Birth is the sudden opening of a window, through which you look out upon a stupendous prospect. For what has happened? A miracle. You have exchanged nothing for the possibility of everything.
~William MacNeile Dixon
I’ve had two cesarean sections. I’m part of the growing minority of women in the United States who had a surgical birth. At last count, the rate of c-sections to vaginal births was about 1 out of every three. In some states, like my own fair state of New Jersey, the c-section rate is just a hair shy of 40% (as of 2009; the last year for which I was able to find concrete records).
I also happen to be part of the other minority group – “crunchy parents”. It presents a conundrum for me. How do I advocate for natural things – like birth – when I’m the recipient of two cesarean sections, without devaluing my own births, nor alienating my cesarean-receiving sisters, nor eschewing my crunchy ideals? It’s a thin line to walk. And it isn’t always straight as there are so many variables when it comes to birth.
Here’s the truth. The increase in cesarean sections is alarming. Cesarean sections present dangers for mothers and babies that just aren’t there in natural births. Advocacy for natural birth needs to continue. Work needs to carry on to help women feel empowered in their decision-making surrounding their own births, to increase the number of doulas and midwives available to assist women in birth, and to make home-birthing a safe and legal option for women.
Within advocacy comes support; and the cause of my writing today. We need to be SUPPORTING women – not tearing them down. Too often, I fear that advocacy in natural birth trends towards guilt, shame, and anger. I’ve read things written about mothers who’ve given birth via cesarean section that make me cringe; that make me SO ANGRY. Women who have had c-sections shouldn’t feel the need to addendum their birth story with excuses, or explanations for their birth. Never should a woman be made to feel shamed, or at fault for how her birth culminated. A birth is a birth is a birth. At the end, every mother who has given birth has the shared experience of growing a birthing her baby. There’s shouldn’t be a dividing line, based on HOW you’ve given birth.
Natural birth is the most likely way to encourage a positive outcome for both mom and baby. There are ways to teach about natural birth and its benefits to both mother and baby, without alienating the very people natural birth will help. There are things you can do to educate and encourage and choices to be made which can increase likelihood of a natural birth outcome. But, it’s important to keep in mind, at it’s core, birth is unpredictable and specifically un-plan-able. The variables are myriad: The ways a woman reacts to pain, fear, anticipation; The support she has through pregnancy and in labor; Health conditions she may have – physical and mental and emotional; Past experiences she’s had – all play a role in how birth plays out.
It every case, birth is one of the most precious, amazing, challenging, awesome, and MEMORABLE times in a woman’s life. Natural birth advocacy should always be about helping and lifting up women, not humiliation. Empowering women, not disenfranchising. Above all, supporting women, no matter what choices are made, what direction birth takes, what the outcome is.
So to that end, here’s what I thought I’d do. I’ve prepared a list of things you SHOULDN’T say to (or about) a mother who’s given birth via cesarean section. These are things which I’ve either heard personally, anecdotally, or seen written. But because I don’t want to dwell on the negative, I’ve also compiled a list of things you SHOULD say to a c-section mom (or one who’s about have one).
Without further ado...
Things you SHOULDN’T say to a mother who’s given birth via cesarean section:
1) “Your C-section wasn’t technically a birth; it was a surgery.”
Yes, cesarean is a major surgery. But a cesarean section is ALSO a method of giving birth. By virtue of the definition of birth:
1 a: the emergence of a new individual from the body of its parent (check!)
1 a: to bring forth (check!)
2 b: to give birth to (check!)
1 a: biological (check!)
It ALSO is birth by virtue of the fact that mothers celebrate their children’s birth days, not their surgery days. A mother who has given birth via cesarean has as much right to birth as her vaginally-birthing sisters. Saying - or even suggesting - that a cesarean section isn't a birth not only makes you sound ridiculous, it's just plain hurtful, so please, PLEASE don’t do it.
2) “Your baby was ripped/torn/cut/pulled/forced out of you - before she was ready.”
We don’t always know what prompts labor, and we don’t always have control over the way our birth progresses. Sometimes, babies come before they are ready. Sometimes, signals point to babies needing help moving earthside. Sometimes, that help is a surgical birth. Regardless, no one needs to be reminded in such a callous way that they were sliced into, nor should any woman have to face the implication or suggestion that was in some way her fault. The vast majority of pregnant mothers do everything they can to ensure a safe birth for their baby. Their decisions are typically based on the knowledge they have at the time. There’s no room for inflammatory hyperbole.
