Listen to Your Partner's View of the Birth Story and Discuss It

Your partner's version of the birth story is also very important, and many women can gain a lot of insight from hearing the story told from his viewpoint.  It may be difficult to get your partner to do this at first, but often if you make a special request of him, or schedule a weekend away for just the two of you and then bring up the request, he may be more responsive (although probably still reluctant!).  Most partners will tell the story as briefly as possible, but with a little gentle questioning, may elaborate more.  Even more insight may be gained from having him write down his version of the story, if he is willing.

However, do recognize that often, the partner has his own grieving work to do.  His fear of returning to that difficult time and his fears and anxieties about any future birth may keep him from starting that grieving work.  Telling his story can help him work through his own issues, help you communicate as a couple, and help broach discussion about choices for the next birth, but don't force your partner into this step.  

Gently request your partner's help with your healing, and encourage him to explore and discuss his feelings about the birth, but don't force the issue if you partner is not yet ready to deal with things.  If he is willing to meet you partway, this step can often be a springboard into greater communication and appreciation of each other's feelings.  It won't happen all at once and it may not always be comfortable, but communication is the first step towards greater understanding.  

Activate and Work Through Feelings of Anger

Many women who have been through cesareans or other traumatic births experience strong feelings of anger, although it may be deeply buried at first.  This anger may be at their doctors, at their nurses, at their midwives, at their in-laws, at their spouses, or even at themselves or their babies.   This kind of anger can be very uncomfortable to admit, and many women feel hesitant at first to access their anger because they feel it is irrational or unjustified.  They feel badly for being so angry at someone else.

Whether the anger is justifiable is not the issue! Your feelings are your feelings.  They don't have to be reasonable.  Feelings are not rational, they just are.  Suppressing the anger because it's not fair won't make it go away; it often makes it burn all the brighter.  Most women find that embracing their anger and delving into it is very revealing and useful in starting the healing process.  Don't second-guess your anger; just let it come out.  

Some women are ablaze with their anger. Their anger is right on the surface, ready to erupt.  They know they have been wronged, and they are righteously aflame with indignity and fury. They need a place to rage where they don't have to be polite or politically correct, where they don't have to hold back their feelings to spare anyone else, where they can just let it all out.  They need to work through their anger so that it is not all-consuming anymore, so they can take that rage and turn it into passion for a cause.  Journals are great for this; many women are really able to let loose on paper, knowing that this does not have to be shared if they don't want to do so, and knowing that there is no need to censor themselves there.  Other women find release in email lists like Birth Rage [see above], where they can rant freely and without reserve, and where their rage can be supported and affirmed.  

More often, however, women do not feel comfortable with their anger.  They try to rationalize it, deny it, or try to push the feeling away.  They apologize for being angry, or feel guilty about it.  Many women have great trouble expressing their anger at first, whether out loud, privately in a journal, or even admitting it to themselves.  These women need time and space to start accessing these feelings gradually, to slowly wend their way towards acceptance of the full scope of their feelings.  Sometimes the feelings come flooding out in a breakthrough moment, and sometimes it takes a slow and methodical chipping away at the barriers that keep us 'reasonable' and 'civilized' and 'nice.'  Whatever way works for you is just fine; the point is not how you get there, but going through the process and getting there.  

One way to process your anger is to write a letter to your provider (or whomever you might be angry with about your birth).  Be as angry and as frank as possible at first; rant and rave and spew obscenities to your heart's content.  Get it all out; forget self-censorship or diplomacy.  Later on, if you wish, you can re-write the letter in a more calm and rational tone, and if you choose, you can even send it eventually.  Sending a letter to your provider is not mandatory for healing, but for some women it can be helpful.  Other women prefer to take their letters of anger and ceremonially burn them.  

If you are having a hard time accessing your anger, do the process the other way around.  Start by writing the letter formally, like you would if you were going to send it.  Express things in a business-like tone, or even write in the third person if you wish.  Then re-write the letter again, this time allowing yourself to use a bit more loaded language, being a bit bolder in expressing dissatisfaction, and maybe slip in a swear word or two!  Then keep coming back to the letter periodically as you work on other healing exercises, and each time try writing it in more direct terms, with more emotion and more freedom of expression.  

Eventually, work towards letting loose with the full force of your anger.  Swear, curse, rant, rave----whatever can help to get the poison out of you.  Madsen suggests, "Uncensored letters are a potent release of the crevices and blocks of lead that are inside of a woman after a negative, disappointing, or traumatic birth.  Visualize the energy of the pain, anger, or other strong emotion flowing down the fingers and out the tip of the pen, onto the paper where it will now reside."  

Unexpressed anger eats you up inside.  Don't worry about being 'nice' or being a 'good girl.'  Even if you don't think that you are angry, take time to try and explore and see if there is any anger, even weak and muted.  Chances are, you will find that there are depths to the feeling that you didn't even know were there.  Although it may take time to access them, getting those feelings expressed can unchain your insides and free your soul in ways you didn't even know you needed.  

And remember, anger is a powerful emotion, one which can give real gifts.  Madsen writes:

Anger is the most power-producing emotion.  It fuels an individual to take action, make changes, plow through mountains if she desires.  It's as though invisible hands push and pull, as though strong wind blows through her, and she learns to appreciate the raw force.  Anger, once turned inward and now flowing outward, creates a whole different perspective.  

When I am angry about being mistreated, I have the energy to change doctors, day cares, relationships.  It enables me to say what I want, gather materials or information together, and decide to stay or leave.  Whatever action needs to occur then occurs.  Anger is a gift of energy.  

Find your anger, and then let yourself vent it freely. Explore your anger, and see what kind of other issues are brought up by it. There may be lessons you need to learn from your anger.  Then use your anger to make changes.  In time, you will be able to reach a detente with your anger, and channel it in a positive direction.  Eventually, you will be able to release it too, but the timeline for working through anger is completely your own.  Don't feel rushed by anyone; let your inner intuition be your guide.  In the meantime, feel your anger, and let it do its work for you.  

Express Feelings Creatively Through The Arts

One of the best ways to access your feelings is through the arts.  Often, when journaling is too burdensome or our feelings are the most 'stuck,' the arts can really help us unlock our feelings and gain new insights.  Each person has their own preferred art forms; start with the ones you are most familiar with but don't be afraid to try one that you don't know much about or that you are 'no good' at.  You are not aiming for high art here, you are using art as therapy, and the key to that is silencing the inner critic and taking risks.  Go for it!

Try illustrating your story with artwork that either literally tells the story of your birth, or symbolically represents how you felt about it. Draw a picture of what you looked like pregnant, or what your baby looked like in-utero.  Paint your feelings of sadness, pain, anger, or joy.  Create a sculpture out of children's playdough or beeswax that symbolizes your relationship with your child, with your mother, with your spouse, etc.  If you are not sure how to get started, just get some blank paper and some strongly-colored markers and start scribbling.  Turn off the inner critic; if necessary close your eyes and just start letting your hands wander on the paper.  Sooner or later, your feelings will start to come out.  

Try writing a poem about the birth, and fill it with imagery of your pain and joy.   If you are having a hard time getting started, start by writing down random phrases that come to mind.  Keep a small notebook full of these phrases, and add to them as inspiration strikes.  Soon they will start coalescing together.  Don't try to control it, just let it flow.  Eventually the poem will write itself.

Set your poem to music, and imagine what instruments would be needed to make it sound the way your feelings feel.  Create a piece of jewelry that symbolizes empowered birthing to you.  Make a collage of your hopes and dreams for your next birth, and then post it in a spot in your house where you see it every day.  There are a million different arts projects you could try; brainstorm up the ones that appeal to you.

The arts can help process our experiences in new ways, retrieve emotions that were deeply buried, break through our emotional roadblocks, and access our own intuition for decision-making.  If you are having trouble accessing or processing your feelings or are feeling especially 'stuck,' try doing some birth art, music, or poetry.  Ideas for birth art can be found in the books, Creating a Joyful Birth Experience and Birthing From Within, and examples of birth poetry can be found on www.birthlove.com.  

Acknowledge the Emotional Power of Anniversaries

It is only natural to find the anniversary of a traumatic event difficult.  Women who have experienced pregnancy losses almost always find those anniversaries difficult.  Many women find the anniversary of their cesarean difficult, because it's both their beloved child's birthday and the anniversary of the operation that created so much pain for them.   Whatever it is about the anniversary that grieves you , take time to recognize the emotional power of that time, and to make a plan for acknowledge the grief as well as your child's importance in your life.  

If you have experienced the death of a baby, the anniversary of that loss may always be steeped in sorrow for you. You may also re-experience the grief on other anniversaries, such as the day the baby was conceived, the baby's expected due date, what should have been the baby's first Christmas, etc.  If you are approaching the anniversary of a loss, take the time that day to make room for the grief, and consider some sort of informal ritual or ceremony to help mark the occasion.  Your child was precious and deserves to be remembered, and doing so can help you access and deal with your feelings of pain.  If you need help with this process, consider the visualization on page 166 of Transformation Through Birth.  It is a beautiful visualization of making contact with your child's spirit, finishing unfinished business, and receiving a gift from your child to take with you into everyday life to help the pain.

Even when living, a child's birthday can be filled with grief for the mother. Such a day combines a celebration of great joy with unforgettable reminders of birth trauma. Children's birthdays are often days of rollercoaster emotions.  It is thrilling to see your child mark an important milestone like a birthday, and wonderful to share the joy of this with friends and family.  On the other hand, it is also deeply distressing to recall the trauma of that day, your sorrow for what the day should have been like, and to hide your your pain as you try to put on a happy face for the occasion.  

Madsen notes, "Anniversaries often are more potent than we realize.  They embody uncountable associations that trigger unbidden memories and feelings, desired or not."  She tells the story of her son's first birthday, a day when she wanted to celebrate his birth, but instead felt like she was 'trying to run through mud.'  She felt like all she could do was make the cake and then show up and let others take over.  Afterwards, she felt like the anniversary had been "a heavy storm of rain, thunder, and darkness.  When the day was over, there was a fresh, new scent, the earth was washed clean.  The storm happened, and then the day became clear.  Just like that."  

 She advocates taking time to grieve the birth on the anniversary itself, saying, 

Like an important dream, if attention is paid, the anniversary will do its job and then go its own way...The paradox is that if permission is given to pay attention to and remember the trauma or loss, room is then created for the celebration that is desired...For example, a mother may get up early the morning of her baby's birthday and go through pictures, letters, journals, or her memories, and give the day its due.  Then she can go on to celebrate, less encumbered.

Anniversaries are hard.  Whether it is the baby's birthday, an anniversary of a miscarriage, or the memory of a difficult procedure, anniversaries can indeed be potent.  If an anniversary lies heavy on your heart but you are not sure what to do, try creating a ceremony or ritual of some kind.  Listen to and acknowledge your grief so you can clear a space for joy and other feelings too.

Share Your Experience With Others Who Understand

Although it is possible to heal in solitary, most people find that the process is considerably eased by working through things with the help of others.  Finding someone else who has been through a similar experience is an extremely important part of healing, and telling your story to others who truly 'get' what happened can be transformative.  Many women find powerful healing in post-cesarean/VBAC support groups.  

If possible, find a local chapter of a cesarean support group.  ICAN (International Cesarean Awareness Network)  has chapters available in many major cities, and they often hold regular monthly or quarterly meetings.  Contact information for local chapters is available at www.ican-online.org/chapter.htm.  If ICAN does not have a local chapter in your area, you can consider starting one!  Many women are suffering from unresolved birth trauma, and there are potential members in virtually every community.  

If local support is not an option for you, join ICAN's online email list for support.  Information on joining is at the ICAN website, www.ican-online.org.  This email list is not just for women who are seeking a VBAC, although the majority of the discussion there does tend to focus on that.  It is also for women who are seeking support after a cesarean, seeking information about how to avoid a cesarean in the first place, or seeking information about how to have a more birth-friendly cesarean if one is necessary. 

Other options for support include talking to a friend who truly understands or is willing to listen without judging.  Although many friends and relatives find it difficult to understand our pain, some can understand it or be empathetic enough to listen without trying to 'fix' things for us.  Sometimes you can also arrange to talk to a local independent childbirth educator to try and work through your grief or to ask questions about medical controversies.  These can help fill the gaps in your support network.  

Childbirth educators may also be able to refer you to a therapist in your area that specializes in birth issues.  Although many women are hesitant to seek the help of a birth therapist, women who have been significantly traumatized by their birth experiences find this type of help especially valuable.  Birth issues therapists often know the best techniques to use to help unlock the pain, to help discover what life issues are resonating in your birth experience, and things to do to help begin to heal and move beyond the pain.  For women who are 'stuck' in their grief, preparing for a new birth (especially a VBAC), or who have experienced significant PPD or PTSD, a therapist who specializes in birth issues can be extremely important.   

Don't forget that a vital part of healing is also listening to the stories of other women.  Many women find great relief in reading other women's stories, in hearing other women speak of their own struggles and their own healing, in knowing that they are not alone.  Actively seek out books like The Vaginal Birth After Cesarean Experience (by Lynn Baptisti Richards) and Silent Knife so that you can read other women telling their cesarean stories, what they did to heal, and sharing their VBAC stories.  

Reframe the Experience to Focus on the Positive and Practice Self-Forgiveness

Change the way you see yourself in the birth, and give yourself credit for your own bravery and emotional fortitude.  What did you do well in the birth, and how have you made the experience transformative in your life?  

If you were another person on the outside, looking in on someone else experiencing a similar birth, how would you respond to that woman in need?  What positive reinforcement would you give her?  What kind of cheering gallery would you create for her?  How would you have encouraged her in the experience?  Now turn that around and see you giving yourself those messages.  Give yourself the compassion and understanding that you would have lavished on anyone else experiencing the same thing.

Change your internal messages.  Instead of always focusing on the negative aspects of the birth, enable yourself to see the things that you did do well, the ways in which the birth was good, and positive outcomes that have occurred because of the birth.  Give yourself credit for the toughness to deal with a difficult birth, for the honesty to deal with your feelings truthfully, and the maturity to let yourself grow from the experience.  

If needed, find a way to forgive yourself for it too.  Forgive yourself for responding normally to a lifetime of medical orientation that believes that doctors always know best and should never be questioned, and that drugs and technology always save lives and never cause harm.  Forgive yourself for going along with the very powerful persuasion techniques used on women in labor.  Forgive yourself for whatever it is you are most angry at yourself about, and realize that you did the best you could do at the time.  

Claudia Panuthos reminds us, "For the woman who has delivered surgically, her task is to see that she was attempting to save her baby's life through an act of personal courage.  The surgery is violating enough, without a lifetime of guilt to follow.  Forgiveness and self-acceptance are the path to peace of mind." 

Rewrite the Birth

Once you have found out what the doctors think happened at your last birth and have told your version of the birth story over and over, you are ready for a very effective healing technique-------rewriting your birth the way you wanted it to have gone.  This is often a very emotional but compelling experience, and the healing it brings can be amazingly powerful.  Don't neglect this experience; women who do this exercise often find that it is an amazing emotional release and a very freeing experience.   

Some women write out their re-created birth in exquisite detail.  They may envision their perfect fantasy birth, or they may simply recreate the prior birth, stopping the intervention or complication that led to their cesarean and then changing the ending from that point on.  Women who have experienced an especially traumatic cesarean may need to recreate a 'safe' or 'better' cesarean for themselves before they can really move on to rewriting the birth as a vaginal one.  Other women may need to rewrite their birth experience multiple times, progressing little by little towards a more normal birth each time.   

Respect your process; if this is how you need to re-process your birth, that's fine!  Just keep going and keep re-creating things more and more normal each time; envision yourself more and more empowered each time, and experiencing a more and more loving experience each time.   

Rewriting your prior birth is a powerful healing tool, and it is also a potent step on the way to creating a different and more empowered birth next time.  Sharing that re-created experience with your child can make it even more compelling. 

