Kate Winslet recently admitted that one aspect of her fabulous image was a lie. Her dark secret? Not drug addiction, plastic surgery or eating disorders, but childbirth. Mia, her four-year-old daughter with her first husband Jim Threapleton, was born by caesarean section and not, as Winslet announced at the time, an "uncomplicated natural birth" at all. "I've never talked about this," Winslet told the New York magazine, Gotham."I've gone to great pains to cover it up. But Mia was an emergency c-section. I just said I had a natural birth because I was so completely traumatised by the fact that I hadn't given birth. I felt like a complete failure."
Columnists this weekend leaped on this as an example of women's lunatic attitude to childbirth and "success" in general. Winslet, wrote India Knight in the Sunday Times, "can only admit to it now because - praise the Lord and hallelujah - she has subsequently given birth to a baby by a 'natural' method the world can truly admire".
This may, in part, be true. But it is not the whole story. By talking about this, Winslet is doing vast numbers of women a great favour. Caesarean sections - particularly emergency ones - can unearth violent, and unexpected, emotions in new mothers. I had my first baby this way. Before it happened, I used to think the surgical route sounded ideal: hi-tech, anaesthetised, your parts left untouched by a baby's head - what could be less traumatic? After my emergency caesarean, however, I remember looking at my daughter and thinking quite clearly, I have a baby, but I don't know what it's like to give birth.
Of course, I did know what it is like to give birth: almost one in four first-time British mothers now do it this way. Indeed, there is even a theory that caesarean birth is becoming "sexy" thanks to celebrities such as Victoria Beckham and Liz Hurley who are "too posh to push".
Some women do, indeed, have positive experiences of surgical birth - whether planned or not. But for others it is far less straight forward. If you are expecting to push your baby out, ending up under the scalpel can be a shocking experience. Instead of a "birth", you get a scary operation. And this - no matter how irrational it seems from the outside - can make you feel like a failure.
The words used by the medical profession don't help. Like about half of first-time caesarean mothers, the three-word reason I was given for my operation was "failure to progress". In the months after the caesarean that word - failure - somehow stuck. I began to feel I had "chickened out" of giving birth; that I had missed some important rite of passage by not pushing out my baby and even - weirdly - that I had disappointed my husband (who didn't care how our daughter got out as long as we were both safe). All of this may seem hysterical and silly in cold blood, and I didn't believe any of these things rationally. But I certainly felt them.
The fact that many caesareans may be avoidable does not help women like me to reconcile ourselves to having had one. In Britain these days our caesarean rate, at five times what it was in 1970, is universally considered to be too high. Indeed, we are not far behind the Americans (around 26%) and the World Health Organisation estimates that half of all caesarean sections performed in the United States are unnecessary. Many women, like me, read up about caesareans after the event in an attempt to get a grip. And many of us come to suspect that if we had done things differently we would have avoided surgery. This, in turn, adds a dose of guilt to the sense of failure.
It can be hard - even if you are not an international megastar with a perfect image to protect - to admit to feelings like this. Understandably, most people think you should pull yourself together, move on and get over it. The one thing they say to you again and again is: "But you have a healthy baby, that's what counts". Of course it is. You would have to be particularly deranged to dispute that a safe, healthy baby is infinitely more important than any amount of hippy-dippy birthing satisfaction. But this does not stop women experiencing powerful, unhelpful emotions alongside those "good" feelings of maternal relief or joy.
The consequences of all this can be serious. The childbirth educator Sheila Kitzinger, who runs a helpline, Birth Crisis, for women who have had difficult or traumatic experiences of childbirth, says that caesarean births, particularly emergency ones, can negatively affect how women relate to their new babies: "Many women find themselves feeling somehow that they are not a real mother. They feel they are acting like mothers, but they don't feel like mothers. Many describe this as a "zombie" state, or "going through the motions", despite their huge love for their babies". Studies into mother-baby bonding after caesareans seem to back this up: caesareans can, for instance, negatively affect how quickly breast-feeding is established, and how long it lasts.
This caesarean fall-out can also affect women's relationships with their baby's father: "Many women feel, after a caesarean, that their body has not worked properly," Kitzinger explains. "Scars can get infected. They can take a long time to heal. They can look dramatic and can affect the way your muscles work. One woman said to me that every time she passed the mirror, or got into the bath, the scar was there, grinning up at her. Many women are simply not prepared for this and it can affect how they relate to their partners sexually."
Perhaps most worryingly, traumatic caesareans have been linked to serious mental health conditions such as post-natal depression and post-traumatic stress disorder, where women have panic attacks, flashbacks or nightmares about the birth (this can happen with a traumatic vaginal birth too).
"Studies have shown that up to 40% of women who have had a traumatic first birth - often ending in a caesarean - can't face having any more children," says Jayne Cockburn, a consultant obstetrician at Frimley Park Hospital in Surrey. "Kate Winslet is very brave indeed to talk about this - it is a common and sometimes devastating experience for many women - and one that goes largely unrecognised, particularly in the male-dominated surgical world."
Jenny Smith, head midwife at Queen Charlotte's hospital, London, agrees. "Part of the problem," she says, "is that when things do go amiss, the birth quickly becomes a 'medical procedure'. Many women say to me that in those first few days after the surgery they felt somewhat unconnected to their baby. This can be very damaging."
Winslet said of her second birth: "It was an amazing feeling having Joe naturally. Fourteen hours with no drugs at all, but then I had to have an epidural because I was so tired. It was an incredible birth."
These emotions are also common. "Many women feel elated by a vaginal birth after a caesarean," says Cockburn. "It can be a huge ordeal for women who have had one traumatic caesarean to even try for a vaginal birth with the next baby, and managing this can be very healing."
The reality is, however, that given our escalating caesarean rates the operating table will be the only experience of childbirth for many women. "Women need to understand that while they should go for that utopian birth plan the baby may, in the end, have different ideas," says Smith. Some women say their caesarean felt like "violation" and even "rape". This may seem extreme, but one thing is clear: there is huge room for improving our experience of caesarean birth.
"Even surgical birth can be magical," says Smith. "While all medical precautions need to be taken, it's important that, for instance, the mother should be able to hold and touch the baby straight away - skin to skin - if possible in the theatre, and she should stay with the baby afterwards, in the recovery room. The moment when you first meet your baby is really the miracle of birth. You can never get that back, and as professionals we should do all we can to help women have these profound first few moments of being together."
If the psychology of surgical birth was better understood, perhaps women such as Winslet might not feel so upset by the route their baby took into the world. Perhaps, indeed, we would all be able to forget about the birth and get on with the bit that matters most: mothering.
· Lucy Atkins is co-writing a book about preparing for childbirth, called Blooming Birth to be published by HarperCollins next year
