Photo-Illustration: Josiah Whitfield; Photos: Getty
I spent much of my first pregnancy learning ways to avoid having a caesarean section. The books I read advised doing everything possible to try to have a vaginal birth and were full of recommendations: hire a doula, consider using a midwife instead of an OB, avoid hospitals with high C-section rates, have the baby at home (or at least work from home for as long as you can), and don’t let them coerce you with Pitocin. When I was diagnosed with gestational diabetes, I avoided refined carbs and sugar, testing my blood sugar after every meal to ensure the baby didn’t gain too much weight. As my due date approached, I did modified versions of downward dog, hoping gravity would encourage the baby to roll over.
But as the weeks passed and my daughter’s head continued to lean stubbornly against my rib, my doctor told me that I should think more seriously about planning a C-section. It is not uncommon for a baby to end up in the wrong position: in about 4% of pregnancies, the fetus remains in seat. It is only one of many reasons why doctors may recommend surgical delivery, some more debatable than others. Currently, almost a third of babies in the United States are born by caesarean section, a number that has climbed in recent decades and is more than double the rate recommended by the World Health Organization – hence the proliferation of advice on how to avoid being rushed by your doctor unnecessarily.
From my research, I figured out that having a C-section was weird and unpleasant and after that just about anything would hurt. If you asked me what my biggest fears were about any type of surgery, I would probably say waking up and feeling the procedure as it unfolded. Both are regular occurrences with cesarean section. In the majority of cases, women are conscious when surgeons make the incision. Most caesareans are performed under regional anesthesia, which numbs the lower part of the body; I was told it wouldn’t be painful, but I would feel some pulling and pressure as the surgeons removed the baby. The diagrams illustrating how the doctors separated my skin and my abdominal muscles made me feel sick. Even worse, the much-discussed 2008 documentary The business of being born, which includes long images of cut and open women. by Emily Oster expect better note it increased risks, including infection and complications in future pregnancies, and points to the “much worse” recovery. “For weeks, you may feel pain with any movement that uses your abdominal muscles (sitting, lying down, standing, rolling over, walking, etc.),” she writes.
Once I accepted the fact that I was probably going to need a cesarean, the planning was a relief. Part of me was sad that I couldn’t experience the work on my own, but I also felt like I had been given a cheat code. The birth had always seemed like a huge unknown. It was comforting to have a plan.
My doctor scheduled me for surgery at 39 weeks. My husband and I showed up at the hospital with an embarrassing amount of luggage, clothes, and other supplies for a few days. “Are you ready to have a baby?” the nurse asked happily, leading us to our room, as if we were checking into an all-inclusive resort. Once they confirmed the baby was still breech, they hooked me up to an IV and shaved the top of my pubic hair where the incision would be.
I felt relatively calm until they drove me to the operating room. The room was brightly lit and freezing, filled with people in work clothes milling around. I was shaking as I sat on the edge of the table, bent over so the anesthesiologist could thread the needle through my spine. The OB held my hands, telling me I was fine, but I wanted my husband in the room; I want to cry; I wanted to ask them if they could please slow down.
The anesthesiologist inserted various needles into my lower back, tapping my thighs and asking, “Can you feel that?” I wasn’t sure and was terrified of giving the wrong answer. Eventually they decided I was numb enough and put me on my back. Suddenly I was like a starfish, my lower body paralyzed and someone was digging around my genitals to insert a catheter. They had put up a screen so I couldn’t see what they were doing, but I could definitely feel it. The next thing I knew, my husband was there, smiling in a surgical cap.
They told me it would take about three minutes to get the baby out. I could hear them talking and feel them doing something to my abdomen, but I tried to dissociate myself, like you do at the dentist when you pray they’re done already. They told me to get ready as they pushed on my stomach. Then I heard someone say, “Mom, look!” They held the baby and I felt disbelief. Who was this little creature, face contorted, body covered in blood and vernix? It didn’t feel real that she was inside me.
Tears streamed down my face as I lay there watching them carry her across the room to weigh and clean her. I felt both overwhelmed and relieved: she was there, she was alive. I had spent so much time imagining what it would be like to hold her to my chest, but when they brought her to me, it was awkward. The doctors were still stitching me up and I couldn’t fully move my arms. It was exciting to see her mouth instinctively seek out my nipple, but as she squirmed, I felt like I needed two extra hands to support her head and hold it in the right position. I wanted to hand it over to someone more competent.
I spent the next 24 hours in bed. I had been uncomfortable with the idea of a catheter, but after being pregnant for nine months, going an entire day without having to get up to pee felt luxurious. Still, I was afraid to sit down, let alone look at my incision. I was afraid it would hurt me when they massaged my uterus or removed the catheter and staples. I dreaded having a bowel movement, which I had heard would make my bowels feel like they were falling out.
Much of my recovery is hazy, probably because as soon as the baby was born I had a lot of other things to think about. I don’t want to sugarcoat it: aside from microwaves to warm up my heating pad, I didn’t walk much that first week after giving birth, and when I stood for more than a few minutes , my incision started to burn. I was grateful to the friend who told me to take stool softeners and ask for the right painkillers. I also appreciated having doctor’s orders to take it easy. It seemed appropriate to rely on my husband to bring me a glass of water or a sandwich while I was breastfeeding. The arrival of my daughter completely changed my life, but I came away feeling that my C-section was not as bad as I had been led to believe.
The majority of the literature on childbirth, with some exceptions, still operates under the assumption that a C-section is an inferior way to give birth. Much of what I read seemed meant to convince me that I shouldn’t resent it. Encouraging women to educate and advocate for themselves in the delivery room is obviously well intentioned. There is evidence that doctors are encouraged to perform caesarean sections for profit and efficiency, even when it is not in the best interest of the patient. But reading many popular books on childbirth, it’s easy to come away with the impression that it’s a woman’s responsibility to avoid being subjected to a cascade of unnecessary medical procedures, even if his doctor advises him otherwise. “Part of childbirth in the 21st century involves understanding two categories of caesareans: those that are necessary for medical reasons and those performed for other reasons,” writes the midwife. Ina May Gaskin. There are plenty of good reasons for not wanting a cesarean. But talking about surgical deliveries primarily as the worst-case scenario to avoid — despite the fact that more than 30% of American births occur this way — perpetuates stigma and fear. Leslie Jamisson observed that “although the backlash to caesarean section was born out of an impulse to empower women, it perversely became another way of shaming mothers, or making them feel inadequate, as soon as they gave birth.”
None of this negates the experiences of those who have found a C-section traumatic. If I had felt pressured or rushed into surgery for obscure reasons during childbirth, as many do, my feelings would probably have been much more complicated. The medical profession has also made efforts to improve the experience: It is now more common for a mother to hold her baby soon after surgery, and many doctors allow patients to use a clear screen if they want to watch their baby being born (such as for a vaginal birth). I also wish my doctor had talked to me in more detail about everything that was going to happen beforehand. For me, the worst part was not knowing what to expect.
I came away from the experience feeling cheated not because I had had a C-section, but because I had been made to feel so bad about it. A C-section was the safest and most realistic option for me, although sometimes when I hear women, including Gaskin, talk about the transcendence of “natural” childbirth, I still feel to have missed something. The truth is that my birth was also an out of body experience. Even though I was lying on an operating table with half of my body paralyzed, it was still the most intense and unreal hour of my life. In the end, I got what I wanted, which was a healthy baby. Now, over a year later, my scar is still oddly numb to the touch, a detail I take perverse pride in telling people. It’s not that I like it, exactly, but it’s part of me – and part of me and my daughter’s story. Even if I could do it again, I wouldn’t change it.