Knowing what to say to a caesarean mother is an issue all NCT workers have to consider; Gina Lowdon looks at ways in which we can respond helpfully and supportively to women who have had a caesarean.

'Actually, I had a caesarean,' can be a conversation stopper at many a coffee morning. Most new mothers like to talk about their birth experiences and whether they were traumatic or wonderful; so do caesarean mothers. Many of us, though, simply do not know what to say to someone who has had a caesarean birth. Should we commiserate, sympathise or congratulate?

One common response is: 'So you did it the easy way'. A caesarean section is an operation: indeed, it is major abdominal surgery, and I have yet to meet a caesarean mother who has hopped off the operating table. However, it is amazing just how widespread is the rosy view of a caesarean being a 'pain-free' birth. I recently heard another mother remark at an NCT open house meeting that she wished she'd had a caesarean: 'It would have to be under general anaesthetic. It must be lovely to wake up knowing it's all over.' Yes, a caesarean can be a wonderful birth experience, and much preferred over vaginal delivery by some mothers, but the plain fact is that there is no 'easy way' to have a baby and recovering from surgery is rarely easy or pain-free.

Another reaction is: 'Oh how awful!' which is equally inappropriate. Not all caesareans are traumatic events: some are positive experiences that the mother would happily repeat. Do not, therefore, assume that a mother will feel bad just because she did not give birth vaginally. This 'Oh how awful' reaction can make a woman feel devalued as a mother if she feels that she has 'failed' to give birth 'normally'.

Showing an interest

So how are we best to react to the 'Actually, I had a caesarean,' remark? The answer is simple: to show an interest but not to express any of our own preconceptions.

Questions that have straightforward, factual answers can allow the caesarean mother to keep the conversation going and allow her to express her own opinions. Ask questions such as:

These allow the conversation to progress in a direction of which the new mother is in control and can benefit from.

It is not generally a good idea to start with the 'whys and wherefores'. This is because the caesarean mother may interpret such questions as meaning: 'Why couldn't you do it right?' or, 'Where did you go wrong?' If she is feeling vulnerable, or has had her own confidence in herself shaken, she may perceive such questions as aggressive or dismissive, which is just what you are trying to avoid.

By starting with the facts, you may often find that more details emerge as the conversation gets under way and it is possible to discover how the mother feels about her caesarean experience. It is worth bearing in mind that women who undergo an emergency caesarean after a difficult labour may wish to opt for a planned (elective) caesarean with a future pregnancy, not wanting to face another protracted labour, or, conversely, they may feel equally strongly about wanting to avoid another caesarean next time.

Caesarean support

It is perhaps surprising just how few NCT branches have an active caesarean support group, although around half have a caesarean support contact and most branches have at least one caesarean mother on their special experience register. As one of the caesarean support co-ordinators on Postnatal Committee, I have spoken to many branches who have tried to start caesarean support groups but - in the words of one member - have met with 'overwhelming apathy'. Is this perhaps because the word 'support' when combined with the word 'caesarean' makes a negative association and thus makes caesarean mothers into 'victims'? Why should a mother go to a 'support' group if she's feeling fine but just wants to talk?

In my own branch, we have started to hold caesarean birth meetings, open to all mothers who have had a caesarean and to those who want to know more about this form of birth, regardless of whether they feel in need of 'support' or not. Numbers have been comfortably small so far - around six - and we have maintained discussions starting with a round of introductions, which has worked well. We also hold a library of information which can be borrowed.

Once a group of caesarean mothers gets together, like parents everywhere who share a common link, the support comes naturally as the result of a sociable morning, where information and experiences can be swapped in an atmosphere where caesarean mothers can be sure of being 'normal'.

First published in the National Childbirth Trust's journal New Generation Digest, December 1995

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