Reconciling Caesarean Birth Stories Through Storytelling with Guest Hannah Marsh

Reconciling Caesarean Birth Stories Through Storytelling with Guest Hannah Marsh

What happens when your birth experience completely contradicts everything you prepared for? For author Hannah Marsh, an emergency cesarean section after 30 grueling hours of labor left her feeling not just physically scarred, but emotionally devastated. Despite cesarean sections accounting for roughly 43% of UK births today, Hannah found herself woefully unprepared for this possibility – having focused exclusively on hypnobirthing techniques and natural birth preparation.

In the years that followed, Hannah began to reconcile her experience of birth as she discovered the history, magic and tales of caesarean birth in years gone by. Hannah's book "Thread: A Cesarean Story of Myth, Magic and Medicine" reframes cesarean birth not as a failure but as part of a rich historical narrative "full of power and magic and ingenuity and determination." By weaving together personal experience, historical research, and mythological connections, Hannah offers something rarely found in birth literature – a validating, empowering narrative specifically for cesarean births.

This conversation challenges the polarized debates in modern birth discourse by highlighting historical parallels between today's tensions and early 20th century divisions between "operators" and "non-operators" in obstetrics. Hannah reminds us that beneath these seeming oppositions, most birth practitioners share the common goal of supporting safe, positive birth experiences.

For anyone who has felt their birth story wasn't worth celebrating or those preparing for the possibility of various birth scenarios, this episode provides both validation and a new perspective on what it means to bring life into the world – regardless of the path taken.

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TRANSCRIPT

(AI GENERATED)Speaker 1: 0:07

you're listening to the birth ed podcast and I'm your host, founder of birth ed and handholder, extraordinaire megan rossiter. The birth ed podcast is here to provide you with the in-depth conversations about pregnancy, birth and parenting that you deserve to be getting in your antenatal appointments but aren't so. If you're ready to take your birth prep seriously and take back control of your birth, but need a gentle holding hand to get you there, you're in the right place. Make sure you hit subscribe so you never miss an episode. Hi everybody, welcome back to the BirthEd podcast.

Speaker 1: 0:42

I'm really excited to be joined today by Hannah Marsh, who is a writer who's recently published a fascinating book called Thread a Caesarean story of myth, magic and medicine. Hannah, I was going to read aloud your bio that explains a little bit about how you came to write a book that I know will be both validating and endlessly fascinating to many women who've faced similar experiences of birth as you have. But I felt like that wasn't really my story to tell, so I thought this might be the kind of most important place to start and this is probably going to be tricky but a brief-ish chat through, kind, of your own experience of cesarean birth and what led you to writing this book.

Speaker 2: 1:27

Absolutely. Firstly, hi, thank you so much for having me on. I'm really really thrilled to be here and, yeah, I guess my association with the cesarean section began in 2017, when I gave birth to my son by an emergency cesarean section. It was very much not the plan. It was not the birth I had hoped for and it was definitely not the birth I had prepared myself for naively, as it turns out. Now, having written a book, I can see so much more clearly the trends and the numbers and how completely naive it was of me to have not prepared for a cesarean section birth at all. But at that point I was very caught up in the idea of an all-natural hypnobirthing scenario, maybe a kind of beautiful water birth, and that is what I had spent my time and energy focusing on and preparing myself for. It wasn't what happens in reality. I had a very late diagnosis of gestational diabetes and that kind of swerved my path. That was the kind of first swerve, I guess, in my path and after that I fell under consultant care. I saw a different consultant each time and that was quite a kind of it was quite a scary and unnerving experience for me. I think I found it quite hard to kind of feel like I was getting the information that I needed or the kind of consistency of care which I was getting from my midwife. And, yeah, I guess it kind of the discussions became different ones. So it was quite late in the day. I controlled my gestational diabetes with diet and I felt quite kind of good about that and I still kind of felt that I could have this birth that I wanted, but it wasn't.

Speaker 2: 3:21

It wasn't what happened in the end. I was, I went, I went past. Well, the consultant that I saw wanted to induce me quite early and I didn't want to be induced early. So I did my research and I went. I went with the nice guidelines in the end which felt like a kind of good compromise between what was being asked of me at the hospital and what I but gave me the kind of, I suppose, what felt like a safe boundary that I wasn't kind of taking too many risks. I think that was 10 plus six days that I went to um in the end, but at that point there was still no sign of my son.

