Motherhood

As humans we have the capacity to become competitive over anything – women, mothers are no different.


I've seen a streak of competitive come out when people start discussing conception (who got there quicker? Who needed assistance and who didn't?), feeding their infant ("oh you breast fed until 6 months, well I got to the 8-month mark") and developmental milestones ("Johnny can sit now unsupported and play the violin; he's only 5 months. Oh, can your 8-month-old not do that?").

The competitiveness, the gentle judgement extends into the birth story. Did you have a vaginal birth, did you use pain relief, did you have a C section? For some reason, you can be judged on how you birth your child now as if the mother and child merely surviving isn't still considered a victory. I still remember the patient who came into my consulting room for her 6-week check (for herself and her infant) – she had ended up having an emergency C-section due to an obstructed labour (the same thing had happened to me a year or so earlier). "So, is there some sort of medal of badge for the women who do this vaginally? Because I've certainly missed out haven't I" – whilst I laughed at her comment and we moved onto the important stuff like how her C-section wound, nipple care, mental health and sex life were going – it later struck me that her throw away comment had hit a chord with me. Was there a medal for those who could manage to deliver their child "normally"? And what does "normally" even mean? The term "normal vaginal delivery" suddenly bothered me very much – as both a doctor and mother. In fact, I've stopped asking women if they had a "normal" vaginal delivery at a 6-week check or cervical cancer screening test – "was the delivery vaginal, assisted or C section?" is usually my question to ensure there is no judgement.

There are many reasons why a woman might have a C section – it can be in an emergency setting due to an obstructed labour for instance or planned ahead for many reasons such as breech positioning, placenta praevia (the placenta blocks the cervical opening) or due to a previous C section where the risk of the vaginal birth after C-section (VBAC) is considered too high. There are many women/couples who opt for a VBAC after discussion with their health care team – the decision is a significant one with women/families weighing up risks and benefit. I would like to say very clearly here – there is no right answer when it comes to this stuff; it's a very personal decision. According to recent research up to 1 in 3 Australian women have experienced birth trauma. How we birth our children, how safe we feel during the process is crucial to how our brains deal with the birthing process. Women are at a higher risk of post-natal depression and post-traumatic stress disorder after a traumatic birth; it should be pointed out that trauma is different for different people. What I may be shaken by during a birth – may not correlate with other women.

My heart sank recently as I saw comments from the Maternity Consumer Network with the release of the birth trauma statistics where they blamed increasing birth trauma rates in Australia on "over medicalisation during childbirth" mentioning that the Australian C section rate of 34% was 3 times higher than the rate recommended by the World Health Organisation. Personally, these types of discussions in the media, bringing up these types of statistics to fear monger, do not help women – at all.

We are all trying our best. The aim of childbirth is not to come out the other end with no intervention and the "badge" of a vaginal birth. Personally, as a doctor and mother, the aim is simple - deliver a healthy baby with a healthy mother surviving, and ideally with minimal trauma to all parties– if that involves a C-section does it actually matter? Let me take you back to 2016. I was heavily pregnant. I had stayed fit and active during pregnancy. My husband, Will, and I had stupidly assumed that being a healthy weight with no co-morbidities would most likely result in a vaginal birth – the doctor in me had convinced the pregnant woman that the odds were saying I would be fine. Trust me, my brain has never made this mistake again and is now likely far too hypervigilant – because what happened was the exact opposite. Here's what I remember:

  • Firstly, our obstetrician who we had specifically chosen and bonded with was one day off coming back from leave – so when my waters broke, I was immediately slightly apprehensive.
  • I remember labouring for 20 hours -after 14 hours I did wonder if this was all a bit much and if we should intervene, but my doctor brain had shut down completely
  • I remember the moment the assisted forceps delivery failed, the obstetrician turning to push the red button I had used myself so many times as a hospital doctor. I was the code this time and it felt surreal
  • I remember multiple people flooding into the room. I was watching the room play out as if I wasn't there. I remember the obstetrician throwing my husband a pair of scrubs with the line "you know what to do Will"
  • I remember being dragged onto the emergency bed, Will acting half- husband half- surgeon helping with the assist – he was so desperate to get things moving he had just become part of the medical team
  • I distinctly remember Will's face as he bent over the bed to kiss me – "it will all be OK Preez" – his tears, his face told me he didn't quite know if that was the case
  • I remember waiting for the anaesthetist in theatre – as she walked in her comment "Oh Willy, hi! Are you doing some private assisting?" I remember lying there listening as Will explained that I was his wife and that the emergency tray of equipment for intubation she was preparing would not be needed, her response "Will I have to do this for everyone, I agree we won't need it."
  • I remember the epidural being topped up so quickly, so the C- section could begin, that my left arm was also blocked – I couldn't move it. What ensued was my brain convincing me I had suffered a stroke – so as I screamed, hyperventilated and told Will and the anaesthetist I was having a stroke I completely missed the joy of holding my new daughter because I was in a complete panic
  • I remember afterwards as we sat in our room exhausted – Will and I certain if we had been in another country without access to the healthcare, we were fortunate enough to receive – both myself and our daughter would be dead.
You can likely see why heavily pregnant at 37 weeks; we are booked for an elective C section

After debriefing with a psychiatrist post birth and dealing with the flashbacks – together we decided we needed utter control this time for the psychological benefit. For us, the C- section was the mechanism by which Will and I felt empowered to give this whole thing, parenthood I mean, another crack. The judgement I sometimes perceive when I tell people we are going down this C section path is exhausting – it can be a certain look, or a "oh" noise – but trust me I, like many of you, am aware of it. I often find myself saying "because of what happened last time with the emergency C section" as I try to justify our choice. Honestly, I shouldn't need to – it's no one else's business. If we get down to it and go really basic – the way, we choose to birth this (seriously huge) child inside of me at the moment is not going to make me more or less of a mother; that's the truth. To those who will ask "but don't you feel like you're missing out on a vaginal birth" "don't you want to experience it?" – the answer is simply, no. I know there are women who may feel like this and I respect that but honestly, there are many of us who couldn't care less – surviving the process is all I have prioritised. To those who make comments suggesting a C section is a "cop out" or that women who choose this path are "too posh to push" – please know it's not helpful and actually the wound, post-operative pain and the inability to safely drive for 6 weeks post procedure (or pick up your older child if there is one) make it a far more complex recovery than some might realise. I'd also say demeaning women with comments like this are simply unnecessary and unhelpful – celebrate women, their achievements, their strength and courage in becoming mothers however they choose to do it. Here's the other truth – a part of me isn't bothered by the rising C section rate, nor the perceived over medicalisation of childbirth – as long as women, their partners (if there is one), their children are safe, content and less traumatised I don't think it should be a point we focus on negatively. If families are achieving safer births with less childbirth related deaths and complications, shouldn't we be grateful? I truly believe that we, as women and families, should feel empowered to do this journey however we desire. Whether or not we choose to have children, how we conceive them, how we birth/feed them is no one else's business – there are enough pressures (including from oneself) to deal with. We all do this journey differently and there is no right way to do it. Nor are there any badges or medals I should point out lest that wasn't clear!

Words: Dr Preeya Alexander | Go to www.thewholesomedoctor.com.au

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