Takedown: ‘Tis the C-son.

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.

Some facts: currently, the C-section rate in America is 32.8%. This is, without question, high. According to the World Health Organization, that number should be more like 15%.

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.

Taken from http://skepticalob.blogspot.com/2010/03/hold-handwringing-is-maternal-mortality.html

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.

Taken from http://skepticalob.blogspot.com/2010/03/hold-handwringing-is-maternal-mortality.html

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.

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Susan

I am old and wise. Perhaps more old than wise, but once you're old, you don't give a shit about details anymore.

17 thoughts on “Takedown: ‘Tis the C-son.”

  1. One of the things that’s led to the increase in frequency of C-sections is the management (and encouragement) of labor through drugs — labors are rarely as long as they naturally might be, which in turn normalizes a shorter duration of labor (which is what leads to the diagnosis of “failure to progress,” which often leads to a C-section.) It was normal back in the day for women to labor for three days the first time a kid was on his/her way. What scares me about the increase in the frequency of the C-section is not the surgery itself (which certainly is necessary at times and undoubtedly saves lives). What scares me is the overuse of drugs that change what counts as a “correct” labor. The biggest thing about birth is that it’s incredibly unpredictable. You need all the resources at the ready (or on call) should it take a turn in an unexpected direction, but deciding that there’s a protocol to be maintained denies the many different ways a labor and a birth can go and still be perfectly healthy for everyone involved.

    1. This is a good point – that “normal” and “dangerous” are not absolute and their definitions change. Then again, when women would labor for days and days, many more women died in labor.

      I don’t believe in the beauty of an unpredictable labor. I think this is what really sets me apart from a lot of people in these arguments – I don’t personally see labor as something miraculous and beautiful in and of itself, but instead, it’s a physical situation that needs to be resolved. This might make me an awful person. But coming from that perspective, I don’t see any inherent value of choosing a certain way just because it seems to be more miraculous.

      Maybe this is a bad analogy – but I’ve never heard anybody talk about the overuse of drugs in dental surgery. My husband is terrified of going under, so he doesn’t, and he does all sorts of terrible surgeries with just local anaesthetic. To him, the risks are too high to go under…but it would be weird for him to talk about how other people are overusing drugs, right? Drugs change labor, it’s true, but for some people, that’s not bad.

      I guess what I’m saying is that everybody weighs the benefits and risks as they perceive them. To me, there is no benefit in a vaginal birth over a C-section just because it was vaginal. To other people, it is hugely important, and that benefit outweighs some of the risks – so they are willing to push for a certain kind of birth even if risks build.

      And the danger comes when I use my perceptions of what is important to tell you what kind of birth story is right.

  2. I was talking to a friend once about how women who have C-sections are villainized by the media. They’ve got this “Too Posh to Push” character they trot out whenever there’s a story about C-sections in the news. They use this (probably) entirely fictional bitch time and again because everyone loves to hate her. In reality, you’re going to find way more women who have had C-sections because they were medically necessary (or at the very least, advisable) than women who schedule as a matter of convenience or vanity. 

    1. Yes! Where does this mythical lady exist anywhere? I certainly don’t know her. Of the many girlfriends of mine who have children, at least 6 of them (myself included) have had a c-section. The reasons are: baby was too large and head wouldn’t fit through the canal (me), complications due to pre-eclampsia, complications due to internal bleeding caused by a previous medical problem unrelated to the baby, laboring for three days without ever dilating past 2, and the baby being in extreme distress. Not one of those women chose to have a c-section; all of them HAD to have one lest them or their babies be in extreme danger; and ALL of them, myself included have had some smug idiot tell us that we should have ‘tried harder’.

      C-sections are surgery. They are extremely painful to recover from, they alter your appearance forever, they rob you of the birth experience, and if that weren’t enough, they are attached with such stigma and guilt, why would anyone voluntarily elect to have one unless they had a damn good reason? The judgment just boggles my mind. I mean, it’s great if you have a miracle birth without the use of drugs and you have your doulas on hand and everything was sweetness and light, but that is not everyone’s experience. What is the point of shaming those who had to take a different course?

  3. It’s weird, if I had been given a choice I don’t think I would have gotten a c-section. It has nothing to do with feeling like more of a woman, it’s more that I’m stubborn and if I started giving birth, I would damn well finish. That said, I have had one of each and neither made me feel more or less like a real woman than the other. And I wasn’t given a choice about the c-section, my water broke in a big way and my daughter was still breech. They needed to get her out as fast as possible before she suffocated. I don’t really understand scheduling a birth, I’ll admit, but my c-section saved my daughter’s life and anyone who has a problem with them can go screw.

  4. The first jerkoff who tries to judge my son’s birth gets throatpunched, end of story. He was born healthy (10lbs 2 oz healthy!), I enjoyed a magical epidural, and I didn’t feel third-degree tearing. WIN-WIN. As far as I’m concerned, it’s just another way for people to attempt to exert their opinions over our reproductive choices.

    1. I think people should be careful about the term “pushing.”  Other than the fact that it’s a trigger for a pregnant lady.  Hahahahaha.

      Just kidding.  Back to my original point.  There are lots of doctors who suggest them, probably more than are strictly necessary, as is evidenced by the fact that there are nearly twice as many as the WHO suggests.  But I think the terminology used is indicative of the type of crap that’s going around…that language is, in and of itself, meant to aggravate.  “Talking about elective C-sections that might not be necessary” sounds entirely different, no?

      1. Yep. I’ve heard that argument a lot. “Oh, but doctors push for them when they aren’t necessary, my post/article/opinion is just to educate women on that”. But, as far as I’m concerned, most women are astute enough and in charge of their own faculties enough to say to the doctor, “Hey, that’s not my birth plan, can we go a different route? Or at least try?” And if the doctor isn’t agreeable, you CAN switch doctors. I think it’s true that more doctors suggest c-sections these days when perhaps they may not have in the past, and that could be blamed on a number of factors, but ultimately, it is still the woman’s choice how she chooses to have her child, and if she trusts her doctor’s judgement, and she is happy with the outcome, then I have no problems.

  5. I plan to be a wuss and have ALL THE DRUGS and if the doctor says I need a C-Section, I am having a mother flipping C-Section.  

    I was born via C-Section because I had a big-ass head and I have a feeling my babby is going to have a big-ass head so I’ll be happy for it to be out any way possible.

  6. I am so happy to read this!  I’ve had two friends (tiny women, really) give birth to rather large babies for their bodies, and both of them should have had c-sections, but they were scared away by doctors and other friends and acquaintances.  Their bodies (and in one case the baby) paid the price in scarring and trauma.  In the case where the baby was injured, she had some sort of palsy which required therapy for several months after birth.  Thankfully she is ok now, but the thought that these women were shamed into vaginal births which were actually the wrong choice for them, and could have been more dangerous than they were, is indefensible.

    No shame for birthing choices please.

  7. 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.

    Oh, goodness. Yes. I wonder if people who behave this way realise how much they contribute to birth trauma, alongside the birth itself? Also, why do other people seem to think that knowing how you gave birth means they had access to your medical record, and as such, know precisely what happened during the birth?!

     

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