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.