This week’s Takedown comes in the form of a picture. A friend of mine joined the group “Occupy Breastfeeding,” which seemed like an interesting topic, seeing as my kid is practically old enough to drive and refuses to give up the boob. I was hoping it might be a support group for women whose kids stage sit-ins against weaning. But no. It wasn’t. Instead, it was one of those groups that is aggressively focuses on Breastfeeding At All Costs Until Your Child Graduates From High School or Becomes Pregnant On Their Own, Whichever Comes First (actually, my kiddo would probably appreciate that kind of group, too). Anyway, one of the first posts I saw was this gem:
Should this Cesareans-are-forever propaganda show up in your feed, here’s a quick, copy-and-paste-able answer: “Actually, C-sections take between 2 and 15 minutes. Isn’t modern science amazing?”
I get this shit on my feed all the time. For some reason, there has been a connection by some people of morality to birth experience. A woman who pushes a fetus out of her vagina without the use of medicine or any sort of intervention is somehow superior to the wussies who don’t. And to get a C-section ““ you might as well just admit that you are an abusive asshole.
Maternal death rates are also high for an industrialized nation, at 12.7 per 100,000 births. The following chart shows the rise in C-section rates and the rise in maternal mortality rates.
SHOCKING, right? I’ve seen approximately one million crapdates that say, basically, that C-sections are killing Americans left and right. However, if we look at another chart, which breaks down the maternal mortality rates by cause, it seems to be something else entirely.
The thing is, over time, we would expect for the rise in maternal death rates to be caused by, well, C-sectiony things, if C-sections cause death. However, C-sectiony things are embolism and hemorrhage, which have remained constant or even gone down over that time period.
The truth of the matter is that we changed the way that maternal mortality is defined in 1999, which may explain the rise.
So. What ARE the issues with the high C-section rate? According to the Mayo Clinic, your uterus could become inflamed and infected, you could have increased bleeding, you could have a bad reaction to the anesthesia, you could develop dangerous blood clots, your wound could get infected, you could have surgical injury, and you have a higher risk of complications in future pregnancies.
Let’s compare that to cosmetic surgery. According to the Mayo Clinic, your surgical area could become inflamed and infected, you could have increased bleeding, you could have a bad reaction to the anesthesia, you could develop dangerous blood clots, your wound could get infected, you could have surgical injury, and you could have breakdown of the skin, which would require further surgery.
This is to say: the risks of the C-section, while different from plastic surgery because it is a different part of the body, are standard fare for any surgery. And while many say that C-sections are often unnecessary, plastic surgery is arguably rarely or never necessary. However, I have yet to have something show up in my news feed trying to shame me out of plastic surgery, even though that show The Doctors on CBS is constantly trying to convince me that it would improve my life.
And there are maternal benefits to C-sections, especially planned ones: reduced risk of urinary incontinence, fecal incontinence, avoidance of labor pain, alleviation of fear and anxiety, reduced worry about the health of the baby, and being able to control the birth. These are never talked about by the crapdate crusaders.
There are also risks associated for the baby during a C-section, including an increased risk of respiratory problems (if you compare term babies to term babies, it’s 12 per 1000 vs. 5 per 1000), an increased risk of premature birth if the C-section is planned and the gestational age was calculated incorrectly, and potential surgery injuries (accidental cuts).
Babies born vaginally, though, face different risks. Those born without any assistance have an increased risk of brain hemorrhaging. (This is early data – it is unclear how these hemorrhages affect the child as it grows.) Those that were born with assistance, like forceps or suction, have an increased risk of brain injury or “other birth injury.”
With a C-section, there are benefits for the baby, as well: unexplained or unexpected stillbirth seems to be reduced by C-sections, lower risk of labor complications like chorioamnionitis, and a lower risk of fetal heart rate abnormalities and cord prolapse. To be honest, until I researched this piece, I had no idea that there were any associated benefits to the baby of a C-section. The benefits aren’t spoken of, because C-sections are inherently evil.
When we look at all of the benefits and risks, it is clear that a C-section is like any medical procedure. Even the scheduled C-sections, even the ones where a woman wants a baby born before New Year’s or a doctor wants to go on vacation.
But why is it any of your fucking business?
The fact of the matter is, these types of pictures are not presented to inform, and while the crapdate poster may feel like they are championing an important cause that SAVES BABIES! and SAVES MOTHERS! and SPREADS KNOWLEDGE!, what they are really doing is attaching a moral significance to something that is really none of their fucking business. Why should somebody else care if a baby exits my vagina or is cut out of my abdomen? No, really. Why is that up for debate by anybody?
