Giving Birth: The Miracle of C-section

If you were reading up on ‘natural’ births, would the word c-section come to mind?

Probably not. And the next question to ask is, why?

A caesarean section, often referred to as a ‘C-section’ is a surgical procedure with a fascinating history. Vaginal birth, however, is often referred to as ‘natural birth’. When something is ‘natural’ we think it is inherently better. But framing something ‘natural’ automatically indicates something else is ‘unnatural’. And in the case of giving birth, that means that somehow, perhaps without meaning to, society has framed c-sections as an ‘unnatural’ way to give birth.

To fully appreciate the miracle that is c-section delivery and how it has advanced over time, we’re stripping it right back.

Why have a c-section?

There are many reasons why expecting mothers may choose or healthcare professionals recommend performing a c-section. We touch on this in our blog ‘C-Section 101: Everything You Need to Know’. But the biggest takeaway is that the decision is made with both mum and baby’s best interests and wellbeing as the focus. 

If you are considering an elective or planned c-section, share your thoughts with your midwife or doctor who can explain the process to you and answer any other questions that crop up, related to for example breastfeeding or back pain after a C-section. 

How Evolution Affected Our Capability to Give Birth 

Women all have one thing in common when it comes to childbirth and labor: it hurts. For some mums it hurts more than others. And for some mums, it hurts because something is going wrong, and the only way may be to deliver baby surgically. 

The history of how the human species has evolved shows how changes to the female body have changed the experience of childbirth and how we know it to be today. Our ancestors were ape-like animals who walked on all fours. When we evolved to walk upright on two legs, our pelvises got smaller to accommodate a closer fit for our legs. Later, we changed again – our brains grew larger. These two changes are primarily at fault for childbirth difficulties among human women. Our smaller pelvis and our big-brained babies are what makes this experience so different and unlike any other animal birth. 

Learn more: C-section 101: Everything You Need to Know

Evolution of Caesarean Section: from Ancient to Modern 

While it’s kind of obvious that women have always been able to give birth vaginally, c-section isn’t a new invention either. There are tales in both Eastern and Western cultures of this operation being successful in saving mother and baby.

The extraction of Asclepius from the abdomen of his mother Coronis by his father Apollo. Woodcut from the 1549 edition of Alessandro Beneditti's De Re Medica. Source. 

The history of how c-sections came to be, milestones in its evolution, and what that looks like in modern practice, is an incredible journey to be grateful for. Below is a brief timeline to value the advancements we have made in recent decades through modern medicines coming into play, and the journey we have yet to go on.

• During its evolution, caesarean operation has meant different things to different people at different times. Interestingly, it wasn’t until 1598 when Jacques Guillimeau’s book on midwifery was published that the word ‘section’ came to be and replaced ‘operation’.
• Until the late 19^th century, women were barred from medical schools in Europe. The first recorded successful caesarean was performed somewhere between 1815 and 1821 by an Irish woman pretending to be a man and serving as a doctor to the British army in South Africa.
• In Europe, caesarean section was a feared operation until the 20th century. According to one estimate, not a single woman survived a caesarean section in Paris for 90 years, between 1787 and 1876. In the 1800s, the best operators were known for speed, not success rate or bedside manner.
• Things changed mid-century when an American dentist used diethyl ether while removing a facial tumour. Diethyl ether has similar properties to propofol and ketamine - it can be used as general anaesthesia. However, anaesthesia was heavily opposed by obstetrics in Europe for biblical reasons.
• Views of using anaesthesia changed when Queen Victoria, the head of the Church of England, had chloroform administered for the birth of her two children Leopold (1853) and Beatrice (1857). The Queen’s births finally popularised anaesthesia and pain relief during childbirth. 
• The last 130-odd years have seen most advancement in medicine and caesarean section has evolved from a feared operation with high maternal mortality to a hospital staple. Epidural anaesthesia has largely replaced general anaesthesia, ultrasound scans help us to visualise the foetus, heart monitors to track a baby’s well-being in real-time, and tools to even operate in utero. All these changes have made the caesarean section a safer procedure.
• Innovative products such as postpartum belly wraps and support bands are being developed to aid women in their recovery after having a c-section. Physiotherapists are now recommending postpartum support bands, like Lola&Lykke’s Core Restore Postpartum Support Band, to alleviate unnecessary pressure on weakened muscles caused by pregnancy and labor.

The discussion around c-section has changed from a religious viewpoint to minimising risks, and from the health of the mother to the wellbeing of the baby.

