Scars that Run Deep: “All that Matters” after a Cesarean
“You have a healthy baby. That’s what matters.”
Mothers who express sadness, anger, or disappointment after undergoing a cesarean section often hear these words uttered by (presumably) well-meaning family, friends, and health care workers. In fact, these words seem to be one of the most common responses that people give upon hearing that a mother has had a cesarean. I presume this is because it can be jarring to witness the juxtaposition of the joy and wonder of a newborn life and the mother’s grief over her baby’s entrance into the world. And so, particularly in a culture that does not have a well-developed ritual for expressing and experiencing grief, people try to fill up the mother’s “empty grief jar” with an elixir of “healthy baby joy.”
But, as we all know, grief and joy don’t work like that.
In fact, for many mothers who have recently–or not so recently–had cesareans, the words, “You have a healthy baby. That’s what matters” are piercing, stinging, and even painful. They hurt because they obscure the profundity of her birth experience. They sting because they silence her emotional–and even physical–pain. And they pierce right through her heart because what she probably hears–what is unwittingly insinuated by these words–is, “Why aren’t you happy about your healthy, beautiful, miraculous baby?” And this thought–that perhaps she isn’t giving quite enough of her own happiness and joy to this tiny creature who is entirely dependent upon her–often leads to feelings of inadequacy and guilt.
In recognition of the grief of cesarean mothers, in honor of their courage, and in the spirit of Cesarean Awareness Month, I want to illuminate why having a healthy baby isn’t all that matters after a cesarean. Why mothers who mourn the loss of a vaginal birth can (and, most likely do) simultaneously celebrate their new child. And why a mother’s birth experience is part of “what matters.”
I do this with the full recognition that women who have vaginal births can experience some of the same feelings of loss and detachment that cesarean moms experience. I also fully recognize that some women who have cesareans do not experience these feelings of loss and detachment. I even recognize that not all mothers are lucky enough to hear that they do, in fact, have a healthy baby.
Nonetheless, these points do not undermine the fact that for many cesarean mothers, their pain is exacerbated by the “healthy baby line.” And their pain, their grief, requires more respect, more space, and more support than what these well-intended words can offer.
Most of what I can say in defense of this position is based on my personal–profoundly personal–experience. It is based on what I can remember, and what I can’t. It is based on what I saw, and couldn’t see during my first son’s birth. And it is based on the feelings of grief that I still–over three years later–feel over what I missed, and couldn’t see, and couldn’t do during that birth.
In fact, in order to explain why “the healthy baby line” can be so painful to a cesarean mother, it is important to examine the mother’s perspective during a cesarean.
When a mother undergoes a cesarean, in many cases…
She is first brought into the operating room by herself. She may be surrounded by doctors and nurses, but she is temporarily separated from those whom she loves–and those who love her. In some respect, then, she is alone. And she will have received her spinal or epidural, been catheterized, draped with surgical cloths, and had her belly exposed and prepared for the surgery while she is alone.
Barring an emergency situation that requires general anesthesia, she is not joined by her partner or other support person until right before or even after the first incision is made. And what she hears in this “holding period” is often not what she imagined she would hear right before her baby was born: not “You can do it!” or “S/he’s almost here” or even “Push!” Instead she hears: “Scalpel. Incision. Suction.”
If she prefers, she may also hear the anesthesiologist (or even the obstetrician) explain to her what is happening during the surgery and what to expect (“lots of pressure”) once the obstetrician extracts the baby. Some mothers have even requested mirrors so that they can view the surgery. Either of these options can be very comforting to a mother who wants to experience her child’s birth as much as she possibly can. Nonetheless, both options still underscore the passivity of her birth experience. The anesthesiologist informs her of what they are doing to remove the baby. The mirror reflects what is being done to her to bring her baby out of the uterus. And she is literally paralyzed (at least partially) as her child is born.
If the baby is expected to be healthy, the mother may get to see the baby held over the surgical screen for a few seconds (sometimes a split second) before the baby is taken to another area of the room to be monitored. In some cases, she cannot see the area where the monitoring is taking place. And by the time the baby is handed to her partner, she is the last of all of the people in the operating room to examine and touch her baby–the baby whom she has carried and been as physically close as is humanly possible for the past nine months.
In many cases, the baby is taken to a separate nursery for additional monitoring while the mother’s incision is being repaired. Many mothers request that their partner accompany the baby to the nursery, if possible. (This is her first act of parental self-sacrifice after the baby is born.) Except in the rare cases where an additional support person has been allowed to enter the operating room, she is, once again, separated from those who love her. More importantly, she is now separated from her baby, after only meeting him or her for mere moments. And this part of the cesarean–the suturing–is the longest part of the surgery.
