Friday, November 13, 2009

Counseling against a cesarean delivery

For some reason, I was thinking about this today as I drove home from my daughter's toddler group, and I came up with an analogy for why counseling against a (chosen) cesarean doesn't always work - and why it would certainly never have worked for me.

To take a step back, let me explain when counseling might be used: if a woman has tokophobia - fear of childbirth - and says to her doctor that she would prefer to have a planned cesarean delivery instead of a vaginal delivery, it is often suggested that she should be given counseling (therapy) in order to help allay her fears.

Fear or simply a different choice?
I am not against this idea; if resources are available and the woman is keen to give counseling a try, then I would agree that it should do no harm. In fact, there is some evidence that women can change their minds about their cesarean birth decision and go on to plan a vaginal delivery (unfortunately, these studies don't follow up after the birth to find out if the women were happy with their decision, which might be an idea for future studies).

However, the women I'm concerned about are these: women for whom no amount of counseling will dispel their intense fear of natural birth, and women for whom counseling is viewed as a completely unnecessary - i.e. their decision to choose a cesarean is grounded in a personal health risk-benefit analysis that favors planned surgery.

It's like trying to piece together a broken marriage when one of you is in love with someone else
You see, to me, counseling can only work when the person being counseled is one hundred percent on board, and they WANT to move towards the same goal as the counselor. For example, if a couple is having problems and both of them want to make another go of things, counseling can have very positive results.

If on the other hand, one of the partners has met someone else, fallen in love, and is just itching to move out and start a whole new life elsewhere, the likelihood is that no amount of counseling is going to help.

Therapy during pregnancy
When I became pregnant with my first child, Charlotte, I already knew I wanted a planned cesarean. My decision was not based on a now suddenly impending birth day, and nor was it influenced by the hormonal changes taking place in my body. I firmly believed that a cesarean was the safest route of delivery for my baby and for me, and I would have hated to be marched off to see a counselor for weeks of therapy before a decision was finally made for me.

I was one of the lucky ones. My pregnancy was never impeded by the 'unknown' (would I be allowed to have a cesarean or would I be forced to deliver vaginally?). But this is what happens to many women around the world, in countries where 'maternal request' is a dirty word(s). In fact, one woman in England contacted me through my website, after she was made to jump through every counseling and cognitive therapy hoop available on the NHS in an attempt to cure her of a severe case of tokophobia.

And the result?

She was told at the end of it all that she would still have to endure a trial of labor - either she hadn't sufficiently convinced her therapists of her fear of childbirth or they couldn't accept that the therapy hadn't worked (I don't know) - and she made the deeply traumatic decision to terminate her pregnancy. It's time we started caring as much about women like this as we do about women who want to give birth vaginally and avoid a cesarean delivery. Their desires may be different but they are surely equal.

1 comment:

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