5 ways a cesarean impacts a new family and what we can do about it

“I hated him”. Sarah took a deep breath. “I know it’s not logical, there wasn’t anything he could do,
but that’s how I felt. I hated him for not protecting me.”
A Caesarean Section is both the most common and least necessary surgery conducted in the United
States. It is also the only surgical procedure that will be up-close-and-personally witnessed by an
intimate partner, and if unplanned, with little warning and no preparation at all.
The effects of this singular event on a couple’s relationship may not manifest until weeks or months
afterwards, with one researcher reporting more adverse psychological effects at seven to twelve
months later and another saying caesarean parents have “more difficulties and differences in the
postpartum period up to 7 years”.
Need for emotional support
Mothers often report feelings of shock, loss of control, loss of self-esteem, detachment, overwhelm,
guilt, violation, trauma, depression, anger, resentment, hostility and anguish. Fathers often report
feeling isolated, inadequate, fearful, worried, guilty, shocked, confused and helpless.
Both can feel “like a failure”: mothers like their bodies have let them down and fathers from failing
to perform “the supportive ‘coaching’ role often prepared for in childbirth classes”.
These are the emotions parents bundle up and carry home with them along with their new baby.
If there is no way to process these feelings they are likely to remain ‘boxed up’ and can undermine
new parenting confidence. Any emotion that sits deep within us is likely to be triggered by our
partner eventually. Parents who have been through a caesarean need the opportunity to explore
and express their emotions, to be heard and their experience validated.
Assertive communication
When our senses are overloaded it affects normal thought processes and the chaos of those first few
weeks means communication can be even more difficult. This environment breeds assumptions and
misunderstandings that cause feelings of isolation and create tension between a couple.
Talking about feelings often takes a back seat to preoccupation with physical needs as Caryl
experienced:
“Steven could see how distressed I was…he looked at my notes and helped me work out
when I would need to take pain killers again, he was so competent, some staff even asked
him if he was a medical professional, it was like he had found his role and something he
could do (after being a bystander at the labour)…but to be honest I would rather have
had his full attention, talking to me, letting me cry, saying he was sorry for what I’d gone
through”.
Steven was aware of it too:
“At the time I didn’t realise how damaging it was for Caryl – to me it was another thing I
could take some ownership of and control while Caryl was recovering. Once home, and over
the next week while I was off work, this practical focus continued. I put Caryl’s tearfulness
down to tiredness and tried to take over to give her the rest she needed to build up her
strength for when I got back to work.
When I did go back to work I just became a bit of a robot – trying to do again the practical
things and tiring myself, not really giving Caryl the emotional support she needed. Maybe I
didn’t want to deal with my own emotions”.
A new awareness of needs and a new assertiveness in communicating them may need to be
negotiated between a couple. Whereas previously, requests may have been hinted at and
resentment set in if a partner didn’t mind-read, a new directness can be beneficial: “can you please
hang out the washing” or “I need you to say nothing and just hold me”. This can feel uncomfortable
at first, but many partners find this new style of communication is actually a relief.
Awareness of Tension
Some women feel ‘duped’ into the operation, told the benefits but not all the costs. Some felt
controlled, manipulated or downright bullied. Many have the “dead baby” card played on them.
They are angry, of course, but not all are aware of the depth of their anger or where it should be
directed, particularly when caesareans are often trivialised or seen as routine. It’s not uncommon
for us to project the deeper, more unconscious layers of anger on to our partner. The lack of
understanding and empathy from medical providers, family, and friends can mean a woman needs
more empathy from her partner at the same time she may at some level be blaming him for the
situation, particularly if the c-section has been traumatic.
Anticipation of Risk for Postpartum Mood Disorders
Women who have undergone a caesarean are more prone to Postpartum Depression and those who
have experienced the birth as traumatic are 75% more at risk. Fifty percent of mothers with PPD,
will have a partner who also becomes depressed, which along with other implications for the whole
family, can mean she is more depressed and for longer. Perinatal screening for mood disorders, for
both mothers and fathers, both having the opportunity to debrief the birth if desired and links to
community and support organisations will, hopefully, eventually become standard practice.
Take time with Intimacy
What’s it like for a woman to see a scar, expected or not, so close to the most intimate part of her
body? What is it like for her partner? And for her to see her partner’s reaction? Having the lines of
communication open about these things allows couples to work through thoughts and feelings.
Nekole Shapiro of Embodied Birth says women can feel ‘pulling’ on their scar during intercourse and
for some anything related to sex can restimulate trauma. It takes couples who have been through
a caesarean longer to resume sex and both partners are naturally anxious. Some cope with this
by going back to the beginning of their relationship, as if they were dating for the first time, start
by holding hands and hugging, then slowly moving on to cuddling and kissing before beginning to
gradually explore each other’s bodies again. The more a partner knows about how a woman’s new
sensitivity, the more sensitive they can be. Her being direct “don’t touch me there, touch me here
instead” can take intimacy to a new level.
It’s obvious to say we need to prepare couples better for the possibility of an unexpected caesarean
birth but childbirth educators will tell you it’s common for expecting couples to ‘tune out’ caesarean
information in classes, expecting it won’t apply to them. Some educators get around this by
presenting the information as a “what if” scenario, playing a short YouTube clip, encourage couples
to discuss it and include a “just in case” section in their birth plan.
Where physical scars are obvious it can be easier to understand just how much support a recovering
mom and her partner will need. If they can be supported to heal psychologically and emotionally as
well, that’s a much better start for a new family.
Bio: Elly Taylor is an Emotionally Focused Couples Therapist, educator and columnist for Practical
Parenting magazine. She is passionate about including fathers (or partners) more in pregnancy, birth
and early parenthood to support the emotional health and bonding of the whole family. Elly lives
in a beach house in Sydney, Australia with her husband, their three children and a bunch of pets.
Becoming Us is her first book: http://www.amazon.com/Becoming-Us-Steps-Family-Thrives/dp/
0992385601/ref=sr_1_1?ie=UTF8&qid=1395975897&sr=8-1&keywords=Becoming+Us .