She is wheeled into a recovery room, and, unless she has additional family and friends available to her in recovery, or unless her baby’s monitoring is complete, she is essentially ”alone” except for a nurse and possibly her obstetrician or anesthesiologist.
The baby’s arrival in recovery often coincides with the wearing off of the spinal or epidural medication. If the mother did not experience labor before the cesarean, this is the most physically painful part of her child’s birth–and it is also, in most cases, her first chance to hold her baby.
She will probably first hold her baby while lying down or reclining. (Worth noting is that this occurs at least an hour after the baby is born.) This is because cradling the baby while sitting up puts pressure on the incision site, which can be extremely painful.
Because of the narcotics used in the spinal or epidural, and because of the intravenous pain medications the mother receives after the surgery, the mother may feel nauseous, groggy, and/or sleepy. Weeks, months, or even years later, she may realize that she does not even vividly remember holding her baby for the first time.
This account is, of course, all-too-brief and incomplete. It does not include the challenge of attempting to care for a newborn while being immobilized for the hours after the baby’s birth. It does not include difficulty the mother experiences when she attempts to walk for the first time twelve hours after major abdominal surgery. It does not include the four to six weeks of recovery that she endures, limiting her ability to cough, shower, brush her teeth, walk up and down stairs, and roll over in bed without pain. And it does not account for the variations of cesarean experiences–the potential complications that can arise during the surgery, the potential reactions to the anesthesia, or even the instances in which the mother cannot truly meet her child until hours or days after the cesarean.
But what it does offer is a glimpse at just how much a cesarean birth can be marked by passivity and separation. No matter how a mother has envisioned the birth of her baby, she has most likely envisioned it as the day she meets her baby. And while not every mother dreams of being active during her child’s birthday, most mothers do not imagine feelings of separation as being central to their birth experience.
One may wonder why this experience produces lasting negative feelings about the baby’s birth, however. Why is it so difficult for many mothers to “move past” their disappointment or sadness or anger and “just be happy” about their new baby?
First, I should point out that being happy–even overjoyed–about one’s baby does not mean that one cannot also be sad about the way that baby entered the world. We are complex creatures who are able to feel conflicting emotions simultaneously. And while one should always be vigilant about monitoring a mother for signs of postpartum depression or even post-traumatic stress disorder, this does not mean that one should encourage a mother to suppress her grief over a cesarean–even if that cesarean was absolutely necessary and/or life-saving.
But this is exactly what the “healthy baby line” suggests. “You have a healthy baby. That’s what matters. [The way your baby entered the world does not matter. The pain and sadness you may experience now does not matter or is in regard to something that does not matter.]“ This may not be what is spoken to a cesarean mother, but this is what she may infer when she hears that “all that matters” is her healthy baby.
In addition, the de-valuing of the mother’s birth experience–a de-valuing implied by the “healthy baby line”–undermines the significance of one of the most transformative days of a mother’s life. For on the same day that her baby is born, she is “born” as a mother. And if this dual-birth is marked by passivity and separation, then it is no wonder that the mother grieves her birth experience. That having her healthy, miraculous, wonderful baby is not all that matters to her.
In fact, her sadness is partially a result of being separated from her healthy, miraculous, wonderful baby during the first few moments and even hours of that baby’s life. And it can be the result of a feeling that her body is “broken,” “unable” to bring her child into the world on its own. And it can be the result of a feeling that her body might not even “know” how to work properly to bring a child into the world. And it can be the result of feeling as if she has disappointed not only herself but also her partner and/or other friends and family. And it can be the result of the sheer difficulty of recovering from major abdominal surgery and simultaneously caring for a newborn baby, two of the most physically and emotionally demanding experiences that any person will ever undergo.
In other words, her sadness and her grief are understandable. They are normal.
So instead of telling a cesarean mother–or any mother expressing disappointment over her birth experience–that a “healthy baby is all that matters,” acknowledge her feelings and provide her with a supportive space to express these feelings. Instead of using the “healthy baby elixir” in order to eliminate her grief, remind her of her courage and her strength in order to allow her to work with and through her grief. Allow her to share her story–negative and feelings and all–so that she can properly process her experience. And continue to marvel at her miraculous, wonderful, and, hopefully, healthy baby so that her joy can be reflected by and even increased in the faces and words of others who meet this new life.
For more tips on physical and emotional recovery after a cesarean, please see ICAN’s resources on cesarean recovery (including a section on breastfeeding after a cesarean).
For a look at how a cesarean section can be different–and how many cesareans are different–please also check out ICAN’s resource on the Family Centered Cesarean.