|
|
Is delivery by Caesarean section merely another way of having a baby? Caroline Flint looks at the psychological effects of this procedure on some mothers and questions its routine use I have heard a number of comments in the last month from women searching in anguish for a reason for having had a Caesarean section. `Caroline', one said, `I feel that someone has been out and bought any old baby and given it to me.' `I feel so angry and resentful, was my operation really necessary?' 'It leaves you feeling so weak and drained and then you have a new baby to look after too, you can't help feeling a teeny bit resentful towards the baby.' `I keep asking myself was it really necessary, did I really need it?' 'I can't get it out of my mind, I keep going over and over it all the time, John is getting really bored with me rabbiting on about it' Not all women seem to go through this sort of soul-searching, some seem relieved to have a Caesarean, some who have very obvious obstetric problems are perfectly happy about it, but many are obviously anguished - and I don't use the word lightly - about what has happened to them. When I discuss this with my medical or midwifery colleagues I am aware of a great gap in perception. Most of them see a Caesarean as just another way of having a baby. All these midwives say: `She shouldn't see it as a failure, it's a success, she's got a live healthy baby.' I remember how amazed I was when I heard one woman who was holding her very beautiful, live, healthy baby say: `I feel that nothing good has come out of all this.' She was an intelligent woman - she knew that she had a live, healthy baby, so I didn't negate her feelings by pointing this out to her. But she also knew that she was suffering terribly from an acute sense of loss, a feeling that somehow she hadn't `made it' as a woman and felt a terrible failure. In the Tooting maternity unit one in every seven women has a Caesarean section, but this is not uncommonly high for a London hospital - indeed there are several units with a higher percentage. Caesareans are carried out in response to extreme circumstances, but how is it that these circumstances occur more frequently in some units than in others? Could it be something to do with attitudes to childbirth, rather than with the actual physical details of the women concerned? In 1982, Judith Trowell studied a group of women delivered by emergency Caesarean section and compared them to a group who had a normal vaginal delivery.' Her results showed that the Caesarean group encountered more depression, anxiety, doubts about their mothering abilities and indeed their behaviour towards their children was less appropriate to their infants' needs. Altogether, these women had a less happy mothering experience than their sisters who had had normal births. If these Caesareans had been life-saving procedures the cost in relaxed mothering might well have been justified, but if they were carried out just because they took place in St Aloysius' rather than in Nether Wallop maternity unit, does that make the cost justified? What about the other costs involved in a Caesarean section? In 1976-78 the Report on Confidential Inquiries into Maternal Deaths revealed that 90 women had died from the effects associated with Caesarean section. Margaret Ackers was awarded £ 13,775 last month because she was conscious throughout the Caesarean operation - she has also found a further five women who claim that they went through the same ordeal. In 1982, Samina Sarwar had a Caesarean section. Her baby daughter is now a healthy three year old - the mother has been in a coma ever since she had the operation. An article about wound infection after Caesarean section 2 (see Nursing Times June 5) quoted an infection rate of 5.1 per cent of women who had minor sepsis, 17.49 per cent who had wound inflammation and 1 per cent who had major sepsis in which the integrity of the wound was threatened. Think of the cost in terms of human suffering, the amount of antibiotics with their associated cost - the amount of anxiety and worry about wounds breaking down, the number of extra days spent in hospital. A Caesarean section is a major abdominal operation - women feel weak for months afterwards, they have problems picking up their baby and they feel anxious and inadequate as mothers. It is not just another way of having a baby, it is a dangerous and risky and mutilating procedure and its sequelae are far-reaching and momentous. It can be a life-saving operation, and it can be the best way of delivery some babies, but let us never lose sight of its other costs which for some women may be too high a price to pay if the only reason for it is the obstetricians' peace of mind. Perhaps we need to get away from the philosophy that it's alright to interfere but it's not alright to do nothing and allow nature to take its course. We should only interfere when we can definitely improve on nature - and that isn't too often. References 1. Trowel l, J. (1982). `Possible effects of emergency Caesarean section on the motherchild relationship.' Early Human Develop ment, 7: pp. 41-51 2. Moir-Bussy, B., Hutton, R., Thompson, J. (1985). `Wound infection after Caesarean section.' Journal of Infection Control Nursing. Nursing Times; Vol. 81: 23, pp. 1314. July 3 1985 |
|