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Making decisions about birth after caesarean

Women's feelings about their previous caesarean

Childbirth is generally thought of as a 'landmark experience' for a woman. Most women attach great importance to how their child is born and will spend a lot of time during their pregnancy thinking about and preparing for birth (see 'Women's expectations for their previous birth'). Even though these days many babies are delivered with the help of interventions such as induction, forceps, ventouse (suction cup) and caesarean, many people still think of unassisted vaginal birth as the 'normal' way to have a baby. It is very common, therefore, for women who have a caesarean to feel dissatisfied with their birthing experience. 

When we talked to women, a year or more had passed since their previous caesarean. For one woman (Interview 26), the experience was 13 years ago. Virtually all the women said they felt the caesarean had been the right thing to do at the time, but most had some negative feelings about it at some point after birth. The extent of these feelings, and the reasons why they felt that way, varied greatly. Several women said they felt in a state of shock immediately afterwards because it had been an emergency operation. Several regretted having lost control over the birthing process. One woman who had a planned caesarean remarked that it felt wrong for someone else to 'chose' her child's birthday. Others said they felt 'disappointed' or 'cheated' out of what they hoped would be a very special experience and admitted feeling envious of mothers who'd had a vaginal birth.

 

She felt disappointed to have had a child without having gone through labour. It was very...

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She felt disappointed to have had a child without having gone through labour. It was very...

Age at interview: 32
Sex: Female
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So, we were talking about the fact that you felt traumatised about having the section so that, this is a very stupid question now, but was your birth like you expected it to be?

No' Not at all.

Can you elaborate on that a little bit? 

I didn't feel a single contraction. And that' I felt quite cheated by that, because that's the whole part and parcel of giving birth. And that's quite odd now because I'm facing that again with fear, thinking, you know, I'm hearing women say how painful it is and that scares me but it's still very important to feel that because, to me, that's part of childbirth and, you know, you do hear people say that they forget the pain. So not, not feeling sure I'd felt a contraction, I was in the water and I felt something but I wasn't too sure if it was. So I'd envisaged the pain and the shouting and screaming and pacing around and in fact I sat there in a pool doing the crossword with my mum and my friend [slight laugh]' that seemed very abstract, and the next thing I know it all seemed very medical and just totally away from what I'd expected because I was lying there out of control, unable to do anything.
 
 

Having a caesarean was the right thing to do at the time, but even so it made her feel 'a bit of...

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Having a caesarean was the right thing to do at the time, but even so it made her feel 'a bit of...

Age at interview: 31
Sex: Female
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How did you feel about the fact that you'd had a section and how you felt about the way that your daughter was delivered?

Yeah, and I think I said' did I say, obviously I was a bit disappointed that I couldn't deliver her naturally, but it was the safest option, and you know, there's nothing wrong with her now. She's a very, very intelligent little girl, you know, I couldn't ask for, couldn't ask for a better daughter really, so, you know, it was the right thing to do.

And did it affect how you felt about yourself at all, the fact that you'd had a section?

Yeah, I, for, I think, I for a while went through a phase of feeling like a bit of a failure, as a mum, and I hadn't made that bond, the initial bond like you do by delivering vaginally, and it's very psychological. Because you know so many people that deliver naturally and there's, I mean, there was one person I knew I think out of the whole of the ante-natal class that had a C-section, you tend to feel in a minority group.

How long did that last, that feeling?

A couple of months. 

Having a birth that was so different to what they had hoped led a few women to look back on their pre-birth expectations as unrealistic. They were critical of the information provided in antenatal classes and thought that the focus on 'natural birth' was likely to lead women to have false expectations (see 'Information needs/sources in previous pregnancy').

Psychological research suggests that people tend to cope better with traumatic events if they had the chance to prepare themselves for them. Women who had a planned caesarean could be expected to feel more positive about their experience than those who assumed that they would have a vaginal birth or felt very strongly about keeping things as natural as possible. Amongst the women we spoke to, those who found it easier to come to terms with their caesarean were women who a had planned caesarean, those who had no strong feelings about how to deliver or who had expected complications. A couple of women who had a planned caesarean nevertheless felt disappointed, and others said the information they had been given beforehand had not prepared them enough for the after-effects of the operation. One woman, who had been advised to have a caesarean because of a big baby, felt angry when he turned out to be normal size at birth. 

 

Doctors advised her to have a planned caesarean because her baby was big. When he turned out to...

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Doctors advised her to have a planned caesarean because her baby was big. When he turned out to...

