In Praise of C-Sections

You know who makes a really macho crowd? Biological mothers. I have watched people who for most of their lives have espoused a mainstream, less-is-better approach to pain suddenly bragging about it as though the involuntary firing of their nociceptors were an achievement. People who are completely pleasant as a rule will hear the word “epidural” and SHOONK they are transformed into The Uterus Gladiators! With savage glee they race into a totally imaginary arena, to compete with other savagely gleeful person-hatchers, in an epic fight to decide once and for all who had the most pain in childbirth, and–importantly–who sought the least relief for that pain.

Whee! This is fun! Pay no attention to that octopus.

Whee! This is fun! Pay no attention to that octopus.

You’ve probably guessed I have limited patience for this brand of one-upmanship. There are women in my life whom I deeply respect that have chosen home birth (okay only one woman but I respect the living daylights out of her judgment), and lots more that have chosen to forgo pain relief in a hospital delivery. That is a totally awesome choice if it is a thing that you want to do, and I’m glad that activists over the years have succeeded in making these options available to everyone. But if that is not your thing, oy gevult don’t feel ashamed of yourself. Like any kind of treatment there are costs and benefits to pain relief in childbirth, but that doesn’t make it bad. I’m hereby giving you permission: you do not and should not have to justify the decision to relieve your pain.

The Uterus Gladiators, however, are nothing compared to the Vagina Valkyries. You know who I mean. The women who have experienced a vaginal delivery and now feel lifetime superiority over the women who required or–gasp!–chose a surgical delivery.  “I had a baby with no medical intervention,” I hear one of them bragging before yoga class, shortly before sprouting wings and flying off to adjudicate some Norse battle deaths. You’d really think from the sound of it that medical intervention was a vice.

C-sections are often not a matter of choice, but a life and/or death situation. Sometimes they are a measure of last resort after the first, second, and third choices have been exhausted. Some c-sections are elective, but the term “elective” is loaded. Are the consequences of not electing this procedure acceptable? That’s subjective. And that’s what bothers me about the push to shame patients out of seeking medical care by convincing them that they are less–less strong, less brave, less womanly, less maternal, less natural, less smart, less aware, less educated, less thorough, less fierce in standing up for their rights, less resistant to domination by medical practitioners. My husband refers to this movement as “the crunchy granola arm of the patriarchy.” I call it rudeness personified.

Maybe it’s time for c-section veterans to start bragging. “Yeah, boyyyyy, I had a major abdominal surgery, and they took a baby out of me. And then I HEALED. And didn’t have any INCONTINENCE. And my vagina has not lost any TONE. Yeah! Yeah! Wooa wooa!”

This might be the time to warn you there’s a picture of a baby being born via c-section at the bottom of this post. If you’re not so good with such pictures, you may want to scroll slowly.

There is a real public health issue at play here. Per the WHO, ideally 10-15% of all deliveries should be c-sections. Fewer than that constitutes “underuse,” which is common in developing countries, and more constitutes “overuse,” which is common in developed countries. Where I live the rate is close to 30%.  So is this a problem, and if so how big? It’s an area of heated debate. Almost all of the evidence comparing c-sections to vaginal deliveries is observational, meaning it comes from studies that compared outcomes from women who wound up with c-sections to outcomes from women who wound up with vaginal deliveries. Obviously, women don’t wind up in these categories at random, so some factors will predict both choice of a c-section and risk to mother and baby, creating spurious associations. I’m personally skeptical that all such factors can be measured and controlled-for in an observational study.

I’d really like to see some randomized trials to help guide decision making, but to date there are almost none. The evidence base, in short, is lacking. Do remember this when everyone starts shouting. However, be comforted by the fact that one reason there isn’t a huge rush to conduct such a randomized trial is that both methods of childbirth are quite low risk. Even if one does turn out to be safer than the other when all the evidence is in (someday, I hope, sigh), this is still a choice between good and better.

I totally hear the historical argument about how birth has been medicalized, and I’m right there with anybody who wants to argue that pregnancy and birth are normal and should not be treated like diseases. But birth also involves things that are the rightful province of medicine–pain, organ damage, morbidity, mortality. No one should be required to make their decisions about these things differently than they would in another context because they are choosing it for a birth. And they are also not required to justify their choices (I said it again). Every birth is different, and you really don’t know what you would have chosen if you had had someone else’s birth experience–this goes double for cis men.

This is not just another I’m-okay-you’re-okay everybody’s-choice-is-great post for the feminine blogosphere. This is a post in praise of c-sections. I am so glad that this surgery exists. I am so glad that we have come far enough that not being able to expel a baby from your body in the traditional way does not mean that it has or you have to die. Cesarean sections save lives. Sometimes they are awesome. So how about we dismiss the Vagina Valkyries with the eyerolls they have earned, and turn our attention to making this life-saving surgery available to every woman around the world that needs it. Or wants it.

This is objectively awesome.

This is objectively awesome.

Photo Credits
Vaginal birth art: Lynn Friedman via photopin cc
C-section photo: emergencydoc via photopin cc