Mum's the Word on Maternal Choice Cesarean

I never had any desire to have a vaginal birth. In another time or place, I may have considered foregoing motherhood or adopting rather than subjecting myself to the conventional whims of nature. However, knowing that cesarean was an option, I knew that foregoing biological motherhood would be an unnecessary toll for wanting to avoid a vaginal birth. I knew that cesarean birth was a feasible (safe and effective) way to have a baby - I lived in a first world country and could find nothing that indicated that women in Canada weren't allowed to have cesareans on demand or that such a choice would be inaccessible in my own community. For myself, it was clearly preferable over conventional birth. It seemed to me that the biggest challenge would be finding a doctor to accede to the request-but given the controversy around maternal choice cesarean, I knew that while many doctors would not accede to a request, that many other doctors would. I felt confident that I could secure a maternal choice cesarean before I even got pregnant - even if it would have meant travelling to access care.

That being said, I also knew that rejecting a conventional birth (a trial of labour in a hospital) would not be a socially acceptable choice. None the less, I was open about my plans during the pregnancy with my daughter. Not because I wanted the stamp of approval from others, but because I felt that it was important for others to know that it was an informed choice that I had made freely. A choice I felt best met my needs and those of my child. That I was happy with choosing cesarean, and that any concern about my birth plan was misplaced.

By the time I was admitted to hospital for the birth of my daughter, there was nothing that had been said to me that had changed my mind about vaginal birth or cesarean birth - not for the lack of trying by others and a hefty dose of misinformation about cesareans. Others regaled me with the horrors of cesarean birth - It's major abdominal surgery! The recovery is horrid! What about the scar! Adhesions! Infection! They further regaled me with the virtues of vaginal birth - it's the way nature intended! With an epidural, it's not painful! The recovery is easy! Thanks, but no thanks. Conveniently absent in the vaginal birth love-in was any acknowledgement of the virtues of cesarean (indeed it does have advantages) or the genital warts of conventional birth (indeed conventional birth is not completely a thorn-free bed of roses).

I was even open about my choice with hospital staff when I was in hospital awaiting for the cesarean that did not happen for the birth of my daughter.

My experience of vaginal birth proved to me why I had wanted to avoid it in the first place, even in the absence of the worst consequences of vaginal birth. I pooped in front of people. I experienced the worst pain of my life. I was terrified. I tore. My daughter needed narcan and resuscitation. I was left feeling violated and abandoned. I developed a vaginal infection. For more than a year afterwards, I had mild urinary incontinence. My enjoyment of intimate relations with my husband was adversely impacted. Memories of my daughter's birth continued to haunt me, and rather than looking at photos of that day with a sense of joy or accomplishment, they are a reminder of the worst experience of my life. I felt socially isolated among other mothers, particularly those with strongly held beliefs about conventional birth.

After my daughter's birth I understood why so many women who prefer birth by cesarean are mum about their preferred path to motherhood. I understood why some mothers make up a medical reason for their cesarean - it is far more socially acceptable to say you had no choice in the matter and in some cases making up a medical excuse might be the only way to access care. In some cases, where cesarean is seen as being inaccessible, some women are choosing to forego motherhood - choosing to prevent pregnancy, adopting or aborting. Other mothers are paying a hefty financial price for their preferred method of birth.

Indeed, during my pregnancy with my son, I found myself being a lot more mum about my choice.

However, being mum doesn't help other moms who share the same view on birth. Being mum does not make it easier for the next mom to make and exercise her choice. It does nothing to ameliorate the undeserved stigma or shame associated with being a woman who would prefer to avoid a conventional birth and choose cesarean. It does little to address the misinformation or myths about mothers who choose cesarean (the vast majority of whom are not "too posh to push"). It does little to address the misinformation or myths about elective cesareans as medical procedures - or even the misinformation or myths about other birth related medical procedures (such as epidurals). It does little to address the problem of those who would seek to deny moms like me their chosen path to motherhood and it does little to help women make truly informed decisions about the birth choices available to them (have I ever blogged about how little data is out there on maternal request c-sections and how they are not formally tracked in administrative databases???). Maternal choice cesarean needs to be an accessible, accepted, and respected choice - and as such moms like me can remain mum no longer.