Speaker 2: 3:55

So I went in for an induction um, something that was just I, something that was described to me by my midwife as a gentle assist to where I was heading anyway, kind of kickstart. So I went in, still kind of feeling quite hopeful that it would be indeed just the kickstart to where I was headed anyway and where I wanted to be. So I went in, excited, hopeful, I had the pessary and I went into labour very quickly. Within a matter of hours I was in kind of full scale active labour and I stayed there labour. Very quickly.

Speaker 2: 4:25

Within a matter of hours I was in kind of full-scale active labour and I stayed there for about 30 hours, which was not one of the best experiences of my life. It was pretty wild and, yeah, shocking in kind of how opposite to what I was expecting, I suppose I think I had ripped my hypnobirthing tracks out of my ears within the first hour because I just could not align what I was hearing with the experience my body was going through, which felt like just totally the opposite. You know it was very far from a flower kind of opening. It was, yeah, it was wild, it was very painful and it was, yeah, a total shock to my system. Anyway, I stayed in labour for about 30 hours and at the end of that I was told that my son's heart rate was dropping. I'd had various pain relief. Through this.

Speaker 2: 5:18

The kind of all natural birth scenario went out the window quite quickly, had a pethidine injection which saw me through a few hours, but I came out the other side of that and I couldn't have another one because it had ideally would have taken me through to birth and I wasn't allowed to have another one. So I had an. I had an epidural after that and that was pretty good. I felt again still. Even at that point I felt quite like hopeful that I was gonna still kind of have the birth that I wanted um, and that we were still on track um. But my son was very keen to stay where he was um, so eventually, with his heart rate dropping about 30 hours in um I, I signed the form so I was wheeled into theatre and I had an emergency cesarean section and it was.

Speaker 2: 6:01

It was shocking, it was, it was. It was a deep shock to me. I mean, I found the idea of it quite frightening. So I'd really kind of veered away psychologically from it because I found the idea of a surgical birth just quite a terrifying one, um, and it took me a long time. It took me a long time to heal physically. I found the physical healing quite difficult. Um, I was breastfeeding my newborn, which had to stay in hospital for a while, um with him afterwards, and it just was. It wasn't the ideal kind of, I wasn't in the ideal physical place to have a cesarean section, you know that far into labor and that exhausted. Um, but emotionally it took me a very long time to process what had happened to me and to begin to make sense of it.

Speaker 2: 6:48

And I guess that's where, although I didn't know it at the time, the book began with me researching, kind of up at night breastfeeding my son, that phone in my hand, kind of going down the rabbit hole that I'm sure lots of new mums will have gone down, kind of googling random stuff on their phone in those hazy, hazy late night feeding sessions.

Speaker 2: 7:13

And yeah, I think I just wanted to find out more about what the c-section actually was.

Speaker 2: 7:20

I didn't know anything about it really, I knew nothing.

Speaker 2: 7:23

I wanted to understand what it was and why it had happened.

Speaker 2: 7:26

But I found myself unpicking a story that felt at once really personal but also placed my story within this kind of complex web of experiences, of both of kind of contemporary trends of conversations that I'd been vaguely aware of but that I could now kind of use to frame my own experience, but also historical, so that I found myself kind of fascinated by the history of this procedure, which is like it's so common I mean, it's the most common way that women in this country give birth over if you're over 40 um, but at the same time it's like a complete miracle.

Speaker 2: 8:05

It's like this extraordinary feat of human ingenuity and perseverance and for me it's like kind of magical and and miraculous that we have this way to give birth. If our bodies or our brains, you know, for whatever reason we don't, we're not able to give birth vaginally, that we have this way of becoming mothers and of birthing available to us. And yeah, also just began to find these kind of characters in myth and folklore that I'd had no idea of, mothers, you know, often quite quiet characters in the background to quite well-known folk heroes. And between those various threads I kind of found myself able to put myself back together and I mean it was late, it was much later, it was years later that I started to kind of weave them together into the book that would become thread, um. But yeah, that was.

Speaker 1: 9:05

That was my unexpected but enlightening drop parachute in it's insane, isn't it where section how these, yeah, how that story can be the kind of what's the word for it, but like the thing that tips over, then this, yeah, this whole life that that follows it. Um, I suppose you know that late night googling that you mentioned I'm sure is relatable for every new mum. I always think, like if you could scroll the phone history of anybody within the first six months of having a baby would just be so entertaining, the interesting and very weird and very obvious things that we end up googling. Um, but I suppose where you kind of, where a lot of people I imagine would go, would be the kind of the data, the science, the statistics, the kind of the why did it happen to me? Um, was it needed? You know what? What could I've done differently? All of those questions, um, but something that I just find so beautiful and so interesting about Thread which is something that I don't think exists and certainly in anything else I've ever read um, is that that's that story and that kind of humanizing of the history of the cesarean birth and that that kind of tying of feeling and emotion to this data that exists in reports and newspaper articles and and all of that.

