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salon.com > Mothers Who Think August 2,
1999
URL: http://www.salon.com/mwt/feature/1999/08/02/c_section
Cut me
open!
I just had my
second scheduled Caesarean and, yes, I still consider myself a
feminist.
- - - - - - - -
- - - -
By Jean Hanff Korelitz
First,
the horror stories.
A little girl, a friend's half sister. She's a teenager now,
alive but completely paralyzed and muted by an obstetrician's
failure to perform a timely Caesarean section on her mother, who was
trying for a natural birth.
A newborn baby boy, whose mother, my friend, had a history of
problems relating to her placenta, and the added misfortune (in this
instance) of being British. In Britain, there is an even greater
effort to limit the use of Caesarean sections than exists here in
America. When the mother's placenta abruptly detached from her
uterus, a rushed Caesarean was indeed performed, but it was too
late. Her otherwise healthy son lived 17 minutes.
I just had my second planned Caesarean section. Anyone want to
fight with me?
Yes, yes, I know natural birth was born of the women's movement.
I know about those midwives down on the
Farm in Tennessee who rhapsodized about "the surges" (that's
contractions, to you and me) in their classic book, "Spiritual
Midwifery," and reminded us that labor is an _expression_ of female
power, an umbilical connecting us directly to the goddess, the
earth, our higher power as we understand her. We're supposed to
eschew pain relief in order to experience fully our transformation
into mothers and the rush of new life.
I understand all that. I even respect it. But I maintain that, in
the end, the natural birth movement has done a great disservice to
women. That its insistence that a mother can and should control her
labor -- equipped with "birth plans" and proscriptions about fetal
monitors and episiotomies -- is both illusory and damaging to women.
Because when you get right down to it, labor can be neither planned
nor controlled; its a kinetic, quicksilver process that may slip
instantly through the fingers of the best doctor or midwife, who
must then be ready to react with any and every available response --
including C-section -- to avoid a tragic outcome for mother, child
or both.
It's the preachiness of the natural birth phenomenon that I can
least abide, the sympathy and tut-tutting of other women when they
discover you've had a Caesarean (the sympathy is if you had
to have one; the tut-tutting if you chose to). And, worst of all,
the utterly unnecessary self-castigation of mothers themselves,
wrought by this absurd requirement that we have a "good" and
"successful" birth experience.
I remember the first of these mothers I encountered, seven years
ago in a prenatal exercise class. She had a young child already and
tearfully confided to the rest of us, first-timers all, that she had
originally planned to wait another year or two before having a
second baby, but the failure of her first birth experience (she'd
been "forced" to have a Caesarean by the fetal distress of her baby
during labor) had proved so overwhelmingly and lastingly upsetting
to her that she felt compelled to try again, as soon as possible, to
"get it right."
This smack of failure, this sense of falling short despite the
best intentions to be "natural," is something I've heard again and
again from otherwise sensible women. And seldom, if ever, do they
pause to consider what the consequences of that catalytic fetal
distress or erratic heartbeat might have been, had some
authoritative and scalpel-happy doctor not burst their bubble by
commanding a Caesarean. It seems to me that the fear of doing it
wrong has replaced our fear of dying in childbirth (which is
now, thankfully, very rare) and surpassed our fear of losing our
baby in childbirth (which is also, thankfully, very rare). But try
thinking of each and every one of those disappointing emergency
Caesareans as a baby who didn't die, or wasn't devastated by oxygen
deprivation on the way to being born. Get the picture?
Of course, adherents of the natural birth religion aren't the
only ones down on Caesareans. There are perfectly sane women who
fervently wish to avoid them on a variety of seemingly sensible
grounds, chiefly a perception of greater pain and a longer recovery
period than that associated with vaginal birth. With the
understanding that I speak only of scheduled Caesarean sections --
and not emergency surgery following long hours of labor -- allow me,
please, to dispel these myths.
Myth No. 1: pain. Sure, a Caesarean is painful, at least
immediately following the surgery. You can't expect to get off
scot-free. When that spinal block wears off, you may feel, as I did
seven years ago, as if Hulk Hogan were sitting on your abdomen. And
yet I clearly recall clicking away at my handy morphine drip and
listening to some poor woman screaming down the hall. I was in pain,
but my pain didn't approach that pain. And it quickly got
better.
