The Faceless Caesarean

By Shawn Gallagher

As a woman who has devoted her adult life to childbirth, I have over the last 23 years been a doula, registered midwife, childbirth educator in Canada and now, as a hypnotherapist, I train couples to use hypnosis during their births.

Caroline Oblasser’s book, "The Faceless Caesarean," is a powerful book containing the stories and photos of 162 women who have undergone surgical birth (some as many as four times). While the book cannot even begin to examine the causes of the rising global caesarean rates, it does ask the women themselves their input on this.

Women currently considering caesarean are unaware that the scar can continue be a source of pain and other distress many years later in life. It is interesting to note that more than one woman in Oblasser’s book reported using traditional Chinese medicine to re-establish the energetic flow of (severed) meridians after the birth.

Medical research is best at measuring averages and statistics. What Oblasser has done is connect a woman’s individual story to the picture of her surgical scar(s) – this helps make caesarean more “real” to women considering the procedure.

Most obstetricians I’ve talked to find the rising Canadian caesarean rate distressing and there is active debate in their community on whether or not women should even be allowed the option of asking for a caesarean.

I believe Oblasser’s book is a healthy start to a discussion that is long overdue. The only caveat I would offer is that pregnant women wishing to avoid caesarean may become more alarmed than reassured. More stories about how emotional “scars” can be healed after surgery would be a fascinating follow-up book. As a hypnotherapist, emotional healing after any birth is a significant part of the service I provide. The stories from women who found their physical scars diminishing once their upset resolved are a fascinating testament to the mind-body connection.

In all my years of practice, I have found that reducing maternal fear and encouraging a good fetal position are absolutely critical in encouraging faster, easier births. When you read "The Faceless Caesarean," mentally note how many women mention poor fetal position (breech, posterior, etc). In fact, “cephalo-pelvic disproportion” is a medical term that can describe poor fetal position…the human body has the capacity to birth large babies, assuming that the baby is in an excellent position and women receive good birth support. I know this from all the births I have attended and also personally – I am slightly taller than 5 feet and had two fast, easy, natural home births with bigger than average babies – one was 9 pounds, 1 oz and delivered in less than 2 hours from start to finish!

Statistics tell us that for more than 85% of mothers and babies, vaginal birth is the best approach medically, financially, physically and emotionally. The statistics also tell us that normal birth is in danger of being forgotten. The most powerful members of this dialogue are pregnant women, birthing women and mothers - get informed, join the dialogue and help return birth to safety and health.

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What a random choice for a book review on JT. What does a book on the rate of Caesarian births in Canada have to do with Japan?

Moderator: The topic will be of interest to any woman giving birth, regardless of nationality.

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To: USNinJapan2 -

Quite. It's not like women are giving birth here or anything.

And even if a few gals still are, it's not like they need to educate themselves about the options and risks connected with what is basically a trivial experience.

Bloody imposition if you ask me, reviewing this book here.

. . .


Anyhoo, I don't know if there still is, but there used to be a misapprehension, didn't there, that a caesarean was the easier, more painless option - just slice 'er open and whip the kid out kind of thinking.

Women considering childbirth (few in number and insignificant in voice though they may be) need the kind of information this book promises.

Hope it's translated.

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In the UK I seem to remember a phrase "To posh to push"

But yes - what has this got to do with Japan where they seem to do everything in their power to avoid a C-section

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This website is aimed at English speakers, right? There might actually be a lot of foreign women reading this site who plan to give birth at some point, whether in Japan or elsewhere. I am personally interested in this book after reading the review. Just because a certain book doesn't interest you, doesn't mean that it shouldn't be included in the book reviews here.

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It is interesting to note that more than one woman in Oblasser’s book reported using traditional Chinese medicine to re-establish the energetic flow of (severed) meridians after the birth.

It's only interesting if you are duped by this pseudoscientific nonsense. Others understand what the placebo effect is.

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As I understand it, a Caesarean is often performed as there are fewer potential complications than a natural birth, and doctors don't want to expose themselves to litigation because of these potential complications. So thank all those mothers who sued their doctors because of getting complications from their natural births for all of the Caesarean births!