Speaker 1: 10:32

Um, so when was it. Would you say that you kind of realized that cesarean birth was so missing from the kind of wider conversation around birth? You know, when somebody said we think you should have an induction of labour, was cesarean birth mentioned to you then in your kind of antenatal education? Do you feel like it was mentioned and you kind of chose to avoid thinking about it? Or was it just not forming the kind of holding the weight that it ought to in that, the kind of psyche of women as we're preparing for birth, given that, as you mentioned, I think it's currently 43% of women in the UK out of all women are giving birth by cesarean, so it obviously probably deserves a bigger spot at the table.

Speaker 2: 11:17

Yeah, I so agree with that. I think, in essence, what I was looking for was a narrative. That was what I was really looking for. I was looking for a narrative that gave me ownership over what this experience that had happened to me. I was looking for something that kind of helped me position my own experience so that I could make sense of it, so that I had a story, so that I had a birth story that felt I don't think I thought about it like this at the time but looking back I can see that this is what I was looking for and it's certainly what I wanted when I was writing Thread to offer to other women in case they were looking for.

Speaker 2: 11:59

Something similar was a was a birth story that resonated, that felt like it reflected the complexity of the procedure that I had experienced upon my own body, that gave me a bit of power over it, that kind of gave me a powerful and beautiful birth narrative where I could appreciate everything that had gone before to kind of bring me to that point where I could be in a relatively safe place giving birth in this way, but also one that kind of recognized the light and dark that the cesarean section is so unique in that it is this incredibly beautiful, miraculous procedure that is built on human determination, ingenuity and love. You know, a desire to save um, a desire to preserve life of both women and and their children. Um, it comes from this kind of determination and desire, but it's also laced through with some quite dark aspects of medical history. Um, you know that exploit a lot of what, a lot of the safety that we enjoy now rests upon the exploitation of some really vulnerable women. Um, throughout history, some of the most vulnerable women throughout history, and I think I wanted to. I mean, maybe we'll talk more about that later, but, um, I really wanted, I needed a narrative for myself, and this is the one that I ended up sort of finding out and I think, the kind of data.

Speaker 2: 13:31

That's where I started, kind of trying to understand who I was like in a contemporary sense. I didn't really know. I did know people who had had cesarean sections, but I didn't know that many. I was probably like in the middle of friends giving birth. I had a, you know, I had a few friends. I was in my 30s when I gave birth, so I'd had a few friends who had given, who'd given birth to their children in their in their late to 20s and I had a few friends who were kind of in the same ish place as me, um, but I didn't, I didn't have that. I didn't have like that many birth stories around me and I think my friends, I had that classic thing that I think when people had had really positive birth experiences, they really wanted to share those with me and they really wanted to like give me the tools that they had used. Um, so the idea of hypnobirthing came from a really really kind and well-meaning friend for whom it had been like an amazing tool. If people had had really difficult birth experiences. I didn't really appreciate what that had looked like for them because they felt that was a difficult thing for them to share with me. They didn't really want to put that on me and they didn't want to give me those stories. And you know I'm grateful for them to kind of for considering me in that.

Speaker 2: 14:46

And then I think, yeah, from from the professionals that I was seeing it, it was a big gap. Yeah, I mean, and I think you know I'm not out to blame anyone and I'm not out to like kind of accuse any kind of section of the of the birth professionals um around me, because I think this is a really nuanced issue, and I can see that one of the reasons I wasn't offered information was that I was really clear that I wanted a vaginal birth and so people were trying to support me in that. But I think that resulted in a bit of a gap in reality. That we do see reflected in those figures, that those figures that you quoted about how many women give birth by ces do see reflected in this, in those figures, that those figures that you quote, that you quoted about how many women give birth by cesarean section in this country. Like, in a sense, that's that's not an issue like if all those women wanted to give birth and they were choosing to give birth by c-section, like in in a sense, that's not really you know that that would be their choice, but the issue is that it doesn't line up with the expectations, and the figures that we have on what women are saying that they, how they want to give birth and what their expectations are and what their ideal birth scenario looks like, don't match up with the reality. There's a huge gap between what people, what women, say that they want and what is actually happening and I fell in. I definitely fell into that massive gap.

