C-section moms to the back of the bus

For years I’ve been reading about how there are too many cesarean deliveries performed in this country, that vain celebrity moms choose c-sections to have smaller babies and preserve their figures or suit the convenience of their schedules or avoid some of the potential after-effects of vaginal birth. We hear repeatedly from natural childbirth advocates that birth should be a natural rather than a medical event, that doctors and hospitals cover themselves against insurance risks by performing excessive and intrusive procedures that make surgical deliveries more likely, and so forth. We hear the laments of women who took their natural childbirth classes, did their breathing exercises, and went to the hopsital with a detailed written “birth plan” that called for no drugs, no IV, no fetal monitoring, delivery by a midwife rather than a doctor, lots of walking around and calming music, delivering in a squatting rather than prone position, maybe even in a bathtub, and hubby there all the while with video camera in hand to capture the magic moment when mom brought forth new life through her own valiant labor, a creative force of nature rather than a patient surrendering her maternal power to medical practitioners — only to have things go terribly wrong and end up drugged and catheterized on an operating table as doctors sliced open their bellies and removed their babies, robbing them of the earth mother fantasy that had been playing itself out in their heads for months.

When I was pregnant with my firstborn, I had none of those dreams of heroic labor. I was in my late thirties, had had trouble conceiving, had repeated miscarriages, and was afraid I’d missed the boat and would never have a child. Under those circumstances, I saw birth as a means to an end, and didn’t much care how I delivered. The doctor could take the baby out my left ear for all I cared, as long as the child was healthy and safe. So when I’d been in labor all day and things didn’t progress as they should have, I wasn’t upset when the doctor said he needed to perform an emergency cesarean. The recovery was painful, but it is after any abdominal surgery, and after a few days of bad pain and a few weeks of limited activity, I was as good as new. I experienced none of the guilt or depression I’ve heard about so many other c-section mothers having. The idea of feeling guilty because I had somehow “failed” at the test of true womanhood strikes me as ludicrous, and yet I’ve read a fair bit about it, and even heard it from women I know personally. I’ve also read that postpartum depression is more common after surgical delivery, but I was lucky enough not to have it, and I know a number of women who delivered vaginally — some completely unmedicated — who had postpartum depression anyway. I’m no expert on this subject, but it seems to me that if the incidence of depression is higher after surgical delivery, part of it stems not from the surgeries themselves but from people making c-section moms feel bad (intentionally or not) for failing to live up to society’s ideals about childbirth.

I have a friend who, like me, has four children. Our firstborns were actually born on the same day of the same year; our seconds were born in the same month, my third a few months before her third, and her fourth a few months before my fourth. Both of us labored with our first and had emergency c-sections. Both of us had the choice of scheduling a c-section for the second or trying for a VBAC (vaginal birth after cesarean). I opted for a second c-section because the admittedly slight risk of uterine rupture in that procedure scared me. My friend, who was pressured by family members to try for a “real” birth (her sister-in-law came right out and said that she wasn’t a “real woman” if she couldn’t deliver her babies vaginally) tried for the VBAC, went through a horrendously long labor but was still unable to deliver, and ended up having another c-section after all. My recovery from a scheduled section was fairly easy, while hers after a traumatic labor followed by surgery was difficult.

I freely admit that often VBACs are successful. I know a lot of women personally who have had them, and were thrilled at being able to deliver naturally after a previous surgical delivery. I’m happy for them, and I agree that the choice ought to be the mother’s. But in all too many cases the choice means pressure to make the right choice: to choose the kind of delivery that will validate your credentials as a real woman, much as the choice of feeding by breast or bottle means that making the wrong choice marks you as a substandard mother.

As I wrote before, my first three c-sections were performed at a hospital in California where a nursery was available. Most of the mothers who delivered vaginally there kept their babies in their hospital rooms with them, and after the first 24 hours after surgery, I kept my baby with me most of the time too, except when I wanted to sleep or shower. But for that first day after surgery, I really could not take care of a baby on my own, and because there was no nursery staff to help, what that really meant was that for c-section moms, the hospital policy was BYOBN: bring your own baby nurse. Pretty neat racket for the hospital, which doesn’t have to pay a nursery staff, and for the insurance companies, which have to pay out less for each hospital stay since c-section moms are eager to get the heck out of the hospital and go home. I stayed four nights after each surgery in California, but only three this time, because what was the point of staying in the hospital when I couldn’t rest? I had to have someone stay with me every night I was there, my aunt the first and third nights, and a good friend (and Portia’s godmother) the second night. The logistics of the BYOBN policy bring me to yet another way this hospital made me, as a c-section patient, feel like a second-class citizen.

