April is Cesarean Awareness Month. Here is a caesarean birth story that became a tool for change! 
“Reading books, going to childbirth classes, making a birth plan, exercising and eating well was not enough. Learning how to cope with labor by reading Active Birth was of no use if it was unlikely that I would be supported to go into labor.” – Ruth 

I Had Always Been Fascinated By Birth

I found comfort in birth as an experience that bonded me with my child, partner, family, myself and with women. Birth was not something I wanted to avoid, but an experience that I wanted! I had been excited about birth since I was a little girl. I knew there must be benefits in a natural birth, for both myself and the baby. I was not afraid, I was excited, and I knew I could do it. I expected that the doctors would support me and that they also believed that natural birth was healthy for mother and baby. I felt that all I needed to do was go to the hospital, birth my baby, and they would not intervene unless required.

An Australian Birthing in India

I was 32 and living in India when I became pregnant with my first child. I was both excited and apprehensive, and I spent much time searching for a place where I would feel comfortable to give birth. I found a nice not-for-profit hospital in New Delhi India. I was seven months pregnant by the time I found this hospital. The female doctor I met was abrupt. She always had many other trainees and colleagues in the room during appointments. She attempted to do a vaginal exam with a room full of people without asking my permission and she was also extremely rude to my husband. I discussed my desire for a natural birth with her, but did not feel comfortable to hand over a birth plan. As an Australian, I thought this must be normal practice in India, and I did not feel comfortable to question her or insist on what I wanted. I put her contempt towards me, abrupt behaviour and my doubts about her in the back of my mind and tried to relax and prepare for the pending birth. I was reading all the right books, (Spiritual Midwifery and Active Birth) and thus I felt that I knew what I had to do when the time came.

Due Date Arrives

I went for an appointment on my due date. The doctor said if I had not gone into labor by Monday the 1st of April that I had to report to her. I reported to her on Monday, three days past my due date, and she asked me to go for sonography. I assumed this was normal and did what was asked of me. During the sonography, I was told that the cord was tight around the baby’s neck. The doctor described it like a noose and said I had to have a cesarean. She told me to go home and come back at 4 pm. I questioned the doctor and was angrily told that my baby would die as I slept that night if I didn’t have a c-section. My doctor made me feel terrified. I briefly considered going for a second opinion, but I could not be bothered. Both my husband and I were scared and confused by conflicting information and horror stories. I was fed up. The stressful trips to the doctors, relatives who were alarmed and all the tests were too much. I needed it to be over. We felt it best to do as the doctor said for fear that we may harm our baby. My son was born by cesarean surgery, without labor, under general anaesthetic.

When I Awoke, I Was Alone

I cried like I had never cried that night. My son was kept from me for 24 hours in the nursery. This was not done for a medical reason, but because it was hospital policy. Despite being heavily sedated, I managed to wake myself up all night in a panic and press the buzzer, asking for my baby. They would not give him to me, and I knew they were feeding him milk formula, which I did not want. When I finally first saw my son I looked at him and fell back in the bed thinking, “I need to go home and come back and do this again.” His birth was an out-of-body experience; my brain could not relate the baby to the event. I had never experienced so much distress in my life. I felt the experience was so awful, that having a child was not worth it. My response to my child shocked me. I thought, “What kind of mother are you?” I dragged myself up, with an enormous painful cut across my abdomen, and began the struggle of bonding and mothering under the exhaustion of an awful depression and post-operative recovery. I did not know how I was going to face the world. I dreaded the visitors. I did not want to meet with other mothers as I felt they shared the wisdom of labor and birth, and I could not talk about it with them because I did not experience it. I also felt ashamed that I had not managed to do the right thing for my son and myself. I had not protected him. Breastfeeding was painful and excruciating. I had lost the birth. I could not lose the precious experience of feeding. I showed my bruised and bleeding nipples to paediatricians and obstetricians, but no one could help me. I refused to give up. My son needed to feed and be close to me. He was as traumatised, if not more, than I was.

Why Didn’t Anyone Warn Me?

The experience took away all of my confidence. I felt that I had failed and I was deeply saddened by the loss of experiencing birth; the sense of failure and loss was debilitating. I did not know how I was going to go forward and mother. How was it possible that I, an educated, independent women had allowed this violence into my life? Losing power over the choice of what was done to my body left me deeply ashamed. I wanted to scream out. “How we are treated, what is done to us, and our children is important!” I was mostly angry with women: my Mum, the female doctor and all the women who had gone before me. How could women have let birth become so damaging and why didn’t anyone warn me?