Speaker 2: 16:03

Um, I attended hypnobirthing classes and at the time that really kind of resonated with me, the idea of the kind of innate wisdom of my body and its ability to give birth regardless, and a kind of what I later kind of reflected on and found to be a dogmatic and kind of non-inclusive approach to birth. Definitely, cesarean sections would never mention that only in a kind of fearful, kind of fear mongering tone of what could happen if I allowed intervention to occur and if I didn't kind of push back and hold my boundaries and I didn't believe in my body, my boundaries, and I didn't believe in my body, um, if and if I kind of failed to uphold the necessary boundaries to protect my birth space, a c-section could sneak in, um, and that that was really difficult for me to reflect on later because actually I think hypnobirthing can be really amazing. You know, essentially it's, it's, it's a form of meditation and you know, I I've taught yoga in the past. I really do believe in the connection of the brain and the breath and the body and I think, actually, as I, as I know, as I know that you, you do, and lots of other amazing professionals working in the birth world do it is really possible to take those tools and apply them to a cesarean situation? And with the birth of my second child, I did work with a doula who used hypnobirthing tools, but in a more inclusive way, to kind of give me something with which to navigate a more open birth path.

Speaker 2: 17:37

But yeah, that first time I definitely worked with a practitioner who was very narrow and I was given a very beautifully illustrated birth pack that kind of charted the journey that I could take and what sort of natural birth could and should look like if I could kind of adhere to the principles, um. And so, yeah, I there was a huge gap. Cesarean section was. I don't think it was mentioned in any realistic sense until I was 30 hours into my labor and, um, the consultant came in and said, you know, I think we're gonna have to look at a cesarean section at this point, and I was like no, but I was so unprepared like it just hadn't been something um, that had really come up as like a kind of real thing until that point, like obviously I knew they existed in the sense that we all know they exist. Both my parents were born by cesarean section. I just in the kind of blinkered and myopic way that I think a lot of us um navigate birth, um didn't think it would happen to me.

Speaker 1: 18:43

Yeah, it's wild to me that for the majority of women that have an unplanned cesarean section, the first time they will see the consent form for a cesarean is when they're being handed it, usually like in the full throes of labor or haven't slept for however many hours, like how hard would it be. And you know I include this in the birth ed method course. That I do is just show somebody the actual consent. This is what. If you have an emergency cesarean, this is what you will be presented with in labor or ahead of labor if it's something that's happening earlier. And this is what you will be presented with in labor or ahead of labor if it's something that's happening earlier. And this is what it says at a time when you can actually understand it and process what that says and ask any questions that you might have about the things that are written on it. Like it doesn't.

Speaker 1: 19:28

I just don't think that it has to be. It doesn't have to be very big changes that can build the conversation around cesarean birth into birth preparation in a way that that does present it as a possible, real, real possibility, um, and but that kind of empowers women to to feel like they understand what it is and when it might happen and why it might be needed, in a way that then kind of removes some of that, those feelings of judgment and shame and the feelings that you shouldn't have to feel like. Obviously it's understandable that somebody might feel disappointed or upset or frightened about what this experience is. But those added layers that come from that societal conversation, that shame, that, that feeling like I've done something wrong, all of that needs to be ripped away because there's already potentially so much to process after a long and difficult birth experience that those extra layers are just so unnecessary and so harmful so unnecessary and so harmful.

Speaker 2: 20:42

Yeah, I absolutely agree that that gap in expectation, um, and in, literally, in sort of course, material or birth preparation or you know even a set of tick boxes, um, left me in a very difficult position emotionally and I I absolutely felt that I had two scars. I felt that I had the physical scar and the kind of immediate scar from the birth and what had happened. But I had a really deep emotional scar and sense of failure that was left by having so thoroughly embraced this philosophy. I suppose that was this dogmatic philosophy that was offered to me by the hypnobirthing teacher who I worked with, who had this mantra that I write about in the book, which is your body won't make a baby that it can't birth. And obviously, like, logically, that's nonsense because, like, obviously women have and continue to lose their lives in childbirth, like in a literal sense, that's just not true.