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In Japan C Sections are rarely performed and the doctors emphasize the natural birth methods (which is very good in my opinion). As far as I know C-section births here are never allowed for vanity reasons only (also the costs are 3-5 times higher than a natural birth)

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what is basically a trivial experience.

lol I take it that's the voice of experience? I've only done it twice (no Caesareans) and each time it was far from being a trivial experience. Probably the most un-trivial experience of my life.

a Caesarean is often performed as there are fewer potential complications than a natural birth

Really?? Never heard that one before. I find it hard to believe that adding in a general anaesthetic and major surgery offers the potential for fewer complications than doing it the way it's supposed to be done (trivially). I would have thought it was the opposite, unless you're talking about a pregnancy with complications to start off with.

I was under the impression that whipping the baby out on a Friday afternoon allowed doting grandparents to visit without having to take time off work, and freed the doctor for his weekend golf.

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I think Maria was being sarcastic and poking fun at USNinJapan2 when she said it was trivial.

I don't think natural birth will ever be forgotten completely. However, it is a little disturbing to see a rise in Caesareans performed for reasons other than real complications. Those other reasons lay in the fact that c-sections make more money for the hospital, they are quicker, they can be scheduled, they are safer for doctors (wanting to avoid possibility of getting sued), and simply because some women fear the pain of childbirth but don't realize the pain of the surgery and the aftereffects could be just as bad and possibly for a longer term.

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and women receive good birth support

hmmm....like, dare I suggest it....pain relief, for example???!

Most caesarians are not performed under general, but with an epidural, and they are statistically safer, more predictable and yes, easier for the doctors. But either way is tough, especially in Japan where they favour natural birth with no drugs. However, there is a tendency to also schedule them through request because they are so much more predictable.

I had two natural births in Japan, and next one is due in November. My best friend had two caesarians. I went through hell each time with mine (Cleo's "trivial experience" comment is SO true!) but I recovered quickly and easily. My BF is still suffering the effects of her caesars.

I think Japan actually has the birth system down to a reasonably fine art here, but I would likie to see more choice for women, especially in terms of pain relief, and low bikini line cuts instead of those awful vertical cuts.

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in my point of view, a C-section should be performed only if there no other solutions.

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Cleo, about my comment that you referred to, check the Wikipedia out for Caesarean section. In one part a doctor comments: "We shouldn't be blamed. Our approach must be understood. We doctors are often sued for events and complications that cannot be classified as malpractice. So we turn to defensive medicine. We will keep acting this way as long as medical mistakes are not depenalized. We are not martyrs. So if a pregnant woman is facing an even minimum risk, we suggest her to [get a c-section]" The feeling is that a natural birth can have complications that could possibly result in litigation, whereas a C-section (although itself having the possibility of complications) must be a safer choice.

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As I understand it, a Caesarean is often performed as there are fewer potential complications than a natural birth, and doctors don't want to expose themselves to litigation because of these potential complications.

your kidding right - that is major surgery!

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oh come on - Japan has got the lowest C-section rate in the developed world, and most doctors refuse pain relief here...

however on reflection im glad my j-doc wouldnt let me have the drugs ...

i disagree with cleo though - my doc worked blooming hard, and was at the hospital 6/7days a week - always available. The poor gynos here dont stand a chance ... i wouldnt want their job!

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My question is more to the point of the cost and difficulty getting anesthesia here. My kids were born in the states where an epidural is common practice. Only a handful of hippies go for the natural route. Here epidurals are uncommon and I can't imagine any woman wanting to face that prospect.

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shufu: Your doctor wouldn't let you have the drugs? Is that because you said you didn't want them in the first place? If so I understand but if he just refused it's called not addressing the needs of the patient.

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Only a handful of hippies go for the natural route.

Then hand me a flower and a sitar....

Here epidurals are uncommon and I can't imagine any woman wanting to face that prospect.

By 'that prospect' you mean childbirth without an injection to deaden sensation? I can't imagine any woman wanting that. You spend 9 months on the wagon, avoiding all kinds of stimulants, chemicals and even spicy food for the sake of the baby, and then you welcome him into the world with a syringe full of drugs? No thanks. Breathing exercises and relaxation techniques work wonders. For a normal, straight-forward birth with no complications, I think only wussies would want an epidural as a matter of course. I'm surprised medication is so widespread in the US.

shufu, I didn't mean that I thought doctors were skiving off, at least not in Japan where, as you point out, c-sections are not the norm. But where they're taken as a matter of course.....

