Reframing Cesarean Birth ( Submitted by CAPPA Member Colleen Goidel )

When a person gets pregnant, they unconsciously develop an internal vision about how they expect their birth will unfold. Their personal history and beliefs, their birth team, their coworkers, friends and family, and the media all influence this expectation—which causes the birthing person to make assumptions about what is true. This is especially so with the concept of cesarean birth.

For most birthing people, birth by cesarean is the most unwished-for birth outcome. To minimize the odds of this outcome, many people invest time and money in classes, prenatal yoga, reading and researching, and hiring a doula.

Our clients look to us to provide up-to-date, evidence-based information so that they can make informed, intentional decisions. How we respond is (hopefully) taken seriously. This is why it’s important to be mindful not only of what we say, but how we frame it.

How we talk about pregnancy, labor and birth—the messages we send—can influence, develop and change their paradigms about these emotional and very personal topics.

In her groundbreaking book, Birthing From Within, Pam England, CNM, describes how she helps expectant couples reframe the concept of Cesarean birth. She invites them to consider the phrase “She had a C-section,” and then “She gave birth by Cesarean.” What they often discover about the contrasting language is remarkable:

  • Being cut vs. birthing a child.
  • A medical procedure vs. a baby being born.
  • Feeling like a body vs. feeling like a mother.

Surgical birth is still the birth of a baby and a family. It’s still a sacred passage. When we remind them with clear language that birth is about so much more than how a baby comes out, f the path of labor ultimately takes them there, they might feel less stigmatized and more at peace with the outcome. Imagine how our birth culture might be different if everyone’s paradigm of surgical birth shifted this way.

Another loaded phrase: “natural birth.” Does that mean no medication? Vaginal only? Birthing at home? Being naked instead of wearing a hospital gown? Birth is natural, regardless of the outcome. Yes, our bodies were designed to do this wondrous work—and that doesn’t mean birth comes easily, or that just by trusting our bodies it will all work out fine. What if we all made a conscious effort to avoid that phrase altogether, instead using  “medicated” or “unmedicated?”

“Empowered birth” is also a semantic pothole. If a woman is fearful of birth (and most are), does that mean she’s not empowered? If she anticipates an unmedicated birth and ends up having an epidural, is her birth not empowered? Empowerment is about making informed, intentional decisions based on evidence and intuition, rather than fear or ignorance or pressure—even if the decision might be to surrender to the next best thing along the path of care.

When I first became a doula, I proudly wore a t-shirt imprinted with “Peace on Earth begins with birth.” As my experience grew, I became more aware of the power of any type of language around birth. If a woman doesn’t have a “peaceful” birth, would my message mean she failed? If she perceives her birth as peaceful, that’s wonderful! But she sure doesn’t need pressure from me (or anyone else) to have one. I stopped wearing it.

The next time you talk about labor or birth, I invite you to be aware of the language you use, and how it can impact others’ attitude about themselves and about birth in general. Our language has the power to shift the way people think. May we all use this power wisely.

About the author: Colleen Goidel, CD(DONA), CPD(CAPPA), is a retired labor doula and an active postpartum doula and childbirth and breastfeeding educator in Atlanta. She is co-founder of Two Doulas & You and a proud member of Emerge Birth Services.

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