Caesarean Section: A Positive Birth Experience

Around 25% of NCT members deliver their babies by caesarean section. Many of these women feel that their birth has somehow been taken out of their control. Fiona Barlow an NCT antenatal teacher, suggests ways in which antenatal class leaders can help parents who are faced with a caesarean section to feel positive and in control of their birth experience.

'Caesarean section? Oh, as soon as I mention sections to a class they all switch off; they never think it will happen to them.' Maybe not our most popular topic...but perhaps when we slip it in at the end of a session or simply offer a handout we are the ones at fault of 'switching off'.

What follows is a brief account of how I deal with the subject of caesarean section during my general antenatal classes. (I also occasionally facilitate small group, or one-to-one sessions, for parents who know for sure that they are to give birth by caesarean section.)

So much of what we discuss in our general antenatal classes is actually highly relevant to women faced with the possibility of having their babies by caesarean; we just need to help them make the connections, for example:

During my classes, I focus for some time on the reasons why a caesarean section may be required. I describe situations when caesarean is the most likely outcome (cord prolapse or placenta abruptio) and compare these with circumstances when management is more open to debate - breech presentation, for example, or 'failure to progress'. I usually find that, far from 'switching off', couples are keen to explore their fears and feelings in these situations; to become aware of the difference between the drama and inevitability of the emergency scenario and other occasions when informed choice and, perhaps, assertiveness play a part. I find the use of BRAN - a discussion of the Benefits, Risks, Alternatives, Nothing - a useful tool for exploring the options available to couples who may find themselves in these situations.

Having considered ways of avoiding a caesarean birth, I then guide the group through ways of improving the caesarean experience, preparing them for an alternative - but perfectly valid - way of giving birth.

I describe what it may be like in the operating theatre, the number of people present and their roles. The sheer numbers involved often comes as a considerable shock to couples, especially if they have been planning a quiet and private birth. I find the 'Playmobile' operating theatre set a useful tool for this exercise - although you do need to buy more people!

We move on to explore the choices available to a woman and her labour partner, antenatally, during the birth and posnatally. People are often surprised at the range of options open to them in the face of a caesarean birth; the little things that can, with a bit of forethought, be done to create a memorable and pleasant birth experience. I suggest that couples may wish to write a birth plan, although I emphasise that this document, like all birth plans, should be flexible. A birth plan does not need to be very detailed; I see it as a way of increasing awareness about choices. I consolidate our discussion with a handout, detailing the questions a couple may wish to ask their midwife or obstetrician in order to gain a thorough understanding of their particular circumstances and management (Figure 1).

I usually use a separate session to talk about the potential problems of recovery from a caesarean section (and other assisted deliveries) - the need to anticipate a slower physical recovery, the possible emotional impact. I stress the need for practical help and suggest ways in which this can be organised. My emphasis is on identifying problems, finding ways to cope and enabling parents to be positively involved in their care. I conclude by offering a handout of practical coping tips for mothers faced with a caesarean birth, compiled by other women in the same situation. I invite the new parents to contribute their own ideas after the birth of their own babies (Figure 2).

Caesarean birth can be a very positive experience. I firmly believe that, as antenatal teachers, we should do all we can to give choice and control back to women faced with a caesarean section. This is not done with the intention of disempowering obstetricians; it is done in the hope that we can encourage all involved to strive to ensure that the birth of a baby by caesarean section is as special and as memorable as any other.

Figure 1:





Figure 2



First Published in the National Childbirth Trust's journal 'New Generation' December 1997

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