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cleo: Have friends who have done both I'm glad my wife didn't need to suffer anymore than she did. An epidural dulls the pain not puts you under. I think she would testify that she still had plenty of "sensation" and enough damage from the size of my son's head that she wouldn't have been thrilled with anymore. To each there own I guess but why suffer needlessly when there are safe measures available to help. That's not being wussie it's called being sane.

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usaexpat - childbirth is darned hard work, but for most normal, healthy women there's no 'suffering' involved. It's certainly not a trivial experience, but the right preparation, physical and mental, can make it a lot easier. I realise some women do have a hard time, and the option of pain killers should be available for those who really need them. But weighing a few hours of maternal discomfort against potentially exposing the baby to unnecessary drugs, I can't help feeling drug-based pain relief should be the last recourse, not the first, and certainly not 'common practice'.

Having said that, a mother who is full of anxiety and fear of pain is not going to be able to savour the experience....if she's done all the right preparations, educated herself about what's going to happen, talked to other mothers about their experiences, and still feels anxious, an epidural may be the better choice. But it's not for me.

Reported side-effects of an epidural administered in childbirth -

Mother: Short term

Dural puncture Hypotension (29%) Nausea, vomiting, shivering (frequent) Prolonged labor Uneven, incomplete or nonexsistent pain relief Feelings of emotional detachment Respiratory insufficiency or paralysis Convulsions Toxic drug reactions Slight to severe headache Septic meningitis Allergic shock Cardiac arrest Maternal death

Mother: Long term

Neurological complications Backache (weeks to years) Postpartum feelings of regret, loss of autonomy Fecal and urinary incontinence or bladder dysfunction (inability to urinate) Paresthesia ("pins and needles") Loss of perineal sensation and sexual function

Baby (More important than the above, to my mind)

Direct drug toxicity Fetal distress, abnormal FHR (can lead to emergency cesarean) Drownsiness at birth, poor sucking reflex Maternal fever (impeded thermoregulation from numb skin) leads to fetal hyperthermia and neonatal NICU workup (spinal tap, etc.) Poor muscle strength and tone in the first hours Neonatal jaundice Decreased maternal-infant bonding, behavioral problems Hyperactivity up to seven years (suspected)


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cleo: My wife is 5 ft tall and weighs 100 pounds with narrow hips, both our children were large (10 lbs) and she's lucky she delivered them at all. I'm surprised and grateful that she didn't have to have a C section but it was a definite possibility. I would go so far to say that if we had thought we wouldn't be able to get pain medication we may not have even conceived. Fresh in our minds was a friend of ours who got to enjoy 38 hours of hard labor (no meds) before an emergency C section with the baby being pulled partially back out of the birth canal. Again to each their own but as a man I'm pretty sure I wouldn't be having a colonoscopy without anesthesia and that is comparatively mild compared to child birth. There are side effects with all treatments but you do realize a side effect of pregnancy and birth meds or no meds is death. Everything has risks and I think we have to agree to disagree.

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usaexpat -

Actually I'm not all that sure we disagree! I did say that the option should be available for those who need it, and it does sound like your wife might be a good candidate. What bothers me is the idea of the use of drugs being accepted as 'normal' regardless of whether or not they're actually needed and without a full explanation to the parents of the cons as well as the pros.

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Why not let the mother choose the method she is most comfortable with instead of hospitals dictating the methods and resources that expecting mothers are offered. From my experience there is serious lack of including the father in the pregancy. Most of the hospitals are only set up for the mother, not families. If you are having your first baby here(Japan) don't expect to be treated like you are making a family, but rather a sales transaction.

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As the author of "The Faceless Caesarean" I have experienced both, the unnatural birth via a C-section, and the phantastic natural boost of an uncomplicated but well prepared homebirth. Just a few weeks ago we have launched our book "The Luxury of Private Birth" which will come out in a few month in English (www.privatebirth.net). Hundreds of homebirth mothers tell their stories, and quite often the mothers have had bad birth experiences in hospitals before deciding to give birth at home. About 95 percent of the Luxury-mothers have classified their homebirth experiences as "very good" (best mark). Nearly every homebirth mother would like to give birth at home when being pregnant again. A few of them wouldn't, f.e. because they have been over 70 years of age when filling out the questionnaire ;-) All the best from Salzburg, Austria, to Japan, where I have lived from 1996 to 1997. Caroline

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