Guest Article by Elly Taylor

“I hated him.” Sarah took a deep breath. “I know it’s not logical, there wasn’t anything he could do, but that’s how I felt. I hated him for not protecting me.”

A Cesarean Section is both the most common and least necessary surgery conducted in the United States. It is also the only surgical procedure that will be up-close-and-personally witnessed by an intimate partner and, if unplanned, with little warning and no preparation at all.

The effects of this singular event on a couple’s relationship may not manifest until weeks or months afterwards, with one researcher reporting more adverse psychological effects at seven to twelve months later and another saying cesarean parents have “more difficulties and differences in the postpartum period up to 7 years.”

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Need for emotional support

Mothers often report feelings of shock and being overwhelmed, loss of control, loss of self-esteem, detachment, guilt, violation, trauma, depression, anger, resentment, hostility, and anguish. Fathers often report feeling isolated, inadequate, fearful, worried, guilty, shocked, confused, and helpless.

Both can feel “like a failure:” mothers like their bodies have let them down and fathers for failing to perform the supportive ‘coaching’ role often prepared for in childbirth classes.

These are the emotions parents bundle up and carry home with them along with their new baby. If there is no way to process these feelings they are likely to remain ‘boxed up’ and can undermine new parenting confidence. Any emotion that sits deep within us is likely to be triggered by our partner eventually. Parents who have been through a cesarean need the opportunity to explore and express their emotions, to be heard, and to have their experience validated.

Assertive communication

When our senses are overloaded it affects normal thought processes and the chaos of those first few weeks means communication can be even more difficult. This environment breeds assumptions and misunderstandings that cause feelings of isolation and create tension between a couple.

Talking about feelings often takes a back seat to preoccupation with physical needs as Caryl experienced:

“Steven could see how distressed I was… he looked at my notes and helped me work out when I would need to take pain killers again, he was so competent, some staff even asked him if he was a medical professional, it was like he had found his role and something he could do (after being a bystander at the labor)… but to be honest I would rather have had his full attention, talking to me, letting me cry, saying he was sorry for what I’d gone through.”

Steven was aware of it, too:

“At the time I didn’t realize how damaging it was for Caryl – to me it was another thing I could take some ownership of and control while Caryl was recovering. Once home, and over the next week while I was off work, this practical focus continued. I put Caryl’s tearfulness down to tiredness and tried to take over to give her the rest she needed to build up her strength for when I got back to work.

When I did go back to work I just became a bit of a robot – trying, again, to do the practical things and tiring myself, not really giving Caryl the emotional support she needed. Maybe I didn’t want to deal with my own emotions.”

A new awareness of needs and a new assertiveness in communicating them may need to be negotiated between a couple. Whereas previously, requests may have been hinted at and resentment set in if a partner didn’t mind-read, a new directness can be beneficial: “can you please hang out the washing” or “I need you to say nothing and just hold me.” This can feel uncomfortable at first, but many partners find this new style of communication is actually a relief.

Awareness of tension

Some women feel ‘duped’ into the operation, told the benefits but not all the costs. Some feel controlled, manipulated or downright bullied. Many have the “dead baby” card played on them. They are angry, of course, but not all are aware of the depth of their anger or where it should be directed, particularly when cesareans are often trivialized or seen as routine. It’s not uncommon for us to project the deeper, more unconscious layers of anger on to our partner. The lack of understanding and empathy from medical providers, family, and friends can mean a woman needs more empathy from her partner at the same time she may at some level be blaming him for the situation, particularly if the c-section has been traumatic.

Anticipation of risk for postpartum mood disorders

Women who have undergone a cesarean are more prone to Postpartum Depression (PPD) and those who have experienced the birth as traumatic are 75% more at risk. Fifty percent of mothers with PPD will have a partner who also becomes depressed, which along with other implications for the whole family, can mean she is more depressed and for longer. Perinatal screening for mood disorders for both mothers and fathers to have the opportunity to debrief the birth, if desired, and links to community and support organisations will, hopefully, eventually become standard practice.