Hold Your Child and Work Through the Birth with Him

When you are ready, you might want to try the above exercises with the child from that birth.  If you prefer, hold the child while he or she is asleep and whisper to the child how you wanted his birth to be different, your sadness in not birthing him as lovingly and gently as you wanted to, and how much you love and accept the child no matter what.  Then hold the child and whisper to him how you would liked the birth to have gone, how your first moments together would have been, and how your lives together would have started.

Often, women are more comfortable starting this exercise away from their children because it can be so powerful at first.  Some women may want to start by writing a letter, describing how you felt, what you wanted to say, what you wanted to do, and how you wanted your beginning time to have gone.  Or cradle one of your child's stuffed toys as a surrogate for your baby, rock it as if it were your newborn, and re-experience the grief you felt about being separated.  Really access your feelings; suppressing them even partially makes them last longer and become more painful in the long run.  Cry, scream, rage---express however you feel.  Get those feelings out.

Nancy Wainer Cohen shares in Silent Knife that for many women, missing the newborn time right after birth is one of the most painful parts of having a cesarean for many women.  If you have trouble getting started on working through the birth with your child, you might want to start here and work backwards.  The grief of separation is often the most accessible and painful to many women, and an easier place to start.  But it doesn't really matter what order you work through things, just be sure to try and find all the areas that need working through.  

The next step is to go ahead and work through all the details of the birth.  Tell the surrogate baby about ' its' birth and your feelings about that.  Tell the whole story if possible; this is a proxy for your child and you don't need to hold back.  But if you can't do it all at first, do it in layers. Eventually you will work through everything.

It's not uncommon for women to need to do this exercise repeatedly to help get all their feelings out.  Each time they do it, they may end up working on expressing a different emotion.  At first, they may simply need to grieve the newborn time they lost with the baby, and it may not seem right to go through their ambivalent feelings about the birth with their 'baby.'  However, at some point, it is important to go through your ambivalent feelings and express them too.  You may feel uncomfortable or guilty doing this, but if those feelings are there deep-down yet unexpressed, they may end up coming out later on towards the real child instead of towards the stuffed toy.  Use the safety of the surrogate baby to get out those 'less-acceptable' emotions and start working through them. 

One of the most difficult emotions to work through is any anger we have with the child, rational or irrational.  It is not unusual for a mother to feel anger towards her child at a subconscious level for 'causing' the difficult birth experience she endured, even as she simultaneously loves the child strongly and cherishes his presence in her life.  This can be very complex to deal with.  Some people feel that deep-down, babies are aware of their mothers' feelings.  Expressing the anger and ambivalence in a safe way, towards the stuffed toy, can help release those emotions and break down barriers.  It is only natural to want to protect our children from our anger, but suppressing it can cause it to fester and poison our relationships.  Release the anger and ambivalence safely; clear that space so that love and acceptance can take its place.   

As you work through your emotions surrounding the birth and your baby, see what other life issues are brought up.  Oftentimes, the things that give us the most grief reflect issues of great conflict in our lives.  Strong guilt over not having 'been there' for your baby at first may be related to issues of abandonment in your own life, for example, or lack of strong mothering from your own mother.  Reflect on your feelings and see if there are any connections to how you were parented yourself, things that you grew up with, or fears that you have about your own parenting skills.  Often feelings that have the most emotional charge for us are there because of our own fears and issues, and discovering this connection can help release some of the emotional charge.  

Eventually, after a woman has worked through all these feelings in a written journal or with a surrogate 'baby' standing in for their child, they are ready to do this exercise again with the real child.  Some women prefer to do this when the child is awake and can respond (Nancy Wainer bribed her son to do it with her!), and some women prefer to do it with the child while they are sleeping, or some parts may be done with the child awake and other parts with the child sleeping.  Obviously, you need to protect the child; what you choose will depend on how old the child is, what they are ready to hear, how much they can understand, etc. 

Doing the exercise first through journaling or with a surrogate figure helps women get out the 'messy' emotions without fear of hurting their child, and without having to censor themselves for the child's sake.  Getting the feelings all 'out there' also helps release some of the emotional charge so the experience does not become too overwhelming when you actually do it with your real child.  Just in case, though, many women prefer to do the exercise with the child sleeping; the important thing is to do what feels right for you and for the child.  Just remember, though, that working through your birth feelings without and then with the real child can be a very important step that really creates some closure and healing for you and your child.  

When you feel quiet and calm, take the child in your arms or lie down beside him and snuggle him.  Tell him all about his birth in a simple way, and tell him about your sorrow that it happened that way.  Reassure the child how much you love him, and how glad you are to have him in your life.  Thank him for coming to you, and for the lessons he has to teach you.

Then go back and rewrite history.  If you wish, start with the time right after the baby's birth if this is easier.  Nancy Wainer Cohen finds that for many women, recreating the moments right after the birth can be powerfully healing.  She says: 

This is [the woman's] opportunity to recreate her first moments with her newborn baby.  She has the right to redo these moments HER way.  Sometimes, during this visualization, a woman will imagine that she is holding her baby in her arms and talking to him.  She can now tell her baby all the things she wanted to say to him that she didn't have the chance to say before he was taken from her.  She may then wish to share with him some of the thoughts and feelings she hasn't been able to express to him about his birth.

Cuddle your beautiful little one, and be with him just the way you wanted to be with him at his birth.  Snuggle him, cuddle him, stroke him, tell him how much you love him, sing to him, tell him about his family---do whatever comes to mind, what you would have liked to have done before had you had the chance.  

Nancy Wainer Cohen also has two other suggestions that some women find healing:

A mother who has been separated from her baby can also imagine that before her infant is taken from her, she is giving him a special gift.  This gift should symbolize all the love she has for her baby.  She can imagine that her baby reaches out, takes the gift, and cuddles it close to his heart.  We then ask the mother to believe that the baby has the gift with him and that he now feels totally loved, protected, secure , and content as he is taken to the nursery.  Some women feel a need to go out into the world to find the gift, or some symbol of it.  Some happen upon the perfect gift when they least expect to find it.  The truth is that babies DO have their mother's 'gifts' with them during the time they are separated.  

A cesarean mother can also imagine that her baby, in his infinite understanding, has given HER a gift.  This gift is something that symbolizes his love, strength, resilience, and forgiveness.  She imagines that she has held this gift close to her during the painful separation.  And the truth, again, is that the mother did have this gift.  

Finally, when you are ready, hold the child gently and softly tell him the story of his or her re-created birth, the magical experience that you have created for the two of you.  Tell him how wonderful and loving and gentle it is.  Fill in as much sensory detail as possible, and emphasize your emotions and your baby's feelings.  Tell the story to your child over and over again; create a new story for yourselves.  Rock your child, sing softly to your child, caress your baby the way you always wanted to, and enjoy your birth the way it should have been.  Although it doesn't change the past, finding the emotional space of a more loving experience can be powerfully healing to many women.  

Create Ceremonies To Help Process and Heal

Several authors have suggested creating ceremonies as part of the healing process.  Although ceremonies are usually used to commemorate an important occasion or a rite of passage, sometimes ceremonies can also be particularly effective at unblocking "stuffed" emotions or difficult memories, or releasing/transforming old pain.  Jeannine Parvati Baker outlines one possible type of ceremony, a New Age post-cesarean 'transformation ritual' in the book anthology, Trust Your Body!  Trust Your Baby!  

Lynn Madsen gives an example of two such ceremonies in her book.  In the first example, the author herself speaks of creating a blessing circle and story-telling tea after the birth of her first baby (born by a true emergency cesarean).  She gathered all her friends together in a circle, and they exchanged blessings for each other.  Then she told her birth story, "for as long as I wished, with as many details as I wished to tell, and with any expression."  Afterwards, they comforted her and praised her, then everybody sang and sat down to tea and treats.  Madsen notes that she has since told the story many times, but "this first telling was so complete, so well listened to, that its power still remains with me.  Many seeds of confidence were planted.  The power of the spoken words and the meaning of community in which to share them were enhanced."  

In the second example, Madsen met a counseling client in the park, carrying a large roll of butcher's paper, markers, wood, water, and matches.  They built a small campfire (hopefully with permission!) and warmed themselves for a while.  Then she had her client write what she was angry about on the paper, as large as she wanted. The client shared what happened next and her perspective of the ceremony:

At first all I could write...were the words "angry-mad-hate."  Big letters.  Scribbled.  Then, with some coaxing, I wrote "I am angry."  Then I wrote what I was specifically angry about.  Really mad at the doctor.  At all of the parts of the operation.

Then came some harder parts.  I was angry at my daughter...for being born by cesarean.  That was really hard.  I was angry at other people, too.  At my husband, at my parents.  At his parents. All that hatred toward my body, how I wanted to rip myself open sometimes, I drew on the paper. Then I realized I was angry at God.  God should not have let this happen.  God should have helped me more.  God screwed up.  Then I went wild with the markers, scribbling for about six feet.  

When I was finished, I began to tear up all this long paper.  I crumpled it up and watched it burn.  I cried, and realized some things as it burned.  I realized I had not bonded with [my daughter] very much.  That caused great pain, and I was overcome with grief. But mostly I watched the ashes float up and felt free.  I was lighter.  

We watched the fire for a while.  Then, like a baptism, I was sprinkled with water, my hands were washed with water, and I drank some water.  Then we put out the fire.  The whole thing only took about an hour.

There are many ways that women can custom-create their own ceremony or ritual for healing after a difficult birth.  Some people use placenta burials as ceremonies to say good-bye to the pregnancy and birth, and to speak of hopes for the future. Some women write down their birth stories, and take these (plus angry letters to the doctors and other people at the birth) and then burn them.  Some women write down their affirmations and decorate them beautifully, then formally light a candle and declare them, ringing a small bell in between each affirmation.  Still other women have a "Blessingway" to help mourn and heal the old birth while celebrating a new pregnancy and preparing for a different and much better birth. (Information about creating Blessingways can be found online).  

Rituals are part of our lives because they are powerful and highly symbolic.  They can help us process our anger, state our hopes for a new birth and a new baby, heal the past and learn to look forwards to a new future.  Consider creating a ceremony to help processing and healing in your life.  

Find Activities That Help Release Your Emotions, Tensions, and Stress

Get regular exercise as you work through your grief.  Taking care of your physical body is extremely important in starting and maintaining the emotional recovery process.  In addition, many women find that exercise is especially helpful in releasing their emotions.  Although it may be very difficult to find the motivation to get out and get moving, it can really help your body start to express and release hidden tensions.

Although it may be hard to think about great nutrition while you grieve, eating healthfully is an important part of honoring and taking care of your self.  It is difficult to heal emotionally when your physical self is not being adequately  nurtured.  Furthermore, if you are reading this shortly after your cesarean, great nutrition is particularly important as your body works to heal itself, return to normal hormonally, and support a child nutritionally if you are breastfeeding.   Cathy Romeo and Claudia Panuthos stress the importance of nutrition and exercise in starting the grieving process in their book, Ended Beginnings.  

Meditation can also be very helpful in releasing stress and finding and understanding the hidden layers of your pain.  Yoga classes are great for this, and many feature special classes that focus on meditation as well as easy yoga.  If you have trouble quieting your mind enough to meditate effectively, try hypnotherapy or relaxation induction tapes.  These can often help 'turn off' a chattering mind and help you start to focus inward.  

Therapeutic touch is another tool for healing that many women find useful.  Nancy Wainer Cohen states:

A woman is extremely responsive and open to touch after childbirth, much as her infant wants and needs to be caressed...Postpartum women have experienced physical and emotional trauma and desperately need to be touched...In cultures where women are touched and massaged after birth, women experience very little postpartum depression, as we know it...In Western culture, women are not touched, held and stroked in ways that might heal natural postpartum depression, thus prolonging and exaggerating the symptom into a disruptive painful event.  Simple holding, back rubs, foot rubs, massage---almost any loving skin contact---can heal the hurts of childbirth in ways that words can never change nor thoughts alter.

Find a massage therapist that specializes in treating pregnant and postpartum women.  Tell her that you have been through a difficult experience and are in need of some nurturing.  Seek out the types of massage or energy work that purport to assist emotional release; Reiki is one form that some people say can help, and Cranial-Sacral Therapy can also lead to emotional release in some people.  If you have physical or emotional issues with your scar, try gentle massage of the scar, either by yourself or by a therapist trained in working with scar tissue (myofascial massage). Ask your spouse to massage you non-sexually, a little every day.  Find whatever form of touch helps you get in touch with yourself and start to heal. 

Taking care of ourselves while we are grieving can be difficult, but paying attention to nutrition and exercise are basic to recovery. Other techniques such as meditation or therapeutic massage may also help.  Each person will have their own activities that help them release their stress and emotions.  Listen to your body and your intuition; they will tell you what activities are best for you.  

 

Take a Long-Term View of Healing

Emotional healing is often a long-term project. It frequently brings up other issues from your life, or makes you deal with unpleasant memories from the past. Personal issues of long standing are often intertwined with birthing issues; it is usually very difficult to see these at first but time and perspective may enable you to see patterns you were unaware of. Often, issues surrounding your own birth or childhood come up, thorny issues that defy easy solutions or quick platitudes. Abuse, violence, co-dependence, control issues, even dieting and body issues can become intertwined with your healing process. 

Don't expect quick, easy answers; healing usually occurs on a number of different levels, from the simple to the complex, and over a longer time period than you might expect. Sometimes it takes years to gain enough distance and perspective from the event to be able to see clearly the lessons learned in that time. Give yourself that gift of time.

Healing often tends to come and go instead of being one constant journey, too.  You may do some healing and think you are done, but then something triggers your need to deal with the birth again, and you re-encounter the healing process again. The healing process often proceeds in a 'spiral' pattern like this. Often, an anniversary in your child's life or the birth experience of an acquaintance will trigger your 're-reaction', and you find yourself once again asking for more details about the birth, reliving it, second-guessing it, or just re-telling it. This is a totally normal response!  

This pattern is very common among women healing after a difficult birth experience. Don't feel guilty for responding in a normal pattern. Don't wallow in self-pity or allow yourself to hold on to your grief forever, but don't be surprised if total healing takes a long while and occurs in stops and starts. Expect your next pregnancy to also have moments of fear, moments of seeming barriers to a better birth (these are really healing opportunities in disguise!), and moments of significant growth too.  Emotions are very tricky things; they do not heal as cleanly and as straight-forwardly as nerves and tissue and muscle, but they DO heal.  

In the meantime, don't forget to let joy into your life. Madsen notes:

In the aftermath of unexpected birth events, joy is often well hidden, as the pain may be so great it needs to be focused on for a long time.  Knowing that joy is present somewhere needs to be taken on faith.  It will spring out in unexpected ways and places.

 

Considering Another Child/VBACs

Oftentimes, a woman feels that she has largely healed from the cesarean, only to experience a 'relapse' when contemplating another child or at some point in the next pregnancy. This is quite normal. Most women need lots of extra support and understanding at this time, both from her partner and her provider. The fear of another traumatic birth can be very, very strong. 

For most women, fears surrounding more children have mostly to do with whether to choose a repeat cesarean or a Vaginal Birth After Cesarean (VBAC), fears about the pain of labor, fears about a recurrence of a particular trauma, fears about possibly having to go through surgery again, etc.  But for some women, the fear can be so strong that they strongly consider not having any more children at all.  

Considering Whether To Have More Children

Some women are so traumatized by their previous birth that they strongly consider never having more children.  Some women agonize over the decision, not sure if they can risk going through all that trauma again.  Some women  strongly desire to have another child but have a hard time bringing themselves to start the process of getting pregnant again.  Some women are seized by the desire to have another child again as soon as possible in order to make a better birth, but find they are paralyzed with fear from the prior birth.  Other women take a leap of faith and become pregnant again, only to be overcome with anxiety and fears in the middle of that pregnancy as all the memories of the previous birth reactivate again. Madsen states:

Residual fear may be stored in a woman's body, trapped because she won't acknowledge its existence in the first place.  It is too scary to acknowledge the fear, and this keeps the fear alive...A woman may be afraid of a future event based on her disempowering experience during birth.  She may have walked into a hospital confidant and optimistic, then been tied down and had her body violated in many unexpected ways.  Fear is born out of the chance for further abuse, out of future times when she may not have the resources to protect herself.  She is afraid of becoming vulnerable again.  Or afraid of further loss if hers or the baby's health was compromised or if life was taken.  Concrete evidence exists that bad things can happen, not only to her body, but to her precious baby.  A woman fears she will not have the strength to stand up for herself or bear further loss.  

