By Maana Lindqvist*
As we near the end of April 2021 Caesarean Section Awareness Month, I wanted to share a few thoughts with you. In particular, I want to talk about the dichotomy of discourse and its implications for birth. What I mean is that there seems to be a chasm between emotions, actions and acceptance between different types of birth. This is partly because of the language used to describe cesarean and vaginal delivery, and partly because of how that language affects thoughts, feelings, and emotions, even individual actions, in our society. Let me explain.
C-section. Often we see it being referred to as “C-section” or simply “section”. It’s a surgical procedure with an intriguing history, which I’ll get to a little further below. However, vaginal birth is often referred to as “natural birth”. As an avid student of linguistics during my undergraduate studies, this bothered me. Actually, it was starting to bother all of us here at Lola
During its development, cesarean section surgery has had different meanings for different people at different times. However, it is important to remember that the original purpose was to retrieve the baby from a dead or dying mother to save the baby’s life, or to bury the baby separately as religion required. It wasn’t done to save Mom’s life. What makes the story of Julius Caesar’s birth improbable: The story goes that his mother was alive to hear about her son’s invasion of Britain. It is possible that the name came from Caesar in another way: he decreed in Roman law that all women who died in pregnancy had to be cut open to save the baby and increase the population. However, it is just as likely that the name is of Latin origin, since “caedare” means “to cut” and babies born by cesarean section were called “caesones”. Sounds brutal doesn’t it, cutting babies out of mothers just to increase the population? Interestingly, you may have noticed that I was referring to a cesarean “operation”: it wasn’t until Jacques Guillimeau’s book on midwives was published in 1598 that the word “section” appeared, replacing “operation”.
There While women were barred from medical schools in Europe by the late 19th century, it is interesting that the first documented successful caesarean section was performed somewhere between 1815 and 1821 by an Irish woman pretending to be a male and working as a doctor for the British Army served in South Africa.
James Miranda Barry is said to have used Western surgical techniques during the operation, but 19th-century travelers reported that indigenous people successfully performed the procedure according to local medical practice: in Uganda, women were given banana wine get intoxicated easily. The same wine was then used by the healer to clean his hands and women’s abdomens in preparation for surgery. With a midline incision, he would use cautery to minimize bleeding. The uterus was massaged to induce contraction, but the incision was not stitched: instead, the wound was pinned with iron needles and bandaged with a paste made from roots. Similar reports are coming from Rwanda, where botanicals have also been used to anesthetize women and promote healing.
Sounds similar and quite alien at the same time, right? The truth is that caesarean section was a dreaded operation in Europe well into the 20th century. The classic midline incision meant a high maternal mortality rate from bleeding and subsequent uterine rupture. Even with aseptic surgical technique, sepsis was common and fatal without antibiotics. I’m not sure how many, but one estimate is that for 90 years, between 1787 and 1876, not a single woman survived a caesarean section in Paris. In the 18 way.
Things changed in the middle of the century when an American dentist used diethyl ether while removing a facial tumor. Well, that may sound far-fetched, but think about it: diethyl ether has properties similar to propofol and ketamine. It can be used as a general anesthetic. If you’ve ever given birth or had surgery, or been in significant pain for any reason, you might agree that numbing that pain is a pretty awesome thing. No wonder this medical use of anesthesia quickly spread across the Atlantic to Europe. And because childbirth hurts, you’d think obstetrics would embrace this new invention. Unfortunately no, my dear reader. Anesthesia was strongly opposed by midwifery in Europe based on the biblical reason that women must suffer to atone for Eve’s sin. Pretty wild argument for us today, isn’t it? This argument was pretty much defeated when Queen Victoria, the head of the Church of England, ordered chloroform for the birth of her two children, Leopold (1853) and Beatrice (1857). The Queen’s births eventually popularized anesthesia and pain relief during childbirth.