St. Vincent’s hospital has two types of rooms in the maternity ward, one for mothers delivering vaginally, and another for patients recovering from c-sections. Because a woman delivering vaginally remains in the same room for her labor, delivery, and recovery, the rooms are large and spacious. They have a table and chairs in addition to the bed, plenty of room for walking around, wood (or what looked like wood) floors, big windows with nice views, and big flat-screen TVs on the walls. The rooms for c-section recovery patients are about a fourth (that’s being generous; it might even be closer to a fifth) of the size of the nice rooms the real mothers get. The window in my room looked out onto the machinery on the roof of a lower level of the hospital, the old TV had a remote that didn’t work (eventually they managed to find one that did), and the baby nurse I was expected to provide for myself had to sleep on a small chair that pulled out into a very uncomfortable and undersized facsimile of a bed. When this “bed” was pulled out, there was barely enough room to get around, and we had to keep moving the baby’s bassinet in order for my aunt (the BYOBN) and the hospital nurses to get to my bed. I was still hooked up to the IV and other unmentionable attachments so wasn’t doing any walking around myself. On the second evening they let me move to a regular two-bed room in the pediatric ward next door (no way they were letting me into one of those posh rooms saved for the real mothers) and the rest of my stay was more comfortable.

In her book about motherhood, actress and c-section mom Patricia Heaton called the cesarean “the kindest cut of all” (for those of you who think I named my baby after a car, that’s a play on a line from Shakespeare’s Julius Caesar — Caesar, cesarean, get it?). After my California deliveries, I agreed with her completely. If enough hospitals go the way of St. Vincent’s here in Santa Fe, I’m afraid we’ll have to put the “un-” back in that line.

Comments 13

  1. Lauren wrote:

    I do admit that I had family pressure to try for the VBAC. However, I am glad that I tried the VBAC even though it ended up in another c-section. I hate the term “failed VBAC”. I do not believe I failed at anything since the outcome was a healthy baby and a now healthy almost 5 year old. I personally would have always wondered whether or not I could have delivered vaginally. My easiest c-section by far was my 3rd when I did not labor or push before surgery. Congratulations again on your beautiful new baby!

    Posted 16 Jul 2008 at 5:25 pm
  2. Nicole wrote:

    I am sorry you had such an awful experience. Some of my vaginal deliveries and PP were awful, too. When my first 3 were born, we had to share a room and bathroom (ick!) with no showers. I clearly remember with my 3rd my “roommate” was foreign and she smelled awful, it was making me sick, she had visitors until midnight, her phone kept ringing & her baby was screaming non-stop. I called dh in the middle of the night and asked him to get us out of there, as I was trying to breastfeed for the first time (which I successfully did for 13 months no thanks to this lady). Another time they forgot to bring me dinner, I asked and asked, never got anything b/c the kitchen was closed. Had to call dh to drive 45 min with a bunch of kids to bring me something. I could go on and on..
    Anyways, my point was, even vaginal birth experiences can be awful. It’s over, so just enjoy your new baby now! : )

    Posted 17 Jul 2008 at 11:12 am
  3. Martha Brozyna wrote:

    I have only one response to those people who go on about how a vaginal birth is better than a c-section because it’s natural — what is natural is not always good for you. Diseases like measles, mumps, and rubella are natural, yet everyone I know vaccinates their kids against them. Infections are natural, but most people run quickly to the doctor for antibiotics if they have a sinus infection. Poisonous mushrooms are natural, yet I don’t see anyone chowing down on those unless they have a death wish. I view childbirth in a similar light. Childbirth, whether vaginal or c-section, is a serious matter. It can kill you. That’s why women should be more rational about their approach to it instead of expecting some kind of mystical experience when they have a baby. And they certainly should not give in to family or societal pressures when it comes to giving birth — your health and the health of your child should be the primary concern. As a historian (my specialty is medieval women’s history, gender and sexuality), I am well aware that childbirth was the biggest killer of women for most of human history. I do realize that women have given birth since the beginning of time and that vaginal childbirth used to be the only way to do it, but the fact is that it wasn’t always safest way to go. I don’t understand why modern women romanticize vaginal childbirth as somehow morally superior because it’s more “natural” (whatever that means, if you really want to be 100% natural about giving birth, you should give birth in a grass hut with a medicine woman chanting incantations while she gives you herbs to munch on).