It is completely normal to feel anxious and fearful at the idea of going through a birth like that again!  If you had a really difficult cesarean previously, it's only natural to fear a recurrence, or if labor was the really difficult part, to wish to bypass it entirely and be tempted to go straight to a cesarean. However, this is not healing the fears, only reacting to them and letting them rule you.  

What needs to be done is to CONFRONT THE FEAR and find out what it is exactly that is so scary to you, why it resonates with you so strongly, and then figure a strategy to prevent, avoid, or work through that fear.  The idea of confronting the fear may be very scary, but it is the only way to start healing the pain.  

Just like labor, the way to get past the pain is to go into it and through it, not to try to avoid it.  As the old saying goes, "The pain that I might feel by remembering can't be any worse than the pain I feel by knowing and not remembering."   In other words, your body knows your pain, and deep-down, so does your psyche.  Avoiding the pain only prolongs it, and oftentimes amplifies it.  

Although it is painful to go into the pain and uncover it fully, it is exactly that which heals us. If you don't address the fears, they have a way of coming out in other ways until you pay attention to them and give yourself the healing you need.  Put another way, "What you resist, persists." Your body has an impulse towards healing and health, and if there is a problem, your body will give you stronger and stronger opportunities to work towards healing.  Sometimes, dealing with these issues and fears is hard.  But always remember, "The other side of fear is freedom."  

If you truly want more children, don't let your past birth experience deter you from having more.  Madsen reminds us, "Some women have only one baby because they do not know that healing from trauma is possible or that birth can be different from what they experienced the first time."  

Remember, every birth is DIFFERENT, and this next birth does not have to be like your last one.   You CAN create a new and better birth experience, and you can find healing for previous births.  Don't let the fear trap you, or keep you from experiencing further joy in life.  If you truly want more children, go for it!  You can do your healing as you go.

On the other hand, if you find that you are having trouble taking the leap of faith to start trying for another child, listen to what your psyche is telling you and wait a bit.  Do some work to uncover your real fears and work through them.  You may not get rid of the fear entirely, but you can 'give the fear edges' (as Madsen says), making it less overwhelming and more manageable.  Eventually you will find a space where you are comfortable enough to make that leap of faith and take that emotional risk of trying for another child.   Many other women have been in this "limbo" before and eventually gone on to be ready to have more children.

Considering Whether To Not Have More Children

Madsen also points out that some women have a cesarean in their last planned birth, then face the difficult decision whether to change their plans and have one more child, or to stop with that cesarean as the memory of their last birth.  This decision can only be made on an individual basis, with much consideration of all the various issues and family factors involved.

Some women discover through their grieving process that they really would like to have more children after all.  Others reaffirm that they really don't want to have any more children, and must face the fact that they will probably never get the wonderful birth experience they were really hoping for.  Others teeter on the edge of decision for a long time, not knowing which way to go.  Obviously, this is a very difficult decision, one that many women agonize over.

Ultimately, the deciding factor is that children should be brought into the world because they are WANTED.   Some women are tempted to have more children in order to keep trying for a better birth.  There is nothing wrong with wanting to have a better birth, but it shouldn't be the only reason or main reason you have another child.  If you are unsure whether or not to have more children, ask yourself if your most fervent desire is for a child, and if you want that child so much that you would be willing to birth him/her in whatever way necessary and still be happy that the child was here. 

If what you really want is a good birth experience more than another child, stop and reconsider; babies need to be wanted for themselves.  Don't make the baby responsible for your healing or not healing.  They can be your ally in healing, but ultimately, of course, the responsibility for healing lies within you, and this does not have to depend on 'having another shot at birth.'  

On the other hand, if you truly want another baby (as well as a better birth experience), then by all means, proceed with your plans!  Your baby will be wanted no matter how it is born, and chances are you will have a better birth too.  The desire for another baby is the most important factor (and babies must be loved fully, no matter how they are born), but it is not 'too selfish' to want BOTH another baby and a better birth!  Although there are never any guarantees, you may well get them both.

Women who are absolutely sure that they are done with childbearing do need to grieve and work through a disappointing last birth too.  Just because their personal experience of birthing is done doesn't mean they don't need healing.  Suzanne Arms points out, "Even for many women who, like myself, will never birth again, the task is to heal scars that are still infecting our lives and our relationships...our work lies mainly in self-acceptance."  [from the Forward to Transformation Through Birth.] 

Women who are done with childbearing need to take the time to grieve and process things, just as any other woman does.  It is never too late for healing, even though the healing may take different forms or avenues than for other women. Women in this situation often become birth professionals, natural birth advocates, or work towards changing outdated obstetric policies.  Or they may not be involved in birth issues at all, but may utilize the empowerment they can find in healing birth issues to work for other special causes dear to their hearts (often in advocacy for women's issues or children's welfare).  Still other women use their birth healing to empower themselves and change their relationships with their families or themselves. The work of healing is never wasted; for women who are sure they are done with childbearing, it can help them find closure with their old life and new direction for the future as they enter a new stage in their lives.

Women who are done with childbearing and who are actively working on grieving their births may be especially helped by creating a ceremony that symbolizes the end of their childbearing years, and their new focus on future challenges and joys.  Rituals are often a key to closure and healing; the cesarean healing ritual described by Jeannine Parvati Baker in Trust Your Body! Trust Your Baby! could easily be adapted to ritualize and heal both the prior cesarean birth and the end of the woman's childbearing years.  

Whatever you decide about whether or not to have more children, healing is available to you.  It does NOT depend on having another birth, having a VBAC, or having the 'perfect' birth.  You can grieve your past births, find a way to come to terms with them and accept the lessons in them, and move on with your life, whether or not you have more children and whether or not you ever have a VBAC.  Have faith in yourself; healing and peace is available to you no matter what. 

Other Difficult Issues Surrounding Future Pregnancies

Deciding whether or not to have more children is not the only difficult issue women face after a cesarean; other issues offer very  bittersweet choices too.  For example, women who struggle with fertility issues may want to have more children desperately, but face the uncertainty of whether they'll be able to conceive again, let alone have a better birth.  Other women may strongly want a normal birth but because of medical circumstances or restrictive policies, may not be 'permitted' to have that birth.  These are difficult situations with no easy answers.

Women with fertility issues may indeed face significant difficulty getting pregnant again. These women may want another baby (and a better birth) badly but be unsure of whether that can actually happen for them.  They may have to face the possibility that their past lousy birth may be their last (or only) experience.   This is a triple load of grief to carry---dealing with the grief and frustration of infertility, the grief of a prior difficult birth, and the difficulty of not knowing whether they will have another birth experience at all, let alone a good one.  

Unfortunately, no one can guarantee that you will conceive, although many women do conceive more easily after their first child is born.  Only you can make the decision whether it is appropriate to try again.  However, please know that many women with past infertility concerns have gone on to subsequent pregnancies, and are often able to improve their birth experience significantly.  Grieving infertility and associated issues seems to be quite important in this process, but remember that this grief work is important to do whether you conceive again or not.  Infertility is a difficult burden, but it too can be grieved, worked through, and healed in its own way, whether or not you have additional children.  Healing does not have to depend on having another child. 

For other women, medical circumstances may dictate that they may never get to choose to birth naturally.  For example, some women have medical conditions (like complete placenta previa) that preclude natural birth, or their providers do not support vaginal birth for them because of some aspect of their medical history or pregnancy.  Other women are barred by current medical policies from even trying for a VBAC, and find themselves between a rock and a hard spot regarding birth choices.  Because of the current VBAC backlash in this country, many providers are placing more restrictions on who is 'permitted' to 'try' for a VBAC, or the mother may be unable to find a provider or birthingplace that will accept VBACs in her situation.  

This is certainly a very difficult situation, one with special implications for grieving.  First, mothers can choose to investigate and question whether it is really true that they should not birth naturally.  In some cases, they may find another provider with different practice standards willing to help them.  In other cases, they may choose from a place of personal power to assume any possible risks and try anyway, or they may choose to circumvent traditional birth settings and practices in order to avoid restrictive rules and interventions.  Many women who have found the door to VBAC closed to them at first have found a way to open a window elsewhere. Don't give up too soon; question the policies that limit you and investigate every possible option available to you, even the ones that seem outlandish at first.  Do the research and check out all your options; you can decide whether you are comfortable with those choices once your research is complete.

Unfortunately, other women may truly have no choice about their manner of birthing.  The sad truth is that sometimes unexpected things happen, or situations arise that cannot be resolved as we desire.  Sometimes, people make stupid rules that restrict us, and while we would like to rebel and reform things, it is not always possible or practical to do so.  Sometimes we simply have to concentrate on what good can come from the situation, and concentrate on fulfilling our needs and our babies' needs as much as possible.  Be as angry as you need to be and grieve the rotten situation that prevents you from having your desired birth, but don't let your anger rob you of what good there can be, too.  

If you must have a required cesarean, work to make it as empowered and loving as possible for your baby and you.  Remember, this is your baby's only birth; help him have as beautiful and welcoming an experience as possible.  Cesareans don't have to be cold, unfeeling experiences.  Women faced with repeat cesareans have managed to make them more of a loving, warm, and even joyous experience.  It may not be quite what you wanted, but it doesn't have to be horrible either.  It's trite but true---when life hands you lemons, make lemonade.   Make the surgery into a birth, and find ways to make it a special day for you and your baby.   

Although this is an extremely challenging situation and no words will magically fix it, it does not mean that there is no healing to be had.  As women grieve the real and significant loss of their desired birth, they should look also at what other life issues may be brought up to them.  It may be that the loss of their desired birth brings the opportunity to deal with other important issues, and that the loss in one area will help bring healing to another. Or it may be that they will find their healing through becoming birth advocates, working to change backwards policies, or helping other women through their pregnancy journeys.  They may not get the outcome of their dreams, but it doesn't mean that healing is impossible.

Sometimes life is hard and offers difficult choices, but healing is always available.  Anger and bitterness at the unfairness of life is a normal response, but if we remain there forever, it poisons us and our relationships with our children.  Eventually grieving and reconciliation of emotions can still occur, and reaffirming of the body can happen in other ways.  How can only be determined by each woman individually, but many of these women do eventually find healing.  Few go unchanged by their grieving process, but they don't have to be destroyed by it either.  Healing is still possible; it may just take a different form or path than they expected. 

The Importance of Emotional Preparation for Birth After Cesarean

After a prior birth by cesarean, women face many difficult choices.  They must decide whether to have more children, and if they decide to have more children, how they will have those children.  Some women's choices are limited because of medical circumstances or restrictive policies, which brings its own kind of grief.  Other women must face the difficult dilemma of whether to choose an elective repeat cesarean or a Vaginal Birth After Cesarean, and all the implications of that decision.  All women must face the memories of their previous birth(s), and the difficult life issues that may be brought up by those memories.  

All of these situations are challenging, yet all can lead to healing.  If you decide not to have any more children, it does not mean that healing is impossible for you, only that it may take a different path.  If you decide to have more children, healing may come as you work through the difficult care decisions that you face, and as you work towards having a better birth experience.   Whatever you choose, it is important to grieve your prior birth(s) as needed, examine your life issues and beliefs, and prepare emotionally for whatever your next stage may be.  

If you do choose to have more children, it is very important that you do your 'emotional homework' for that pregnancy.  Doing an emotional housecleaning can create closure for your last birth, and help clear a space for next time.   Whatever your choices are, making thoughtful, conscious birthing choices that come from a place of healing and peace instead of a place of fear and trauma can help create a much more satisfying pregnancy and birth.

One of the most difficult decisions women face in a pregnancy after cesarean is the decision between Elective Repeat Cesarean Section (ERCS) and Vaginal Birth After Cesarean (VBAC).  If you are very unsure about whether to choose VBAC or repeat cesarean, Penny Simkin (author, doula, and childbirth educator) suggests that you address the trauma of your last birth before making the decision.  Chances are that starting the grief work will point out your critical issues, identify your fears, and help clarify your decision for you. 

Even if you choose or are required to have elective repeat cesarean, it can still be very helpful to work on grieving the last birth and doing emotional preparation for the next birth.  This can help you make the next cesarean different and more empowering than the last.  For example, a mom who had a very traumatic labor, general anesthesia, delayed access to her newborn, and trouble breastfeeding may find that it is most important to her to be awake for her birth, to have protocols that promote breastfeeding success, and to ensure plenty of bonding time with the newborn.   Because she has started to deal with why her prior cesarean was difficult for her, she can work to change things next time.  

If you decide to choose VBAC, it is especially important to prepare emotionally as well as physically for that choice.  Lois Halzel Freedman stresses this in her practice, saying:

Pregnancy can trigger intense feelings of anxiety, anger, or guilt that have not been sufficiently resolved following the previous cesarean.  Because women do not usually deal with their feelings shortly after a cesarean section, I find that when preparing for a VBAC, they are often ready for and in need of grieving before the next birth.  Processing the emotional aspects of their previous birth experiences can be an important part of their preparation for the subsequent pregnancy, labor, and postpartum period.  

Understandably, women pursuing a VBAC often have a lot of resistance to VBAC preparation for fear they will "fail again."  I assure a client that she did not fail; rather, she did her best under the circumstances...She may have trouble believe that her body is capable of giving birth naturally because she has not yet experienced it.  Some women state that they are disappointed in themselves because they could not cope with the pain of labor.  A woman may be urged to "just listen to the doctor" by close family and friends, which leaves her feeling alone with her decision to attempt a VBAC.  Many women striving for a vaginal birth after cesarean feel ambivalent about committing to and obtaining support for it.

Most women who choose VBAC for their next pregnancy benefit greatly from doing emotional preparation for that choice.  They usually need to work through again what happened to them in their previous birth(s), grieve the difficult parts of their experience, and work through their anger and disappointment over the birth.  They may need to work on bonding issues with their prior child or with the present baby in utero, or they may need to work out issues of support and childbirth decisions with their partner.   

One of the most pressing issues that most women really need to address is their fear over problems recurring again in the next pregnancy.  This is an extremely common fear; afterwards, some women discuss feeling that in a way they were giving birth to two babies at once----their past baby, and this baby as well.  This may be about fears of recurring problems, and either avoiding or resolving those problems more positively this time around.  Or it may be about 'clearing' and resolving the prior birth as part of the process of the birth of the next baby.  

It is important to start the process of emotional preparation for VBAC early.  Working on it before the next pregnancy even begins or early in the next pregnancy can help in clearing a space for a new and different birth to take place. If you do not start until late in the pregnancy, there may not be time to fully work through all your ambivalence and fears before the birth occurs.  Although it is never too late to start emotional work for a VBAC, it is most helpful to start it sooner rather than later, if at all possible.

Whatever you choose, however, emotional growth and healing is possible after a cesarean.  It is important whether or not you have any more children, whether you have another child and choose a repeat cesarean, or whether you have another child and choose to go for a VBAC.   Take the time to listen to your inner voice, grieve your sorrows and losses, examine your life issues, and work through your emotions.  Difficult as this work can be, it is the path towards healing and ultimately, greater peace.  

 

Repeat Cesarean or Vaginal Birth After Cesarean

Vaginal birthing has the potential to produce more emotionally satisfying birth experiences with less recovery time and more natural energy for beginning the long-awaited mother-child connection.  Because recovery demands less energy, women are more able to integrate and process the experience of birth and perhaps heal any remaining emotional and, in some cases, physical conflicts.  Claudia Panuthos, Transformation Through Birth

After a prior birth by cesarean, one of the most difficult decisions is making birthing choices for the next pregnancy.  As noted above, some women do not have a choice, and that can bring significant and very real grief.  Other women, however, can choose between Vaginal Birth After Cesarean (VBAC) or Elective Repeat Cesarean Section (ERCS), and the difficulty of that choice brings its own dilemma. 

