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.