I Chose a C-Section and I Won’t Apologize
“I felt the searing pain of my body being ripped in half. Vertically, horizontally, everywhere. I will never forget it.”
I asked her if she would have known,would she have chosen differently. Would she have elected a cesarean?
Kayla’s* story is one not told very often. Shrouded in shame, elective cesareans are the thing rich elites do-the ones who are too “posh to push” as it were. That the everyday person only wants to give birth by cesarean when necessary is the collective belief pervasive in online birthy/mom groups, media, and common discourse. However, the reality is that many people, up to 18% worldwide, request surgical birth and the reasons are far more complex than the reductionist view many claim.
Cesarean birth accounts for approximately 33% of all births in the United States. Many a study have hypothesized that cesarean birth is responsible for a host of serious, long-term health outcomes for both the birthing person and the infant. Even the World Health Organization has recommended that the rate be closer to 15% and in keeping with that recommendation, they have created (sometimes disastrous) guidelines to be followed by OB/GYNS and hospitals. However, the science is dubious at best, particularly in its dissemination and understanding by the general public, as it is difficult to extrapolate causal relationships between mode of delivery and specific health implications forty years later, as many claim to do.
While vaginal birth is the physiological norm, and should be supported and encouraged by appropriate care providers, the sweeping generalization that vaginal birth is preferable for all birthing persons, all the time, is flawed when looking at birth as an individual event, experienced by an individual human. Humans are not statistics and something as pivotal and life-altering as giving birth has to be met with careful consideration for what’s the best choice in that time and place.
While vaginal birth is the physiological norm, and should be supported and encouraged by appropriate care providers, the sweeping generalization that vaginal birth is preferable for all birthing persons, all the time, is flawed when looking at birth as an individual event, experienced by an individual human.
When Lydia* was pregnant, she asked her doctor if they could schedule a cesarean. “He was shocked that I requested one at first because it was my first baby. He counseled me on the fact that if I wanted more children, maybe a C-section wasn’t the best idea. I didn’t want to confide why I wanted to go that route, at first. Eventually though, I told him of my past-that I was a sexual assault survivor. After that discussion, there was no hesitation on his, or my part. I chose a C-section and I don’t apologize for that for one minute.” Lydia’s story isn’t uncommon. In fact, it is one of the most cited reasons for maternally requested cesareans.
In 2013, the American College of Obstetricians and Gynecologists updated their guidelines to include respecting maternal choice after weighing the risks-to-benefits ratio. After looking at the data, it becomes increasingly more difficult to pin long-term complications such as asthma on the method of birth itself for numerous reasons. One major factor in the inability to get a clear picture is due to potential ethics violations and lack of controls and variables. There is no way to conduct a double-blind study in situations surrounding pregnancy and birth especially when surgery is involved. It would be inhumane to withhold the proper treatment or action in situations of life-threatening scale. Still another reason that demonstrates the difficulty in attributing “negative outcomes” to cesarean delivery is because the reason for the birth might be the initial cause of birth. Meaning, complications in the pregnancy, whether acute or chronic, necessitate immediate delivery, often prematurely. Could it be that being born early or experiencing intrauterine growth restriction are responsible for adverse health conditions later?
Scientists are currently working on some answers which prove to be elusive. It appears that chronic obesity, hypertension, and diabetes play a role in the increased number of cesareans; however, it is unclear to what extent these conditions affect the baby. In addition, some doctors and human rights advocates suggest that bodily autonomy and mental health outcomes should be a focus in consideration equal to the physical outcomes. What is clear is that emergency, early-term cesareans carry the most risk, not planned births at term.
Sandy* says that her cesarean wasn’t a matter of choice. She became suddenly ill with preeclampsia. Having suffered from chronic hypertension beginning in her twenties, she knew the risks of developing the life-threatening condition. When she began swelling and feeling extremely tired, she went to the ER. It was within hours that she delivered at 34 weeks gestation. “I feel like I never got to understand what was happening. Healing wasn’t easy, the incision got infected. I had people tell me that at least my c-section was necessary. It rubs me the wrong way.” When asked to expound further, Sandy says that she disliked the idea that her birth is more worthy than another’s because of a silly caveat. She continues, “Necessary. What does it mean? Isn’t that personal anyway? I describe it as just an emergency.”
There were days that were so dark, there wasn’t a tunnel.
Kayla agrees. She feels that any future babies will definitely and necessarily be born by cesarean. “I can’t go through that again. It took three years to get physically normal again. I hurt for three years. I experienced severe depression. There were days that were so dark, there wasn’t a tunnel. There was no light. I eventually found other moms who experienced (perineal) tears like I did and whose doctors didn’t just write it off as normal. Having support and having an OB/GYN now who has already respected my choice has made me hopeful again.”
And that is what new and expectant parents deserve to feel. Hopeful and surrounded by care providers, family, and friends who understand the reason for one’s choice and trust in their ability to weigh the risks, and ultimately, make a decision that gives them the best possible experience.