Guest Article by Elly Taylor

“I hated him.” Sarah took a deep breath. “I know it’s not logical, there wasn’t anything he could do, but that’s how I felt. I hated him for not protecting me.”

A Cesarean Section is both the most common and least necessary surgery conducted in the United States. It is also the only surgical procedure that will be up-close-and-personally witnessed by an intimate partner and, if unplanned, with little warning and no preparation at all.

The effects of this singular event on a couple’s relationship may not manifest until weeks or months afterwards, with one researcher reporting more adverse psychological effects at seven to twelve months later and another saying cesarean parents have “more difficulties and differences in the postpartum period up to 7 years.”

Need for emotional support

Mothers often report feelings of shock and being overwhelmed, loss of control, loss of self-esteem, detachment, guilt, violation, trauma, depression, anger, resentment, hostility, and anguish. Fathers often report feeling isolated, inadequate, fearful, worried, guilty, shocked, confused, and helpless.

Both can feel “like a failure:” mothers like their bodies have let them down and fathers for failing to perform the supportive ‘coaching’ role often prepared for in childbirth classes.

These are the emotions parents bundle up and carry home with them along with their new baby. If there is no way to process these feelings they are likely to remain ‘boxed up’ and can undermine new parenting confidence. Any emotion that sits deep within us is likely to be triggered by our partner eventually. Parents who have been through a cesarean need the opportunity to explore and express their emotions, to be heard, and to have their experience validated.

Assertive communication

When our senses are overloaded it affects normal thought processes and the chaos of those first few weeks means communication can be even more difficult. This environment breeds assumptions and misunderstandings that cause feelings of isolation and create tension between a couple.

Talking about feelings often takes a back seat to preoccupation with physical needs as Caryl experienced:

“Steven could see how distressed I was… he looked at my notes and helped me work out when I would need to take pain killers again, he was so competent, some staff even asked him if he was a medical professional, it was like he had found his role and something he could do (after being a bystander at the labor)… but to be honest I would rather have had his full attention, talking to me, letting me cry, saying he was sorry for what I’d gone through.”

Steven was aware of it, too:

“At the time I didn’t realize how damaging it was for Caryl – to me it was another thing I could take some ownership of and control while Caryl was recovering. Once home, and over the next week while I was off work, this practical focus continued. I put Caryl’s tearfulness down to tiredness and tried to take over to give her the rest she needed to build up her strength for when I got back to work.

When I did go back to work I just became a bit of a robot – trying, again, to do the practical things and tiring myself, not really giving Caryl the emotional support she needed. Maybe I didn’t want to deal with my own emotions.”

A new awareness of needs and a new assertiveness in communicating them may need to be negotiated between a couple. Whereas previously, requests may have been hinted at and resentment set in if a partner didn’t mind-read, a new directness can be beneficial: “can you please hang out the washing” or “I need you to say nothing and just hold me.” This can feel uncomfortable at first, but many partners find this new style of communication is actually a relief.

Awareness of tension

Some women feel ‘duped’ into the operation, told the benefits but not all the costs. Some feel controlled, manipulated or downright bullied. Many have the “dead baby” card played on them. They are angry, of course, but not all are aware of the depth of their anger or where it should be directed, particularly when cesareans are often trivialized or seen as routine. It’s not uncommon for us to project the deeper, more unconscious layers of anger on to our partner. The lack of understanding and empathy from medical providers, family, and friends can mean a woman needs more empathy from her partner at the same time she may at some level be blaming him for the situation, particularly if the c-section has been traumatic.

Anticipation of risk for postpartum mood disorders

Women who have undergone a cesarean are more prone to Postpartum Depression (PPD) and those who have experienced the birth as traumatic are 75% more at risk. Fifty percent of mothers with PPD will have a partner who also becomes depressed, which along with other implications for the whole family, can mean she is more depressed and for longer. Perinatal screening for mood disorders for both mothers and fathers to have the opportunity to debrief the birth, if desired, and links to community and support organisations will, hopefully, eventually become standard practice.

Take time with intimacy

What’s it like for a woman to see a scar, expected or not, so close to the most intimate part of her body? What is it like for her partner? And for her to see her partner’s reaction? Having the lines of communication open about these things allows couples to work through thoughts and feelings.

Nekole Shapiro of Embodied Birth says women can feel ‘pulling’ on their scar during intercourse and for some, anything related to sex can re-stimulate trauma. It takes couples who have been through a cesarean longer to resume sex and both partners are naturally anxious. Some cope with this by going back to the beginning of their relationship, as if they were dating for the first time. Start by holding hands and hugging, then slowly moving on to cuddling and kissing before beginning to gradually explore each other’s bodies again. The more a partner knows about a woman’s new sensitivity, the more sensitive they can be. Her being direct, “don’t touch me there, touch me here instead” can take intimacy to a new level.

It’s obvious to say we need to prepare couples better for the possibility of an unexpected cesarean but childbirth educators will tell you it’s common for expecting couples to ‘tune out’ cesarean information in classes, expecting it won’t apply to them. Some educators get around this by presenting the information as a “what if” scenario, playing a short YouTube clip, encouraging couples to discuss it and include a “just in case” section in their birth plan.

Where physical scars are obvious it can be easier to understand just how much support a recovering mom and her partner will need. If they can be supported to heal psychologically and emotionally as well, that’s a much better start for a new family.

Bio: Elly Taylor is an Emotionally Focused Couples Therapist, educator and columnist for Practical Parenting magazine. She is passionate about including fathers (or partners) more in pregnancy, birth and early parenthood to support the emotional health and bonding of the whole family. Elly lives in a beach house in Sydney, Australia with her husband, their three children and a bunch of pets. Becoming Us is her first book, find it here. You can also find her online at Parent Support Online.