Literature Review: Grieving the Idea of a Vaginal Birth When having a Cesarean Birth.
When I was in graduate school working on my Master’s in Social Work I was assigned a literature review with the topic being any relation to nondeath loss grief. I chose to write about the grief one may experience when not experiencing the vaginal birth wester society deems valid. If you are interested in this topic, it is a fairly quick read. I’ve included the articles I pulled information from HERE and HERE. If you have any questions reach out! If you need to process your birth, also reach out!
*NOTE that this information is not all-inclusive and des not apply to everybody. Many people choose to have a planned cesarean for many different reasons. There has been little research done on this topic, but I am sharing what I found at the time.
Sarah Bourestom
Grief Counseling: SW393
Erin Spalding
October 17, 2021
I reviewed the literature on the grief that follows a cesarean birth when parents prefer a vaginal birth. Parents grieve the idea of having a planned vaginal birth sometimes feeling as though they didn’t “actually birth” the baby, feel embarrassed about the cesarean, and sometimes are made to feel shame around cesarean sections. There was an underwhelming amount of information on this topic but I was able to gather a few sources. The two main pieces I reviewed were longitudinal studies from parents who gave birth via planned and unplanned cesarean sections.
Dr. Puia’s piece, “First Time Mothers’ Experience of a Planned Cesarean Birth,” uses thematic narrative analysis from eleven postpartum mothers who shared their stories. It was discovered that there were themes of these parents needing education and support specific to planned cesarean sections before the birth to help with the process of adapting to this plan by creating realistic expectations. Samantha Van Reenen and Esme Van Rensburg are the researchers “South African Mothers’ Coping With an Unplanned Cesarean Section.” Raneed and Rensburg discuss different people’s experiences and how they coped with the transition of plan, with a focus on trauma from birth and coping mechanisms used throughout birth. The last article was published in the Australian and New Zealand Journal of Psychiatry which researched via a longitudinal study of pregnant parents who had not had any previous children through a set of interviews through pregnancy, birth, and postpartum. This study determined that the more obstetrics interventions one has, the more mental health declines to a form of grief and PTSD.
I chose this as my topic because I am a birth and postpartum doula and I have found my niche to be the overlap of birthwork and mental health after working in the crisis department at the local mental health authority for 3.5 years prior to my career change. All birth is natural, but the experience of birthing a baby vaginally versus via cesarean are vastly different experiences that hold different stigmas within western society today. The grief that comes along when someone's life story changes that they do not always have control over can be intense, and full of a wide range of emotions, grief being a primary.
I believe there is a shortage of information surrounding this topic. There are many populations and considerations that are missing from the pieces I read. People from different cultures, colors, etc. A consideration in this research could be to look into information in different locations around the world as it is my understanding in Texas hospitals OBs get paid more when the birthing person has a cesarean birth. In this case, it makes sense why a provider was pushing their client for a cesarean, because they get paid more, rather than continuing to try alternate routes for the birthing person continues laboring naturally.
Three main points that stuck out to me in the literature is, having informed consent, feeling heard themselves helps to process, and knowing that expectations need to be flexible. Consenting to what is happening to your body is important, making informed and grounded decisions before any think happens is key. In the laboring room sometimes there is so much going on that the provider doesn’t take the time to help the client fully understand what is happening to them but are in a state of frantic pain so just agree to whatever will stop the pain. Multiple people reported back that if they were able to slow down and explain the options in a manner that the birthing person can comprehend and fully comprehend everything helps them to feel more in control of their body and the situation. Having this informed consent should lead to having appropriate expectations for what to expect as follows. Having true and accurate expectations provided and talked through what is happening was reported to vastly change the outcome of the procedure. After the cesarean, or any birth really, having a support person to talk everything through is helpful in processing the situation and how they feel.
While all genders can and have birthed babies, I was only able to find pieces that strictly interviewed and followed along with cis women - the data is gendered and not all inclusive. There is a large amount of stories and perspectives that are being missed as some people who do not identify with their vagina but still want to use their other bodily abilities to create life may have a different experience with the methods in which they birth a child. Including these other perspectives would really be important in getting the full spectrum of experiences. I also believe discussing more about cultural relevance and feelings is important. There are cultures that support and prefer cesarean section births so their reactions to having a cesarean over a vaginal birth are probably accustomed to this benign primarily the only option.
In general, pregnant people receive a lot of advice and attention but little actual emotional support. Once baby is earthside, people tend to no longer care about the delivery, just that baby is here and typically the parents are no longer cared for after the first week or two, if at all. Having providers who are not aware or care for the mental health of their clients is a large detrimental factor when providing care. In the standard western medical society, mental health comes second to physical health rather than of equal importance.
An additional challenge with this form for grief is that there was not only no death, but there was life. The typical support person or people don’t think to check in regarding how the birthing parent is coping postpartum. Non-death loss grief is typically disenfranchised in general. There is little sympathy or thought given to people who were still able to bring a baby home, regardless of how baby got there, despite the physical and emotional trauma of birth.
There are plenty of parenting and prenatal groups, but little space to process the birthing experience. Having someone to bare witness to your birth and process it afterwards can be tremendously healing. One of the roles of a postpartum doula is to hear the story of their clients and help them to process. A doula is a large way of addressing this issue. A more preventative way to address this need is to help birthing people to know they have options and ensure they are able to provide informed consent. Even after someone gets a cesarean they are still able to give birth to their next child vaginally if that is what they desire and need to know that is an option.
References
Fisher, J., Astbury, J., & Smith, A. (1997). Adverse psychological impact of operative obstetric interventions: A prospective longitudinal study. Australasian Psychiatry : Bulletin of the Royal Australian and New Zealand College of Psychiatrists, 31(5), 728–738. https://doi.org/10.3109/00048679709062687
Puia, D. (2018). First-Time Mothers’ Experiences of a Planned Cesarean Birth. The Journal of Perinatal Education, 27(1), 50–60. https://doi.org/10.1891/1058-1243.27.1.50
Van Reenen, S., & van Rensburg, E. (2015). South African Mothers’ Coping With an Unplanned Caesarean Section. Health Care for Women International, 36(6), 663–683. https://doi.org/10.1080/07399332.2013.863893
