What Did I Do Then?

I watched a video recently of a medical professional explaining what actually happens during a Caesarean section.

Skin. Fat. Fascia. Muscle moved apart. The abdominal cavity entered. The uterus opened. A baby reached for somewhere deep inside the body and lifted out into the world.

And despite having had two Caesareans myself, I watched it thinking: Jesus Christ.

Because somehow, when it's happening to you, nobody can really explain the enormity of it. You're too busy having a baby.

I had two C-sections fourteen months apart to get my girls here. And I tried very hard not to have either of them. I wanted to give birth naturally. I wanted my body to do the thing women's bodies had supposedly been doing forever. I tried. My doctors tried. My babies apparently had other ideas. 

Before my first C-section I had already spent three days in labour pains with almost no change in dilation. My body was contracting, hurting, exhausting itself, and still not actually getting anywhere. I reacted badly to the medication too — my insides went into spasms, and much of those three days was spent in pain with very little relief beyond paracetamol and a TENS machine.

By the time the decision was eventually made to take me into theatre, I was exhausted. Not disappointed, in the neat, cinematic way we sometimes talk about birth plans changing. Absolutely fucking spent. I hadn't properly slept for three days. And now I was going to have major abdominal surgery. While awake.

I remember lying on the operating table with the anaesthetist beside my head. There was a screen between me and what was happening to my body, but of course you know exactly what is happening on the other side of it. At one point he leaned towards me and said something along the lines of:

"Right, now you're going to feel like somebody's doing the washing-up inside your stomach."

It was such a bizarre description. And he was completely right. There was pulling. Tugging. Pressure. Movement from somewhere deep inside me. It wasn't pain exactly, because the anaesthetic was doing its job, but I could feel that things were being moved. Manipulated. And "somebody doing the washing-up inside your stomach" remains one of the strangest and most accurate descriptions anyone has ever given me.

Then I reacted to the anaesthetic. I started shaking uncontrollably. I was retching. My whole body seemed to be doing things I couldn't stop while somewhere just beyond my head my daughter had finally arrived.

Halle. After three days of trying to get her here, she was here. And I couldn't even hold her. My body was in such a state that I physically couldn't.

That is one of the strange cruelties of some Caesarean births. You can spend days labouring. Endure medication, fear, exhaustion, surgery. Finally hear that your baby has been born. And then be unable to do the one thing every part of you wants to do. Pick them up.

It didn't end when they wheeled me out of theatre. After Halle was born, the itching started — not an annoying little itch, but an unbearable, all-over-my-body itch I couldn't escape. I'd reacted to something in the spinal anaesthetic and needed antihistamines, but it took around three hours before I was finally given anything that relieved it.

Three hours perhaps doesn't sound particularly dramatic. Unless you remember that by this point I hadn't slept properly for three days, I'd laboured, I'd had painful reactions to medication, I'd been operated on, and I'd shaken and retched through the birth of my daughter. My body was absolutely begging for sleep. And now I couldn't sleep because I wanted to claw my own skin off.

Meanwhile there was a newborn baby who needed me. I remember nursing Halle and physically falling asleep while I was holding her. Not gently drifting off. Dropping. My body simply couldn't keep itself awake anymore. And I was frightened. I kept thinking: ‘what if I fall asleep and drop her?’

Thankfully, Ste was there. He watched us. Helped me hold her. Stepped in when I couldn't do something. Stayed alert when there was absolutely nothing left in me capable of being alert. And, on more than one occasion, he had to advocate for me too.

Two of the midwives caring for us seemed to be constantly bickering with one another. Communication with one of them was incredibly difficult, and even in my exhausted state it felt obvious that the situation wasn't working. Imagine being three days without sleep, recovering from surgery, shaking, itching, trying to learn how to feed your first baby and understand what the hell has just happened to you — while the people you're relying on to make you feel safe are arguing around you. Eventually I asked the anaesthetist whether he could help us get somebody else.

After the operation, when I was still shaking so badly that I couldn't safely hold Halle, there was pressure on me to feed her. I wanted to feed her. Of course I did. I just couldn't. My body was in shock. There is an enormous difference between a mother who doesn't want to care for her baby and a mother whose body, minutes after major surgery, physically cannot do what is being asked of it. At that moment I needed somebody to recognise the difference. Instead, I remember being spoken to in a way that made an already frightening experience worse.

Eventually Ste stepped in and made it very clear that what I needed was kindness. Support. Help. Not pressure. I've never forgotten that. Because we talk so much about what women should do immediately after birth — skin to skin, breastfeeding, bonding, holding the baby. All beautiful things. But sometimes a mother has just been through hell. Sometimes the most important thing anyone in that room can do is look at the woman before they look at the checklist.

Fourteen months later, it was Nell's turn. And this time I knew things. Experience is a strange advantage when the experience you've learnt from was awful.

Before the operation I spoke to the man responsible for my anaesthetic. His name was Joseph. I told him everything — the shaking, the retching, the itching, the substantial bruising I'd had afterwards around my hips and spine from the attempts to get the spinal anaesthetic into the right place. I basically asked him: ‘please go steady with me.’

And he listened. Joseph worked magic. The difference was extraordinary. Minimal bruising. None of the chaos I'd experienced the first time. Everything went swimmingly. Same woman. Same body. Same type of birth. Completely different experience.

Perhaps that's one of the most important things my two Caesareans taught me. The operation matters enormously. But so does everything surrounding it. Being listened to matters. Having somebody believe you when you explain what happened last time matters. The competence of the people around you matters. A calm voice matters. Kindness matters. Good maternity care isn't an optional extra attached to childbirth. It becomes part of the birth itself.