Each choice carries with it certain benefits and risks. At this time, the choice is also a very political one, as there is currently an anti-VBAC backlash, with many doctors placing more restrictions and using more scare tactics on women who want VBACs. Yet rarely do these doctors also fully discuss the risks and future implications of choosing a repeat cesarean, either.  

Whether the mother chooses VBAC or ERCS, the emotional implications of the choice abound.  Our high-tech society tends to see ERCS as the "easy" choice.  It says a lot about our attitudes towards birth that recovering from major surgery is seen as "easier" and more desirable than going through labor, and that having a baby normally is seen by some as the 'riskier' choice.  A cesarean is hardly seen anymore as the MAJOR abdominal surgery that it is, and people have become very casual about its occurrence.  

Yet the choice for a VBAC is not an easy one either.  The scare tactics and distortion of facts by doctors and the media have scared many women away from considering it, and those who do are often accused of being 'selfish' for wanting a decent birth experience and no surgical recovery afterwards.  On the other hand, the convenience of scheduled cesarean birth is enticing to some women, while others may have factors like abuse in their backgrounds that make them uneasy with the idea of vaginal birth.

An exaggerated fear of labor is a strong motivator for some women to avoid a VBAC.  This is especially true of those who have been through a long, painful, and difficult labor.  The most painful labors are often due to inductions that don't work, labors that have been artificially augmented with powerful drugs, and often those with baby malpositions.  Women who have been through really tough labors like these remember labor only as being a long hellish ordeal, and are understandably not eager to go through that again.  They don't realize that it is the drugs (or malposition) that cause the abnormally difficult pain, and that most naturally-occurring labor is not nearly so difficult.  

Many of these women choose to have an elective repeat cesarean because their greatest fear is to go through an ordeal like that again, and they hope to avoid the problem by bypassing labor entirely.  Their strongest motivation is to avoid any possible repetition of the previous birth, and they accomplish this by simply scheduling surgery from the beginning. In reality, all they may need to do in order to create a different labor is avoid the induction/augmentation drugs and hire a less-interventive provider.  Yet even knowing this, many women find it difficult to trust that things can be different from before.  

Because many physicians subtly or overtly encourage repeat cesareans (which are easier for them logistically and legally), a very high percentage of women choose a repeat cesarean instead of VBAC.   Unfortunately, many doctors fail to fully inform these women of the substantial risks also involved in repeat cesareans, and the women do not make their choice from a fully informed point of view.  

This FAQ is not the place to discuss extensively the relative risks and benefits of VBACs or Elective Repeat Cesarean Sections (ERCS); more information on this choice can be found elsewhere on this site and online.   A brief summary is presented here to familiarize women with the subject; references for this information can be found elsewhere on this website and at the ICAN website, www.ican-online.org.  Women are also strongly encouraged to do more in-depth research on their own as well.  

Keep in mind that when most doctors and media reports discuss VBACs, they emphasize only the risks (which are fairly small) and ignore the benefits.  Furthermore, almost all fail to discuss the real risks associated with repeat cesareans.  When making your decision, it is VITALLY important that you consider not just the risks of VBACs, but also the risks of repeat cesareans too.  

Summary of Risks and Benefits of VBAC and ERCS

Successful VBAC is clearly associated with the best overall outcomes for mother and baby.  Study after study show those women and babies who have a VBAC fare much better than those who had an ERCS.  They recover faster, have less bleeding, less infections, less postpartum complications, and fewer problems in future pregnancies.  Their babies have fewer breathing problems and future pregnancies have fewer problems with the placenta that place both mother and baby at risk. 

However, there are risks associated with VBAC.  The subset of women whose trial of labor ends in another cesarean have a higher risk for infection.  And of course, the risk OBs emphasize the most is uterine rupture, which in rare cases can lead to a hysterectomy, maternal death, and damage or death for the baby.  However, although these risks are real and not negligible, the risk is relatively small, and is offset by the fact that babies born to women with 'successful' VBACs do better overall.  Since about 70% of women who try for a VBAC have one, there are clear overall benefits to having a VBAC 'trial of labor'.   

Although uterine rupture can occur even without a trial of labor, having a trial of labor probably does raise a woman's risk for rupture somewhat.  Exactly how much is unclear, because recent studies have shown that induction and augmentation drugs used to stimulate a woman's labor artificially also strongly increase her risk for uterine rupture.  Even so, uterine rupture is a relatively rare occurrence; approximately 0.4% - 1.0% of women with a trial of labor experience uterine rupture.  By strongly emphasizing spontaneous labor and no labor augmentation, it is likely the uterine rupture rate can be reduced.  Although data on rupture during spontaneous labor is limited, it is probably about 0.4% or so.  

Women should also realize that when rupture does occur, it usually does not result in catastrophic outcome; most women who experience uterine ruptures do not need a hysterectomy and their babies are just fine.  Although doctors emphasize the worst-case scenario, rupture does not result in death or disability in most cases.  This does not mean this risk should be dismissed, just that it should be kept in perspective.   The risk is not negligible; it is real.  However, most babies in rupture cases do turn out okay.

Although some doctors suggest avoiding a trial of labor (TOL) entirely because of the small risk for uterine rupture or infection after a  'failed' trial of labor, the best response to these risks may instead be avoiding the protocols that increase these risks.  This may include avoiding drugs that increase rupture risk, to be more watchful for and respond more quickly to rupture if it occurs, to minimize procedures (such as vaginal exams) that are known to increase infection risk, to be very proactive about preventing infection if a TOL cesarean does occur, and to study ways to raise  the rate of VBAC success so that more women receive the better outcomes associated with successful VBAC.  

Some women choose Elective Repeat Cesarean Sections because they are afraid of the potential risks of VBACs.  However, ERCS also clearly present substantial potential risks which tend to be glossed over.  Uterine rupture is still possible even if a TOL is not chosen; choosing an ERCS does not 'guarantee' avoidance of uterine rupture. Fetal respiratory problems, both temporary and long-lasting, are clearly much higher with elective cesareans.  Maternal morbidity (infections, hemorrhaging, postpartum complications, scarring, adhesions, long-term pain, ectopic pregnancy, and possibly infertility) is also clearly higher with ERCS.  

But the risks of multiple cesareans are most clear if a woman desires more children; each successive repeat cesarean raises the risk of abnormal placental implantation or abruption in the next pregnancy, and this can put the lives of both baby and mother at risk in the future.  There are cases where babies have died or nearly died because of placental problems like these, and the risk for these problems rises with every cesarean that occurs.  In addition, there are also cases where the mother has died because of massive hemorrhaging after abnormal placental implantation from multiple repeat cesareans.  In addition, research shows that emergency hysterectomies are more likely to occur because of repeat cesareans than because of uterine rupture during VBAC.  

Although doctors frequently mention the possibility of maternal or fetal risks from a trial of labor uterine rupture, they conveniently forget to mention that disastrous outcomes have also been associated with ERCS.  Repeat cesareans are often presented as being without substantial risk, and as being much 'safer' than a VBAC.  However, a closer look at the data shows that neither choice is without risk, and that ERCS also present substantial risks, especially if you desire more children in the future.  

However, just as with VBACs, the risks of ERCS must also be kept in perspective.  Great strides have been made over the years in making cesareans (especially elective ones) safer and less traumatic, and there are things that can be done to minimize infections and other morbidity.   In addition, although the risks for placental abruption or other abnormalities are substantially increased, the majority of women who have multiple repeat cesareans do have healthy pregnancies and healthy babies.  

In other words, the reality is that the risks from both VBACs and ERCS, while real, do have to be kept in perspective.  Both have potential for catastrophic consequences, and these risks are real and must not be regarded lightly.  But even so, the actual occurrence of problems associated with either VBAC TOL or ERCS are low, and the vast majority of women who chose either a VBAC or an ERCS will be just fine either way.  

No choice is risk-free; once you have had a cesarean, you are somewhat more at-risk for problems of all kinds, whether or not you choose to labor or not next pregnancy.  This is why it is SO important to avoid unnecessary cesareans in the first place!  It is the PRIOR CESAREAN that puts you at risk in the next pregnancy, whatever you choose next time.  

Although it is obvious that Kmom's preference and personal choice was VBAC, it must be emphasized that whatever a woman chooses should be respected.  Kmom simply urges that this choice be made from a well-informed point of view, and after careful exploration of fears and pertinent issues.  Please don't make a knee-jerk decision based on fear from the trauma of your last birth or overhyped fears from your doctor or the media; carefully examine and work through your fears and concerns in order to arrive at your decision from a place of peace instead of from a place of fear.

Choosing a Provider for a VBAC

If you choose VBAC, it is extremely important to choose a provider that is totally supportive of VBACs, has a high success rate with them, and is totally committed to helping you have one. Many health providers pay lip service to VBACs but in reality are lukewarm to them and place so many constraints on them that they never have a real chance for success. 

It is VITALLY important to carefully research and understand VBAC issues and choose your provider accordingly, not just automatically select the provider you had last time. You must also be willing to consider switching providers should they seem to be supportive at first but show doubts, place constraints on your labor, and suddenly propose interventions late in the process. Unfortunately, knowing how to help and not hinder a VBAC is still not well-understood by many practitioners, and the economics still strongly encourage interventions, inductions, and repeat sections. So choice of provider is an absolutely critical issue in VBACs.  Claudia Panuthos echoes this, saying, 

VBAC couples must be even more careful than others in their choice of physician and place of birthing.  Since we have recognized that fearful beliefs about birth contribute to Cesarean deliveries, having a physician who is 'willing to let you try' is not good enough.  Old beliefs are easily activated under stress, and birthing (especially VBAC) women need more than just allowance, they need support and genuine confidence.

Many hospitals still...consider [VBAC] mothers as having a 'trial of labor.'  The VBAC mother needs acknowledgment and support, not criticism and judgment.  She and her uterus are not---must not be---on 'trial.'   

It is not enough just to have a provider that seems supportive about VBAC, either.  The provider must also be respectful of your feelings, supportive of you as a person, and not just treat you as a baby incubator. Although of course their first priority is going to be on maternal and fetal well-being, they must also have respect for the role that a birth experience plays in the emotional life of a woman, and have a strong commitment to helping this birth experience be as positive as possible, no matter what.  Panuthos also emphasizes the importance of a respectful provider:

As women, we are responsible for whom we bring into our lives and into our birthing rooms.  Hopefully, our choices will honor and respect our birthing process and our human dignity...[You] should only seek [providers] who treat you decently and with dignity in all matters.  Otherwise, you are bringing to your child's birth an energy that does not believe in you, that anticipates failure and defines you as incapable right from the start.

An excellent guide to questions to help you select a good VBAC provider can be found in the book, The VBAC Companion, by Diana Korte (available from www.amazon.com). This book is a must-read for anyone trying to decide about VBACs. Another good book is Natural Childbirth After Cesarean (available from La Leche League, www.lalecheleague.org). Online, the International Cesarean Awareness Network, www.ican-online.org has information about selecting a provider, too. 

Another resource can be Vaginal Birth After Cesarean by Dr. Bruce Flamm, one of the leading medical researchers into VBAC issues, although a few of its recommendations are outdated or a bit conservative since it was written a decade ago, fairly early in the medical movement towards VBACs. However, if you or a family member need to see a book written by an M.D. in order to feel more comfortable about VBAC, this may be a helpful book to you.  

It is also worth noting that there is currently a backlash from the medical community about VBACs and there is a lot of rhetoric in the air, so it may be more difficult to find a truly supportive provider right now. After the current backlash runs its gamut and careful study is made of the issue, Kmom is convinced that history will bear out that VBAC is the best choice for most women.  In the meantime, though, this backlash can make finding a provider truly supportive of VBAC extra frustrating.  Yet this search and this struggle is often very important in a woman's growth and empowerment towards a better birth.  Lois Halzel Freedman notes:

Giving birth can be an empowering experience in a woman's life because she and her partner have the opportunity to make important choices that influence the outcome of this significant life event.  They are able to research and select the childbirth educator, health care providers, and the people who will support them during and after pregnancy.  Couples become confident by gaining information and working for the birth experience they want for themselves.  A woman needs encouragement to look to her inner resources...She has many of her own answers.  

Although finding a truly supportive and non-interventive provider can be challenging, the process of educating yourself,  looking inside for guidance, and searching for a compatible provider is a vital and dynamic part of preparing for a different and better birth. Don't let the process get you down; consider it part of your process of empowerment! 

More information about VBAC can be found in other FAQs on this website, at the ICAN website, and at many other websites.  There are many terrific resources for VBAC besides the books listed above; you can find Kmom's favorites at her FAQ on Great VBAC Resources.  Kmom urges women to do a lot of reading and exploration of resources as preparation for choosing their providers; these resources really can be very helpful.  

Avoiding the Pass/Fail Mentality

VBAC should not be viewed as a 'pass/fail' test. Women can face great stress from having an 'all or nothing' attitude towards their next birth. This can be an emotional sand trap.  Don't view birth from a "success/failure" paradigm.  Panuthos cautions:

It has also been our experience that Cesarean mothers tended to seek perfectionism in themselves in many areas of their lives and had been extremely hard on themselves when goals were not achieved...VBAC is not the primary goal but rather is secondary to maternal well-being---mentally, emotionally, physically, and spiritually.  Well-being cannot be found in perfectionistic demands, even if the goals are good in and of themselves.  Physical surrender is much easier when the body's performance is not the criterion for self-love.

Any woman, no matter how normal her pregnancy and labor is, faces a small chance of an unexpected c-section, no matter what. It is not possible to completely eliminate this possibility; a placenta may abrupt (separate from the uterus prematurely) or a cord may prolapse, etc.----all truly life-threatening occurrences that are best served by a cesarean. 

In Kmom's opinion, a woman should work towards a VBAC with everything in her power and expect it, but also have a birth plan for a c-section, should one become necessary at some point. It is better to be prepared for a just-in-case scenario, and there are ways to help make a c-section experience a more natural, healing, and wholesome birthing experience instead of just a cold, clinical surgery. In all likelihood, this part of the birth plan won't be needed, but if it is, it is possible to still have a decent birthing experience, if not precisely the one you most preferred.  Being emotionally prepared for any eventuality is an important part of the healing process.  

A VBAC is not an 'all or nothing' proposition.  The outcome is not as important as the journey is.  You are a wonderful person and a loving mother no matter how you give birth, and you always will be.   To reiterate Panuthos, don't make the body's performance the criterion for self-love.  

Conclusion

Choosing between VBAC and ERCS is a very difficult choice.  There are so many factors to be examined, risks to be weighed, and fears to address.  In addition to the rational aspects of choosing, however, is the emotional influence of a woman's prior birth, her basic birth beliefs, and her life issues.  Some women choose the mode of their next birth in reaction to the trauma of their last birth. Other women choose based on their birth fears or unresolved life issues. Sadly, some women don't get to choose at all.

Taking time to work through your emotions can often help you decide what to do if you are unsure.  It can help you recognize the issues that may have influenced your prior birth, work though and change those beliefs if desired, identify the expectations that are most important to you, and create a plan to help meet those expectations.  Even if you do not get to choose VBAC vs. ERCS, you can still work through your emotions about this and make choices about the things over which you do have control.

Taking the time and space to work through your emotions can help you clarify which decisions are right for you. Whatever a woman decides, the most important thing is to find a way to make each birth BETTER, and every woman must personally decide what exactly this entails for HER.  As Panuthos says: 

The real question is...'Can you love yourself no matter how you birth, where you birth, or what the outcome?'

 

Preparing for the Next Birth

Once you have decided that you are ready to take that leap of faith to have that next baby and have made some choices about how you want that birth to happen, you are ready to get down to business and do some of the hard work of preparation.  Note that while many of the choices listed below refer to planning for a VBAC, some could also apply to those planning a repeat cesarean.  

Remember, your aim here is not to create rigid prescriptions about the way that next birth must be, but rather to work towards setting some priorities, working through the pain of the last birth, confronting your fears about next time, finding ways to make things different as much as possible, and visualizing many different ways of empowered birthing.   

Gather Information to Help Understand Your Experience and to Make Changes for the Next Birth

Research childbirth issues to help better understand the decisions that were made in your birth and the choices you face next time.  Read books about childbirth from a variety of perspectives, so that you see all the various choices and consider important issues from a variety of points of view.  