In recent years, the number of c-sections performed in countries such as the UK and Finland has been increasing, with other countries reaching nearly 50% or more births resulting in an elective or emergency c-section. It could be questioned that these figures highlight a lack of knowledge, intervention, or resources to support expecting mothers and healthcare professionals. However, it could also be argued that these figures are also affected by societal influences and the language we use to talk about c-sections in comparison to vaginal births.

While there is reasonable evidence that caesarean section may be used too often in some societies, the operation which was once difficult to survive, now saves lives. Caesarean section has transformed the lives of women, unborn babies, and the whole medical profession.

Real mum story: Will I feel them cut me open?’ - Two mums, an emergency C-section, and a happy ending

The Birth Story You Deserve 

Birth stories may be some of the most important ones we share. During birth, the parents and child(ren) are on equal footing – they are all stars of the show. Many times these stories are shared when meeting other new mums; they are a unifying memory that connects people. But many mums who have had a c-section birth have a particular tone in their voice, a subtle mark of disappointment. 

Our society has perfected guilt, and insecurity is monetised. In the New York Times, Thalia Mostow Bruehl states that c-sections are at the top of that list, written with permanent marker. If you have ever heard of the 2008 Ricki Lake documentary ‘The Business of Being Born’ you may not be surprised. While the story follows a beautiful, vaginal water birth story in a home-setting, I’ll borrow Mostow Bruehl’s words describing the documentary’s take on c-section: 

“The documentary likens scheduled C-sections to plastic surgery, referring to them in one scene as “designer births.” The film blurs the line between elective and medically indicated cesareans at times, and even goes so far as to compare medical interventions during delivery with the horrors that resulted from mothers taking the drug thalidomide.” 

We are truly given only two options in this popularised narrative: the joy of vaginal delivery with its golden crown, or the defeat of a caesarean. We live in a society where individuality and autonomy should – are even expected to – be accepted and praised: sizes, shapes, styles, colours and more. I can’t comprehend why a c-section would be a reason to diminish a woman’s birth experience.

Fear of the unknown is completely understandable – we have closed the doors on birthing mothers for so long that it would be strange if we didn’t feel afraid! Have you held a newborn baby before? Do you actually know what happens during birth? All those embarrassing but oh so completely normal functions a woman’s body does? Do you know what you need to do to recover from a C-section? How much do you know and how much does that affect the decisions you make for your birth plan? 

We are so proud of everyone who has embraced educating women, parents, and carers about pregnancy and the variety of options there are. From our own collaboration with maternity professionals to introduce the Pregnancy, Birth & Beyond educational series to everyone engaging and empowering those (wanting to be) pregnant. And those sharing these stories, like @csectionstrong on Instagram. It really is time women took over their own pregnancy: knowledge is power, and hiding all those painful, scary and unavoidable things will do you the world of good. Our society has great ways to give almost every woman a great pregnancy and birth experience. We want you to be able to feel you are being heard and listened to and your choices are respected whatever they may be.

Learn more: Birth Trauma and C-sections – Managing your emotional and physical pains after a traumatic birth

Evidence-based Medicine Even in Birth 

There are around 140 million babies born annually according to the UN. The medical journal The Lancet reported surging caesarean section rates in 2018: from about 16 million births (12%) in 2000 to an estimated 29.7 million (21%) in 2015. The nation with the highest rate for using the surgery to assist childbirth is the Dominican Republic with 58.1%, followed by Brazil and Egypt (55.5% respectively). The lowest rates were found in West and Central Africa (4%). Across all 37 OECD countries 28% of live births were performed as c-section in 2017. That sounds like a lot, doesn’t it? 

In 1985 a group of healthcare experts convened by the World Health Organisation in Fortaleza, Brazil, to discuss the perceived high rates of caesarean sections. Based on the evidence available at that time, these experts concluded ‘there is no justification for any region to have a caesarean section rate higher than 10-15%’. This has become the universally agreed ‘sweet spot’ where there is evidence-based benefit from lower mortality rates. But across the OECD countries the caesarean rate is almost 30%, never mind the Dominican, Brazilian, or Egyptian rates nearing 60%! It means there are many c-sections done due to preference (of mum’s, or doctor’s even) rather than medical indication. This is partly due to attitudes and beliefs, and partly due to less informed women choosing to have a caesarean in an attempt to avoid labour. More recently, there’s been an increase in women choosing to have babies in their 40s which can result in further complications. 

And yet, on the other end of the spectrum, you have the mothers who desperately need the medical intervention that a c-section can resolve, but it is unavailable to them. In some countries, such as India and Malawi, c-section birth rates are lower than 10%. These countries have fewer health workers who can do the procedure and don’t have hospitals equipped to do it. But in many instances, there are also behavioural reasons behind women not getting needed c-sections. Where the language used to talk about c-sections is rooted in the beliefs and actions of that society. When something is ‘natural’, something else must be ‘unnatural’.

