Giving birth via caesarean section – in which a baby is delivered via a cut made to your tummy and womb, rather than through your vagina – is incredibly common. According to the NHS, around 1 in 4 pregnant people will have the operation.
You might plan to have the procedure (an 'elective caesarean') for myriad reasons that would make a vaginal birth riskier. Some people choose to have the procedure for other reasons, such as having had a previous traumatic vaginal birth. Others will end up having unplanned, emergency caesareans, due to an unforeseen problem.
While C-sections are incredibly normal and are often lifesaving, for parent and baby, many new mums report feelings of guilt, for not having had their child in the 'natural' way.
Of course, no person should ever feel bad about the way that they give birth. But to dig into why this phenomenon exists, this Maternal Mental Health Awareness Week, Chloe Lovell, a 35-year-old writer from Surrey and mum to Eleri, 6 and Lyla, 17 months, shares her experience with C-section guilt.
Every ache felt like a sharp reminder of my failings as a mother. As I sat in the hospital bed and looked into my little girl’s eyes, feelings of shame overwhelmed me and I felt as though I couldn’t breathe. Tears poured from my eyes as I began to weep. My mind was seized with a question: 'Would I ever recover from this crippling feeling of disappointment?'
But it wasn't an act of negligence that had caused me to feel this way – no harm had befallen my healthy, happy baby. Instead, the root of my distress was that, while in labour, I had been rushed into theatre for an emergency C-section after my induction process took several turns for the worse, putting an end to my plan of a vaginal birth. Now, this was now triggering endless feelings of guilt.
How many people have C-sections?
C-sections are common. NHS data shows that 1 in 4 pregnant people will have this major surgery. Despite its ubiquity, the operation seems to cause feelings of guilt in a sizeable minority (but of course, not everyone) of those who have undergone one – something that could be linked with results from a 2020 survey from charity Birthrights, which showed that 74% of those asked said that they were given the opportunity to discuss the benefits of a vaginal delivery with a medical professional, but only 42% said they were given the opportunity to discuss the benefits of a C-section.
For me, sitting on that hospital bed a year and a half ago, all I could think about was why my body had not behaved in the way that I felt it should have. If giving birth is ‘natural’, then why couldn’t I do it?
This deviation from what I thought birth would look like is a typical trigger for what I'm terming C-section guilt, says Dr Rebecca Moore, a perinatal psychiatrist and co-founder of Make Birth Better, an organisation dedicated to working against conditions that can lead to birth trauma. 'It is common for women to feel guilt or shame after a C-section, especially if the surgery had been unplanned,' she explains.
Why do some people feel guilty after a C-section?
'People hope, expect and plan for their birth to be one way, and never really imagine that they might end up having a C-section. That can be a real shock, and they can end up being really hard on themselves, feeling afterwards that they didn't do birth correctly, somehow.'
This resonates for Brenda, co-founder of the motherhood group Orbit. After an emergency C-section was needed to deliver her first child, the feeling of 'failing' at birth haunted her.
'The focus throughout my pregnancy was getting prepared for a vaginal delivery, to the point where I felt that I didn't actually birth my baby because I had a C-section. I was set on having a water birth with absolutely no pain meds,' she details.
Brenda was 40 weeks and 3 days pregnant when she suffered a migraine that lasted 24 hours. Feeling concerned for her and her baby’s health, she headed to the hospital for advice. Protein was found in her urine, which is a sign of pre-eclampsia. This meant that Brenda needed to be induced straight away.
The process was traumatic. 'I begged the midwife to be gentle with the induction, but she did the opposite. I felt extremely violated and like I had been assaulted.' Shortly afterwards, Brenda started bleeding. Her contractions came fast and sharp, she lost consciousness and her baby’s heartbeat couldn’t be found. The only option was to have an emergency C-section.
Brenda never thought it would be her own family to make her feel like she had failed at birth, but, after bringing her baby home, those closest to her questioned if she had really needed a C-section – or if she had she been persuaded to abandon a ‘natural’ vaginal delivery. Their words hurt and Brenda found herself feeling ashamed for a medical emergency that was beyond her control.
Where did this focus on 'natural' births come from?
But why has this focus on a 'natural' birth taken such deep roots?