Because it isn’t simple, and people who are propagating a moral superiority because of the way they birthed children are just wrong. According to the American College of Obstetricians and Gynecologists:
If taken in a vacuum, the principle of patient autonomy would lend support to the permissibility of elective cesarean delivery in a normal pregnancy, after adequate informed consent. To ensure that the patient’s consent is, in fact, informed, the physician should explore the patient’s concerns.
The article goes on to explain what is meant by the “if taken in a vacuum” part of the quote. Elective C-sections do have higher risks to the mother and the child than vaginal deliveries, depending on how you weigh certain risks and certain benefits. However, emergency C-sections have the highest risks of all ““ so planning for an elective C-section is actually in the middle, and those that decide to try for a vaginal birth when they are at high risk for a C-section may actually be better off planning the C-section to begin with.
In other words: if you refuse a planned C-section, you may end up with an emergency one, which has higher risks. Going around insisting that people who have planned C-sections are terrible people who only care about themselves completely ignores that side of the equation; many times, planning a C-section actually mitigates the risks.
The danger of the crapdate, though, goes beyond looking like a smug asshole. Perpetrating this idea that a woman who has a C-section is less of a person is mean, reprehensible, and dangerous.
There are real, awful reasons why you might need a C-section. After all, the World Health Organization suggests that the rate should be about 15%. Among the reasons why you might need one: your baby’s head is too large to fit through the birth canal, the shape of your pelvis isn’t working for the birth, you have placenta praevia, your child is in a difficult position, your child’s feet are coming out first, your baby is distressed because of lack of oxygen, you have eclampsia or severe pre-eclampsia.
I’ve heard people say that the female body is designed to give birth, that women have been doing this for millennia, and that a woman’s body will just know how to do it, so a C-section is interfering with the natural processes. This just isn’t true. Maternal death rates in America were around 1000 per 100,000 in 1900, down to about 12 per 100,000 live births today. Modern medicine, and this includes the ability to perform a C-section, has drastically improved a woman’s chances of making it through labor alive. According to Dr. James Low’s article, “Caesarean Section–Past and Present,” published in the Journal of Obstetricians and Gynaecologists of Canada (2009):
The role of Caesarean section in the management of labour and delivery has been an important consideration during the last five hundred years. Developments during this period, reflecting the achievements of health care professionals, have led to a striking decrease in maternal mortality, particularly during the last 150 years.
Suggesting that C-sections are superfluous and nature conquers all is absurd.
And then there are the consequences. The woman who was charged with murder after refusing a C-section led to the death of one of her twins. Or the hospital being investigated for refusing to give C-sections and a high rate of stillbirths and/or maternal death. Or the woman who wanted a C-section but was not given one, and whose child suffered brachial plexus traction injury and shoulder dystocia due to his size ““ leading to permanent disfigurement and necessary surgeries.
Let me talk a little bit about my own experience. Labor was the worst day of my life. I was in distress, to say the least, and my 9-pound baby was, too. My doctor tried to suction her out, which led to a scabbed, bloody, and misshapen head, and the baby eventually tore me open from hole to hole. In the midst of all of this, I trusted my doctor completely, and when she suggested a C-section, I nearly cried with relief. The baby ended up ripping her way out of my vagina, but at that moment, I am so fortunate that I was not thinking about the shame of a dreaded C-section.
And I shouldn’t have been thinking about it. Bearing a child is an enormous strain on the body. I can’t imagine any other situation in which a person is so overwhelmed, physically and psychologically, and yet whose choices are somehow connected to their inherent value as a person. I trusted my doctor. My doctor had 25 years of experience after 8 years of intense training. My ability to take in shitty crapdates advertising the moral value of certain types of births over others does not trump that.
Because isn’t that what this all comes down to? Somebody who sees this type of propaganda knows, going into labor, that to end up with a C-section is something to feel deeply ashamed about. The psychological cruelty that this lays on a new mother, at a particularly vulnerable time in life, is disgusting.
I’m not saying that all doctors are trustworthy. Hopefully by the time the baby is crowning, the woman has found a doctor that she trusts.
What I am saying is that every birth story has its own factors. And every mother has the right to decide for herself what risks and benefits are the most significant for her.
Maybe you had a non-medicated, fairy-dusted birth experience. Maybe you convinced your doctor that you would rather die or let your baby die than to have a C-section. Maybe you gritted your teeth and made it through a 9-pound baby and a fourth degree tear, and you never felt that you or your baby might die if you didn’t take certain measures. Good for you. Celebrate your good fortune.
But don’t try to extrapolate from your experiences onto anybody else’s. C-sections are not forever. Shame is forever. And by laying it out thick onto people who have acted in the best interest of their child, you are being a disgusting human being.