Learn more: How Many C-Sections Can You Safely Have

Positive Birth Stories

Many c-section mums are wary to talk about their experience, especially if the birth story involves an elective caesarean. As well as emergency or elective caesarean sections, the term for women who choose to have a c-section is called “elective c-section”.  An emergency c-section seems more accepted due to often being the last choice. But by that point, something will have gone wrong already. The procedure has different risks than giving birth vaginally but women who have opted for this procedure are often afraid to share their birth story in fear of judgement. Their stories are always different as their paths and experiences are unique.

Lean more: C-Section Hospital Bag Essentials for Mums: What Do I Need?

Love like no other 

Thalia Mostow Bruehl’s daughter loves hearing about her own birth. And I’ve rarely heard of a birth story so filled with love than Thalia’s. Due to previous hip surgeries, she always knew a vaginal birth would not be an option for her. And I just love how different she describes her c-section experience compared to her previous surgeries: 

“… it wasn’t scary or lonely. My C-section was the most romantic moment of my life. Better than my engagement, wedding or honeymoon.” 

The procedure itself was quick, and connected Thalia and her husband in a new way, connecting them as a family of three with a healthy baby with the perfect APGAR score. She shares the importance of skin-to-skin contact soon after birth – regardless of the method – and held her own baby in her arms before leaving the operating room. The newborn baby girl latched onto her breast as soon as the happy family was wheeled into recovery.  

Sounds like everything went perfect for Thalia, and I am so very thrilled to be able to share this beautiful story with you all. 

Learn more: C-section Birth: What Dads and Partners Need to Know

Every mum has a mind of her own 

Another elective c-section mum, Morgan Celeste, knew her decision early on when she discovered where babies come from. To her the choice was not difficult but sharing that decision during her early 20s saw many people doubting and discounting her: “You’ll feel differently when you get pregnant.” I’ll not lie, that sentence gives me hives! So many people face a variation of this sentence when it comes to decisions about children: when and if to have them at all, how to have them, and how to raise them… you can probably add a few more. It is clear our mind may change – but sometimes it doesn’t, and it is not okay to question these choices. 

Morgan’s mind didn’t change when the time came. If anything, she wanted it even more. And she discussed it thoroughly with her doctor. Understanding the risks associated, Morgan and her doctor decided to schedule her surgery a week before her due date to minimise the chances of her going into labour. Her family was there, and everything went according to plan. The procedure began at 7:30am and at 8:18am her little girl was born. Like Thalia, Morgan got to hold her baby immediately after her birth. In her own words: 

“It is cliché to say, but it was an incredible moment.” 

After surgery she found it difficult to move; not being in pain, but her body just slightly uncooperative following a rearranging of her insides. No significant pain, no unintentional pooping, but a pleasant experience and good memories. 

No, I was not “too posh to push” 

Learn more: Understanding C-Section Overhang: Causes, Solutions, and Support

Lastly, let me introduce you to Nicola Prentis’ story. She wanted the best for her baby, just like any parent would. With three weeks to go before her due date, she was packing for herself and her baby, organising a three-hour train ride, and trying to find a place to stay: she was trying to change her prenatal care to somewhere where she would be listened to. 

Nicola knew long before her pregnancy what she did not want. She didn’t want to hear the word ‘emergency’ anywhere near her or her baby. She did not want panic, uncontrolled haemorrhaging, the sound of flatlining heart monitors, or having to make life-saving decisions after 30 or more hours of labour. She did not want forceps or a vacuum-assisted delivery, nor episiotomy. 

Instead she studied caesarean section extensively. She found out that while a longer hospital stay is considered a risk, it’s few extra days at most. Nicola learnt that vaginal birth and caesarean section have different risks involved, and by the time she met with a consultant at 37 weeks, she was able to advocate for herself. But her doctor refused to do the procedure. She finally found a hospital and a doctor willing to admit her three days before her due date. The actual experience, she describes, was a big deal, but no ordeal. And perhaps more overwhelming than she had initially anticipated. 

Real mum story: A Weird Mix of an Elective-Emergency C-section: A Mum and Dad’s Tale

Food for thought 

At the end of these three very different stories, we circle back to those thoughts of individuality and autonomy. Society focuses a lot on the right of a woman to choose whether she wants to have children. And that’s important! However, we need to change the perception that has been created about c-sections and remove the guilt that some mums feel when being asked about their birth story. Giving women the tools to make an informed decision over which their preferred method of birth is, should be obvious. Informing everyone else on how to support them with their decision, is even more important.

Join us on our mission of “Mama first” and giving new and expecting families the support they need to make their birth story one to be proud of.