And then comes the part I still find baffling. You've just been cut open. Your baby has been removed through your abdomen. Your uterus and abdominal tissues have been closed back up. And then, astonishingly quickly, everybody starts talking about getting you up. Walking. Showering. Feeding the baby. Going home. Carrying on.

I understand now that early movement after surgery is medically important. But psychologically, the whole thing felt absurd — as though I'd had a particularly tiring afternoon rather than major surgery.

And then comes the magical six-week marker. The point at which women are so often spoken about as though they should essentially be recovered, as though somebody flips a timer when you leave theatre and, six weeks later, the final grain of sand drops and your body is restored.

But a wound healing isn't the same thing as a woman being healed. Her abdominal wall is recovering. Her uterus is recovering. Her hormones are changing. She may still be bleeding. Her breasts may be producing food for another human being. She may be sleeping in ninety-minute fragments, processing a frightening birth, and already have another small child at home who still wants picking up and bathing and cuddling. And everybody else has gone back to normal.

That is the part I think we get wrong. And not only with Caesarean mothers. With mothers.

I'm eight years postpartum from my second daughter now, and I still don't think my body ever entirely returned to what it was before pregnancy and birth. Perhaps bodies aren't supposed to. I have sometimes thought of what followed those years as a kind of postpartum depletion — not a neat medical diagnosis, just a description of how it felt. Pregnancy. Birth. Surgery. Fourteen months. Another pregnancy. Another operation. Babies. Breastfeeding. Hormones. Broken sleep. Motherhood. My body gave and gave and gave, and sometimes I wonder whether I ever properly replenished everything it gave away.

We talk about being "postpartum" as though it's a temporary administrative category. Six weeks. Six months. Maybe a year if we're feeling generous. But I don't think women's bodies experience motherhood according to the dates we put on forms. Some things heal quickly. Some things take years. Some things simply become part of the new body you live in. Common doesn't mean insignificant. Caesarean sections happen every day. That doesn't make what happens to a woman's body small.

Watching that video also made me think about the women who came before me. Because whatever happened during my births, I had something countless women throughout history did not: modern anaesthesia, antibiotics, sterile instruments, blood transfusions if I needed them, monitoring, trained surgeons, pain relief, an expectation that both my baby and I would survive. I lay on those operating tables frightened, certainly. But in the history of childbirth, extraordinarily privileged.

There is a harder piece of that history worth sitting with, too. Some of the knowledge behind modern reproductive and gynaecological medicine was acquired through the suffering of women who had almost none of the choices I had. Enslaved Black women — women like Anarcha, Lucy and Betsey — were subjected to repeated experimental reproductive and gynaecological procedures in nineteenth-century America, procedures that included early Caesarean experimentation. Their bodies became part of medical knowledge, while the doctors who operated on them were the names history was far more likely to remember.

I think about that now, lying on a table with a calm anaesthetist and a curtain and a choice of pain relief, because none of that was inevitable. It was built — sometimes by people who consented to give something, and sometimes on the bodies of women who were never asked. Medical progress doesn't belong only to the men whose names eventually appeared in textbooks. Sometimes it belongs to the bodies on which that knowledge was learned. Thank you feels ridiculously inadequate. But gratitude is probably where I have to begin.

Years later, my Nanna Bette — not actually my nanna, but a lady who'd lived three doors down from my mum's house for so long that somewhere along the way she simply became one — said something to me. We were talking about childbirth, and she said:

"But you didn't give birth."

I remember thinking:

“well, what the fuck did I do then?”

Because I certainly didn't order them from Amazon. I grew them. I carried them. I laboured for them. And then, when they couldn't safely make their way into the world one way, a room full of people opened my body and brought them out another.

If that isn't giving birth, I'm not entirely sure what is.

There is a strange language around Caesareans. People ask, "Did you have them naturally?" "No, C-section." And we understand exactly what they mean. But think about the language for a minute. If vaginal birth is the "natural" birth, what does that make mine? Unnatural? Somehow less real?

There has always seemed to be a quiet hierarchy around childbirth — women who gave birth without pain relief, women who did it at home, women who laboured for thirty hours, women who pushed their babies out, and then, somewhere further down the imaginary achievement table, those of us whose babies came through an incision. Occasionally you'll even hear a Caesarean described as the easy option. There was absolutely nothing easy about mine.

I don't accept the idea that I somehow didn't give birth. My daughters entered the world through an incision rather than a birth canal. That's it. There doesn't need to be a hierarchy attached to that sentence. Women who labour for thirty hours, who give birth in water, who have epidurals, who birth standing up, whose babies arrive before they make it to hospital, who need forceps or emergency intervention or a surgeon to carefully lift their baby from their uterus because that has become the safest way — different births. Not opposites. I laboured, and then I had major abdominal surgery. One simply followed the other.

Sometimes I wish we talked about Caesarean sections with a little more awe. Not horror. Not pity. Certainly not as the easy option. Awe — because a woman lies down on an operating table and allows people to open her body so that her child can arrive safely. Then they close her back up. And before she has even begun to heal, she becomes somebody's mother.

We spend months looking after pregnant women because they're carrying something precious — appointments, blood tests, scans, blood pressure, questions. Then the baby arrives, and our attention understandably turns towards this completely new human being. But the woman didn't disappear. She has just undergone one of the greatest physiological events of her life.

Maybe the question isn't whether she's lost the baby weight, or whether the baby is sleeping through, or whether her scar has healed, or whether she's "back to normal." Maybe it's simpler than that.

Has anyone been looking after you?

Because mothers need mothering too.

And no, Nanna Bette. I didn't push my daughters out. But I absolutely gave birth to them. Twice.

And looking back now, I think what my body did was fucking incredible.