The Gentle Caesarean – is it the solution?

All areas of maternity care are in dire need of improvement. The Maternal Assisted Caesarean is truly a step in the right direction, but it can only do so much.

The Gentle Caesarean – is it the solution?

Maternal Assisted, or The Gentle Caesarean. It’s all the rage this week. Women everywhere are gushing about how it will give them back their power, heal them from trauma, and how it’s a perfectly valid choice. But there’s so much more to it than meets the eye. This really needs to be explored more thoroughly before we jump on the bandwagon.

Elective caesareans should definitely be an option for childbirth, but we have to be realistic, and ensure that women understand the true risks, and they aren’t under any illusions about the potentially dangerous, unpredictable complications that could occur. A Maternal Assisted Caesarean (MAC), is still a caesarean, and caesareans are major surgery.

In those rare situations when a caesarean is unavoidable, and can be planned ahead, there is no question that the woman should be able to choose how it occurs. That includes whether she will be given a general anaesthesia, or an epidural with gentle music playing, or participating in the actual caesarean itself, as happens during MAC.

But caesareans should not be so appealing to women. The fact that the MAC has been so widely celebrated tells us something about the way women have come to fear loss of control during labour. They fear hostility, unnecessary pain, they fear loss of dignity, and critically, they fear all those things more than they fear major surgery.

The trouble with MAC as the solution to these fears is that if complications arise on the operating table, the woman will most definitely not retain her control, in fact things could get very scary, very fast. Of course that’s exactly the same conundrum faced during vaginal birth, but the difference is that with a vaginal birth, caesareans are there as back up. If complications occur during a caesarean, what is the back up plan?

Not only are caesareans risky when they are occurring, they are also risky to future pregnancies. The more you have, the greater the risks. So maybe the first MAC would be ok, and maybe the second would too, but by the time you reach your third, you might experience placenta accreta and lose your uterus. Given the nature of placenta accreta, it would be problematic to organise an MAC to begin with. And of course you may end up losing your uterus in any MAC, not just your third or fourth.

Surgical instruments for caesarean surgery
A gentle caesarean – complete with scalpels.
License: Creative Commons CC0.

Another element that seems to be largely ignored is the potential for birth grief. No matter how grateful a woman may be in the early days for the opportunity to have an MAC, birth trauma and grief have a notorious way of not showing up until months later. This happens after totally unavoidable caesareans, as often as it happens after others.

Maternity care has come to be so routine that it lacks the personal touch many women seek on the day they meet their baby. Championing the MAC is not the solution to impersonal maternity care though. Wherever possible, caesareans should be performed in ways that respect the delicate balance between the health of mother and baby, and the personal wishes the mother has for her birth.

The problem is that providing MAC will not humanise birth. By promoting MAC we run the risk of increasing caesarean numbers unless we align the more personalised, respectful aspects of MAC, occurring in operating theatres, with the rest of maternity practices as well.

Whilst MAC is a marvellous option for women who require surgery, it is not the solution to all maternity care problems that it’s being lauded as. Since the buzz began, many women have reported being scoffed at by their providers upon requesting MAC.

This highlights the fact that not only can MAC not divert impersonal, hostile conditions for birth, but for many women, it will be a long time before they even have the option of MAC.

All areas of maternity care are in dire need of improvement. The Maternal Assisted Caesarean is truly a step in the right direction, but it can only do so much. MAC can not reduce the risk of birth grief or trauma, it can not safely replace normal vaginal births, all it can do is provide a respectful alternative to the current practice of caesareans. When major surgery creates this much hysteria because it is respectful of women and babies, we must be keenly aware of the way women view standard maternity care.

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