'There’s a very common belief, encouraged by some natural birth proponents, that a woman can control the kind of birth she has, so that if she goes in with the right mental attitude, for example, she will be able to push the baby out without any interventions. The truth is that things go wrong in childbirth all the time, and it’s never the woman’s fault. It’s just that birth is inherently risky,' says Kim Thomas of the Birth Trauma Association.
It's an ideology that impacted Louise*. She gave birth at the start of the pandemic in March 2020 and still holds mixed feelings when it comes to her labour. After arriving on the labour ward and being advised that she had another few days before the baby arrived, she went back home. But, with contractions coming thick and fast, her waters broke two hours later. Swiftly, she returned to the hospital, where she was told that her baby’s life was at serious risk.
Louise was dilated but had a prolapsed umbilical cord, which meant if she continued to have contractions and deliver vaginally, the cord would be compressed, cut off blood supply to baby and result in a stillbirth.
'I know that the C-section saved my baby's life, but I can’t help but feel ashamed and embarrassed that my body was not able to birth naturally. When people ask about my birth, I find myself explaining it was an emergency and that my first child was natural,' she says.
It's important to note that these feelings – as severe as they can be – are likely to heal, with time. Thomas highlights that when new mothers meet, they can spend a lot of time discussing how they gave birth, but those conversations don’t go on forever. 'As your child gets older, you’ll start worrying about whether they know how to make friends and how to make sure they eat their greens. After a while, the matter of how your child came into the world will seem very insignificant in the scheme of things.'
Dr Moore stresses that, if you are suffering with it, that you can work through C-section guilt and it’s all about finding the right people to support you, making a proper treatment plan and remembering that it can take time. In her own clinic, she reminds new mums that having a C-section is never something that you should ascribe blame to.
Brenda also advocates for therapy, and believes it helped her to no longer feel guilty for how she birthed her baby. She also calls for further change in how we speak to people who have just had a baby.
How do we put a stop to C-section guilt?
'I think we need to change our language around birth. When a woman has a new baby, don't ask her if she gave birth "naturally" or "normally". Ask if she is ok, instead of a hundred questions about what her vagina did or didn’t do.'
One tool that Dr Moore recommends in healing from C-section guilt and accepting your birth story is social media, which she believes has been 'amazing' when it comes to the representation of C-sections.
'You see people, including celebrities, posting unfiltered postnatal snaps and proudly showing their C-section scars. I think this is really important because it makes women feel less alone. It normalises that this is what postpartum bodies can look like and shows that they are not to be hidden and that they're not shameful. It’s part of your pregnancy and maternity journey and that is hugely powerful.'
This is something that I realised when I finally decided to seek professional support for how I was feeling. I opted for a ‘birth reflections’ session, provided by the NHS, with the hospital that carried out my cesarean. I was told I could have as long as I needed to talk through all my maternity notes, and what happened at every stage of my labour. Although more tears were shed, I found great comfort in talking everything out.
What I hadn’t appreciated until after the surgery was how heavily influenced I had been by the unfair notion that giving birth ‘properly' meant to give birth vaginally, and that C-sections were somehow a ‘second best’ route or an ‘easy option’. Now, I feel proud to say that I no longer carry feelings of guilt or inadequacy.
Having someone listen to and validate my experience and feelings was invaluable, and at the end of my birth reflections session, I was even able to take a walk around the maternity ward which gave me a sense of closure.
Instead of failing to birth my baby, I realised I had actually been successful in protecting her from harm, and agreeing to a procedure that ultimately saved mine and my little one’s life.
*Name has been changed
If you need help with these issues:
Been affected by the issues mentioned above? The below might help.
Make Birth Better
If you had a traumatic birth, you can find support at makebirthbetter.org.
If you are planning on a c-section and need enhanced support, Birthrights can help you ask for a caesarean, help you to know your rights or help you make a complaint. For any of the above, contact email@example.com.
NHS Birth reflections
Contact your maternity ward, to ask about this service. This is not counselling, but an opportunity to review your care.
If you are worried about your mental health, speak to your GP, who can help you to receive the care you need.
Five X More
If you are a Black woman or birthing person and want to contribute your experiences to the organisation's Black maternity experience survey, fill it in at fivexmore.com.
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