As an aside, if a mother wants to talk to YOU about her feelings that her baby may have arrived before he was ready, or that her birth felt less than consensual or not as calm as she would have wished; please listen. Honor her feelings. There are unfortunately cases of women who aren’t treated well in birth and whose wishes aren’t respected. But even in those cases, exaggerating the negative isn’t helpful.
3) “Be happy; at least you have a healthy baby.”
I understand when this is said, it’s intended to be comforting. But really, saying this is a denial of feelings. No mother who is mourning the loss of her birth-as-she-planned-it wants to be brushed off. And every mother is grateful their child is healthy. Having a cesarean is typically NOT a planned event, and even when it is, it’s not what most women choose (in spite of what the media likes to portray – women as “insisting” on elective cesareans for “convenience” reasons). Disappointment or concerns over birth are valid! Listen, reassure, comfort; don't brush aside feelings.
4) “If you’d done (or didn’t do) x, y, or z, you could have birthed your baby vaginally.”
Look, unless you are the attending midwife or doctor, you JUST CAN’T KNOW whether X, Y, or Z would have resulted in a different outcome. Even if you WERE the attending midwife or doctor, you can’t change NOW what has already happened, so keep it to yourself.
In birth advocacy there is certainly a time and a place for analyzing your birth story, for thinking over what you wish had gone another way, what you’d like to try differently, what you want to do the next time, or even what you wished you’d tried. There needs to be time for grieving and for accepting and healing. But that’s for YOUR OWN birth. It’s not your right to analyze anyone else’s birth for them. Ever.
Things you SHOULD say to a mother who’s given birth via cesarean section:
1) “Good job, mama.”
Just that. No matter what transpired, no matter how the birth progressed, no matter how far "off birth plan" things went, a new baby was born to a pregnant mama, and that mama deserves a pat on the back. End of story. If that mama wants to talk about her birth, let her do so. Support her. Be there for her. Without judgment.
2) “How can I help you?”
Cesarean births present unique challenges to mothers and babies. It can be difficult to walk in the first few days post partum. Holding baby, changing your own position, breastfeeding, regular self-care, all can be more challenging after the stress of birth AND a major abdominal surgery. Many doctors advise weeks post-partum without resuming regular activities – like climbing stairs, lifting anything other than the baby, or driving.
Personally, even though I felt my recoveries were quick and relatively easy, there were certain physical challenges that were just a drag. I couldn’t do laundry, I couldn’t comfortably make it upstairs to my bedroom, I couldn’t move baby to where I wanted her to be when I wanted her to be there. Having someone there (husband, doula, friend) to pick up around the house, entertain siblings, cook meals, change diapers/clothes, can make all the difference in the world!
3) “If you need to talk, I’m here to listen.”
Every mother likes to talk about her birth story; it’s a defining moment in life. Some stories are joyful and easy, some are difficult, trying, tearful. Each emotion is real, valid, and needs to be addressed, in order to heal and move on. I’d say this is particularly true for a mother who planned her birth to be natural, who felt like she’d dotted all the i’s and crossed all the t’s, but whose birth didn’t turn out the way she’d hoped. When you’ve done “everything right” and things don’t go as planned, a shoulder to cry on, a non-judgmental ear to listen is so very important.
- - - - -
The truth is, current birth climate in the US is a challenge. Birth in the media is still most often depicted as scary, icky, and unnatural. Misinformation and assumptions about the benefits/dangers of natural and/or homebirth birth versus hospital and/or surgical birth are rampant, and the number of cesarean sections is still growing. Advocating for natural birth is necessary; I want my own children to be able to make empowering choices about the direction of their/partner’s future births (if they so choose); I want them to have even better experiences with birth than I did. But to get there, we need positive change. Commentary on what a mom did “wrong” in birth isn’t useful, it isn’t helpful, it isn’t advocacy. It’s hurtful, it’s shameful. The last thing we need in this world is more judgment. You want to see change in the birthing world? It doesn’t come from negativity folks; it doesn’t come from divisiveness. It comes from unity, from sharing our stories, understanding others’ points of view, using your experiences to educate, accepting differences of opinion and experience, listening, empathizing, and learning from one another. Every birthing mother has the right to feel good about her birth; it’s an amazing moment in time; whether it occurred in the birthing tub in your own home, or under the bright lights of the OR.
Words are powerful. Choose them carefully.