Good books about childbirth issues include Obstetric Myths vs. Research Realities or The Thinking Woman's Guide to a Better Birth (both by Henci Goer), A Good Birth, A Safe Birth (by Diana Korte and Roberta Scaer), Immaculate Deception II: Myth, Magic, and Birth (by Suzanne Arms), The Complete Book of Pregnancy and Childbirth (by Sheila Kitzinger), Birthing From Within (by Pam England and Rob Horowitz), and Birth as an American Rite of Passage (by Robbie Davis-Floyd).  

After you have read some of these books, go back and re-examine your last birth.  Go online and discuss any questions you might have with others in support groups such as the ICAN mailing list.  Decide how you could have changed things, or how you might change things in the future.  Then consider ways that can help your next birth different than your previous birth, no matter what.  

Work To Clear Your Prior Birth

Whenever possible, it is extremely helpful to start clearing and healing the prior birth experience(s) before the next birth.  Oftentimes, women find that the specter of the last birth tends to impede on the next one, unless healing has taken place and a space has been cleared for the next birth to be different.  Madsen notes:

Previous births are a part of a woman's history, and will influence an upcoming birth more than she expects...Recognition of unresolved, buried, or traumatic issues is a valuable tool with which to go into labor.  Then at least one knows which dragons are being fought, and the barriers that block an effective labor can more easily be broken down.  Pregnancy is a good time for sorting, healing, and building strength with whatever building blocks remain from a previous birth.  Associations from the past pregnancy, labor, and delivery emerge, and if a woman acknowledges them to herself with someone she trusts, she has a better chance at changing her history.

Think about your fears of your past birth repeating itself.  Many women find that they are very concerned that the same problem that happened last time might recur again.  Working through that fear and identifying proactive steps that you can take to help avoid a recurrence if possible can be very helpful.  Sometimes an issue does arise again, which may be an opportunity to fully resolve the issue that happened before in a more positive way.  If an issue or complication arises again for you, see it for what it is---an opportunity for resolution of the last birth as well as this one. 

In Vicki's story (see below), she refers to the fact that she felt like she was giving birth to two babies at once, one from the past and one from the present.  Be aware of how this might impact your next birth, and don't forget to let people around you know of your concerns so they can be aware of possible patterns, repeating concerns, etc. and help you work through them next time.

Jeannine Parvati Baker points out that many midwives feel that, "The laboring mother must psychologically give vaginal birth to the surgically removed baby before she can deliver her present baby spontaneously...Whatever dynamic was involved in impeding the previous birth is still present until it is understood---is forgiven."  Going through the exercises explained elsewhere can help you figure out what truly happened in the previous birth, access your feelings about that and work through them, and then mentally 'rebirth' your prior child the way you would have wanted to.  This puts some closure on that birth, and helps finish that chapter in your life so that you are more ready to move on to a new one.

Andrea Frank Henkart points out, "It is important to remember that you are not the same person this time around.  You are already a mother and the previous child has prepared the way for this one to be born...Take active responsibility in this labor and delivery.  Anything you and your birth assistants can do to assist you in moving from a 'stuck' place into a less fearful, more powerful feeling within your body and mind will be beneficial."  

Although it is not absolutely imperative to work through every feeling before you give birth the next time, it really can be helpful.  Make every effort to do as much work as you can on the last birth so that the next one can be different.  Remember, both your past baby and your present one are your ally in healing.  They can help you find your way towards healing and peace.

Differentiate The Next Birth From the Last One

It's usually very important to make the next birth as different as possible from the last birth, both physically as well as mentally.  Changing the physical circumstances of your next birth is helpful in reminding your psyche that this birth is fresh and all-new, and concentrating on the differences between pregnancies and births can help your brain feel freer to create a new ending this time.

Therefore, most VBAC experts recommend that you find a new provider and a new place for birth, change the people around you, hire more (or different) labor support, envision new positions to labor and birth in, go to a different childbirth education program, hire a birth therapist, join a prenatal yoga class, get more exercise, practice more careful nutrition------do everything you can do to make this pregnancy and birth as physically different as possible from the last one.  

Many women are very reluctant to do this.  They want a different birth, but hire the same doctor as last time, go to the same hospital as last time, surround themselves with the same people, etc.  Lois Halzel Freedman writes about  how important it was for her to find a new provider, "[One] willing to begin from the premise that my body was strong, healthy, and capable of giving birth naturally."  She also notes, "It is generally preferable to change facilities from the one where the cesarean occurred when trying to have a VBAC because a woman tends to feel safer laboring and giving birth in a new location."  

Although this is certainly your choice and you don't have to change anything if you don't want to, most women find that if they do not change enough circumstances, they get dragged down into the same scenario as before.  Even if your prior provider was 'really nice', find a new provider anyhow.  You need to change mentally all the things you associate with your prior outcome in order to help you find your way to a new outcome.  This is a hard lesson many women are not willing to learn, but while some women may be able to have a different outcome with the same doctor or in the same facility, most women find that changing as many things as possible was important in creating a new and more empowering birth.

Wherever and with whomever you plan to give birth, though, remember that this birth is different, just as this baby is different, and that a mental emphasis on changes and differences can be important too.  Andrea Frank Henkart reminds women, "It is also important to remember that this baby is different---this baby has her own birth script and is not the same as the last one...Whatever little difference you can find will help you to realize that this will be a different birth.  Relax, gather your strength, and prepare for a new experience."

Address Fears About the Pain of Labor

Many women find that they have an exaggerated fear of the pain of labor.  Often these women had their labors induced last time, or had pitocin (a.k.a. oxytocin) added to their labors.  Women should understand that induced or augmented labor pain is NOT like normal labor pain, and most women find it difficult to do a full labor induction (or augmentation) without pain medications.  That doesn't mean you would respond the same way to spontaneous, natural labor, which many women find much easier.

Another type of labor that tends to be very painful and create a lot of fear of recurrence is that associated with baby malposition.  If the baby was head-down but facing the wrong direction, had a hand beside its head, or had its head tilted to one side, this often causes extra intense labor that is difficult to handle.   See the FAQ on this website on Malpositions for more information.  Many women with malpositioned babies may also have a back or pelvis that is out of alignment, and this may also strongly increase the sensation of pain, especially during pushing.  For more information on this, see the FAQ on Pubic Pain.  These situations are preventable, but most doctors (and even many midwives) don't know how to prevent them.  There is help!

Women who had an elective cesarean may also fear the unknown strongly.  Some fear the pain of labor so much that they would be willing to trade a few hours of labor pains for several weeks of post-surgical pain.  This is not a rational trade-off.  They need to find out why their fear of the natural pain of labor is so strong that they would do endure weeks of needless pain to avoid it.  Often, there is another underlying fear behind this, and only in addressing that underlying fear can they free themselves and be ready to accept their labor as it comes, without so much fear. 

It is normal and understandable in our modern society to be afraid of pain and to desire to avoid it.  This is the cultural attitude we have all grown up with.  And of course, we do have some recourse to pain medications and epidurals if things really become unbearable; it is not a failure to choose to utilize pain medications if we do so from an informed position.  

However, many women also find a great sense of empowerment and strength from facing the challenge of labor naturally.  When women are 'allowed' to labor upright and mobile (instead of tied down into bed), without labor strengthening drugs like pitocin or cytotec, helped to get the baby into its best possible position, and given active labor support from a knowledgeable and professional labor support person, many women find that natural birth is very doable, and normal healthy labor pain is reasonable and even transforming.  

Lois Halzel Freedman in Birth as a Healing Experience finds that facing the fear of the pain of labor is a very important part of the counseling she does with women preparing for birth.  She writes:

A woman may worry about how she will deal with the pain of labor...I may ask her what she is afraid of.  As we address her anxiety, I pose a question about her feelings of facing the pain of labor.  I encourage her to believe that she has the inner strength to confront the discomfort of labor and remind her that she can also rely on the help of her support people...By sharing emotions, a woman prepares for the surrendering that is necessary during the birth process and finds some relief from her feelings of apprehension.

Women have been dealing with labor for thousands of years---you can too. These are not just the super women of pioneer days, they are also women who had hurts and conflicts and emotional wounds just like we do, yet were able to handle labor anyhow. You  can too.  You have the inner resources to take healthy pain and use it to help your baby into the world.  You have the inner strength to deal with whatever comes up, and to surrender into however your labor happens.  You have the inner power to flow with your birth, meet the challenge of the discomfort of labor, and transform it into a powerful experience of rebirth and healing.

Work On Your Other Fears and Underlying Beliefs

You don't have to have all the answers before you start trying to conceive or even before you give birth, but it does help to start working on your birth fears and issues beforehand.  If you are not sure what your fears really are, don't forget the importance of dreams in uncovering and working through fears.  Madsen states, "If a woman is afraid about the upcoming birth and has no outlet for expressing her fear, then her dreams may take up this important task for her."  Other authors believe that some dreams may actually be the baby trying to communicate with the mother, trying to help reassure her or communicate important messages.

You might also want to work on uncovering any underlying belief systems that might interfere with normal birth.  Many women, upon close examination of the subtle messages they have received or believed all their lives, find belief patterns such as "My body doesn't work right," "I can't do anything right," "I don't feel safe," "I won't be a good parent," "Birth is not safe," "My babies are always malpositioned," "I don't deserve to have a good experience," "Nothing ever comes easy to me," or "I can't trust my body."  Just becoming aware of these patterns and thoughts takes away much of their power, and active work can really help change them. Change these negative thoughts into positive ones.  Say the positive versions of these thoughts to yourself every day, write them down, post them around the house, etc.  Although it seems silly at first, many women find that daily affirmations can really help.

Therapy is also often helpful in working through fears and beliefs. Try to find a therapist in your area that specializes in birth issues.  Therapists who do not usually work with birth issues often are not as helpful, may not know the best techniques to assist birth grief recovery, and may even be dismissive of birth issues. If you cannot find a therapist that specializes in birth issues in your area, try calling local childbirth educators and see if they know someone or will work with you themselves.   Birth Works, Birthing From Within, and Hypnobirthing classes are often very good for helping women access their inner feelings and fears about birth, and helping them to work through these.   

But remember, you don't have to have worked through every emotional issue in your life in order to give birth normally----if that were the case, the human race would have perished long ago!  It does help to work on your issues and try to find what meaning they have had for your past births, but you don't have to be 'cured' in order to birth normally.  Nancy Wainer Cohen reminds women in Silent Knife

Remember, it is not necessarily a solution to a particular conflict that brings release, just a recognition of the conflict.  It is unacknowledged and unaddressed stresses or fears that are likely to spin cobwebs in the nooks and crannies of a uterus or cervix.  Uncovering the conflict depletes its energy, its power to restrain you.  Like bats, conflicts fare better in darkness; so shine some light on them! You needed far more energy to keep the conflict hidden and in check.  Just saying, "Yes, I do feel that way..." enables you to step away from the conflict ANYWAY, to go beyond it for a time.  You can sweep it aside and clear a passageway for normal birth.

Keep a Pregnancy Journal

As noted, many women find that keeping a journal is extremely useful in working through emotional issues and dealing with fears.  This is even more true when a woman is pregnant.  Emotions are often closer to the surface than ever, and fears (logical and illogical) are also close at hand.  Because the emotions are so powerful during this time, the potential for working through them and healing yourself is also that much more powerful.  Keeping a pregnancy journal can really help.

Lois Halzel Freedman writes:

A helpful tool for a woman to utilize during pregnancy is keeping a journal.  Writing is useful to sort through the many emotions that may emerge as well as a means to record the details of the process.  If a woman is afraid or has other painful emotions, the act of journaling can be a way to release them.  She may find the writing time helps her gain insight into the source of her anxiety.

If you are having trouble getting started, start by mentally relaxing, sinking deep down into your body and 'seeing' your uterus, then sink even deeper into your uterus and 'see' your baby.  What does it look like in there?  What does it feel like?  What does your baby look like?  Does your baby have any special messages for you?  Do you need to tell the baby anything in particular? Now write about this experience.  Be as descriptive as possible.  Cover not just physical characteristics but emotional feelings too. 

Writing about birth fears is often particularly powerful for women.  As Pam England says in Birthing From Within, "Worry is the work of pregnancy."  There isn't a woman alive who doesn't worry about all kinds of possible problems, from the very real to the most unlikely.  Even if your fear seems ridiculous, write it down.  List them all, and then go through and ruminate on them all.  Are there any common threads?  How do these fears reflect your life issues?  How do they relate to your prior birth(s)?  Try talking to your baby about these fears.  Share your concerns, and ask baby to share its wisdom with you.  Oftentimes, through your writing or during quiet meditation time, answers to the fears and questions will come, if we listen carefully.  

Or you can try writing out the story of your ideal birth.  Where would you be, who would be with you, how would you know you were in labor, how would you handle contractions, what positions would you use for birth, how do you see your baby coming out of you? It doesn't matter whether this exact story comes true or not; just write about how you would give birth if the world gave you the most ideal birth possible.  Then go back and see which parts are the most important parts to you, and write about how you could incorporate this into your birth plan, and how you could communicate these priorities to your support team. 

You can also try some of the writing and art exercises in the book, Creating a Joyful Birth Experience by Cappachione and Bardsley.  Their non-dominant hand writing technique often helps unlock lots of feelings and fears.  It really seems quite ridiculous at first, but women who try it often remark how powerful a tool it is.  Although they do feel silly using it at first, they are surprised at how revealing and helpful it can be.  Creating a Joyful Birth Experience is a very powerful book for opening up your emotions and working through fears, if you can just take the risk to try the exercises.

Journaling is a very powerful healing tool, and can be especially helpful and revealing during a subsequent pregnancy when emotions are very near the surface and issues are ready to be worked on.  If you are really serious about creating a better birth for yourself, be sure to try journaling.  

Utilize the Power of Visualization

The power of visualizing a new and different birth outcome is also an important step towards a more empowered birth.  Freedman suggests doing meditation and visualization on a regular basis, and many other resources have also found meditation, relaxation exercises, self-hypnosis, and especially visualization to be powerful tools for childbirth preparation.  Take time to imagine a beautiful and gentle birth every night before you go to sleep, and every morning as you are waking. 

If you have trouble visualizing a normal vaginal birth, this may indicate that you have special issues that need working on, and may benefit from more in-depth work on birth issues.  Processing these will help you visualize things more effectively.  Assistance with an active visualization of a normal and empowering birth can be found through the Birth Works childbirth education program, audiotapes by Gayle Peterson [see below], and  hypnotherapy (if it is done well).  In addition, active visualization exercises for birth can be found in the books Transformation Through Birth, Creating a Joyful Birth Experience, Mind Over Labor, and Trust Your Body! Trust Your Baby! 

Sometimes birth videos can be helpful in learning to visualize a normal vaginal birth.  Most women in our society have very little experience of birth from our friends and relatives, and we often have no idea what 'normal' birth looks like.  Our biggest images usually come from the media, and those images are vastly distorted, usually entailing a crisis situation and lots of intervention.  Even the "Baby Story" shows on television present an abnormal view of birth much of the time, with mothers on their back or immobilized for labor, tied to all kinds of machines, experiencing very painful induced or augmented labor contractions, drugged to the gills, using 'purple pushing' techniques, etc.  That is NOT normal birth, and if you watch those images too much, your brain tends to strive to meet those internal pictures.

If you want to use videos of childbirth to help you visualize a normal birth, then choose your videos wisely.   Think about the unconscious message your body and subconscious are getting from the video----does it portray normal, unremarkable, healthy birthing with no interventions?  Or does it show helplessness, intervention, and powerlessness?  One great video for understanding what non-interventive birth looks like is "Birth in the Squatting Position."  Although this video is ostensibly about using the squatting position for birth, it is really simply a representation----over and over again----of normal, healthy birth.  In particular, the viewer sees babies emerging from their mothers' vaginas over and over again, a powerful image to help change your expectations and internal pictures if you are a person who has had difficulty imagining yourself giving birth normally.  

