A midwife's views on Casey B's Caesarean

Private midwife Karen Clark wrote this letter to Fit Pregnancy after reading Casey B. Dolan's dramatic birth story.

Dear Casey B,
Reading your story made me really want to write to you, not only to tell you that it didn’t have to be like that but to say that I wish you could have felt held and honoured, rather than traumatised and humiliated, as you gave birth to your son.

These memories will fade, and you will get on with things and, yes, you have a beautiful baby, but these memories are events that you shouldn’t have had to experience. I have seen similar processes in hospitals here and abroad and felt for women who have suffered at the hands of their “caregivers”, who have not adequately cared for them. It is for this reason that I am writing to you.

I do not know whether you are planning to have any more children. In case you do decide to have more children, I just wanted to trickle a message through to you that there is another way, that there are women experiencing good births, that there are women who walk away from their births with an overwhelming feeling of “I did that myself”, as opposed to “that was done to me”. There are women who were held by caring hands and who were able to wait the time it took for their babies with big or small heads to make their way through big or small pelvises into the world.

Birth is an unknown process and has unknown time frames. Medicine, with all its technology and machinery, does not understand this mystery. For this reason, the main operation performed in the US on women is a Caesarean. For this reason in the private sector in South Africa, we have a 60-80 per cent Caesarean rate. For this reason, babies are hurried out of their mothers’ bellies to meet artificial time constraints.

Women and the birth process are no longer honoured in medical institutions. We are part of a hurried society and this rapid pace has a huge impact on how we give birth to our babies. Women who have suffered bad births at the mercy of this system, rather than mourn their losses, rather than wishing for something else, often just cut their losses and get on with motherhood and all that that involves.

But if we as women can pause for a minute and value ourselves, our experiences and be totally honest with ourselves, I think many women would say, like you have, that they were “deeply disappointed by the way things turned out”. We can take that disappointment and share it with other women, not by saying “I went through hell and so will you” but “I went through this and you don’t have to”. We must encourage women to make careful choices.

We must remind them that there are other ways, ways that nurture and respect you as you journey into motherhood, ways that gentle your baby into the world just by waiting, ways that are healthy and happy for you and your baby. Perhaps by informing other women to make considered choices, rather than telling just another birth horror story, we can afford them the opportunity of having good birthing experiences themselves.

Often after hearing one of these horror stories, I think to myself, well, if the options are that horror story or a Caesarean, I would opt for a Caesarean. But, the thing is, those are not the only two options available. In South Africa, we are fortunate to have many midwives working in private practice and we have doulas (birth assistants) supporting women. It just takes some careful thought and careful decision-making and you, too, can have a wonderful birth.

You might have to change your caregiver from an obstetrician who you are currently seeing or who cared for you in a previous pregnancy to a midwife but, surely, for a good experience, it is worth it.

As women, we need to value ourselves and choose carefully how, where and with whom we give birth. This is not just another hairdressing appointment. You are having a baby and these memories will stay with you for the rest of your life.

Midwives are the other option. They are specialists in normal birth, in the gentle care and patience that is required to assist a woman to give birth to her baby without harming either mother or baby. Midwives are skilled birth attendants who have been trained to observe women, to correct abnormalities and to refer to an obstetrician (who specialises in abnormalities) when appropriate. Midwives attend women as they birth their babies at home or in hospital. They are there to protect the birth environment and to care for the mother as she gives birth to her baby. Midwives carry all the necessary equipment required to safely attend a birth. Midwives attend 90 per cent of births across the globe.

We do not have to have our babies, as Shakespeare put it, “untimely ripped from our wombs”. There is another way and it does not involve major abdominal surgery nor a traumatic and over-managed birth, just careful considered choices and womanly wisdom.