In the pursuit of learning, every day something is acquired.
In the pursuit of Tao, every day something is dropped.

Less and less is done.
Until non-action is achieved.
When nothing is done, nothing is left undone.

The world is ruled by letting things take their course.
It cannot be ruled by interfering.

Tao Te Ching

Sunday, March 6, 2011

Empowered Caesarean: caesarean promotion or a much needed resource?

By Amy Hourigan

As a committee member of CARES SA (Caesarean Awareness Recovery Education Support South Australia) I come in contact with lots of women who have had caesareans. Most women come to CARES SA because they have had a negative caesarean birth experience and want help to make positive choices to increase their chances of achieving a vaginal birth.

Occasionally we are contacted by women who need to have a caesarean for medical reasons or are choosing a caesarean due to mental health reasons ie. fear or previous birth trauma. Because of this small group of women we decided to put together a brochure called ‘Empowered Caesarean’. Now I must say that as an organisation we wholeheartedly support vaginal birth after caesarean as the safest choice in a complication free pregnancy but in saying that we believe that every woman has her own journey to birth.

We believe that if a woman needs to have a caesarean her experience should be as positive as possible. She should feel as in control as possible and know her rights and options. For example many women do not realise that they are able to call the shots during a caesarean from asking for music to be playing in the background to demanding skin to skin contact promptly after the delivery.

Why do we encourage positive caesarean experiences? We realise that around 85% of women who have had a caesarean will go on to have a repeat caesarean for subsequent babies. As women who have all had at least one baby born by caesarean we understand the need for a less than perfect birth experience to have as many positive aspects as possible. I personally still struggle nearly 5 years after the birth of my caesarean baby with the amount of time we were separated after she was delivered by caesarean section. I still feel the guilt 5 years on and feel this need to make it up to her, effectively parenting out of guilt and fear rather than from the healthy place I am able to parent my baby who was born vaginally.

The prolonged separation of mother and baby can have many consequences the main one being the difficulty in establishing a good breastfeeding relationship. Many Mums of caesarean born babies describe the intrinsic need to be able to breastfeed their babies as a way to make up the trauma or lack of a natural birth experience, hence why women need to know that it is possible to request (or demand) skin to skin contact straight after caesarean birth. In some cases it can be negotiated that baby goes into recovery with the mother to minimise any separation.

Another very important reason why we provide this information is because many times the women who come to CARES who seek a VBAC would return to CARES coffee mornings (or not return at all) because despite trying so hard for a vaginal birth they have ended up with a repeat caesarean. These are women who often had made every effort to get a vaginal birth including; homebirth, being drug free, and extremely long active labours. Often these women would come back to CARES and feel like a failure because they hadn’t achieved a VBAC.

We then came together as a group and decided to rename VBAC. We now refer to VBAC as an EBAC (Empowered Birth After Caesarean). If you are going to try to have a VBAC you will be aware that in a public hospital setting your chances of a VBAC sits around 70% (70% is the figure that the hospitals use although we doubt that 70% of VBAC women get a vaginal birth) so we thought it was important for the 30% of women who do not achieve a VBAC to not feel like failures. Because even though they may not get the vaginal birth they so desired it was still possible to feel empowered. It is possible to feel empowered if you are the one in control, the one who calls the shots and makes the decision rather than just a another cog in the hospital machine. It is possible to avoid some of the sadness that often comes with an unwanted caesarean if you feel like you have done everything in your power to provide your body and baby with all the chances of having a positive birth experience.

We don’t believe that giving women the information to have an empowered caesarean is promoting or encouraging caesarean. We don’t believe that having this information readily available sways women’s decisions to choose caesarean over vaginal birth. What this information does is allow woman and babies a chance to minimise birth trauma, to encourage positive bonding, to encourage breastfeeding and to hopefully give women a chance to be understand that they have the right and ability to stand up to the medical establishment and demand positive birth experience’s even if the circumstances are less than ideal.

For every woman that demands a positive caesarean experience it hopefully plants a seed in the minds of the people attending to her that woman and babies deserve to experience positive births and deliveries. So while in an ideal world the caesarean rate in Australia would sit under 10% of all births this is currently not the case. We think it would be very remiss of us and doing women a disservice not to empower women to experience the most positive birth experience they can have, and the flow through effect is immeasurable.

For information on VBAC or EBAC contact or email

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