by Leticia Mooney
Positive caesarean. Apparent oxymoron: Two words that together don’t seem to make sense.
‘If you had to have a caesarean it wouldn’t be the end of the world. I’ve had clients who’ve had really beautiful, positive experiences,’ enthused my doula, Sonja.
I smiled and nodded in acceptance of her truth, without actually feeling that this was possible. How any type of major abdominal surgery could be positive, with its long recovery time and associated pain and drugs, eluded me. When applied to birth, something that I saw as a rite of passage, it appeared to be frankly impossible.
That impossibility persisted, despite how often I heard about positive caesarean being possible.
Now you’ll understand why I have to admit being horrified every time a woman told me she planned a caesarean. It always seemed to me like such a selfish thing to do. In true honesty, I have to say that I saw it as skipping out on the opportunity to do what only women can do. The idea of choosing caesarean for ‘convenience’ runs against the natural process of creating new humans. Plus, the very idea of choosing someone else’s birthday for them feels fraught with all kinds of spiritual issues.
They’re pretty full-on beliefs, aren’t they? Maybe this is why I had to eat my own attitude and plan my own baby’s “sunroof” entry into the world.
At the time of writing, which is three weeks into recovery time, I have to admit that the entire process was beautiful.
Yes, darling reader, it’s true: Positive caesareans really do exist, and are even within your reach.
Birthing is surrounded by advice of all kinds. So, rather than give you advice, as I sit here on my bed at three weeks post-surgery, I’d like to tell you my own story.
I’m a 40-year-old, first-time mum. Despite being considered a person of ‘advanced maternal age’, we had a dream pregnancy. My scant 11 weeks of seasickness in the beginning was the envy of many; as were my rampant good spirits and fantastic physical health: No diabetes, no oedema. Not even swollen toes! I kept up my hobby of attending ballet classes right up to 36 weeks—and only stopped because other participants made me feel unwelcome, not because I didn’t feel able to participate safely.
We were lucky to have midwife-led care. And we were on track for the homebirth that we really wanted. My husband and I studied hypnobirthing early—by 16 weeks!—so we had loads of time to practice.
Along the way, we created a birth plan. Sonja helped enormously by providing examples from other people’s birth plans. Everyone counselled us not to rely on The Plan, but to be flexible to whatever might happen. As such, our birth plan ran to seven pages, catering for all types of contingencies.
Well, every contingency except the one we faced: Our little love decided not to turn around.
In utero, he looked rather like Vishnu: One foot down, one foot tucked up, arms up next to his head. During ultrasounds, people would joke that he looked like he was dancing; and after the (frankly excruciating) external cephalic version we attempted, the team suggested the baby was meditating. He was calm and happy where he was.
But I wasn’t.
I was devastated that our homebirth was off the table. That perhaps even natural birth at all might be off the table.
The medicos wanted us to book in for an elective c-section as soon as they learned he was breech; the midwives argued that breech delivery is possible, if bubs lifted its feet up; Sonja was armed to the teeth with suggestions as to what might encourage baby to turn naturally. Three people; three conflicting perspectives. I decided to wait as long as we could while attempting every alternative to a c-section.
Our attempt to turn bubs included literally everything that often works. It involved Spinning Babies, homoeopathy, acupuncture, moxibustion, swimming, long walks, Webster Technique, meditation, visualisation, and hypnosis.
This is important for you to understand: I went into our caesarean knowing that I had done literally everything else I could to encourage our baby to turn. There is no regret, no wondering if something else would have worked. The fact that nothing did work meant that we had just one option left.
Thus it was, during our last ultrasound on the Friday of our 41st gestation week, we learned that our baby was still a footling breech. The risk of an emergency caesarean (under full general anaesthetic) as a result of a cord prolapse, if I were to labour spontaneously, was extremely high.
We’d come to the point where a decision had to be made. That decision did not involve natural birth. That decision was when will the caesarean take place. I felt defeated, and exhausted.
Sitting on the bed in the birthing centre with my midwife, doula, and consultant, I was advised that I had two options: Either opt into the ‘emergency surgery gap list’ over the weekend, or wait until the following Thursday for an elective caesarean.
I didn’t answer for a moment. I knew the Benefits; I knew the Risks; I knew there were no Alternatives; I knew that there was no Doing Nothing. I breathed, thought about putting off the decision. But all of a sudden, my intuition kicked into high gear. I was overcome by a feeling that we had to plan for Sunday; that going any longer would be a Very Bad Idea.
So, we booked ourselves into the ‘emergency gap list’ for the Sunday.
Once I’d done this, I went home to amend our birth plan for the last time.
This situation forced me and my husband to consider what it was about a birth that was really important to us.
Writing a birth plan for a home birth had been a visualisation process. It was like documenting our ideal, dream scenario. But writing a birth plan for an unavoidable caesarean was a wildly different matter. The only question we had to answer was: What elements in birthing were important to us, and why?
In writing this caesarean birth plan, I asked myself: How did I want to remember the experience? What can we do to make it as personal as possible? Knowing that so much was out of our hands, what specifically could we design so that we felt that we had participated, been respected, been listened to, and been cared for?