In the last 130 or so years, medicine has evolved the most, with cesarean section evolving from a dreaded operation with high maternal mortality to a staple in the hospital setting. Sterile seams, peelings, dissolving threads… Spinal or epidural anesthesia has largely replaced general anaesthesia. All of these changes have made cesarean sections a safer procedure. Discussion of this has shifted from religious pretense to risk minimization and from maternal health to baby well-being.
With available fetal visualization technology, heart monitors can track the baby’s well-being in real time, and Tools to operate even in the womb, it’s your baby who has become the patient. Medicine has grown with advances in other fields, leading to today: from saving the soul, if not the life, of an unborn child, to saving the distressed mother, to saving both mother and child.
While there is reasonable evidence that cesarean sections have become too common in some societies in recent decades, the operation that once killed women indiscriminately is now saving their lives fear the pain of childbirth, but do not expect it to kill them. That cannot be said of Parisian women of the 18th and 19th centuries, nor of any woman of that time. Moreover, most women today expect children to survive their pain the birth. That’s a modern assumption, dear reader, one that most women throughout history have been unable to make. The cesarean section has transformed the lives of women, unborn babies, and the entire medical profession.
Birth Stories are perhaps among the most important ones we share. During childbirth, parents and child(ren) are equals – they are all stars of the show. Often these stories are shared as we meet other new moms; They are a connecting memory that connects people. But many mothers who have had cesareans have a certain tone to their voice, a subtle sign of disappointment.
Our society has perfected guilt and monetized insecurity. In the New York Times, Thalia Mostow Brühl writes that caesarean sections are at the top of that list, written in permanent marker. If you’ve ever heard of Ricki Lake’s 2008 documentary The Business of Being Born, you might not be surprised. As the story follows a beautiful tale of a vaginal water birth in a home setting, I borrow Mostow Brühl’s words describing the documentary’s take on caesarean section:
“The documentary compares planned C-sections to plastic surgery and referred to them as “designer births” in one scene. The film at times blurs the line between elective and medically indicated cesarean, even going so far as to compare medical interventions during childbirth to the horrors caused by mothers taking the drug thalidomide.”
Conthalidomide, in case you don’t know, was a drug advertised for morning sickness in the late 1950s and early 1960s. Only it later turned out to cause irreversible damage to the fetus, and thousands of children were born with severe congenital deformities. Many of them did not survive more than a few days after they were born.
But let’s get back to The Business of Being Born and the picture it builds about childbirth. We are really only given two choices in this popular tale: the joy of vaginal delivery with its golden crown, or the defeat of a cesarean section. We live in a society where individuality and autonomy are meant to be accepted and praised – and even expected: sizes, shapes, styles, colors and more. I don’t understand why a caesarean section should be a reason to belittle a woman’s birth experience.
Previously I spoke about the harrowing past of caesarean sections. There is much death and suffering in those years when mothers were cut open without anesthetic or disinfectant. We celebrate medicine in so many other ways today, from prosthetics to brain surgery. And more closely related to female health: family planning. I won’t dwell on the birth control debate here, but we must accept the empowerment it has brought to people around the world. Still, cesarean doesn’t seem to be one of the things we really celebrate.
I have to point out one thing I’ve found over and over again while writing this article – it has thrown me off track so many times I’ve stopped counting! – That said, while I value women who give birth safely, using whatever method they prefer, I also find it difficult to accept the risks women take when they choose to have an elective cesarean. First, I just can’t understand how anyone can think that a cesarean, highly invasive abdominal surgery, is the “easy way out.” Second, I find I have a problem with how distant we are from birth. The fear of childbirth has probably increased as we have distanced ourselves from the reality of childbirth. Fear of the unknown is totally understandable – we’ve closed the doors to mothers in labor for so long it would be strange if we weren’t afraid! Have you ever held a newborn? Do you actually know what happens during childbirth? All those embarrassing but oh so normal functions a woman’s body performs? Do you actually know what you have to do to recover from a cesarean section? How much do you actually know, and how much does it affect the decisions you make about your birth plan?
