April 26, 2012

Defining Moments: Pauline

Community member Pauline is co-author of Choosing Cesarean: A Natural Birth PlanShe believes the internet would be a much friendlier place if mothers could all respect each other's birth choices and outcomes and not look to judge or attack.

As a mother who chose a Cesarean delivery and advocates for others who do the same, she knows firsthand about online attacks. Pauline is a strong supporter of The Mom Pledge.

What were your plans for the delivery of your first child? What did an ideal birth look like for you?
I planned a cesarean birth from the very outset of my pregnancy, long before discovering that our baby was breech. An ideal birth for me was the safe arrival of our daughter, and I genuinely had no expectations of the birth as an experience in itself (e.g. a rite of passage into motherhood). It was simply a means to a wonderful end.

What factors influenced the decisions you made concerning your delivery?
I always knew I wanted a cesarean, and after doing a great deal of research, I felt very strongly that for me personally, the risks associated with this birth plan were more predictable and tolerable than those associated with a trial of labor. Also, my obstetrician was completely supportive of my birth choice, which gave me further peace of mind. I was so grateful for her positive attitude throughout my pregnancy, as I know this is not the experience of many other women.

Tell me a bit about your actual birth experience...
I was nervous about the spinal anesthesia, but very excited that we were finally going to meet our baby. My husband was beside me, taking photos and video, and my doctor chatted to me throughout. I felt that I was in very safe hands, and I was happy for my husband to follow our baby to the nursery for her newborn health checks. I honestly had no concerns about bonding at all, and was happily reunited with our daughter shortly afterwards.

How did that experience shape any future births/birth plans you may have had?
I planned a second cesarean with the same obstetrician, which meant driving 1.5 hours each way for all my antenatal appointments because we'd moved house in the meantime. Also, although my husband and I have always wanted two children anyway, I knew that maternal request cesarean is only advisable for women planning a small family (because of the increased risks with multiple surgeries), so family size was an important consideration for my birth plan choice.

Have you ever felt judged for the way you gave birth?
I have certainly received some puzzled and even disparaging looks when people discover I chose to have a cesarean, but I'm very lucky because I feel confident about the choice I made for myself and my family and don't feel upset personally if this happens. That said, I've been on the receiving end of some very angry and even quite vicious online messages because of my birth choice and the campaigning work that I do, which is not at all pleasant. I am also contacted by many other women (with a mix of cesareans that were chosen and/or needed) who describe feeling both judged and upset by their family, friends and colleagues when they admit to being happy with their birth, and so I am acutely aware of how prevalent contempt for cesarean birth is, and I look forward to a day when this birth choice is better understood, more widely accepted and respected - and not judged.

Tell me a little bit about the work you do in support of women who deliver via c-section…
Most the work I do involves campaigning for planned cesarean birth to be understood and accepted as a legitimate choice, and to dispel some of the disparaging myths that exist about women deemed "too posh to push." I am also concerned for women who may not have a strong birth plan preference at all, but who simply want a healthy and happy outcome on the day. The advice they receive during pregnancy helps them to decide which plan to choose, and in many cases, the risks of a planned cesarean can be heavily emphasized, with the risks of a planned vaginal birth underestimated or not even mentioned at all. I think there needs to be more balance. I also try to support women who need a cesarean, but who feel guilty or fear criticism from others. Even women who chose their cesarean sometimes tell others that it was on doctor's advice because they want to avoid any confrontation. A huge cultural shift needs to take place in many countries before c-sections are accepted as a normal and natural birth choice for some women, and this is what I'd like to see.

Were you prepared for the negative response you have received, and how have you handled it?
In terms of any negative response I've received from some, I would say that I certainly expected it, but I'm not sure that you're ever fully prepared for it. I tend to take the approach that 'the truth will out', and focus instead on the wonderful emails I receive, thanking me for the work I do. I also think about stories where mothers and babies have died or been seriously injured after their cesarean request was denied, and I concentrate on the knowledge that for every woman or baby helped, and for every mother who feels happy and confident that she is not alone in her choice, then it's all worthwhile. So the criticism may sting, but the positive responses offer great relief!

Thank you so much, Pauline, for sharing your views and experience. The Mom Pledge strongly advocates being able to discuss these important issues.

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