Age at interview: 37
Sex: Female
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It was just the final decision, you know, in hindsight, he wasn't a big baby and it's just - if they, they knew that the method of measuring wasn't accurate then' I found that difficult to understand, if they know it wasn't accurate but, you know, they sort of put me down to have an op, a major operation. It seemed' I'm trying to make myself clear' it was sort of a bit of a risky decision really. I don't know, it just seemed a bit odd, that they weren't that- they weren't more accurate. I mean there's quite a difference between seven-ten and a good ten-pounder really.

Actually, you know, I felt angry at the beginning in the first sort of eight weeks after [Son] was born, I felt, I felt quite angry. Because they got it wrong, but then I thought, well, they're in a very difficult position. If they hadn't have done what they did and things had gone wrong and he was big and he did get stuck and whatever, then I'd be saying well, why didn't you-, you know. So I sort of calmed down after a while and thought oh, well, you know, that's the way it is and it's, they did the best they did for, for me and that's fine. And actually, if I'm honest, it's quite a stress-free way of having a baby [laughs]. You know, now I'm faced with the- having a natural birth, you know, it's pretty stress-free really, you go in, you're booked in, you lie there, you wait to go down to theatre, I mean it's nothing. And after, I was fine. I had no problems.

And you were concerned about being awake?

Yeah that sort of, as soon as I was numb, that all went really. When it was all happening I forgot about that.
 
 

She was advised to have a planned caesarean and had the operation the next day. The experience...

She was advised to have a planned caesarean and had the operation the next day. The experience...

Age at interview: 24
Sex: Female
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Was it like you thought it would be, the first birth?

No.

Could you say why it was so different?

Just having it sort of over and done with in' literally you're in and out really.

And how do you feel now about the way that your son was born?

Feel cheated a bit really.

Could you say what you mean by that?

Well, it's like everyone says oh you didn't do like the labour and all this, and'

Not all women had negative feelings about their caesarean. Several women felt that it wasn't the birth that they had wanted but it was the only option available in their particular circumstances. They trusted in the decisions made by the medical staff and felt that the operation had saved them and their babies from more serious harm. Thinking like this helped them to accept what had happened. A few women also stressed that it had been important for them to at least attempt a vaginal delivery. They had felt involved in decisions about how long to labour and when to stop trying. Knowing that they had tried their hardest made it easier for them to accept that vaginal birth was just not going to happen for them. 

 

She feels very practical about her caesarean. It was important to attempt vaginal delivery, but...

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She feels very practical about her caesarean. It was important to attempt vaginal delivery, but...

Age at interview: 38
Sex: Female
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And you didn't have any worries about any effects on yourself, kind of emotionally about the fact that you'd had to have a section?

No. I felt quite practical about it. I know people say things like feeling failures because they didn't, you know, but absolutely not. I'm a very practical person.

Good. And what about your husband? Did he have any'?

Actually, I think I was very brave to have tried, considering the background.

That's very true, actually.

But that's why I'm very, very sure of the fact that this time I'm, I just want to go into, straight into the elective caesarean.

And overall, how would you sum up that you feel about the way that your son was born? 

Fine... I think that was, yeah' I was, I think' I don't think it could've gone any other way because I wouldn't have wanted an elective caesarean without even trying, but at the same time' no, no, no, that was it, that was fine. I mean I wish it had, maybe we'd come to the conclusion that I wasn't going to dilate within twenty-four hours instead of forty-eight [laughs]. But I suppose it couldn't be avoided, and I was quite happy with him being born by caesarean in the end. As, as I say I feel quite satisfied that at least we tried. 

So, how did you feel about having the section? 

I was, at the end I was very' very pleased to have the section.

Just get it over with.

Yeah, absolutely.

And was it like you thought it would be?

Yeah. Well, it was even better, because as I said, I thought I'd have to like spend two or three days in bed, but I was up on my feet the next day. 
 
 

She has no regrets about her caesarean. She felt involved in decision-making at all stages and...

She has no regrets about her caesarean. She felt involved in decision-making at all stages and...

Age at interview: 40
Sex: Female
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And how did you feel about having a section?

Okay, fine yeah. 

Was the birth or the delivery anything like you expected it to be?

Its funny isn't it because you think oh well I'm going to have a natural labour and it's going to pop out and everything and you' but because I had a section, that didn't concern me and so' I was just happy that the baby was out and well. And I suppose if I thought afterwards, 'Oh that's a shame I didn't have that naturally', I didn't think like that at all. My main concern was making sure that the baby was well, so'

And how do you feel now on reflection?

Same, same. I wouldn't have done it any other way you know, as long as the baby came out and it was' everything was okay. And I was okay.

And do you think that feeling was enhanced because you were allowed to labour for so long and go overdue and have that control?

Absolutely yes, definitely.