If you still have trouble visualizing a normal vaginal birth for yourself, try some of the relaxation and affirmations tapes that are available for pregnant women.  There are good tapes available over the Internet, or you can go to a professional hypnotherapist and have one created specifically for your situation and concerns.   

Gayle Peterson (author of Pregnancy as Healing and An Easier Childbirth) has also done extensive work in the use of prenatal  self-hypnosis and guided visualization to help women improve their birth outcomes.  She has an excellent audiotape available; the first side promotes relaxation and a deeper bonding with your unborn child, and the second side takes you through an active and multisensory visualization of normal birth. It is a powerful audiotape that women report to be particularly useful.  

Many women report that visualization was one of the most powerful and most effective tools they had for creating a better birth experience.  Relaxation tapes and judicious use of good birth videos are other tools that many women have found useful in creating more empowered births.    Recommendations for specific resources mentioned here and where to find them can be found below in the references section and in the Great VBAC Resources FAQ. 

Access a Spiritual Connection and Let Go

One of the most difficult aspects about birth for many women is the fact that it is not controllable.  Although it is important to learn about birth issues to help you with decision-making, and to plan ahead and visualize how you would like to give birth, ultimately you have to surrender to the birth process and let it happen how it's going to happen.  Many moms have a hard time empowering themselves and taking control of their pregnancy and birth choices and then letting go for the birth.   But release of control and a surrendering to the process----however it's going to unfold----is a vital part of birth.  

Women need to get out of their heads and let their bodies take over during labor and birth.  Your body already knows how to give birth----really!  But many women have difficulty trusting in this, and they may try to hang onto control during labor.  This is also a reason why a provider you can really trust is vitally important at your birth; if you have to second-guess or question labor management, then you are back in your head again instead of letting your body take over and just give birth.  A good provider can be trusted to make the 'head' decisions and will help you find your own rhythm to relax into your body. It is vitally important to feel safe at your birthplace, to feel loved and supported, and not have to fight anything so that you can get out of your head and let your body take over.   

For many women, calling on a higher power for help is useful in releasing control.  Freedman writes:

The process of giving birth is not something that is controllable.  Trusting in the process of birthing is very important.  Whatever a woman's religious beliefs or lack thereof, she will have to surrender to the power of the childbirth experience and trust that it is not up to her alone.  Tremendous strength can be achieved by a woman looking inward and believing that support and assurance can come from accessing a spiritual connection.  

For some women, calling on their higher power helps them release control and just let be.  Other women find it helpful to think of all the women who have birthed before them, surrounding and supporting her as she too joins the circle of birthing women.  Still other women find it useful to call on their future selves or their babies to help them through.  However you find it easy to release, remember that this stage is coming, and be ready to flow with it when the time arrives. 

When a woman feels safe, loved, secure, and supported, her body can open up naturally and do what it already knows how to do. Nancy Wainer Cohen writes [emphasis hers]:  Birth is not a performance.  When we can give up, when we can let go of our inhibitions and fears, we can allow our bodies to do what they absolutely, positively know how to do."  

Conclusion

Taking that leap of faith to have another child after a prior unsatisfying birth is an amazing act of love, trust, devotion, and commitment.  When you choose to have another child, remember that THIS IS A NEW CHILD, A NEW PREGNANCY, A NEW BIRTH.  Things do NOT have to go the same way that they did before!  You are older now, you are hopefully a wiser health consumer, and you can make new choices this time.  Even if your prior cesarean was unavoidable and truly necessary, THIS pregnancy and baby are new and different, and this birth CAN be different.  

Commit yourself to having an Empowered Birth After Cesarean (EBAC).  Don't get caught up in the 'successful VBAC/failed VBAC' mentality of so many doctors.  Even if, God forbid, you ended up with a necessary cesarean next time, it does not have to be a bad birth experience, and it is most certainly not a failure!  There are ways to make a cesarean a more birth-friendly experience, and even if it is not how you wanted to birth, a cesarean does not have to affect you emotionally the same way it may have affected you in the past.  

By creating new circumstances and empowering yourself as a birthing woman, chances are excellent you can  have a normal vaginal birth, but no matter how that birth ultimately unfolds, you can change your birth, find a way to surrender to the flow of how that birth happens and its outcome, and still be an empowered woman and a loving, welcoming mother.

Birth is not a pass/fail activity.  Let go of control.  The point is not to create rigid checklists of what constitutes a 'successful' birth, but to work towards a better birth experience-----an empowering, loving, and healing experience, however that unfolds.  

 

Summary

"Each woman needs to decide for herself what her birth means to her, how she needs to heal, and how she will integrate her birth experience into the rest of her life."  Lynn Madsen, Rebounding From Childbirth

In our male-dominated society, therapists and doctors have been slow to recognize that childbirth is a major rite of passage for women, and that a woman's experience of birth can often affect her profoundly emotionally as well as physically.  Lois Halzel Freedman writes in Birth as as Healing Experience:

Childbirth represents a major developmental rite of passage in a woman's life.  The experience of giving birth and becoming a mother affects every aspect of her existence...Her entire identity is transformed.  Childbirth is a pivotal experience that deserves a place of honor in a woman's life and in society.

However, our society tends to have little respect for the developmental importance of pregnancy and birth in a woman's life, and as a result, the emotional effect that pregnancy and birth can have has been downplayed.  In addition, many have dismissed the trauma that a difficult birth can cause for women.  In recent years, though, there has been a growing recognition that childbirth trauma can be as profoundly affecting as other kinds of trauma, and that these women are in need of healing just like any other victim of trauma.  

When a cesarean or other traumatic birth occurs, different women process it in different ways. They draw upon their own life history, their beliefs about themselves, their birth beliefs, and their life issues in this processing.  How a woman is treated during pregnancy, labor, birth, and post-partum also has a significant impact on her perception of the cesarean.  Between the different "emotional stacks" that women bring to birth and the influence of various aspects of the birth itself, it is only natural that different women process the 'same' experience differently.  

For some women, a cesarean is no big deal and never will be.  Some women "love" their cesarean, enjoying the convenience and predictability of it, or perhaps seeing it as a rescue or way to circumvent difficult issues in their lives.  For some women, a cesarean is a disappointment and a let-down, but not devastating to their lives.  Yet for other women, a cesarean can be experienced as the absolute worst kind of trauma and violation.  All of these responses are normal and understandable.  Madsen points out:

Every woman reconciles her experiences differently.  For some, a traumatic birth unravels many parts of life.  Marriage, career, and family relations are all reevaluated, and sometimes destroyed in order to rebuild on a new foundation created by what has been discovered.  Others take trauma in stride, coping with the healing process as a companion to an intact life.  If the birth tapped into deeper issues of abuse, opportunity exists as this door has been opened to begin or enhance healing.

For those whose cesareans were distressing or traumatic, it is important to remember that birth is not only a major rite of passage, but also an amazing time of emotional growth and tremendous potential for healing.  Freedman notes this by saying: 

Giving birth is a sacred life experience to be honored by all those who are involved with or working with women.  The period from pregnancy through postpartum is an important developmental stage in a woman's life.  This time presents a special opportunity for women to explore the many emotional issues that may arise as a result of the profound act of bearing and giving birth to a new being.

Although experiencing a difficult birth is hard, it can also be the springboard to life-changing growth, a new purpose or direction in life, and healthy changes in relationships. Panuthos agrees, concluding: 

Parents who have the consciousness to use childbearing as a growth opportunity seem to gain in personal strength, resources, and depth of relationship.  They often alter many other areas of their lives, such as their relationships with their own parents, children, and friends, as a result of their learning through emotionally conscious childbearing.

If you experienced a difficult birth, you can find healing.  That trauma does not have to keep you from bonding with your baby, keep you locked in past patterns of negativity or victimhood, keep you afraid of having more children or going through labor again, or keep you from finding joy again in your life.  Things can get better, you can break old patterns, you can find healing and growth in your life issues, and you can have a better birth next time if you have more children.  The healing and growth may not always be quite what you expected or most desired, but it is there, waiting for you.  

Nicette Jukelevics tells women to start the healing by listening to and understanding the messages in their thoughts and feelings.  Your feelings are your guide to your pain and to your healing, so take time to uncover them, fully feel them, and come to understand them.  She points out that YOU are the source of your power and that you can learn how to use it.  Let your feelings  help you figure out what you need and what you want, how to help get yourself there, and how to find healing and peace.

No matter what your particular situation, it is critical to realize that you did the best job you could given the circumstances, given your life history and prior "emotional stacks," and given your beliefs at the time.  If you were transported back in time, knowing what you know now, you would have the strength and knowledge to do it all differently or to be able to experience it differently.  But back then, you didn't know these things, and you were only doing the best you knew how at the time.  Forgive yourself and nurture yourself. You did not fail; you did the best you could under difficult circumstances, and enduring being cut open for the sake of your baby was an act of courage and amazing maternal devotion.  

There are a wide variety of responses to grief, and however you experience it, it is normal and appropriate for you. Don't try to judge your grief or let other people deny it or rush you through it.  Women rarely progress conveniently from one stage to the next in a neat and orderly manner.  Grief is often awkward and inconvenient because of all the stress, physical recovery, and emotional recovery required. Don't worry about trying to 'handle' things or 'do things right;' just take things as they come, try to minimize what stress you can, and concentrate your energies on being as healthy as possible for you and the baby.  Do your grief work, and ignore any critics.  Do it on your own terms, as YOU need to do it.

As noted throughout, there are several excellent books to help in the recovery process, including Rebounding From Childbirth: Toward Emotional Recovery by Lynn Madsen, Silent Knife by Nancy Wainer Cohen and Lois Estner, Birth as a Healing Experience by Lois Halzel Freedman, Trust Your Body! Trust Your Baby! edited by Andrea Frank Henkart, and Transformation Through Birth by Claudia Panuthos.  All of these books are available from the Birth and Life Bookstore/Cascade Books, www.1cascade.com.

Read all you can about cesareans, recovery from childbirth, etc.  Find a support system that understands and will listen, and work on your emotional recovery through the use of sharing, journal-writing, art work, poetry, bonding with your child, reading about emotional recovery from childbirth, or therapy with a counselor that specializes in birth issues. Remember that it may take months or years to recover emotionally.  Recovery doesn't have to take place overnight or even right away, but it shouldn't be neglected. Work at it, but trust that it will happen in its own time.

Lynn Madsen notes:

Healing happens as a woman is open and ready to do the work involved.  Like feelings, memories also have lives of their own...Trying to hurry the situation will produce frustration and a sense of failure at not being done yet.  Every time a piece of insight or resolution is found or another layer of fear is released, relief is experienced and is real.  At each of those moments, pause and take satisfaction in the accomplishment. A valuable gift to give oneself is as much time as needed to heal.  It represents acceptance of oneself, trusting that when there is a need to heal, the need will be tended to.

Please, give yourself the gift of time to heal. You cannot make a difficult birth experience go away, but you CAN find healing from it, be open to the life lessons available in it, and integrate it into yourself and your personal history.  You can accept it as yours, as having happened and being a part of your life, without necessarily accepting all the circumstances around it as good. It will always be with you, but it doesn't have to define you or limit you.  It can simply be accepted as having happened, as having lessons for you, as being part of your history, and be used as an instrument of change for the future.  When you are ready, you can move on.

Nancy Wainer Cohen writes:

Birth is one of the most profound teaching experiences life offers.  It touches us in the depths of our souls, the most private recesses of who we are.  It requires that we respond with more creative energy, more conviction, more trust, than almost anything else we do.  Birth requires an intensity that is rarely demanded by other experiences.  And through it, we can learn more about ourselves, our strengths, our weaknesses, our relationship patterns, and our needs than through almost any other experience we will face in our life.

Childbirth is one of the defining moments of many women's lives.  A difficult pregnancy or birth experience can have a long-lasting impact on a woman's emotional life, but it can also bring great healing. Listen to your intuition, make your babies your ally in your healing, and it will come.

Healing CAN happen.  It may not always happen in the way you wanted or thought it would happen, but it can bring great blessings to your life, however it happens.  Open your heart and let it in.

 

Women's Stories of Struggle and Healing

"Surgical deliveries have profound psychological effects on all women, whether the surgery is actually necessary and life-saving or not."  Claudia Panuthos, Transformation Through Birth

Reading other women's stories of recovery after a cesarean can be very healing.  Sometimes, confronting women's pain (or our own) can be distressing, but it is running away from or avoiding the pain that prolongs it.  Dealing with the pain when you are ready can be very revealing about general life issues (not just cesareans!), can help you heal many ways emotionally, and can help you face your fears and prepare for future pregnancies and births.  Remember, "The other side of fear is freedom."  

If you are interested in sharing your story here, you are welcome to send it to Kmom for consideration.  She is interested in stories that explore how a cesarean impacted you emotionally, how it reflected underlying issues in your life beyond birth, and what worked for you as you strove for healing.  Please keep your story fairly brief due to space considerations, and please do NOT send your story as an attachment.  It is also important to explicitly give permission to publish your story, as well as what name you want it published under.   

It is Kmom's hope that reading other women's stories of pain and recovery will hope women know that they are not alone, that healing is possible, and that, indeed, the other side of fear is freedom.  

Kmom's Story - (induction, traumatic c/s, problems breastfeeding but eventual success, path to emotional healing)

My first birth was extremely traumatic, so I am acutely aware of these emotional recovery issues. After a long, difficult induced labor with great pain and a 'failed' pushing stage (the baby was malpositioned and got stuck), I had a c-section. At first I viewed the idea of a cesarean as a welcome 'rescue' from a difficult and painful labor.  The anesthesia was not sufficiently strong, however, and I felt the surgery intensely.  Although I had no name for it then, I did experience a degree of PTSD for some time afterwards; the memory of having to endure surgery with nearly full feeling haunted me for years afterward and impacted future births. 

I feared for my life and for my child.  It was a horrible experience; they started the surgery even after I told them I was still feeling sensation.  They either didn't believe me or it didn't matter to them; they kept going, telling me that no additional drugs were possible until after the baby was born.  Those 10-15 minutes or so were the longest and most awful of my life.  I got my hands free and fought the surgery; they had to struggle to hold me down.  I begged my husband not to let them tie me down, but what could he do but let them?  I felt betrayed by them all.

Outside my husband tells me I was not making a lot of noise but inside I was SCREAMING but couldn't get the sound out.  I felt like I was gasping and choking, like no air was coming in to give me the oxygen I needed to get the sound out, to SCREAM for them to stop, to fight them off.  I felt like a was a fish, flailing around out of water, helpless and tortured and dying. The pain was so great I kept passing in and out of consciousness, and I felt deeply, deeply traumatized.  In fact, even after the baby was born and they gave me more drugs, according to the medical records the surgery was still strongly felt by me.  Although the drugs they had given me blocked this part of my memory, my body remembered, and did so for a long time afterwards.

For weeks afterward (and to a lesser degree, later), I had recurring nightmares of the surgery.  In my dreams, I felt hands crawling all over me (probably the hands that had held me down).  I cannot express how creepy that was, feeling those hands on me, holding me down, trying to tie me down as they hurt me, feeling the hands all over me as my body was being cut into, screaming and no one hearing me.  

The baby had been flashed in front of my face right after she was born; it breaks my heart still that I could hardly care because of the pain.  In addition to everything else, they also stole my joy for her birth, and that has been very hard to forgive.  My main reaction was that good, now I could go.  On some level I think I felt like I was dying.  The baby was taken away into the baby unit; my husband went with her at first and then tried to run back and forth between us for the rest of the time.  I saw her briefly when I awoke in recovery; I have a foggy memory of singing 'Happy Birthday' to her, and then I don't remember much more.  I didn't really get to hold her or nurse her until about 8 hours later.  I think this separation is one of my greatest sorrows even today; I have pictures of her, alone in her little isolette, bundled up, with a binky in her mouth to keep her quiet.  She looks so incredibly lonely and scared.  She needed me, and I wasn't able to be there for her.  But I was lucky; after I did get her, I hardly let go of her, and we did manage to bond fiercely then. 