I’m so proud of everyone who has made it their mission to empower women (and men and everyone else) about pregnancy and pregnancy how many options and choices you actually have. From our own collaboration with maternity professionals to introduce pregnancy, childbirthIt really is time for women to take charge of their own pregnancy: knowledge is power, and hiding all those painful, scary, and inevitable things has never done anyone any good. Our society has great opportunities to offer a great pregnancy and childbirth experience to almost every woman. I want you to feel heard and listened to, that your decisions are respected, whatever they may be, and I want you to feel that your baby journey went well.
Evidence-based medicine from birth
According to the UN, around 140 million babies are born every year. Medical journal The Lancet reported increasing caesarean section rates in 2018: from about 16 million births (12%) in 2000 to an estimated 29.7 million (21%) in 2015. The country with the highest rate for using the surgery for childbirth support is the Dominican Republic with 58.1%, followed by Brazil and Egypt (55.5% each). The lowest rates were found in West and Central Africa (4%). In all 37 OECD countries, 28% of live births in 2017 were by cesarean section. That sounds like a lot, doesn’t it?
In 1985, a group of health experts was convened by the World Health Organization in Fortaleza, Brazil to discuss the perceived high rate of cesarean sections. Based on the evidence available at the time, these experts concluded that “there is no justification for a cesarean rate greater than 10-15% in any region”. This has become the widely accepted ‘sweet spot’ where there are evidence-based benefits from lower mortality rates. But in OECD countries the caesarean section rate is close to 30%, not to mention the Dominican, Brazilian or Egyptian rates approaching 60%! This means that many caesarean sections are performed based on preference (of the mother or even the doctor) rather than medical indication. This is partly because of attitudes and beliefs, and partly because of new dangers mothers face: elderly or obese mothers are becoming more common and they face new risks.
Instead of talking about over-medicated birth, I would like I to point out to you which countries have low caesarean birth rates – under 10%. This means that there are thousands of mothers who do not have a caesarean section despite medical reasons. We look at low-income countries: India and sub-Saharan Africa like Malawi, for example. In these countries, there are few health professionals who can perform the procedure, and hospitals are not adequately equipped to do so. But in many cases there are also behavioral reasons why women do not have the caesarean sections they need. And that brings us back to linguistics and the language-based behaviors that underlie most traditions, beliefs, and actions. If something is “natural”, then something else must be “unnatural”.
Sounds like a vicious circle, right? Although cesarean section is a perfectly normal way of giving birth these days, it is still stigmatized in some parts of the world while in other parts of the world you cannot get one due to lack of resources. I can’t help but think that despite all this discussion about caesarean section, the best way for a woman to give birth is the way she decides after researching her options. For some it is a cesarean section, for others it is a water birth at home and for some it is a hospital birth with all the ingredients and medicines available. The most important thing that stands above everyone else is to give women the knowledge to make the best decision for themselves. And a little bit higher up to make sure their questions and requests are heard.
Many cesarean mothers are tired of talking about their experiences, especially when the birth story involves a voluntary cesarean. You may have noticed that I wasn’t talking about emergency or elective C-sections, just referring to C-sections overall. This was a conscious decision: an emergency C-section seems to be more acceptable as it is often the last choice. But by then something will have gone wrong. And yes, the procedure carries different risks than a vaginal birth. The fact remains, women who have chosen this procedure are often afraid to share their birth story for fear of judgment. Their stories are always different, their paths and experiences unique. I want to share some of these stories with you.
Love like no other
Thalia Mostow Brühl’s daughter loves to hear about her own birth. And I have seldom heard a birth story as full of love as Thalia’s. Due to previous hip surgeries, she always knew that vaginal birth would not be an option for her. And I just love how differently she describes her C-section experience compared to her previous surgeries:
“…it wasn’t scary or lonely. My cesarean section was the most romantic moment of my life. Better than my engagement, wedding or honeymoon.”