Speaker 2: 21:46

Like many women's bodies make babies that they can't birth for really complicated reasons, you know some, and for really layered reasons. Some of them might be innate, but some of them might be kind of socially inflicted. There might be kind of issues around malnutrition or something Rickets through the 1700s and 1800s and some of the urban centres would cause women to have malformed pelvises. That meant that they often couldn't birth their babies vaginally. But that's still their body making a baby that they can't birth. So these things are really complicated. The reasons yeah, I think we tried to be, emotional as well.

Speaker 2: 22:22

It's so simple. It's so simple it could be emotionally that, like there's something traumatic for you or blocking you that still means that your body can't give birth or it just simply may not be safe for you to do so in the part of the world, um, where you live, um, and the health care that you have access to, so like. On a logical level, it's a bullshit thing to say, but it's a really powerful thing to say. And and that the headspace that I, in the kind of vulnerable throes of pregnancy where I was looking for a narrative, looking for someone to kind of give me information on this path that I was about to navigate that I'd never navigated before you know, it was the first time of being pregnant and giving birth for me, um, I, it was really powerful. I was. I was like, yeah, yeah, this is a really like I had a very smooth pregnancy, so that probably really helped with my absorption of that narrative. Like everything did feel really natural and kind of great and I felt like, yeah, no, it's, my birth is going to be really smooth and natural. Because, like, I totally buy into this.

Speaker 2: 23:26

But it left me with a huge sense of failure because I couldn't square the fact that my body had made a baby, that I'd ended up not being able to birth vaginally, with the fact that I'd so heartily ingested that narrative and there was like I felt, like, well then, I must have failed, I must have, I must be the only person who couldn't birth naturally or vaginally because I didn't like. That didn't happen for me and it wasn't easy and it wasn't smooth and it wasn't that, it didn't feel natural, it didn't feel good, I felt frightening and it felt traumatic and I thought I was going to die and, like you know, I couldn't make those two ends meet. And that gap I, I feel, left me with more trauma than the physical trauma of of what happened to me in the moment yeah, absolutely.

Speaker 1: 24:18

And I think one thing that is so validating about including those those stories from like long, long, long ago history in the book is to to kind. It's that realization because there's so much conversation at the moment, particularly in the news and in kind of data, about these rising rates of cesarean, these rising rates of intervention, which is a conversation that is absolutely important for us to have, but it can leave people feeling like this is a kind of exclusively modern problem, like until now everybody was just giving birth, absolutely fine. And when you go, oh, hang on, the cesarean has basically existed for as long as humans have used tools. Like this is something that has we have kind of over many, many, many thousands of years, got to the point where now it is a relatively safe procedure, um, and can be a really empowering way for some women to give birth. But reading those stories from history and that kind of realisation that like, oh no, it's not just me and it's not always just the fault of the maternity system kind of inflicting this upon me.

Speaker 1: 25:30

But yeah, there are these women in thousands of years gone by that have kind of faced the same difficulties and unfortunately, in those points in history, devastatingly, that the cesarean birth was not a safe way to give birth and the majority of those women would have lost their lives, but led us to this point where it can happen kind of safely today. And I just I just thought that was a really like a perspective that many women having a cesarean birth would never have thought of and would never have thought of the of safely today. And I just I just thought that was a really like a perspective that many women having a cesarean birth would never have thought of and would never have thought of the kind of long history that exists before them yeah, and I think it's for me that was really powerful.

Speaker 2: 26:07

For me that was like understanding where the contemporary cesarean section sits in its historical context was so powerful, probably the most powerful thing for me in terms of really shifting the foundations of how I felt and causing me to understand. Because I felt I I felt I write this in my book like I did not feel lucky at that point, when I was like on the operating table, um, you know, and this thing had happened and my birth plan was like out the window. I felt so unlucky. I was like why is this happening to me? Like this is so horrendous, I can't actually bear it. Like this, like there's hands in my body and I'm cut open, and like this is just the worst thing that could ever happen to anyone, um, and understanding that it really is not the worst thing that could ever happen to someone, that, yeah, I think if I had ever given thought to the c-section, I would have thought it was a kind of relatively modern thing and I think to understand that it has an incredibly, as you say, a history that goes back to humans using tools. It's it's possible that the first time a human used a tool upon another person, human's body was to try and posthumously birth an infant after its mother had died, um, trying to give birth to it, um, and that it has this kind of yeah, that was a.

