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Cesarean Semantics

Birthing From Within talks about the power of language and the difference between a C-Section verses a C-Birth.

A C-Section implies distance and being an observer to what is happening. Whereas C-Birth includes women as a participant at their own birth.

It's important that when a woman does have a Cesarean Birth that her family and friends support this path and do their best to empower her. The language that is used around her to discuss her birth is the first step.


Gretchen said...

I'd suggest that rather than arbitrarily choose what term to use in describing the surgery known as cesarean, the family and support team take their cues from the mother. Some mothers do prefer cesarean birth, others are very offended by it. Whether or not a cesarean constitutes a "birth" is actually a very hot topic amongst women who've had them. There's a well-intentioned but short-sighted desire to "reframe the experience" (when the experience isn't what was expected or planned or wanted) into something more "positive" that I see a lot in doula's and other birth workers which in the end discounts the mother's experience...if it sucked, it sucked and reframing it isn't helpful. If she is content with it, then she is content with it and she doesn't need someone else making it "better". Plus, many women's impressions of their experience change over time....I think the best gift a doula or supporter or family member can give to a women who's had a surgical delivery is to just listen without putting outside interpretations on the experience.

Courtney said...

Thanks Gretchen. I completely agree with you that the objective of the mother's birth team is to fully support her regardless of their own personal beliefs and standards.

With that said, I disagree that reframing an experience isn't helpful. If you've ever been able to step away from a negative situation and try to look at the event from a different perspective, then you are reframing your experience and it is most likely helpful.

Here is an off-topic example:

Picture yourself lying in a canoe, relaxing in the middle of a lake. All is quiet and peaceful and you are loving your new metal canoe. Suddenly, another canoe slams into your new canoe, puts a dent in it and scares the crap out of you.

You sit up and look around. What's your first reaction? How do you feel in your body? How do you react if the canoe that hit you is empty and just drifted from the shore? What about if the canoe has someone in it? How does your reaction change then?

Most people accept the situation easier if the canoe is empty vs. if there was a person in it responsible for hitting your canoe.

If we can take ourselves out of any tense situation and understand that the canoe is always empty, then we can step away from our ego and move with the situation.

That’s just a random example of a way to guide a mother to look at a negative cesarean in a different light. If a woman believes that a cesarean was “done to her” than it might be helpful, when the time is right, to offer her another way of looking at her situation – that it was a course of the Universe and no one meant to harm her.

I don't believe any person needs to live with a negative experience. Our own helaing ability is significant and we have the power to change our views on past experiences and how we look at our current ones.

Gretchen said...

I guess I'd still have to disagree with the basic premise of "reframing the experience" as a goal in and of itself. I've been working with women who've had traumatic births (of varying degrees) for about 8 1/2 years now -- not all were c/s but many were -- and while I completely agree that we have an incredible capacity to heal, honestly I've seen more harm done with efforts to "help" the mom not see her c/s as negative than help -- often because the time frame to a better integration of the experience is much longer for some women than is socially acceptable (often years, in my experience). If she thought it was awful, it was for her. We might think she's over-reacting but it really doesn't matter what we think, as we aren't living in her place. She may well change her thinking, and good support will be there to hold her up while she works it out, but to take a lead in that? I think saying "now is the time you need to think differently" assumes too much knowledge and is much too generalized to serve any individual woman. Sometimes I think its a bit arrogant, as if we can say we know better than she does.

That said, I also know that each woman has her own unique experience and her experience does change with time and some women really don't have a problem with an unexpected or unplanned outcome.

I do take issue with the notion that you can always find an empty canoe in an unwanted birth outcome. For some women, this may be the place they end up. For others, it simply isn't true. There are some wonderful physicians and nurses within the maternity care system and many of them are hampered by the fundamental flaws of the system. However, there are also people in that system who do systematically punish and brutalize women, especially women who attempt to stand up for themselves and I can't agree with a philosophy that says in the end, that's the course of the Universe and no one meant to harm her -- sometimes, someone definitely did mean to harm her. Perhaps my view is informed by my work with women who want VBACs -- often these women are brutalized, until they learn to leave the system or they give in and once again become "good little girls". Better to acknowledge that and come to terms with the basic fact that bad things happen in this world, bad people do exist and sometimes we can't rationalize them away. Then we can figure out how to move on, rather than pretend that everyone meant well and there was just some lesson there you were meant to get (and may be feeling awful about not getting). Otherwise there ends up being a lot of buried feeling and no safe way to express it, if one has to believe that what happened was supposed to happen.

I know that people who care for women after an unplanned outcome really do, almost always, want her to heal and feel better. But I also believe that more often than not, we rush women through an artificial process (ever said "after all, in the end, what's important is a healthy baby"?)...we are uncomfortable with the idea that a birth experience can also be a horrible experience. (speaking of our culture/society -- not you!) We are desperate for them to feel better and so we try very hard to make it happen. Then women find people like me a couple of years later and discover that nothing is better and a lot of time has been lost in healing simply because the woman never felt the freedom to actually feel what she felt and never felt safe enough to talk about it, especially after the initial glow of having that new baby faded. Most women will get to a healthy acceptance and won't find themselves haunted without someone else showing them the way -- what they need is someone willing to be on the journey for the long haul, with them, while they make their way to whatever healing is the right healing for them.

Courtney said...

YES! Thank you so much for making clear how important each woman's personal timeline is.

In general, we (people) don't like when others are unhappy, uncomfortable, upset and our nature is to comfort and make better.

Unfortunately, we sometime do that so we don't have to suffer with this it's more self-serving than anything.

As Doulas and Midwifes we have to honor each woman's process. In fact, it is one of the most important things we can do for women and mothers.

Thank you for talking to this point in such a thorough way Gretchen.

Anonymous said...

Two thoughts:

1. I *never* use the term "c-section"... I never write it like that... I never write "c/sec" or "c/s"; I write out "cesarean" every single time, no matter how many times I have to write it. I also tend to leave off "section" because of the _Silent Knife_ saying that "grapefruits are sectioned, not women." I don't put "birth" either because not everyone has come to that place or wants to. Just an idea.

2. I think that re-framing is a CRUCIAL skill for doulas and midwives. I think re-framing should happen in the mom's timetable, but there are absolutely women who will bury themselves in self-pity for YEARS without nudges from a re-framer. No, it isn't my place to decide when women are done mourning, but it isn't so hard to see which women are mourning and which women feed off the negative energy of their horrid birth stories.

I think that having a lot of experience in incest/abuse survivor work has helped, along with my own decades of therapy enables me to discern where the lines are drawn. So far, so good... and if I were wrong, I would definitely adjust my energy around the woman.

Anyway, I believe that re-framing is a healthy part of healing from a traumatic birth and care providers or doulas that don't believe (or understand) that foster a woman's extended submersion in her pain.

I wrote an extensive piece on this very issue.

Good discussion.