Myth No. 2: a long recovery period. Here, it's important
to take into account the extenuating circumstances of a scheduled
Caesarean. You know when you are going to give birth -- it's
scheduled. You go out to dinner the night before, for a festive (if
non-alcoholic) farewell to your childless state. You go home. You go
to bed and sleep a civilized eight hours. (Farewell to that too, but
that's another story.) You wake up in the morning, read the paper
and drive to the hospital. You have your baby. You begin your
recovery. Stairs and lifting will be difficult for a while. You'll
have to press your hand against your abdomen when you cough or
sneeze. On the other hand, you won't have to sit on one of the those
silly doughnut pillows while your episiotomy heals. I was back in
exercise class two weeks after my daughter was born.
And let us not forget: One of the more horrific truths of
modern obstetrics (or, more accurately, modern medical insurance) is
the lightning-quick hospital stay for a vaginal birth, a rule that
shoves you out the door, in some cases, within hours of giving
birth. A Caesarean section, on most plans, buys you four days of
hospital time -- four days in which you can continue to be checked
by your obstetrician and your baby by his or her pediatrician, four
days in which you can sleep between feedings and the nurses can show
you again how to get the baby to latch on or how to clean the
baby's navel. I'll never forget an Australian woman I met during my
stay in the maternity ward. In Australia, she sighed, the postnatal
stay was a mandated eight nights, and on the final night, the nurses
watched the baby while you went out for dinner with your spouse. I
liked that woman. I always wish I'd gotten her name, but I didn't
have a chance. She was out the door too fast.
Seven years ago, during my very first obstetrical appointment, I
asked my doctor if I could choose a Caesarean. She frowned at me.
One did not choose a Caesarean; they were scheduled for
medically indicated reasons only. Months later, my daughter
obligingly got herself into a footling breech position. "Well it
looks like you're going to get that Caesarean you wanted," my doctor
said.
Last fall, when I became pregnant again, I asked her again for a
scheduled Caesarean. "Hmm," she said, considering. A first C-section
doesn't necessarily confer inevitability on subsequent ones.
Successful VBACs (that's Vaginal Birth After Caesarean) are often
touted by secondarily successful natural birth enthusiasts. But
during the intervening years, my doctor had undergone a few changes
of her own. A marriage, a difficult pregnancy, a Caesarean, a
healthy baby. "It's fine with me," she said.
You may call me reactionary if it makes you feel better, but I
can assure you that my feminist credentials are intact, at least
where I think they count -- my daughter's life is a Barbie-free
zone, my surname unchanged since my parents gave it to me. I don't
advocate a return to the kind of gassed-into-unconsciousness birth
experience condemned by Jessica Mitford in "An American Way of
Birth," nor do I hold with Joan Rivers' version of the ideal labor:
"Knock me out with the first pain, wake me when my hairdresser
arrives." I'm only urging a return to perspective.
Historically speaking, women and infants died in childbirth until
a very, very short time ago, too short for us to forget (or at least
fail to imagine) what that must have been like. The advances --
Caesarean section among them -- that made labor and delivery safer
for us and our children are to be welcomed with gratitude as the
valuable, lifesaving tools they are, not distrusted as the long
fingers of the patriarchy. To condemn the widespread use of
Caesareans is as nonsensical to me as condemning any other advance
that has contributed to the relative safety of modern childbirth.
Though the precedent is certainly there: 150 years ago, Hungarian
obstetrician Ignaz Philipp Semmelweis was hounded to an early death
and ridiculed by his colleagues as "the Hungarian crank" for having
the temerity to suggest that doctors wash their hands after leaving
the autopsy room and before examining their recently delivered
patients -- a small innovation that would ultimately make the
dreaded epidemic of childbed (puerperal) fever virtually
unknown.
A successful birth is not a birth without drugs or monitors or
surgery. A successful birth is when you're alive and the baby's
alive. Feel free to bring along any mood music you want, but if you
lose sight of that priority, then you really have failed your
first act as a mother.
salon.com
| August 2, 1999
