Today, we are increasingly and more loudly talking about freedom and the right to choose. The right of a woman to have control over her body according to her beliefs, experience, emotional state, worldview, including religious beliefs. Often this is in the context of demedicalization of childbirth, emphasizing the importance of natural and intervention-free births. But in this article, we will talk about another aspect.
When it comes to childbirth — especially “deviation” from the norm — a woman’s freedom is often questioned. Especially when she chooses something different from what is accepted in society. The pressure of social norms, moral “authorities,” and even medical professionals can be so intense that real autonomy dissolves behind a wall of disapproval and distrust. A woman’s choice to give birth by cesarean section is often doubted, condemned, and pathologized.
❖ But every story is individual.
For some women, there is a deep internal experience behind this choice: fear, pain, trauma. Sometimes — fear of the fear itself. This is not weakness. This is experienced or anticipated trauma, which has a scientific and clinical basis.
What does science say?
Tokophobia
— pathological fear of childbirth — is recognized in the international classification of diseases. There is primary tokophobia (in women who have not given birth) and secondary (after traumatic childbirth). Research shows that this fear can be so pronounced that it becomes an indication for a planned cesarean section (Ayers, 2014; O'Connell et al., 2017).
O'Connell MA, Leahy-Warren P, Khashan AS, Kenny LC, O'Neill SM. (2017). Worldwide prevalence of tokophobia in pregnant women: A systematic review and meta-analysis. Acta Obstetricia et Gynecologica Scandinavica.
In the case of women who have experienced sexualized violence, the invasiveness of vaginal birth can be retraumatizing, and cesarean section becomes a way to maintain control and boundaries. This is not a medical whim, but a conscious and psychologically sound strategy. (Sperlich et al., 2017)
Sperlich M, Seng JS. (2017). Survivors of rape, war, and childhood abuse: Implications for perinatal care. Journal of Midwifery & Women's Health.
A study by Garthus-Niegel and colleagues (2013) highlights that perinatal anxiety and PTSD associated with childbirth can be significantly reduced if a woman feels in control of the birth process, regardless of the mode of delivery. Elective caesarean section may be a key factor in maintaining mental health.
Garthus-Niegel S et al. (2013). The role of labor pain and overall birth experience in the development of posttraumatic stress symptoms: A longitudinal cohort study. Birth, 40(3), 221–229.
Perinatal Psychologist — A Modern Form of Diagnosis and Professional Support
The good news is that in some countries and systems, for example, in developed EU countries, the opinion of a perinatal psychologist has become a significant factor in making clinical decisions about childbirth. Yes, bureaucratic and ideological challenges still exist. But there is hope — when the doctor is ready to listen to the psychologist, and the psychologist is ready to listen to the woman. An elective cesarean section is not a whim. Sometimes it is the only humane, safe, and psychologically justified way to give birth.
Important: Informed Choice Of course, a cesarean section is surgery, and every woman must have full information about its possible consequences: risks for physical recovery, features of the postpartum period, potential difficulties with breastfeeding and physical intimacy. But it is equally important to talk about the risks of forced (for the woman) “natural” childbirth, especially if it occurs against her psycho-emotional state.
The conclusion is simple: Every woman has the right to an informed, respected, and supported choice. Even if that choice is not in favor of “natural birth.” I believe in psychologically safe motherhood.