Speaker 2: 27:29

That was kind of a shocker for me, I think, and I I think one of the biggest shockers was the idea, was kind of understanding, that the C-section has its roots as not even something where anyone was trying to save a woman's life. In its original form it was a posthumous procedure. That's how last resort it was. You wouldn't even carry it out on a living woman. It was a posthumous procedure that existed, so that cultural rights around burial burying a mother and an infant separately, for example or around baptism if movements of a child could still be felt after a mother had lost her life in childbirth, a cesarean section might be carried out by midwives in order that that child could be baptized and that its soul could be saved um, we're talking kind of medieval europe at this point, um, and it really wasn't until much, much later that the survival of the mother, or even that the procedure will be carried out upon a woman who was still alive, um, was a possibility. I think that was kind of deeply shocking to me.

Speaker 2: 28:35

And then, as you say, the fact that it's really not until relatively recently, because before anesthetic sorry to get a bit like historical here it was really not until the 1800s that the C-section even had a chance of kind of becoming something that was a viable option for women to survive. That was a viable option for women to survive. And in the 1800s we had these three like really key developments that kind of changed the game for the C-section and took it to a different place where it was sort of unfold over the course of the 1900s. But in the 1800s we have anesthesia used in surgery for the first time. So it was in 1846 in London a surgeon called Robert Liston, who was quite a character, removed someone's leg to perform the leg amputation, I think in 28 seconds, which is impressive in itself, um, and slightly terrifying, absolutely terrifying yeah, surgeons were pretty terrified at this point.

Speaker 2: 29:30

Surgery was conducted kind of on a stage, literally in a theatre, with, like, the germs of London breathed down upon you. Have you been?

Speaker 1: 29:38

to that one in London.

Speaker 2: 29:39

I remember going as a child very weird.

Speaker 1: 29:42

My mum took me. I think yeah, and yeah, it literally looked like a in the round theater with this table in the middle of the room. It's great.

Speaker 2: 29:49

It's wild, isn't it? Yeah, and and like lit by candlelights, this kind of dramatic scene and the surgeons themselves were often quite like dramatic characters. They had to be immensely physically strong because before anaesthetic you were kind of dealing with someone who was like trying, you know, trying to escape you, trying to kind of get their leg off, and it's really quite dramatic. You have to be incredibly strong to kind of wield the tools, um. But anyway, off topic, um, yeah, in 1846 ether is used for the first time in a surgical setting. It had been used in dentistry previously, which is kind of how it reached the ears of this pioneering surgeon, liston, um, and that the removal of the pain barrier in surgery was like so huge, really really massive, um, and there were two people in that audience who would have quite an impact for how that would kind of impact birth. One of them was James Simpson, the obstetrician who would pioneer chloroform as a anesthesia that was more suited to childbirth, um, along with some other kind of pioneering things within obstetrics. But the other person who was in that audience and I love the fact that he was actually there as a medical student was Joseph Lister, who would dedicate. I mean, he knew what he was seeing and he really appreciated the like it, the impact and significance of the fact that he was witnessing the removal of this huge barrier to successful surgery and he would then dedicate his life to develop to the second, probably the second biggest barrier in surgery with his work in germ theory and antiseptic. So those two things kind of unfolded. And the third because actually, although those two things were huge within surgery, the cesarean section was really unique. It wasn't an arm or a leg, it wasn't an amputation, it's something that happens really deep within the body and, as you will know, the uterus is still contracting throughout the operation and how to kind of seal this wound was huge. So actually, even when surgery was moving on a pace, the cesarean section remained this kind of unique challenge.

Speaker 2: 32:07

And it wasn't until towards the end of the 1800s that an obstetrician called Max Sanger pioneered the use of silver sutures in terms of how he would suture the uterus, that an obstetrician called Max Sanger pioneered the use of silver sutures in the insert um in terms of how he would suture the uterus, and that then really reduced the risk of hemorrhage. So those like pain, infection, hemorrhage were like the three biggies when it came to a c-section and the reason that no obstetrician would willingly carry out a C-section unless it was, I mean, they did. They did occasionally carry them out, but it was so risky, the women so rarely survived. It was just the last, last port of call, really, um for an obstetrician, um, we're talking kind of this is quite a Western focus, um, because actually there were some other parts of the world where there was some slightly different approaches to cesarean sections and probably quite a lot more sophisticated in terms of how they were dealing with infection, um, and pain management, um, but from a kind of western point of view, yeah, really, up until that point it was just a no-go the thing that is, um, that then becomes very difficult to, I think, kind of navigate in a modern world is there's a real, you know?