Take time with intimacy

What’s it like for a woman to see a scar, expected or not, so close to the most intimate part of her body? What is it like for her partner? And for her to see her partner’s reaction? Having the lines of communication open about these things allows couples to work through thoughts and feelings.

Nekole Shapiro of Embodied Birth says women can feel ‘pulling’ on their scar during intercourse and for some, anything related to sex can re-stimulate trauma. It takes couples who have been through a cesarean longer to resume sex and both partners are naturally anxious. Some cope with this by going back to the beginning of their relationship, as if they were dating for the first time. Start by holding hands and hugging, then slowly moving on to cuddling and kissing before beginning to gradually explore each other’s bodies again. The more a partner knows about a woman’s new sensitivity, the more sensitive they can be. Her being direct, “don’t touch me there, touch me here instead” can take intimacy to a new level.

It’s obvious to say we need to prepare couples better for the possibility of an unexpected cesarean but childbirth educators will tell you it’s common for expecting couples to ‘tune out’ cesarean information in classes, expecting it won’t apply to them. Some educators get around this by presenting the information as a “what if” scenario, playing a short YouTube clip, encouraging couples to discuss it and include a “just in case” section in their birth plan.

Where physical scars are obvious it can be easier to understand just how much support a recovering mom and her partner will need. If they can be supported to heal psychologically and emotionally as well, that’s a much better start for a new family.

Elly Taylor

Bio: Elly Taylor is an Emotionally Focused Couples Therapist, educator and columnist for Practical Parenting magazine. She is passionate about including fathers (or partners) more in pregnancy, birth and early parenthood to support the emotional health and bonding of the whole family. Elly lives in a beach house in Sydney, Australia with her husband, their three children and a bunch of pets. Becoming Us is her first book, find it here. You can also find her online at Parent Support Online.

8 Comments

  1. christine April 18, 2014 6:47 pm  Reply

    a million times yes.
    my c section was very traumatic I suffered PPD and still have pain in the area a year later.
    my body will never be the same and I have yet to show my partner to look. I’m sure he’s seen it from time to time. but i don’t allow him to touch it or even be anywhere near it without the lights off. I hate it and I hate my birth.
    thank you for writing this. c sections are a big deal and they should be treated as such and be used only as a last resort.

  2. Amanda April 18, 2014 9:11 pm  Reply

    Very nice article. It was like you were in my house the first year after my c-section.

  3. Elly Taylor May 14, 2014 12:14 am  Reply

    Christine, it’s a lot to have to cope with and a new baby as well. C-sections are a big deal and we need to acknowledge that.

    Thank you Amanda. It must have been hard for you.I hope that by bringing attention to the difficulties, we can get new moms and new mom-agains the support they need and deserve.

  4. Kat June 30, 2014 5:15 pm  Reply

    My c-section was almost 25 years ago, following a home labor. The resident (a woman) was great, but the attending gave me an ultimatum on his arrival in the morning: c-section or get out of “his” hospital. (Note that my son’s apgars were 8/9) My husband did not seem to think he needed to give me any special treatment and even commented about my “saggy” belly. Not surprisingly, we divorced when my son was 13 months old (I say “my” because he was not very involved in the upbringing). BTW, tell people NOT to say, “but aren’t you glad your baby is alive?” It’s insulting; implies that you are so selfish you would prefer to let your baby die!

  5. hiba July 6, 2014 3:51 am  Reply

    I just had a c section last month on 23 may 2014..i want to know when i can conceive again safely? The gap should be how much? I need another baby soon. Plz help me n suggest me

  6. Amy July 24, 2014 4:37 pm  Reply

    I have done lots of research since the birth of my son in 2006. I believed then and I still do that I had an unesscary c-sec. Its was trumatic for me and I believe I suffered ptsd because of it. In my reseach I have learned that my doctor was impateint and didnt believe I could have delivered my son without trouble. I still hate her to this day because of her lack of support. THe father of my son and I had multiple problems before during and after pregancy. Recovering took triple the normal amount of time for me it seem like. I don’t reconmend or suggest a c-sec to anyone ever. No matter if its the first or multiple. Major surgey is not the answer to bring a baby into the world. What happened to the days of doctors only did them as an absolute last resort or if mother and baby truely were in danger of death. I hate regular OB’s now because of my experince. What happened to caring for the pateint as a whole? This is why with second child I have choose a Midwife and have 2 doulas. I have surrounded myself with only positive supporters. My husband now is an awesome supporter. We are very excited and I hope I can personally heal more from this birth. This webcite is amazing I hope to tell every woman about them. Every woman should know her rights and be informed.

  7. Wise Soul August 18, 2014 5:55 pm  Reply

    Thank you for your article. Do you have any more articles and books that you could recommend on healing mentally and emotionaly after a c-section. It’s been almost 5 months for me and I’m still trying to work through it.

    • secretary August 30, 2014 4:03 pm  Reply

      We recommend Birthing From Within by Pam England! They have partnered with us to provide help for healing from traumatic births.

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