After the operation, NOBODY took the failed anesthesia seriously.  Not one nurse mentioned it, not ever.  The OB only mentioned it after I brought it up to him because I told him I was afraid to have more children.  He sat down for a minute or two and told me it didn't have to be that way next time, that a spinal would probably offer more complete anesthesia.  That was it.  That was the extent to which it was ever addressed by the people involved.  And for years afterward, almost no medical personnel EVER took it seriously either.  None of them even mentioned that they were sorry it had happened or that I had gone through such a difficult birth experience, most of them minimized it and tried to tell me that I had not really experienced what I thought I had experienced.   Many tried to tell me that I only experienced pressure and tugging.  NOT!!  I certainly didn't pass out from the pressure of a little tugging.  How insulting it was to suggest that it was all in my imagination!  It was like they were implying that I had imagined it all or was exaggerating the feeling. After all, I had a healthy baby, what more did I want?  {How about a loving and gentle birth experience???}

After I came home from the hospital, I was quite passive and uninvolved in life (except for the baby) for the first couple of weeks.  I had help with things at home so I was able to withdraw.  I felt lousy, I could not find a comfortable position at night, and I had trouble sleeping.  The nightmares bothered me, and the fact that no one seemed to care or understand about what I'd gone through in surgery was very upsetting.  I felt betrayed by my body yet again, my milk took a long time coming in, breastfeeding was difficult at first, I doubted my ability to be a good mother, and I just basically felt like a real failure.  The one saving thing was the tremendous bond with my daughter.  As breastfeeding began to get smoother, I used that bond and the success I felt from breastfeeding to soothe my soul and quiet the flashbacks.  I was amazed at how healing I found it, since I really wasn't all that enthralled with the idea of nursing in the first place. Being able to do this felt tremendously right, like my body was finally able to carry out a task correctly and wasn't quite so dysfunctional after all, and the thrill of seeing my child absolutely thrive on my milk and nothing else was very empowering.  I began getting more involved in the care of the baby and the house again, and re-integrating with the world.  

Interestingly, there was a Learning Channel program on cesareans on a week or two later.  The idea of watching an actual cesarean being performed filled me with dread; my pulse would race, my heart would flutter, and my stomach went to my throat just thinking about it.  But because there was so much I didn't remember or understand about the cesarean (and my husband didn't want to talk about it), I decided that I should at least try to watch it.   When it came on, I kept the controls right by me so I could switch if it got too distressing.  Although there were a few rough spots in watching it, for the most part I actually found the program relieving----I'm not quite sure why.  I guess I was able to put some intellectual understanding onto how my baby came to be in my arms, I was able to reconstruct a bit of what must have occurred, and I was able to put my experience at a safer distance.  I also think I saw how it was supposed to have happened, and realized that all cesareans didn't have to be like mine had been.  That seemed to be important in my recovery.

For some time I believed that my cesarean was probably necessary; that my baby was either too big or my pelvis too small. When eventually I found out that my c-section experience was likely unnecessary, I experienced a resurgence of grief and anger. There was hope for the future of avoiding a repeat performance, but it was terribly frustrating that I'd had to go through that awful experience when it was probably unnecessary.  I didn't feel I'd had a c-section, I felt I'd had a vivi-section----and unnecessarily, too.

Although I got better, I still felt periodic anxiety at reminders of the cesarean over time.  Going to that hospital to visit a friend after the birth of her baby was hard. Sometimes I felt a bit sick just driving by the hospital.  At first I emotionally walled off the experience as best I could and just didn't deal with it.  After some time, I was able to refer to the trauma of unanaesthetized surgery from an emotional distance.  I could tell people it had happened to me, but I couldn't really revisit the experience without it being too threatening.  

Needing to keep it at a distance in order to keep my sanity made it difficult to heal, and the childbirth education class I took in my second pregnancy did not have an emotional healing component.  I learned about childbirth issues and controversies, but I never really got to deal with my deepest fears.  I think that my blocked emotions blocked that birth too, in effect.  

When I had a repeat cesarean after a long trial of labor with my second child (he was also malpositioned), I was very panicky, worrying about whether the anesthesia problem would recur.  We used a spinal instead, and people were very attentive to listening whether I felt anything, so this time was a 'good' experience as these things go.  The staff was much better this time about keeping the baby with us, delaying unnecessary tests and procedures until later, and no bottles were given this time. I was awake and able to nurse right away in recovery, which completely eliminated all the difficulties we encountered last time. Unfortunately, I was still not 'permitted' to see the birth of my baby and was not able to hold him right away, and emotionally, it was hard not to get my much-desired VBAC. I sorrowed over my dreams of a gentle, loving birth (instead of a surgery) and being able to connect with the baby right away, but this birth was still far and away better than the first.

Although I was very disappointed and upset to have had another cesarean, I wonder now if I needed to have a 'good' cesarean in order to start processing the trauma of the first cesarean, and to really be forced to start addressing the earlier traumas of my life.  It was a hard lesson to learn. On the other hand, the benefit from this birth was learning that it's possible to have a gentle and loving birth even with surgery; that a c-section doesn't HAVE to be painful, cold, or impersonal. My goal for my next birth was to have that gentle, loving birth as much as possible, whatever the circumstances were, c-section or VBAC.

Committing to another pregnancy was hard, even though I very much wanted another child. I felt very emotionally stuck; I needed to heal the whole "surgical awareness" thing. I took some healing and grieving workshops, but bringing up the whole trauma of the first surgery was somehow just too much for me at first.  I would break out into a sweat and get palpitations just thinking about doing it.  Eventually, I did choose to conceive, but partway through the pregnancy I just knew deep-down that this was something I had to face NOW in order to have my next child. So I went to a Birth Works workshop where they had me specifically relive the experience of going through feeling the surgery.   I didn't sleep much the night before, I had bad dreams, and I was literally shaking and in tears before we even started.  It was very difficult to find the courage to relive it and face it, but ultimately, that was the thing that healed me the most.  

They had me retell the story as if I was re-experiencing it, asking me about smells, temperature, colors, etc. that I remembered, as well as relating all of the events and my feelings about them.  When I got to the part about how they didn't believe me when I said I felt the surgery, I just burst into sobs----deep, heaving, gut-wrenching sobs.  As I told them the rest of the story, for the first time I spared no details.  Always before I would skip the gory details, the detailed description of the hardest and most painful parts, but now I used the emotionally loaded language that I needed to use instead of trying to be neutral about it, and I told it all.  And as I told it, I realized how it also made me flash back to an incident of abuse I had experienced earlier in my life, and how many details paralleled-----not being believed, begging for help and not getting it, screaming yet not being heard, and the minimization or denial of everything.  Only much later did I realize that some women who experience PTSD after a traumatic birth are actually often processing earlier traumas in addition to later traumas.

I have since told the story of the surgery in vivid detail a few times, and each time it gets a little easier, but even now my heart still pounds when talking about it at any length.  It doesn't hold the power over me it once did, but I'll never regard the experience casually either.  Going through surgery with virtually no anesthesia is not a normal experience, it is life-threatening in its own way, and it was terribly traumatic.  Although I was lucky enough not to experience Post-Partum Depression, I did experience PTSD to a degree.  I was not crippled by it, and my bonding to my child was not affected by it (thank goodness), but the surgery did rob me of a beautiful, loving birth experience, it robbed me of the joy that should go along with birth, it made my life as a mother start out on a terrible note, and it robbed me of so many precious hours with my first-born.  

It still holds quite a bit of emotional charge for me, but the charge is not so intense, not so  life-draining and full of fear anymore.  Eventually, I was able to take the emotions generated by the experience and channel them into a positive direction, using the pain for transformation and activism and healing.  Although I cannot be grateful for such a terrible experience, I can accept that it happened, I can acknowledge that it has a place among my life's experiences, and that a great deal of good was eventually generated by the experience.  I can be grateful for the good ultimately created by the experience, yet still be upset over the difficult nature of it.  

My third birth did turn out to be a VBAC, although not necessarily an easy or painless one.  The baby was slightly malpositioned again, and my provider unfortunately convinced me into inducing labor a little early.  Between the induction and the malposition, the labor was intensely painful, which I found very challenging.  [Life lesson:  Only natural labor for me from here on in!]  However, eventually I helped my baby's position resolve, and he was born very quickly afterwards.  I'll never forget the way his head felt when I touched it shortly before he was born, and I'll never forget the total  joy and ecstasy of holding my baby immediately and bonding with him without any delays. Oh, what I had missed with my other babies!  But along with the joy of this birth was the bittersweetness of having missed this with my other children.

This birth was not the gentle and peaceful birth I had dreamed of, and there are some things I would change if I could.  However, it still was a wonderful change from my prior births, and a precious memory that I will always hold close in my heart.  Although not an ideal birth, it was a much more empowered birth, much easier to recover from, and infinitely more satisfying.  I am very grateful for the gifts of this birth, and they will be with me forever.

Integrating the disappointments of previous births has not always been easy, but it has happened. With time came the recognition that the trauma of my experiences also created a tremendous opportunity for learning and emotional growth.  It led to a new assertiveness and self-respect, a determination never to settle for disrespectful treatment again, and to always question and research my health care issues. The cost of these lessons was quite high and I can't be glad of that, but I can integrate the lessons learned and even be grateful for the impetus it gave me to take charge of my own care, become more proactive, and heal my life.

However, I recognize that everyone's experiences are different and not everyone will feel that way. Some women heal very quickly from traumatic births and are able to shrug it off easily; other women take years to recover. For those who are bothered by your birth experiences, you are NOT alone. Your experience and your grief DOES matter, and there IS support available for recovery.  But it's up to YOU to do the hard work necessary to process it all and work towards healing; you may be surprised by the life lessons it has for you and the good it can create in your life.  No one should have to endure a difficult birth; sometimes they happen even under the best of circumstances, and sometimes they could have been prevented.  However it happened, though, it can be grieved and healed, and eventually, good can come of it too.  Reach for the healing.

Vicki's Story excerpted from Rebounding From Childbirth - (difficult cesarean surgery, difficult recovery, VBAC)

[Vicki's surgery was similar to Kmom's in that she felt the surgery due to anesthesia failure.] 

I had a lot of anxieties when I was pregnant with Lara [my second child], and one of the main fears was that I wouldn't have her vaginally after having had such a big mouth about things...The only way I could think about it is that the same exact thing could happen again.  The same rape.  And I don't think that everybody's c-sections are like rape, whether they're necessary or not.  But all I could think about was this horrible thing happening again.

It was a very conscious effort for me to heal enough before Lara's birth, it didn't just happen.  I really had to consciously say, I don't want to live like this any more.  Even though the first birth happened the way it did, I had to somehow rise above it.  Like [my husband] had said, "Are you going to let him [the doctor] ruin us, too?"...

Nothing from the experience has gone away on its own, nothing, not one ounce of it.  I think it was my inner strength that got me through.  I didn't want to be consumed by the past.  I had to make the choice about whether to let the past situation ruin my life or not.  It has permanently affected me in a lot of ways, I'll never be the same.  But now there's hope...

With Lara's birth, all through the entire delivery it was like I gave birth to two babies.  I would do things for both of them.  For the birth of me and for her...There are no words to describe what her birth did for me.  It's almost selfish to say, because it was her birth, but it was mine, too.  A rebirth, because I really had died after my c-section.  I would always say to [my husband], "I'm dead inside.  I love you and the baby, but I'm dead."...

I've always had this fairy tale life, things had always gone my way, I was this, I was that, I was everything, and something happened to her.  Now at least I'm alive again.  

 

References

*More resources can be found in the FAQ on Great VBAC Resources on this website.

Books on Emotional Recovery After Childbirth

Madsen, Lynn. Rebounding From Childbirth: Toward Emotional Recovery. Westport, Connecticut: Bergin and Garvey, 1994. Available from www.amazon.com.

SUPERB book about recovering emotionally from childbirth and pregnancy. A bit flaky and 'New Age' in a few parts, but overall is just excellent. Highly recommended!

Panuthos, Claudia. Transformation Through Childbirth: A Woman's Guide. Westport, Connecticut: Bergin & Garvey, 1984. Available from Cascade Press/Birth and Life Bookstore, www.1cascade.com  - (503) 371-4445 or (800) 443-9942.

Great book on emotional preparation for or recovery from birth. Kmom highly recommends it. Unfortunately, out-of-print now, but Cascade Press has a few left.

Panuthos, Claudia and Catherine Romeo.  Ended Beginnings. Westport, Connecticut: Bergin & Garvey.  1984.  www.1cascade.com or www.birthworks.org has this book.

Deeply affecting book about processing all kinds of pregnancy-related losses, including infertility struggles, cesareans, miscarriage, stillbirth, early neonatal death, etc.  Very hard to read the first time but definitely worth sticking it out and re-reading multiple times.  Offers suggestions for dealing with the pain of pregnancy losses on physical, mental, emotional, and spiritual levels, and help in moving beyond the losses and healing when ready.  Excellent book. 

Freedman, Lois Halzel.  Birth As A Healing Experience: The Emotional Journey of Pregnancy Through Postpartum.  Binghamton, New York: Harrington Park Press.  1999.

Book on the emotional aspects of pregnancy and postpartum, emphasizing the opportunity for healing potential.  Utilizes many individual women's stories.  A good introduction to the subject, but more detail and stories would have been helpful.  The author is a certified childbirth educator with a private practice in individual prenatal and postpartum counseling in the Boston area.  

Wainer Cohen, Nancy and Lois J. Estner. Silent Knife: Cesarean Prevention and Vaginal Birth After Cesarean.  South Hadley, Massachusetts: Bergin and Garvey Publishers, Inc., 1983.  Hard-to-find these days, but Cascade Books still has some, www.1cascade.com, 1-800-443-9942.  Some LLL chapters may also have a copy in their lending libraries.

An older book, the first on VBACs, and often angry in tone in places (but that's what was needed!).  Unvarnished look at the pain that c/s deliveries often cause for mothers ("Voices of the Victims" is an especially powerful chapter, and the "Mindscapes" chapter is a must-read for uncovering birth beliefs and psychological influences on birth).  This book is great for uncovering and starting to work through anger over previous births.  Because it was written in the early 80s, some of the medical information is a bit outdated, but most of it still rings very true and is valuable even today.  Classic must-read in the VBAC field.

Henkart, Andrea Frank, Editor.  Trust Your Body!  Trust Your Baby!  Childbirth Wisdom and Cesarean Prevention. Westport, Connecticut: Bergin and Garvey, 1995.  

Another childbirth/VBAC book, with different chapters by various contributors.  Emphasizes the whole pregnancy and birth experience including conflicting feelings, good medical consumerism, rituals to recover from a c/s emotionally, dealing with fears, using visualization,  questions to ask a provider, the role of the husband, taking each birth one at a time, etc. A good addition to a basic VBAC library of information, but shouldn't be your only VBAC book.  Use it as a supplement if desired.

General Information about Cesareans and Birth Management

Goer, Henci. Obstetric Myths vs. Research Realities. Westport, Connecticut: Bergin and Garvey, 1995. Can be ordered online from http://www.efn.org/~djz/birth/obmyth/

This excellent book reviews common obstetrical practices and analyzes which practices are truly justified by medical research. Superb review of the medical literature and whether it supports most common obstetric practices on issues such as episiotomy, active management of labor, amniotomy, gestational diabetes, cesarean for breech, epidurals, etc. If you wonder whether your cesarean was necessary, or whether medical practices used in your birth may have caused your cesarean to become necessary, this is the book to read.  Also contains a MUST-READ section on VBACs vs. repeat cesareans.  Backed by impressive analysis of obstetric research and a clear writing style that helps laypeople understand the research.

Sutton, Jean and Pauline Scott. Understanding and Teaching Optimal Foetal Positioning. Tauranga, New Zealand: Birth Concepts, 1996.  Available from Cutting Edge Press, www.childbirth.org/CEP.html, (802) 635-2142, www.birthworks.org, or www.midwiferytoday.com

MUST-READ booklet on the importance of fetal position on labor progression and birth.  Many c-sections and/or complicated births are actually caused by fetal malpositions (sometimes subtle ones), but the majority of the obstetric community pays little attention to fetal position once the head is down and don't know how it impacts labor.  This booklet, written by a New Zealand midwife and a childbirth educator, summarizes normal positioning and various possible malpositions, what effect this has on labor, and ways to help correct the problem.  Excellent.  If you had a cesarean for FTP or CPD, get this book.