Speaker 1: 33:23

I imagine this is something sort of versus the kind of the medical, the obstetrics, and sometimes the kind of friction can come from really understanding, as we've kind of mentioned, the quite barbaric history that has led to the modern maternity system as we know it, and then we sometimes forget to celebrate those things that you've just mentioned. Like bloody hell, we can literally operate on a woman so she can birth her baby, we can stitch her up and the chances of her having an infection that is severe and untreatable, bleeding so heavily that she doesn't survive, like the chances of those things happening are. They exist, but they are extremely small in comparison to even just kind of 200 years ago, um, and it's it's like our society cannot fathom that actually, we can be grateful for some aspects of it and want to condemn other aspects of it, and it leaves us in this kind of yeah, real kind of friction place when we can't see both sides of that perspective at the same time.

Speaker 2: 34:50

Yes, so much and I think that historical context it really helped me position what had happened to me in that, in that surgery it really allowed me to kind of appreciate the full weight of what a cesarean section had meant for most of its history and it allowed me to feel a lot of gratitude and a lot of luck for where and when I gave birth and how that happened to me. But I do think that that historical context is missing, along with a huge amount of nuance, in a lot of the debates that we have about the cesarean section now, and I do think that it is not just women who undergo cesarean sections who would really benefit from appreciating and understanding more about that. Um, you know well, you know we're all different. I'm not saying that what helped me will definitely help someone else, but I do think that kind of more information and context can be a really helpful thing. But I think that the same goes for a lot of our birth practitioners, because I think we can be quite myopic and we can be quite detached when we talk about birth and we can be looking at like one metric. This is kind of a broader point, but I we can be very prone to looking at like one metric and then like putting the blame on one thing and not tying that, not recognizing that some of these conversations we've been having for centuries like one of the most enlightening things I think that can come, when we do place things in the historical context, is understanding that like there's nothing new here, like we're not having new conversations.

Speaker 2: 36:18

Um, there were so many conversations that I recognized, from a contemporary viewpoint, that we've been having for so long. I mean conversations around power in the birth room who gets to hold that and what that looks like. Um, is it men? Is it women? Um, is it the person doing the birthing? Is it the person you know? Who is it who really holds and controls that power in the birth room? We were having those conversations in the birth trauma report that came out last year. But we were having them when Henry VIII and his reforming bishops banned women from offering their prayers and pleas for help during labour to female Catholic saints and told them that they needed to direct them only to one male god, this male entity who kind of entered the birth room long before men were allowed to enter the birth room in their kind of bodily, corporeal form. They kind of did a bit of a spiritual takeover and we're still having those conversations now like who's listening, who's holding the power and why does that matter? How does that impact birth? Um, we're still having conversations around shame and judgment of women, around failure of of of, you know, failure to progress. Um, you know, there's so many phrases that we hear now and some, some of these themes are in our oldest myths um, around how women are treated and how they're seen by society, how they're seen through a kind of patriarchal gaze and what the kind of appropriate treatment and expectation for them is, how we dismiss their pain and their fears and their experiences, and how women are not listened to.

Speaker 2: 37:53

There were discussions between this kind of binary division between us and them that you mentioned. In the early 1900s in the US there became this kind of big two-sided debate between what they were dubbed the operators and the non-operators, and there were these two kind of strands of obstetrics one very pro-intervention and quite kind of pioneering and keen to kind of explore the options available to them in terms of pain relief, and quite kind of big intervention, including the cesarean section, and the non-operators who really believed in kind of bare bones, basic obstetrics that there was. It was actually very unusual that a woman would require anything more than than kind of manual support. Um, and that's really the same discussion that we're having. Like that almost hasn't really changed, like we're still having that. And interestingly I found and I think this is really relevant to how we talk about birth now the two most vocal, the two biggest voices on the two sides of that argument.

Speaker 2: 38:55

Operators and the non-operators were actually good friends.

Speaker 2: 38:58

They were two obstetricians who had a lot of respect for each other and in actual fact, both were on the side of wanting to preserve women's lives, to support them, to enable them to give birth safely, and they wrote to each other a lot and they were respectful colleagues within this world.

Speaker 2: 39:18

But in terms of their philosophies they were quite polarised and I found that really interesting because that was really something that I found listening to a lot of voices from a contemporary perspective.