What It Means To Choose Birth Support

I learned that choosing birth support is the most important work that needs to be done.  I felt that the expensive 5-star hospital with the famous doctor was where they must know best, where I would be safe. I now realise money does not translate into care or the protection of my rights. I now know that in choosing an obstetrician, I chose a surgeon. A professional trained to handle emergencies, not the normal process, and who doubts women can birth. A professional who views normal birth as something to fear. A profession that does not value women and treats them as if they are stupid and with contempt. Obstetricians are not trained to support normal birth. They do not believe that women’s bodies work. There was nothing wrong with me. I could have birthed my child. She stole birth from me, she damaged and hurt my child and me.

The point of getting to know my doctor was to learn about her level of respect and if her beliefs matched mine.  I needed to be sure that at any moment when I did not feel comfortable that I was prepared to address this with her, consider her response, and if necessary walk away. No matter how tired and fed up I was. No matter how close to the due date or  afraid I was or how troublesome it seemed. After the birth, I felt I had been a stupid fool. After all of my birth preparation, I was clueless.

Trust Your Intuition 

In hindsight, I was not clueless. My doctor’s behaviour was all the information I needed to warrant me to leave. My intuition had been talking to me since I was a child, reminding me of the awesome potential of birth. My intuition was giving me all the warning signals: doubt, suspicion, anxiety, and fear. I chose to ignore this valuable resource. I was unprepared to take on the responsibility, and I handed over responsibility. I said, “That will do,” when I knew it was not good enough. Reading books, going to childbirth classes, making a birth plan, exercising and eating well was not enough. Learning how to cope with labor by reading Active Birth was of no use if it was unlikely that I would be supported to go into labor. There was no point in attending a class that did not provide the information and skills I required to navigate and unsupportive care providers and a class that even hid things from me.  I was angry with my birth educator; 12 out of 13 mothers in her class had a cesarean. The educator did not prepare us for what I now know is the most common way to birth in urban India: a cesarean section without labor and under general anaesthesia.

There Was Nothing Wrong With Me

I now know there was nothing wrong with me; being overdue is not an indication for a sonography. Gestation is 38 to 42 weeks. Even the Indian obstetrics textbook supports this. Research also supports 42 – 43 weeks as perfectly normal gestation. Additionally, only two sonographies are recommended during pregnancy in the second trimester. I was in an entirely normal state. I now know that as many as 30% of babies are born with the cord around the neck and rarely does it result in a problem. The decision should have been to recognise that both the baby and I were well, let labor start naturally and monitor fetal heart tones every 20 minutes. I was coerced and led into a cesarean section by a diagnosis that was outside of the evidence-based medical recommendations. I could have safely gone home and waited for labor. I could have asked more open questions to doctors and childbirth educators about local birthing practices. I could have sought support and gathered information from other women. I could have hired a midwife for a home birth or a doula as a support for a hospital birth.

I wanted to believe in the professionals. I could not face that I may have been lied to and manipulated. I asked, “What kind of world am I living in?” However I did eventually have to face this, and it shattered my worldview. It was the hardest realisation of my life, but oddly enough one of the most liberating. I had been naive up until this point. When I first came across the notion that I may be responsible for what occurred, I feared to accept this notion may destroy me. To let go of anger was difficult. Some women choose to view a cesarean as surgical birth. Same thing as vaginal birth, just different. I do not deny anyone their healing, but for me, a cesarean is not birth. I accept the reality that my child and I unnecessarily lost many lifelong health benefits that natural, vaginal birth provides and surgical birth does not. The expulsion of a baby through the vagina to me is the only birth; there is no other, and the experience was lost.  In time, I came to understand my role in what happened and taking on responsibility was liberating, in fact, the birth of my son has been one of the most profound experiences of my life. The learning I have gained by reflection has made me a healthier mother. Almost daily, there are opportunities to enlighten and empower my children.

My process of healing has included a need to know the truth and to offer a space for more women to get that information. I know that Birth India has helped many mothers to find a better birth.  I also know that the letter I wrote to the hospital and the many media articles that have been written about my experience have created awareness and change. 11 years ago, no one accepted that cesarean rates were high. Today, no one doubts it. I was a part of that awareness gaining, and I hope whoever reads this will join me in supporting women to birth in health, safety, dignity, and respect, even if that does mean that they genuinely need surgery.

Ruth’s Birth Story was originally featured in Mother and Baby, April 2009 Issue. Image Courtesy: Akshay Kulkarni and Ruth Malik.

Ruth Malik, Founder – Birth India. After two avoidable and unnecessary caesarean surgeries, Ruth’s traumatic birth experiences motivated her to start Birth India in 2006. A Postgraduate in International Health, a trained doula and hypnobirthing practitioner, with 14 years of experience supporting women to make informed choices in pregnancy and childbirth.



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