    I’ve had two c-sections because of my small pelvis, and I don’t feel inferior in the slightest to women who give birth vaginally. I can’t count how many times women have said to me “oh, I’m so sorry” when they heard I had a c-section after one of my children was born. Don’t feel sorry for me, I’m grateful that I live in a time, and in a medically advanced country like the United States, where I can have a c-section for my physical well being and for the well being of my child.

    At the end of the day, women should have a choice of how they’d like to give birth, provided that it does not harm the baby. You want have VBAC, fine, you want to give birth vaginally with pain meds, also fine, you want to give birth in your bathtub with a doula while filming the whole procedure for a documentary (like Ricki Lake did), great. I have a serious problem, however, with this ridiculous trend in recent years of making women who have had c-sections feel inferior. Those who believe that you can only be a “real woman” if you deliver vaginally should perhaps look to poorer parts of the world like Sudan, Afghanistan or Bangladesh, where women give birth naturally and don’t have the option of pain meds, c-sections, or epidurals and see if these women romanticize their plight.

    Posted 17 Jul 2008 at 1:06 pm
  4. Melissa wrote:

    I’m glad you survived the hospital and at least were able to get a mini-upgrade in your room. Although I stayed in a pediatric room after my 4th and it depressed me. I did want to add that many of the ‘nice’ rooms at St. Vincent’s also look out on HVAC equipment. And the TVs are just inside built-in cabinetry. The remotes are hard to come by anywhere in that hospital. Not sure what’s up with that! Anyway, I’ll bet coming home felt nice after all that.

    Posted 19 Jul 2008 at 4:01 am
  5. Joline wrote:

    Nice job here. I labored with my first and delivered via c-section and chose a c-section for my second.

    No regrets.

    I just figure it was how it was supposed to go for me. And I really loved and trusted my MD who had a very low c-section rate – like 1%. She knew what she was doing and what she was advising me to do.

    Thank you for being a champion for us.

    I LOVE my scar!

    Posted 09 Aug 2008 at 3:52 am
  6. Kellie wrote:

    I’ve had three myself with the last being the hardest to recover from. My hospital stay was somewhat the same too. I refuse to feel any guilt. I have a sister in law who thinks my other sister in law was never really pregnant bacause she delivered by section a very premature baby. He is now a healthy 6 year old.
    Congratulations on your beautiful baby girl. She really is beautiful I’m not just saying that because its the polite thing to say! Love the name too.

    Posted 13 Aug 2008 at 12:00 pm
  7. Myron wrote:

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    Posted 20 Aug 2008 at 4:18 am
  8. Valerie wrote:

    I had a C-section almost 9 months ago, because after 2 weeks overdue plus homeopathy, 2h cycling per day for 15days, acupuncture, acupressure, up and down stairs, sauna, bath with special herbs, special massages, midwife cocktail and injected prostaglandine, my cervix simply would not dilate. I had contractions, with a closed cervix, so as the doc said: ” it’s like banging the head of the baby on a wall”. Still, today went to see my GP – he didn’t know me before the birth- because I still have a 4cm gap between my abdominal muscles and back pain…. He saw I had a C-section and assumed I would prefer to have an operation to tighten my muscles instead of doing exercises. He then felt free to lecture me on the positive aspect of a natural birth and natural things and natural that, told me that I should be jogging at least 3 times a week (I jogg 2hrs per week, which I thought was already not so bad!! on top of walking the dog 2hrs per day!)…. And I came home and cried, and cried, and cried…. but now that I read all of you, I feel a lot better. Thank you. I think I’ll try to love my scar too :-D, as well as the extra skin that is still floating on top of it :-D.

    Posted 08 Dec 2008 at 2:31 pm
  9. Billigflüge wrote:

    excellent article
    As i was expecting my second baby I wondered whether or not I could have delivered vaginally.Fortunately thanks to my doctor I had a successfil VBAC and I poved that the speech “once a Cesearean, always a Cesearean,” isn’t true. The fact that my previous c-section was not classical one was the most important factor of success.

    Posted 11 Apr 2009 at 8:26 am
  10. Elizabeth wrote:

    Hurray for you and this great blog post!
    You bring out some excellent points.

    I’m also a c-section mom and an author on the topic. I work really hard at helping c-section moms feel at ease with their decision and cope with having surgery. Its not fair to them to feel that they are less of a mother or a woman.

    Please note that I am not for or against having a c-section but am in support of women who need them and I am dedicated to helping them have the best c-section birth that they can, despite having surgery.

    Thank you for your great post, all very well said :-)

    Posted 16 Jul 2010 at 9:33 pm
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