In the end, we asked for:
- dim lights if possible, knowing the restrictions of theatre
- delayed cord clamping; this gave our baby one full minute delay, which was better than nothing
- my husband to trim the baby’s cord (knowing that he couldn’t cut it himself)
- use of a soft cord umbilical cord tie, instead of a hard plastic clamp
- skin-to-skin as soon as possible and for as long as possible afterwards
- music of our choice to be played
- a member of the nursing team to take photos for us
- the surgical team to be aware of (and use) only positive language, because studies show that language used affects health outcomes.
Once this was done and sent off to our midwife and the team, my husband and I were able to really relax for the first time in more than a month. We knew that we’d done everything we could ahead of time. We knew that we could do nothing more than ensure our baby’s safe arrival.
Two days later, we arrived at Flinders Medical Centre at 0630. Our midwife arrived at about 0700; she was the one who prepared me for theatre. She gave my husband the signature green scrubs to wear.
Then we waited for a gap in the theatre cases.
The team asked if I was excited.
‘Not really.’ I was blunt, unable to summon any warmth.
‘But you’re about to meet your baby!’ they enthused.
‘Sure,’ I acknowledged. ‘But there’s this whole surgery thing in front of it.’
It seemed like nobody really grasped this fact. My anxiety was pretty intense. I’d never had major surgery of any kind. Not able to eat, I spent the day breathing and meditating, and taking slow walks up and down the corridor. My husband was unfazed and didn’t really understand my anxiety. My midwife at least acknowledged that for her and her colleagues it is so easy to downplay the seriousness of the procedure. They do caesareans all the time, and forget that it’s a big deal.
By the time we got to theatre, we had been waiting for over nine hours. At last notice, we were waiting for a major head trauma and a post-birth tear. With luck, we were told, we’d go around 4 pm.
As we were warned, when it was our time to go, things happened quickly.
The anaesthetist came in to discuss the spinal block and any anxieties or fears I might have. He was down-to-earth and lovely, and took every one of my concerns seriously. He answered my questions with respect and care.
I still couldn’t quite believe this was going to happen, even as I was being wheeled into theatre. For a few moments I felt like everything had been taken out of my hands. That this was not the birth that I had thought about, visualised, dreamed. I even had a brief, irrational moment of thinking that this was being done to me, and I wondered if I could escape.
But once I was actually in theatre, and I knew that this was really going to happen, all I could do was surrender.
The irony of this sounding just like a good natural birth is not lost on me.
When AC/DC was turned up on the theatre speaker system, I smiled. When my husband was asked to stand up and announce the sex of the baby, and was invited to participate in everything, I knew that all of our preparations had paid off.
Within ten minutes, of the anaesthetic taking effect, my baby boy was on my bare chest and already trying to suckle on my throat! The only time our little boy was taken off my bare chest was to be weighed, and cleaned up. It seemed like forever to me, but in reality it was probably only five minutes. The anaesthetic nurse scooted around photographing as much as she could, loving every minute.
Once I saw our boy, I didn’t care that I had to stay there for the next 40 or 50 minutes being stitched back together. I didn’t care that I caught a glimpse of my innards in the overhead lights, which reflected what was going on below. I didn’t even care that I was through the easy part of caesarean delivery and about to face the next challenge.
I can only look back on my own caesarean as an overwhelmingly positive experience. It was a birth filled with love: Everyone involved was beautiful, upbeat, and excited.
Every one of our wishes was fulfilled, which was empowering and satisfying—and not just for me. My husband describes the birth in the same terms as I do.
Caesarean might not have been how we had wanted our baby boy to arrive. But given the circumstances, it was the absolute best birth that we could possibly have had.
Many women elect to have caesareans, rather than to go through birthing. Even now, out the other side of my own positive c-section experience, I still think they have rocks in their heads. The first few days post-surgery carry an indescribable pain, especially when your pain medications aren’t right (as mine weren’t). Standing up to walk that first time, barely 16 hours after the surgery, was the most painful thing I’d ever experienced: I remember being stuck between standing and sitting, held up by two nurses, and wailing, wishing someone would just hit me on the head and knock me out completely, rather than talk to me when I couldn’t process what they were saying. My anxiety about going home after just three days was intense (if unjustified). The weeks that follow force you into a state of dependency, which is jarringly difficult.
Caesarean is not a decision to make lightly. But when you do make the decision to bring your baby through the sunroof rather than the playground, know that you can still make it your birth experience.
A positive birth experience is about empowerment. It isn’t about the delivery, or where you do it. It’s about why and how you birth the way you choose to.
It requires preparation and dedication. It means establishing boundaries. It means being a good communicator.
If you’re able to do this, then no matter how your birth happens, all you can do is ensure that you make decisions your way, in a timeframe you are happy with, for what you consider to be the right reasons. Nobody else’s reasoning or opinion matters.
Pregnancy and birthing are extraordinary experiences. They are also two areas that are filled with opinions and dogma. Remember: The only thing that matters, in the end, is how you come into your own power, and how you leverage it to design your best birth experience. If you are able to do that, then you will have a positive experience almost by default, regardless of circumstances. Even if, as in my case, your birth turns out to be the polar opposite of your dreams.
About the author
Leticia Mooney is an Australian businesswoman, author and ghostwriter. She’s new mum to a fabulous little boy named Beren, which is Elvish (Sindarin) for ‘brave’.