“I didn’t think you were the type to have an elective caesarean,” said an acquaintance when I told her of my plans.
Once I stopped choking on the judgment I got to wondering: What exactly is the ‘type’?
Is it the heartless ambitious career woman who has her PA schedule the birth of her child between client meetings? Or perhaps it’s the vain yummy-mummy who needs to plan around her pedicure and her plastic surgeon’s availability to give her a simultaneous ‘mummy tuck’? Or maybe some other cardboard cut-out mother who only exists in Hollywood scripts?
Whatever the cliché, the clear implication is that women who opt for a caesarean are immoral, lazy and self-indulgent and probably going to Hell.
Luckily, I avoid this fate once I supply the reason for the elective caesarean: that my first daughter got stuck and could have died and there is a reasonable chance this baby could get stuck too. I am then redeemed and the judgment about my poor morality is reversed.
Having a c-section is not the problem. The sin is CHOOSING it.
In the ultimate in disempowerment, modern medicine has given women the option of a legitimate medical procedure but they are only allowed to have it if they would prefer not to.
My obstetrician, who fully supports my decision to have an elective c-section, says that she rarely recommends c-sections for first-time mothers. Not because they are unsafe or inferior but because women are often traumatised by the sense of failure and shame.
“There is so much social pressure for women to deliver naturally. It’s crazy the pressure women put on other women,” she said.
But according to Dr Hans Peter Dietz, Professor in Obstetrics and Gynaecology at Sydney Medical School Nepean, this is not just a problem of peer-pressure in the sisterhood.
“We seem to be obsessed with how a baby is born, and we don’t seem to give a toss about what happens to women in the process. Tears to the pelvic floor muscle and anal sphincter can have an impact on the next 50 years of a woman’s life,” he says. “We’ve got it the wrong way around. And it’s not just the public. It’s policy makers as well.”
For example in 2010 the then NSW Labor government released the policy directive ‘Towards Normal Birth’ instructing public maternity wards to reduce the number of c-sections from about 30 to 20 per cent by 2015.
While there has been a change of government since, and the target is no longer being pushed, neither has it been revoked or revised. And, as NSW Health’s website still makes clear, ‘Compliance with this policy directive is mandatory.’
Interesting that women’s bodies are being used to achieve someone’s Key Performance Indicators.
Dr Dietz is not against natural births. He feels that for many it’s the better option. What he objects to is the pressure women face to attempt a normal birth, especially after having a first child by casesarean.
He also says that most women are not fully informed of the risks, such as anal sphincter tears and pelvic floor muscles being overstretched or torn. This can lead to fecal incontinence, problems with sex, or female organ prolapse later in life.
“I deal with the damage women suffer in childbirth every day,’ he says. ‘Only about 25 per cent of women get what they want and expect — a non-traumatic normal vaginal delivery that does not do serious damage to their pelvic floor or their anal sphincter,” says Dr Dietz.
“And this is first time mothers. If we did this kind of analysis on women who try for a VBAC (vaginal birth after caesarean) it would probably be as few as 10 to 15 per cent.”
“We push women in a certain direction and make them feel bad if they require any intervention, and we tell them very little about the things that can go wrong. It’s the biggest event in a woman’s life. We need to do better,” he says.
What I don’t often reveal when discussing my elective caesarean, because I don’t want to deal with the ‘too posh to push’ judgment, is that I want to do it. I’ve done 14 hours of labour in my life, and every second of it sucked. I don’t want to, or feel I need to, ever do it again.
And I’ve heard too many stories of women who wet themselves every time they laugh or have to have a couple of glasses of wine before having sex so it doesn’t hurt.
I’m not suggesting that one birthing method is better than the other. I respect women’s right to choose a vaginal birth without judgment. It would be nice if the same courtesy was afforded to the women who choose a caesarean.