Cesarean section as a narcissistic injury

Why are some women devastated by a C-section? Why are VBACs portrayed as “healing”? Perhaps it is because those women experience C-sections as a narcissistic injury.

Narcissistic injury is a term from psychoanalysis. A narcissist is a person who suffers a deep sense of inferiority and masks it by projecting an air of grandiosity and excessive self regard. A narcissistic injury occurs when reality threatens the narcissist’s carefully constructed facade of perfection.

Narcissistic injury may lead to narcissistic rage:

Narcissists are often pseudo-perfectionists and require being the center of attention and create situations where they will receive attention. This attempt at being perfect is cohesive with the narcissist’s grandiose self-image. If a perceived state of perfection is not reached it can lead to guilt, shame, anger or anxiety because he/she believes that he/she will lose the imagined love and admiration from other people if he/she is not perfect.


… rages can be seen as a result of the shame at being faced with failure. Narcissistic rage is the uncontrollable and unexpected anger that results from a narcissistic injury – a threat to a narcissist’s self-esteem or worth. Rage comes in many forms, but all pertain to the same important thing, revenge. Narcissistic rages are based on fear and will endure even after the threat is gone.

To the narcissist, the rage is directed towards the person that they feel has slighted them; to other people, the rage is incoherent and unjust. This rage impairs their cognition, therefore impairing their judgment. During the rage they are prone to shouting, fact distortion and making groundless accusations… [N]arcissists may even search for conflict to find a way to alleviate pain or suffering …

Sound familiar? It certainly reminds me of a number of VBAC and homebirth advocates, including their propensity to distort facts and make groundless accusations against anyone who disagrees with them.

In other words, for VBAC, homebirth and some NCB advocates, not having an uncomplicated vaginal birth is viewed as an imperfection. Hence the use of words like “failed” and “broken”, the insistence on comparing birth to competitive sports, and the use of goofy birth “affirmations” that are all variants of “I can do it.”

Keep in mind that a narcissistic injury is not simply an imperfection. It is an imperfection that threatens the narcissist’s protections against feelings of inferiority.

For example, many people need vision correction, but the overwhelming majority are able to accept that their eyes are not perfect without viewing it as a fundamental deficiency. Similarly, many women have C-sections and view the surgery as nothing more than one of many acceptable ways to have a baby. In contrast, a small proportion of women have such a fragile sense of self, and have constructed such elaborate defenses to protect against these feelings, that a C-section is experienced as a “failure,” a sign of being “broken,” and an insupportable assault on a very fragile sense of self-regard.

Experiencing C-section as a narcissistic injury can explain many confusing aspects of homebirth and natural childbirth advocacy, particularly among advocates who have already had a C-section. The refusal to see a doctor (with some women even refusing to see a midwife) can be explained as the inevitable result of regarding even the possibility of pregnancy complications as personal criticism, combined with the inability to tolerate criticism of any kind. Homebirth midwives are notorious for pretending that complications are “variations of normal” and for praising women for highly risky decisions. Unassisted birth can be viewed as an effort to make absolutely certain that there is no one to dent their fragile self-esteem by questioning them in any way.

It can also explain the seemingly inexplicable reactions to the death of a baby at homebirth. Reacting to a baby’s death by being “proud” of oneself for having a vaginal birth is extremely bizarre. However, it makes sense if the mother’s overriding preoccupation is to preserve her narcissistic mask of perfection and keep feelings of inferiority at bay.

The real problem, then, for women who view C-section as “failure” is not the C-section, but the outlook of the women themselves. C-section is experienced as a narcissistic injury, not because it really is an injury, but because women with carefully constructed defenses that keep feelings of inferiority at bay feel those defenses threatened by the lack of perfection.

Obviously homebirth and natural childbirth advocates will be loathe to acknowledge this. Narcissists are notorious for their lack of introspection and their insistence on blaming everything on everyone else. They could never acknowledge that the source of their distress comes from within; they are compelled to externalize it to others who are supposedly criticizing them or disrespecting them.

Adapted from a piece that first appeared on Homebirth Debate in November 2008.

10 Responses to “Cesarean section as a narcissistic injury”

  1. TiffanyEpiphany
    March 1, 2013 at 2:11 pm #

    Highly interesting, making connections between psychoanalysis and NCB/HB movements. Really enjoyed this; thank you for posting it.


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