Speaker 2: 39:29

I listened to obstetricians, midwives, doulas, women who were giving birth, and I really heard a lot of voices who, in actual fact, had huge amounts more in common than perhaps some of the discussions and debates we might see on social media or like here in other places would lead us to believe and the ability to like, hold varying viewpoints and to respect someone else's position and hear where they're coming from, while maintaining your own, um, your own position, but kind of also seeing the common ground, is something that's been a bit lost. Um, we're not very able to do that, and if kind of more broadly socially um, but definitely I think we see that in the birth world a lot, um that it's become quite polarized and we're really unable to kind of accept the fact that actually we might mostly be on the same side, um, but we but a good outcome might look slightly different depending on where you're looking at the situation from.

Speaker 1: 40:38

Yeah, yeah, absolutely. I'm going to wrap us up because I want people to actually go and read the book. I don't want to give everything away in this conversation, but it really is just a fantastic read and a really refreshing and new perspective on conversations around cesarean birth that I don't think I certainly haven't seen anywhere else before. So if you have had a cesarean birth and you've got sort of feelings and emotions that you're finding difficult to reconcile or you just want to learn more about that before it is potentially a possible way that you might experience giving birth, then, yeah, absolutely buy it and have a read of it.

Speaker 1: 41:16

I will put a link to the book in the kind of show notes of this podcast, but I just wanted to kind of wrap up with one thing that you wrote in your book about a particular emotion that you felt, um and I know that this will resonate sadly for lots of women um, and it was that you worried that no one would be proud of you for the way that you'd given birth and that you didn't feel proud of yourself.

Speaker 1: 41:39

Um, and I know that we don't know each other well, but I just wanted to say that I'm proud of you and whilst your experiences were so hard and you were let down in so many ways. What you went through to bring your babies here and what you've now created is going to be a lifeline to so many women who are sat there wondering if they're the only person to feel exactly as you did, and that is mega. So, um, I, yeah, I just wanted you to know that you've created something really special and that that was the kind of starting point to, yeah, creating this resource that is going to just be really really helpful for so, so many women.

Speaker 2: 42:16

So, thank you, thank you thank you for saying that and it's yeah, it's worth saying that I don't. I don't feel like that anymore, that, but that was so real. That was, that was really how I felt after the birth. I remember um me, you know bumping into a friend and his wife had given birth and he the way he talked about it was he was just so full of pride. He was like beaming from his face and I just smiled back at him but inside just kind of crumbled because, yeah, I felt such a lack of pride. I felt like that had been. No one would ever think about the way that I gave birth in that, in that way.

Speaker 2: 42:52

But I don't feel that way now and I think I really hope that this book offers a narrative that gives women something different, that gives them a narrative that is beautiful, that's full of power and magic and ingenuity and determination, inventiveness and bravery, and that also recognises the nuances, the suffering of some really vulnerable women.

Speaker 2: 43:19

Some of them were enslaved, black women in America and Haiti, whose bodies were experimented upon and they didn't own the consent to give.

Speaker 2: 43:27

Some of them were very poor women in Europe who lived in slums, for whom rickets was an issue, who couldn't give birth vaginally and actually they were the women who kind of drove the developments in the cesarean section by the necessity of what had been inflicted upon their bodies by immense poverty and degradation and um so but I hope that that kind of comes together to kind of weave together this really human story.

Speaker 2: 43:54

I think, you know, humans are imperfect and most of our history is kind of dark and rancid in some areas, but kind of I like to maybe I'm an optimist, but kind of ultimately hopeful, as there are always. You're always going to find these amazing characters and these kind of fascinating people who drive forward these amazing innovations, like the cesarean section. And I I hope, I hope that thread offers a narrative that is nuanced, balanced, but ultimately powerful and hopeful, and that's it. If you're in a place where you feel like that's something that you need, that you don't have that narrative, you don't feel that power of your birth and a kind of sense of pride, that maybe Thread will offer you something where you can find something that you need or that makes you feel a little bit differently about it.

Speaker 1: 44:47

Yeah, amazing. Thank you so so much for joining me. Um, uh, yeah, remind us just the full name of the book so people can go on Amazon.

Speaker 2: 44:56

The book is called Thread, a cesarean story of myth, magic and medicine, and you will find all of those three things within its pages awesome.

Speaker 1: 45:07

Thank you, bye. So much. Thanks so much for listening to the birth ed podcast. I know you're already feeling how much of an impact these conversations are having on your own pregnancy and birth plans and parenting journeys and I want that impact to be as far-reaching as possible. But I can't make it happen without your help. If you've got two minutes now to five-star rate and review the episode or send it to a friend, this is what helps us creep up the podcast charts and into the ears of more and more parents. To be together, we really can change the face of birth as we know it.