The procedure itself was quick and reconnected Thalia and her husband in a new way, connecting them as a family of three to a healthy baby with the perfect APGAR score. Sharing the importance of skin-to-skin contact soon after birth — regardless of the method — she held her own baby in her arms before exiting the operating room. The newborn girl clutched her chest as the happy family was wheeled into recovery.
Source: https://www.nytimes.com/2020/04/15/parenting/pregnancy/c-section-judgment.html
Sounds like everything went perfectly for Thalia and I’m so happy to share this beautiful story with you all.
Every mother has a mind of her own
Another opt-in c-section mom, Morgan Celeste, knew her decision early on when she found out where babies come from. For her, the choice wasn’t hard, but when she shared that decision in her early 20s, many people doubted her and ignored her: “You’ll feel different when you get pregnant.” I won’t lie, that phrase causes me hives! So many people face a variation of that phrase when it comes to making decisions about children: when and if to have them, how to have them, and how to raise them… You can probably add a few more. It’s clear that our minds can change – but sometimes we don’t, and it’s not okay to question those decisions.
Morgan’s mind didn’t change when the time came. If anything, she wanted it more. And she has discussed it thoroughly with her doctor. Aware of the risks involved, Morgan and her doctor decided to schedule her surgery a week before her due date to minimize the chance of her going into labour. Her family was there and everything went according to plan. The procedure began at 7:30 am and at 8:18 am her baby girl was born. Like Thalia, Morgan was allowed to hold her baby immediately after birth. In her own words:
“It’s a cliche to say, but it was an incredible moment.”
Source: https://www.scarymommy.com/elective-c-section-not – embarrassed/
After the operation she found it difficult to move; not in pain, but her body was only slightly uncooperative after reorganizing her insides. No significant pain, no unintentional poo, but a pleasant experience and good memories.
No, I wasn’t too noble to push
Finally, I would like to introduce you to Nicola Prentis ‘ Story. She wanted the best for her baby like any parent would. Three weeks before her due date, she was packing for herself and her baby, arranging a three-hour train ride, and trying to find a place to stay: trying to move her prenatal care to where she would be listening.
Nicola knew long before her pregnancy, which she didn’t want. She didn’t want to hear the word “emergency” around herself or her baby. She didn’t want panic, uncontrolled bleeding, the sound of flatline heart monitors, or life-saving decisions after 30 hours or more of labor. She didn’t want forceps, vacuum-assisted delivery, or an episiotomy.
Instead, she delved deeply into caesarean sections. She found that a longer hospital stay is considered a risk, but at most a few extra days. Nicola learned that having a vaginal birth and a caesarean carried different risks, and when she met with a counselor at 37 weeks, she was able to speak up for herself. But her doctor refused to perform the procedure. Eventually she found a hospital and a doctor willing to admit her three days before her due date. The actual experience, she describes, was a big deal, but not an ordeal. Definitely more overwhelming than she initially expected. But who is really ready for their newborn’s first cry?
Suggestions for thought
At the end of my thoughts and these three very different stories, I want to come back to the thoughts of individuality autonomy and give you some food for thought. Society focuses heavily on a woman’s right to choose whether or not to have children. And that’s important! But like I thought before, we’re not talking as much about how she gets to choose how her body delivers her baby. Despite Nicola Prentis’ safe and desired c-section, she had to fight tooth and nail to get her favorite birthing experience. Morgan Celeste was condemned by her family and friends. Just because someone wants a voluntary cesarean doesn’t mean everyone will ask for it. I’m so proud of all of these women who, despite negative comments from friends, family, and even their doctors, researched and stood by their decision. After all, we have perfected the caesarean section.
Giving women the tools to make an informed decision about what their preferred method of childbirth is should go without saying. And vaginal birth is still often the preferred way of giving birth. But that doesn’t matter here – it’s still April and we’re still celebrating the miracle of the C-section!
*Maana is Lola