Caesarean is a major operation and recovery after a section is often slower and more painful than after a vaginal birth. Unsurprisingly, women's feelings about their caesarean were also influenced by how much pain they had experienced, how long it had taken them to get 'back to normal' and how well their caesarean scar had healed. For a few women, recovery had actually been better and quicker than they had expected, so they thought of themselves as lucky compared to other women. (See 'Recovery and complications after previous caesarean'.)

 

She felt fine about having had a caesarean. It didn't make her feel different about herself,...

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She felt fine about having had a caesarean. It didn't make her feel different about herself,...

Age at interview: 31
Sex: Female
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Did you feel differently about yourself at all, after the section?

Not really, I don't think. No, I mean, I think because it's, it's such a small scar and you can't, and it healed very well as well, and so it wasn't as if I felt that, you know, it wasn't as if I felt that I had been disfigured by it or anything like that (to baby) No, naughty baby, no. Go and see daddy. But I think because' I think I kind of felt that there are so' I mean, your body is so different after you've had a baby anyway' there's so many things to, that you know, to, to adjust to like having different sized, you know, having different sized boobs and trying to get your stomach back and things like that, that to be honest, it was only one of a number of things, and I, I would say I probably thought about it a lot less than I thought about how much I weighed, for example.
 

Most women didn't doubt that their caesarean was medically necessary. However, a few women had gained additional information that had made them more critical of the care they had received. They felt that a caesarean could have been avoided if their labour had been managed differently. A couple of women said they had never received a proper explanation about the exact reasons why a caesarean had been performed. Not understanding the reasons made it more difficult for these women to come to terms with things and made them anxious that problems might repeat themselves during a future birth.

 

She thinks mistakes may have been made in how her labour was managed. Six years on it still...

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She thinks mistakes may have been made in how her labour was managed. Six years on it still...

Age at interview: 32
Sex: Female
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It's funny, because three years ago I would have had a different outlook, but now I can see that it was probably a mistake on their part to put me in the water so soon' But obviously, at the end of the day it's really just that last centimetre of dilation that I just didn't do in time' for them.

So how do you feel now about the way that your baby was born?

'Glad that he was healthy and happy really. With nearly six years gone by, it's' it easier to think, 'Just be grateful that he was born okay', that he was born healthy, rather' and don't dwell on what I missed out, or how I felt because at the end of the day we did bond. It may have taken a few weeks but we have bonded, he's a wonderful little boy. Time heals everything doesn't it, I guess. It was really initially afterwards and times when I feel emotional like now, when I'm going to be talking about it and reflecting on it. It's like anything, if you're feeling emotional then something traumatic will make you, make it come out. But' basically, I don't really know how to feel about it because, like I say I feel they, they put me in the birthing pool too soon, which was their mistake. 

And, you know, I can't help but wonder how things would have gone if they hadn't done that. Would I have built up contractions slowly and would it all have gone okay? I mean, I got to nine centimetres but then I don't think they ever really explained why' that half-hour made all the difference. He was saying, you know, you've got to nine centimetres, we should see a baby in the next half-hour and I'm up on the roof really excited.

Why was it, why did it have to be half-hour? It's meconium I think, isn't it, it just boils down to the meconium. But then I hear other stories about somebody's left, or their baby had passed meconium twice and, you know, they were allowed to do that and they were disgusted that there, that nothing was done about that, so you can't really sort of win. But yeah, I just feel, I feel mixed, very mixed.
 
 

She thinks having someone explain to her why things happened the way they did might help her come...

She thinks having someone explain to her why things happened the way they did might help her come...

Age at interview: 30
Sex: Female
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Now the next question sounds ridiculous, but was the birth like you expected it to be?

[Laughs] No, but I had unrealistic ideas.

Do you think so?

Yeah I think so, I think I was fooling myself. One of my friends had recently had a water birth and it had just gone so wonderfully and, you know, two pushes and it was out. And I thought, 'Oh yeah, that's what I'll do too.' I knew I was fooling myself but I'm still sticking to that dream, yeah.

So how do you feel about the way that [daughter] was born now?

Well it's sort of faded over time, but I'm still disappointed about the way it went, but there's nothing that can be done to change it, and it would be nice to look back over my notes or have a chat with somebody that was there, you know, and wasn't on Pethidine and so knew what was going on, and perhaps that they would be able to explain why certain steps were taken at certain stages and then I would be able to accept it a bit more.

Many women find it difficult to voice disappointment about the birth of their child. They might think of themselves as ungrateful, because they feel low even though they have a healthy baby. Also, a sense of excitement about the new baby amongst family and friends might make it difficult for women to express negative feelings. 