Simkin, Penny and Ruth Ancheta with Jilly Rosser.  The Labor Progress Handbook. Oxford: Blackwell Science Limited, 2000.  

Another must-read book on the importance of fetal position and how to recognize and help correct any problems before and during labor.  Written primarily by two doulas (professional labor support personnel), the emphasis is on low-tech, non-surgical, non-pharmacological solutions to help a stalled labor or a 'stuck' baby.  Writing is a bit technical at times and is clearly aimed at doulas, maternity nurses, midwives, doctors, etc., but many moms can also understand and benefit from this book.  If you had a cesarean for FTP or CPD, get this book too, either for yourself, your midwife, or your labor coach!  Available from www.amazon.com, among others.

Goer, Henci. The Thinking Woman's Guide to a Better Birth.  New York: Berkeley Publishing Group (A Perigee Book). 1999. More info at www.efn.org/~djz/birth/betterbirth/order.html. Can also be ordered from Henci Goer, 970 Buckeye Court  Sunnyvale, CA 94086, or WeGoers@aol.com. Also available from Cutting Edge Press, (802)635-2142, or www.childbirth.org/CEP/. 

Outstanding review of many childbirth issues, especially induction of labor.  However, VBAC section is so-so; some VBAC proponents feel that this book is more cautious than Obstetric Myths, possibly for political reasons.  First half of book is no-nonsense guide to pros and cons of various birthing issues; second half is a detailed medical reference section, discussing and analyzing studies. Couples can simply use the non-technical summaries in the first half, delve into the medical studies and analysis in the second half, or access both as needed. Although the author has definite opinions, she presents both sides fairly and gives valuable  hints on maximizing outcome if an intervention is chosen. If induction in particular is an issue for you, get this book.  As simply a VBAC resource, however, OB Myths is a better investment.

Vaginal Birth After Cesarean Information

Korte, Diana. The VBAC Companion: The Expectant Mother's Guide to Vaginal Birth After Cesarean. Boston: Harvard Common Press, 1997. Available from www.lalecheleague.org.

THE best book on VBACs around! Superb! Very supportive of mothers considering VBACs, even those who choose not to pursue them. Extremely informative without engaging in excessive rhetoric; excellent questions for choosing a provider to assist in a VBAC and designing a birth plan. Also has a good section with valuable tips on helping to overcome common obstacles to a VBAC, and addresses the emotional issues of c-section and VBAC 'trials of labor' well.

Crawford, Karis and Johanne C. Walters. Natural Childbirth After Cesarean: A Practical Guide. Cambridge, Massachusetts: Blackwell Science, Inc., 1996. Was available from www.lalecheleague.org.  May be unavailable now; check with amazon.com to see if they can find a used copy.

Another excellent book about preparing for a VBAC, with an emphasis on the authors' own professional expertise and personal experiences. Practical and useful information, clearly written.  Full of helpful hints about handling different types of problems that can lead to c-sections, including many concrete and practical suggestions about specific situations. Also addresses well the emotional aspects of childbirth preparation, using visualizations, and exploring fears.  Also highly recommended.  Kmom suggests buying both The VBAC Companion and Natural Childbirth After Cesarean if you can.  

Wainer Cohen, Nancy and Lois J. Estner. Silent Knife: Cesarean Prevention and Vaginal Birth After Cesarean.  South Hadley, Massachusetts: Bergin and Garvey Publishers, Inc., 1983.  Hard-to-find these days, but Cascade Books still has some, www.1cascade.com, 1-800-443-9942.  Some LLL chapters may also have a copy in their lending libraries.

An older book, the first on VBACs, and often angry in tone in places (but that's what was needed!).  Unvarnished look at the pain that c/s deliveries often cause for mothers ("Voices of the Victims" is an especially powerful chapter, and the "Mindscapes" chapter is a must-read for uncovering birth beliefs and psychological influences on birth).  This book is great for uncovering and starting to work through anger over previous births.  Because it was written in the early 80s, some of the medical information is a bit outdated, but most of it still rings very true and is valuable even today.  Classic must-read in the VBAC field.

Flamm, Bruce. Birth After Cesarean: The Medical Facts. New York: Simon and Schuster, 1990.

Early book establishing the safety and viability of VBACs, complete with medical references, written by the author of world's largest study on VBAC. Since it was based on information gathered in the 80s, it tends to be a bit conservative in some of its recommendations (mandatory continuous electronic fetal monitoring, for example) but it is a good overview of VBAC issues from a medical research perspective.  If you need something for a skeptical spouse or relative who needs reassurance from someone with "M.D." after their name, this is your book.

Wainer Cohen, Nancy. Open Season: A Survival Guide for Natural Childbirth and VBAC in the 90s. New York: Bergin and Garvey.  1991.

Sequel of sorts to Silent Knife. Filled with lots of rhetoric on the politics of birthing which not all readers will enjoy or agree with, but also gives a lot to think about.   However, the section on childbirth education, dealing with fears, dealing with past birth negatives, etc. is QUITE good. Definitely worth reading, but is not meant to be a guide of step-by-step practical advice for planning a VBAC. Use as additional reading if desired.

Richards, Lynn Baptisti & Contributors.  The Vaginal Birth After Cesarean Experience: Birth Stories by Parents and Professionals. South Hadley, Massachusetts: Bergin and Garvey Publishers, Inc. 1987.

Great book of anecdotal VBAC stories.  Good for inspiration and 'you-can-do-it' motivation. Hard-to-find book but worth searching for! Is full of inspiring VBAC stories both from moms and health professionals; offers many lessons for women seeking a VBAC.

Emotional Preparation for Another Pregnancy and Birth

England, Pam and Rob Horowitz. Birthing From Within.  Albuquerque, New Mexico: Partera Press, 1998. Also available at their website, www.birthpower.com or www.birthingfromwithin.com

Holistic birth book, encompassing both technical information and emotional preparation. Extremely user-friendly. Some readers may be uncomfortable with the art and self-discovery exercises contained within, but they are usually the ones who would most benefit from these!  Has numerous examples of birthing art and how this reveals mothers' anxieties and concerns, and has suggestions for working through the concerns. Also has excellent information on coping with labor, the advantages of natural childbirth, the compassionate use of drugs and epidurals, and "gestating parenthood". Highly recommended, but best used in conjunction with at least one other pregnancy manual.  

Capacchione, Lucia and Sandra Bardsley.  Creating a Joyful Birth Experience: Developing a Partnership with Your Unborn Child for Healthy Pregnancy, Labor, and Early ParentingNew York: Simon and Schuster.  1994.  Can still be found from www.birthworks.org or www.waterbirth.org (1-800-641-BABY). 

An EXCELLENT childbirth preparation guide with an emphasis on emotional preparation too.  Uses many "New Age" type exercises like artwork, writing with the  non-dominant hand, imagery, and visualizations to work through issues, but if you can get over a resistance to the 'crunchiness' of some of these techniques they can really be helpful.  Unfortunately, the book may be out of print, but the above sources still carry the book, or a used copy can be found.  HIGHLY RECOMMENDED.

Jones, Carl. Mind Over Labor New York: Penguin Books, 1987.  Available from www.amazon.com. 

Very good book for using visualizations, imagery, etc. for reducing the fear and pain of labor.  Many excellent exercises that can be used to change previous negative birth associations, deal with fears, visualize a normal natural birth, and affirm a positive attitude.  If you have a lot of fears or worries about past births or a future pregnancy, this book may be helpful. 

Baldwin, Rahima and T. Palmarini Richardson. Pregnant Feelings: Developing Trust in Birth.  1986. Available from www.1cascade.com,  (1-800-443-9942).

Also helpful in preparing emotionally for childbirth. Workbook format, with lots of writing exercises and exploration activities. A bit hokey at times---women are encouraged to dialogue with their 'Birthing Energy', which many will disdain or feel far too silly trying to do---but the basics of the book can be valuable and insightful for those willing to do the work.

Peterson, Gayle, PhD. An Easier Childbirth: A Mother's Guide for Birthing NormallyBerkeley, California: Shadow and Light Publications, 1993. Available from www.1cascade.com or  www.amazon.com.

"A mother's workbook for health and emotional well-being during pregnancy and delivery. Focuses on exploring and resolving emotional issues during pregnancy through guided imagery, visualization, and journal keeping." Deals extensively with learned attitudes towards pregnancy from cultural influences, your own birth circumstances, and family attitudes. Also has a great deal on coping with labor, dealing with pain and surrendering to birth, etc. A strong emphasis on journaling and inner dialogues, which is uncomfortable to some, but still a good tool for learning and growth. Also recommended.

Audiotapes and Videotape Resources

"Body-Centered Hypnosis for Pregnancy, Bonding, and Childbirth."  Gayle Peterson.  Birth Resources, 1749 Vine Street Berkeley, CA 94703.  (510) 526-5951.  Can be ordered from www.1cascade.com

Excellent audiotape for helping prepare for normal pregnancy and birth.  Side One is for relaxation during pregnancy and bonding with the unborn child.  Side Two (to be used at the end of the pregnancy) is a complete 'rehearsal' of labor and birth, creating an emotional 'experience' of a normal birth ahead of time.  Peterson is a family therapist in Berkeley specializing in pregnancy, birth and parenting, and has authored a number of important books in childbirth education and preparation (see above).  Highly recommended.  

"Ancestral Mother Series" (3 audiotapes for pregnancy).  Karen Frank, Birthwise.  P.O. Box 1111 Decatur, GA 30031, www.birthwise.com.  Can be ordered from www.1cascade.com too. 

Guided imagery, affirmations, and music for pregnancy and birth.  The three audiotapes include "Ancestral Mother", "Heart Healing", and "Releasing".  Other titles available too.  Very peaceful, relaxing, and useful.  "Releasing" is particularly good.

"Birth in the Squatting Position." Polymorph Films.  95 Chapel Street  Newton, MA 02158.  1-800-370-FILM.  Available from www.1cascade.com

EXCELLENT  and very affordable video for getting *normal* birth into your mind!  Only 10 minutes, but very powerful visually.  Graphically shows a number of babies crowning and being born with no interference.  Its graphic pictures are a bit startling and shocking at first, but few other videos show *normal* birth so well and so vividly to help your mind visualize the reality for yourself.  Originally made in South America to help promote the use of the squatting position for birth, positioning becomes secondary to the effectiveness of the visuals of normal natural birth.  HIGHLY recommended, especially for women who had problems/fears about the pushing stage or visualizing themselves giving birth normally.

Grieving Resources

Organizations

Books

Panuthos, Claudia. Transformation Through Childbirth: A Woman's Guide. Westport, Connecticut: Bergin & Garvey, 1984. Available from Cascade Press/Birth and Life Bookstore, www.1cascade.com  - (503) 371-4445 or (800) 443-9942.

Great book on emotional preparation for or recovery from birth. Kmom highly recommends it. Has a good chapter on pregnancy losses, and a great visualization exercise/ceremony for grieving parents when they are ready. Unfortunately, out-of-print now, but Cascade Press has a few left.

Panuthos, Claudia and Catherine Romeo.  Ended Beginnings. Westport, Connecticut: Bergin & Garvey.  1984.  www.1cascade.com or www.birthworks.org has this book.

Deeply affecting book about processing all kinds of pregnancy-related losses, including infertility struggles, cesareans, miscarriage, stillbirth, early neonatal death, etc.  Very hard to read the first time but definitely worth sticking it out and re-reading multiple times.  Offers suggestions for dealing with the pain of pregnancy losses on physical, mental, emotional, and spiritual levels, and help in moving beyond the losses and healing when ready.  Excellent book.  All women who have experienced pregnancy loss should have this book.

Breastfeeding and Cesareans

Willis, CE and V. Livingstone. Infant Insufficient Milk Syndrome Associated with Maternal Postpartum Hemorrhage. Journal of Human Lactation. June 1995. 11(2):123-126.

Examines a possible association between insufficient milk syndrome and maternal postpartum hemorrhage. 10 consecutive cases associated with hemorrhage were examined; all of the babies were 'failing to thrive'. 6 of the 10 mothers experienced a significant drop in hemoglobin, and 2 of the 10 experienced very large drops in blood pressure at times (can be a cause of fainting). 5 infants experienced dehydration and elevated sodium levels. "These data serve to heighten awareness of insufficient milk syndrome as a potential consequence of postpartum hemorrhage. Early postpartum review of all breastfeeding mothers and infants is strongly encouraged."

Laufer, AB. Breastfeeding. Toward Resolution of the Unsatisfying Birth Experience. Journal of Nurse-Midwifery. January 1990. 35(1):42-45.

"The act of birth and the way it is managed have great meaning for many women. What may appear to professionals as a routine or remarkable delivery may be perceived by the mother as humiliating, mutilating, or dehumanizing. If the mother has an extremely negative perception of her birth experience, she will suffer a loss of self-esteem, and it is more likely that she will have trouble taking on the maternal role. A successful breastfeeding experience builds up a mothers' confidence and self esteem and facilitates acquisition of the maternal role."

Blomquist, HK, et al. Supplementary Feeding in the Maternity Ward Shortens the Duration of Breast Feeding. Acta Paediatr. November 1994. 83(11):1122-1126.

Compared the breastfeeding rate at 3 months postpartum for 521 babies born in a certain maternity unit. Analyzed a number of factors, including supplementary feedings (mother's milk, donor milk, or formula), to see how they related to 'long-term' breastfeeding rates at 3 months. Using a multiple logistic regression analysis, found that infants given a supplementary feeding had 4x the risk of not being breastfed at 3 months. Other risks also included maternal age <25 years, maternal smoking, and an initial weight loss of 10% or more (who would be likely to be supplemented). "Thus the administration of supplementary donor's milk or formula during the early neonatal period was associated with an increased risk of a short duration for breast feeding, even after adjustment for a number of potential confounders."

Perez-Escamilla, R et al. The Association Between Cesarean Delivery and Breast-Feeding Outcomes among Mexican Women. Am J Public Health. June 1996. 86(6):832-836.

This study examined the impact of cesarean delivery on the initiation and duration of breastfeeding among 2517 Mexican women. Multivariate Logistic Regression was used to determine the odds ratio of cesarean mothers not initiating breastfeeding (odds ratio=.64) or for breastfeeding less than one month (odds ratio=.58). If c/s mothers were able to successfully initiate bfing and nurse for at least a month, a c-section delivery was not found to be related to the overall duration of bfing. C-section was found to be a very significant factor in impacting breastfeeding rates. "It is desirable to provide additional breast-feeding support during the early postpartum period to women who deliver via cesarean sections."

Mohrbacher, Nancy and Julie Stock. The Breastfeeding Answer Book. La Leche League International. 1997 Revised Edition. Available from www.lalecheleague.org.

The ULTIMATE reference for up-to-date information about breastfeeding and medical issues. Extensively referenced and researched. Very expensive book to purchase for yourself but many local LLL chapters will have this book available in their lending libraries, or one of the Leaders will.

Asselin, BL and RA Lawrence. Maternal Disease as a Consideration in Lactation Management. Clinics in Perinatology. 14(1):71-87. March 1987.

Treatise for OBs, perinatologists, pediatricians, and internists on how to handle lactation issues in women with chronic diseases such as diabetes (mostly type I), severe asthma, kidney disease, and chronic hypertension. Written by 2 doctors/medical school professors with great expertise in lactation issues; excellent resource for the medical professional. Most lay readers will find it a bit dense for their purposes, but a few may find it useful for ideas to share with their health provider about how to preserve breastfeeding in the face of chronic maternal disease.

General Resources

Beattie, Melody.  Beyond Codependency.  New York: Hazeldon Foundation.  1989.  Available from www.amazon.com

Classic text on codependency issues.  If you are a controller, then you might want to look into codependency issues.  This book is helpful to gain more understanding and compassion for yourself, and to recognize and help break old patterns so new and healthier patterns can emerge.  

 

Online Resources 

 


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