The Trauma of an Unexpected Cesarean Section

Even after 30 hours of labor with pitocin, no dilation or advancement towards a delivery, and amniotic waters full of meconium, Nina Sherman Green was surprised to learn that she was heading into the operating room for an unplanned cesarean section for the birth of her first child. Nina shared, “I was definitely scared, and definitely felt very alone, even with having fifteen, twenty people in that operating room. And I was just zoned out and having a conversation with God, praying, ‘Help me out here. Let's make this work. Make sure my kid is okay.’ It was a major trauma, definitely a very scary moment.” Nina was one of millions of woman who had a cesarean section for the birth of her baby, but also a minority in that the cesarean was unplanned and an emergency. According to the Centers of Disease Control, there are approximately 1.1 million cesarean sections performed yearly in the United States, accounting for about one-third of all births. Of these cesareans, it is estimated that one of every five women has an unscheduled cesarean during active labor, due to reasons including concerns about the fetus or the labor not progressing.

Professor Sharon Dekel

Source: Mass General Research Institute

Professor Sharon Dekel, an Associate Professor of Psychology in the Department of Psychiatry at Harvard Medical School and Founding Director of the Postpartum Traumatic Stress Disorder Research Program at Massachusetts General Hospital, studies the adaptation of mothers following childbirth. Interested in the experience of these unexpected cesarean deliveries, Dekel and her associates (Allouche-Kam et al., 2025) surveyed 1,146 women within two days of the birth. The researchers then also followed up with 70% of these patients within two years after the birth. They compared women who had vaginal, assisted vaginal (i.e. vacuum or forceps), planned cesarean, and unplanned cesarean deliveries. Significantly, they found that one out of ten mothers met the criteria for clinically acute stress from the birth. However, for women who underwent an unscheduled cesarean, 26.6% reported clinical stress, and there were even higher rates (29.3%) of stress if a cesarean was performed during labor. Therefore, compared to a vaginal delivery, a woman having an unscheduled c-section was found to be four times more likely to be at risk for acute stress.

Unexpected cesarean sections can be traumatic

Source: SDI Productions / Getty Images

Having an acute stress response to the birth was found to be predictive of later posttraumatic stress disorder (PTSD), depressive symptoms, and difficulties in the maternal–infant bonding. Given Professor Dekel’s focus on the birth experience and understanding how the birth experience might impact maternal psychopathology, she urges clinicans to screen “in real time” for the patient’s birth experience and potential birth-related trauma. Women may need additional support or to be screened for post traumatic stress symptoms in the aftermath of the birth. Additionally, these mothers may be stressed by the birth experience, in pain from an unexpected surgery, and then need to go home and both take care of themselves and a new baby, only to then experience depression, bonding difficulties, or PTSD.

Professor Dekel urges each woman to prioritze her mental and physical health, and to focus on what will make her feel “as much as possible trust, support, empathy, and empowerment” during the pregnancy and birth. The woman can also lean into her support network, whether her partner, friends, family, or professionals. Additionally, she encourages a flexible mindset when approaching the birth, as the delivery experience might not unfold as planned or hoped for.

Finally, having a support in the delivery and recovery room – whether a loved one or a doula – can also enhance support and care. Rachelle Paneth, who had an unplanned cesarean section four months ago for the birth of her first child, shared that after her birth, “Thank God I had a doula who showed me photos of my baby. Otherwise, I literally just would have been lying there alone for several hours, not knowing where my baby is, not knowing what she looks like, not knowing where my husband was.” Nina Sherman Green echoed this sentiment, saying, “The moment I did lose it was when the doctors told me that my husband couldn't come into the operating room. And that's when I was like, ‘Oh…that really sucks’. I wanted a healthy baby but I really wanted my husband to be a part of that experience, and to cut the umbilical cord, and, to be a part of it, and just…And now realizing he's not even going to be in the room. When it was all over my husband brought his phone, and he showed me photos and videos of our child. She was healthy, thank God, she was fine. So I just cried a lot, and I was very grateful.”

The maternity wards and birthing centers also have much to take from this study’s findings, specifically with regard to screening for stress in the immediate aftermath of birth prior to the patient leaving the hospital – and following up with these patients upon their return home. Educating their practitioners and clinicians in trauma-informed care is crucial, as is checking in with how the patients are doing emotionally in the aftermath of C-sections. Professor Dekel believes that, “there could be all kinds of ways to better integrate the trauma-informed care already during pregnancy, such as assessing for prior trauma, especially sexual assault, identifying high-risk people early on, and having these important conversations.”

Ideally, Professor Dekel hopes that her findings will enhance the accuracy of mental health assessments, enhance the access and availability of early and effective treatment. She is currently preparing to film a documentary about birth trauma. Overall, Professor Dekel hopes to better prepare future patients for future – and hopefully less traumatic – pregnancies and birthing experiences.