“Where’s my baby?” What is the maternal experience of separating well mothers and babies at caesarean section birth?
Creators: name: Deys, Linda
Publisher: name: Australian Catholic University
Year: 2024
Subjects: women
skin-to-skin
feminist
caesarean section
birth
mother
midwife
phenomenology

description: Problem: Separating women and babies in the first hours after birth reduces birth satisfaction and contributes to a poor birth experience and trauma.

Background: The experience of birth is as individual as the women who are birthing, a complex interaction of when, where and how, influenced by people both in and out of the room. This experience changes the woman in an instant, as she transforms to ‘mother’. She is changed physically, emotionally and spiritually, and how she feels during each of her births will remain with her over a lifetime.

In a landscape of birth trauma recognition, simply becoming a mother and getting a ‘healthy baby’ is not enough. Negative experiences of birth affect maternal mental wellbeing, parenting, relationships and future pregnancy planning. The experience of fear, loss of control, grief and shame are influenced more by the people and environment the woman births in than how her baby is born.

Birthing by caesarean section increases the risk of separation and is known to reduce maternal satisfaction and negatively impact transition to motherhood. It is often not the woman’s preferred mode of birth and commonly occurs in an emergency scenario. Operating theatres are cold, bright, sterile, and noisy, the opposite to the ideological environment for a baby to be born. This further limits bodily autonomy for the woman and increases fear. While alterations to the physical environment can be minimal, adjusting the clinical practice of care givers in the birthing space can improve the experience for women.

Keeping a woman in close physical contact with her baby after birth, ideally skin-to-skin, is known to create a positive experience. This facilitates a sense of control over her own body and baby which improves the overall experience alongside bonding, mothering and feeding outcomes. While this has been standard practice at vaginal births for many years, women birthing by caesarean section continue to be separated from the baby at birth even when both are well. 

This study was conceived through an antenatal lactation clinic environment where I supported women with previous breastfeeding issues. While breastfeeding is well known to be negatively impacted by the separation of the mother and baby, it was clear that their experiences were about more than poor breastfeeding outcomes. Women who had birthed by caesarean section stood out as they recounted the experience of being separated from their baby. No skin-to-skin, not knowing if the baby was safe, and the ongoing trauma associated with this separation. Evidence on the benefits of skin-to-skin and policies to support it were not enough to make this standard practice within my local health district. This anecdotal experience of women was not valued as sufficient proof to change practice and there was insufficient evidence to be found in the literature to support this important aspect of caesarean birthing.

Aim: The aim of this research was to understand the experience of women who were separated from their baby at caesarean section birth without a medical need. 

Methods: Participants were purposively sought through a social media maternity advocacy group in one local health district. Inclusion criteria included women who had birthed by caesarean section in the previous ten years and had been separated from their newborn baby without medical indication. Fifteen women from across Australia were subsequently interviewed using an unstructured phenomenological interview style. Data was coded with NVIVO software then analysed using a Modified van Kaam approach. A novel feminist phenomenological framework embedded with two birthing theories was then used to explore the experience of the participants. 

Findings: The results of this research exposed the significant trauma experienced by all study participants from both the separation event and overall perinatal care. Four major themes emerged from the data and characterised the experience of being separated from one’s healthy baby at caesarean section – Disconnection (from their own body, baby and partner), Emotional Turmoil (intense and prolonged feelings that impacted their significant relationships), Influence (displaying the vulnerability and unequal balance of power for women) and Insight (the reflection and wisdom of women as they came to terms with their experience). 

The importance of the birthing event and the transition to motherhood did not appear to be acknowledged by the health care providers caring for the participants. Provider and facility needs were valued above those of the woman, decision making and control were balanced firmly in favour of the hospital, and the powerlessness and subsequent violation of human rights of women were not recognised. Woman-centred care is a notion that appears frequently in maternity services policy and education and linked to midwifery care through foundational and ethical documents. However, this did not translate to woman-centred practices as shown by the participants stories.

Conclusion: Separating mothers and babies at caesarean section birth causes and exacerbates significant trauma for women. Midwives are particularly well placed to advocate for, protect, and support women to have choices around their pregnancy and birthing care. Within the operating theatre environment, a midwifes purpose is similar to that of the birthing unit - to provide and relay information, encourage and emotionally support the woman, and observe for signs of wellbeing in mother and baby. Enabling the woman to have skin-to-skin with her baby and not be separated promotes essential physical and emotional health and should be recognised for its significance in perinatal care. Midwives are the key in keeping mothers and babies together and improving birth experience.