The majority of women said the caesarean had not affected the way they felt about themselves. However, for a few women, a personal sense of failure about not having managed to give birth 'properly' lingered on long after the caesarean. Reflecting on what had happened brought back painful memories for some women and made them feel very emotional. A few women experienced postnatal depression or a long period of low mood after their baby's birth and felt this was at least in part because of the trauma of caesarean birth (see 'Bonding, feeding and support after previous casesarean').

 

She was grateful to have a healthy baby but couldn't help feeling disappointed about the way she...

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She was grateful to have a healthy baby but couldn't help feeling disappointed about the way she...

Age at interview: 36
Sex: Female
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I think I was more concerned about [daughter's name] and whether she was okay, and the fact that she was distressed' I, I just wanted her to be delivered as fast as possible, to make sure that she was alright. So, any other worries about me didn't really sort of come into play, if you like.

And how did you feel after, about the fact that you'd had a section?

Really quite disappointed.

Right. Could you say a bit more about that?

I just felt that my body had let me down a bit and it, it wasn't something that I'd planned for or sort of' I just assumed that I'd have a natural birth and, and I don't know, I just felt that I'd let myself down a bit, which might sound completely daft [laughs].

No, it's a common, it's a common feeling'

'and I think even now, talking about it, I still think, you know, but then I think, you know, I've got a great daughter and she's healthy and she's fine.

Is that how you feel about it now?

I still sometimes feel a bit disappointed about it. But, not so much now. It does sort of fade over time, I think.

As time went on, women gradually became reconciled to what had happened and looked at things in a more detached way. Some had consciously tried to put it to the back of their minds and not dwell on it. However, a couple of women said they felt judged by other mothers because they hadn't had a 'natural birth'. 

 

She feels happy about how her twins were born, but found that other women can be quite...

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She feels happy about how her twins were born, but found that other women can be quite...

Age at interview: 33
Sex: Female
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And how do you feel now about the way that your babies were born?

I'm actually happy about the way my babies were born because at the end of the day, my main objective was to have two healthy babies and, you know, I don't have any hang-ups about the fact that it wasn't, they weren't naturally born or anything.

And, do you have any long-term concerns about either the effects of the delivery on them or you at all?

'not really, apart from the fact that it's quite funny that the second twin is now the first twin and the first twin should have been - they're the wrong way round, if you see the pictures, scan pictures and things, but whether that will affect them as they get older [laughs] stole my birthright [laughs].

And did you have any feelings about yourself at all that were different after the section?

'possibly not at the time but more so now because people speak to you as if you've had a natural delivery and now that I'm having a second child and then when you tell them you've had a section, they go, 'Oh', which is sort of strange, like and you don't, because like people tell you all the gory details of their birth now because you've got children and then you sort of say, 'Oh, okay' whatever and then they ask you how far apart they were born and then you say, 'Two minutes', and they go 'Oh, wow, how's that?' And, 'It's because it's a section.' And I sort of feel it's a little stigmatised, but maybe that's just the circles I particularly move in, but '
 
 

Her baby's premature birth was a shock. She did not feel like a Mum until he was able to come...

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Her baby's premature birth was a shock. She did not feel like a Mum until he was able to come...

Age at interview: 22
Sex: Female
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And how do you feel now about the fact that you had a section?

Well, I'd say I didn't enjoy it at all, but'obviously I wasn't prepared at all for it so it was a bit of a shock, and obviously [Son] was in the baby unit for ten days, so I sort of felt like he was took away, if you see what I mean, for the first week' But' wouldn't, wouldn't really like one again.

Right. So, would you say the birth was like you expected it to be?

It was, or it wasn't, sorry?

It wasn't?

No.

And do you feel that having a section affected your son in any way? I mean, the fact that he was prem and you didn't spend time together, did that worry you at all?

Yeah, I didn't get any post-natal depression, but I did sort of' I didn't feel how I thought I would feel until I brought him home. For the first ten days I didn't really' it wasn't reality that I was a mum, if you see what I mean.

That must have been weird, having had a baby and not-, not being with him.

Yeah, because I come home after about four days, because obviously I needed to get premature things and everything ready.

So, you know, my bump was gone and I had no baby' and it was a bit strange.

And did you feel different about yourself at all, the fact that you'd had a section?

'I did in a way, because a lot of this' you know, you've got the rumours about, 'Too posh to push', sort of thing, so a lot of people will judge you because you've had a caesarean, but obviously in my case it' I didn't have a choice anyway, so'

Did you feel that people did judge you at all?

No, not- not my friends and family, because obviously they, they all was aware of why I had to have it. But when you're sort of talking to other mums now'

Do they find it a bit odd that you had a section?

Yeah, yeah.
 

Last reviewed August 2018.

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