So Are We All Just Going CRAZY?
Often for mothers who experience caesarean sections for whatever
reason, we are left with a heap of emotions that we donÕt seem to
understand or know what to do with. Many times we are given ÔthatÕ
comment ÒWhat are you sad about? You have a healthy baby?Ó
É..hmmm why are we sad? As the mothers of the children of course
we are grateful that they are healthy. But what do we do about the
way we feel? Usually we just try to get on with it and pack those
feelings away. For some, we donÕt even bother to address them at all.
Why bother? No one understands. It can hurt so much! Sound familiar?
Well, take heart. There are very good reasons for having emotional
issues after caesarean. In a presentation I made to the new round
of registrars at Flinders Medical Centre, SA, I attempted to explain
why women who birth by cs are vulnerable to grief reactions after
cs, even with a healthy baby as the outcome. I offer this information
to you so you can see for yourself, you are not going crazy!
DE-PERSONALISATION
Both professional and woman have to de-personalize what happens behind
closed doors. In no other situation would women allow themselves to
be so ÔopenÕ (pardon the pun) to strangers. In a time when we are
not obligated to tell someone if we are a ÔMissÕ or ÔMrs.Õ, we need
to depersonalize procedures associated with the whole giving birth
thing! But in doing this are we doing our birth experiences an injustice?
Why do we do it?
- The necessity to accept and allow invasive procedures to be preformed
- Implication that regret or distress about cs is socially unacceptable
- Birth is separate to baby and can be an event of separate psychic
significance
Studies have been done into the possible psychological outcomes
of caesarean births.
EMOTIONAL EFFECTS OF CAESAREAN BIRTH CAN INCLUDE:
*depression, anger, grief
*diminished clarity of thinking, efficiency & enthusiasm *marked
decrease in self-esteem
*belief that intervention was required due to personal inadequacy
or failing (rather than factors beyond their control)
*short term diminished responsiveness to external world, in particular
to the child
*diminished social and occupational functional capacity
*less likely (even avoidance) of conceiving again
LOWERED SELF-ESTEEM RESULTED FROM:
ÒÉdamage to feminine identity and body image and , because of heightened
dependence following surgery, to diminished self-worth.Ó (Fisher)
EXTERNAL FACTORS THAT CAN INFLUENCE A BIRTH EXPERIENCE:
*familiarity of care providers and trust in their care-continuity
of care and information
*mutual respect and understanding of perceptions of birth
*involvement in decision making
*full understanding of the necessity for intervention
*intrapartum apprehension for well being of child and self
*long and/or difficult labour
*having partner or support people present
*complete change of physical location
*introduction of strangers (other care providers)
*conduct of personnel in operating theatre
*initial contact with child; seeing, touching, holding etc
*respect for the actual birth of child Ðnot simply a ÔextractionÕ
*separation during recovery
*post operative pain
*post operative support
Nearly all of the above listed things can be addressed with very
little effort. Some interesting statistics from the Fisher study compared
the experiences of cs with vaginal births (VD):
- Less likely to have partner or support person present (VD 92%
vÕs CS 81%)
- Less likely to see babies during first 5 minutes of life (VD
97% vÕs CS 60%)
- Extremely less likely to hold baby immediately after birth
(VD 90% vÕs CS 12%)
REASONS FOR DISTRESS
- Involvement in decision making
- Emotional stress of well being of child and self
- Increased likelihood of substantial separation (31% didnÕt hold
baby after birth for 8 hours or more)
- Unexpected obstetrical intervention at a time of heightened vulnerability
THOSE WHO ARE MOST AT RISK OF DEPRESSION:
*expected a natural birth
*inadequate help or support during labour, surgery, post operative
recovery
*general anaesthesia or combination of drugs that cloud memory
or had unpleasant side effects
*felt coerced by hospital and/or partner
*felt that cs was a surgical procedure not a ÔbirthÕ *expected
to breastfeed, but found difficult after surgery
*isolation or lack of support at home
*guilt over grief
Here are some more quotes that come from a study conducted into
the psychological impact of operative obstetric interventionsÉ( details
of study given below).
ÒÉoperative intervention in first child birth carries significant
psychological risks rendering those who experience these procedures
vulnerable to a grief reaction or to post traumatic disorder.Ó
(Fisher, J. ÒAdverse psychological impact of operative obstetric interventions:
a prospective studyÓ, A&NZ Journal of Psychiatry 1997;31:728-738)
ÒÉwomen who experienced caesarean child birth felt significantly
worse in the postpartum period than they did in late pregnancy. They
reported increased symptoms of depression and irritability and a deterioration
in efficiency and clarity of thinking. Anxiety levels had reduced
marginally from late pregnancy. Their self-esteem was significantly
diminished.Ó (Fisher)
Emotional distress associated with traumatic birth does not become
apparent for some weeks, months or even years. ÔHealthy Mother, Healthy
BabyÕ extends past the six week check up!
ÒBecause it is the one thing that will give me back my life, erase
the feelings of abject failure and make me feel like a true mother,
not one that canÕt even accomplish the first task required of her,
that is giving birth to her child.Ó Anonymous quote from a woman
when asked why she wants a vbac
So one day when it is the right time for you,
unlock that special place where your feelings are hidden away and
see if any of the above rings a bell. Negative feelings are normal
and should be addressed. They donÕt just go away.
To understand that there are reasons for how you feel will assist
in moving on.
Good luck!
Jo Bainbridge
Co-ordinator CARES SA
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