I wasn’t going to write this, I was going to be the “bigger” person and just laugh at the clueless-ness of the uninformed. But, after a disheartening remark from a new neighbor only 4 days from my scheduled c-section, I just can’t let it go unaddressed. These “uninformed” people I speak of feel that if you’re having a c-section then they have a free pass to tell you what their personal opinion is regarding your decision. No matter how well or how little they know you and certainly without being prompted by me for their opinion.
It all started innocently enough with my new neighbor commenting on my belly and asking when I was due. I told her I was having my c-section this Saturday and she said “Are you sure you want to do that?” My husband couldn’t believe it. I, on the other hand, know how common this thinking is (especially here in the Bay Area), so I brushed her comment aside with “My son was born c-section,” and a swift change of subject Needless to say the small talk ended shortly after the C-BOMB was dropped. Certainly, everyone has an opinion on c-sections, the problem is that people think it’s appropriate to lecture or convince someone that what they are doing is wrong. Just like politics should stay out of polite conversation, so should your opinion on someone having a c-section.
THE SOCIAL STIGMA OF HAVING A C-SECTION (OR THE 9 LEVELS OF C-SECTION HELL)
If you are having or had your first c-section, you need to be aware of the social stigma attached to the birth of your child. Congrats! You are now a member of what I like to call “the levels of c-section hell.” Taking some literary license from Dante’s Inferno, depending on which level you end up on in “c-section hell” directly correlates to how much a person feels they can berate you for having your c-section! Fun!
I’ll be gentle and break you in slowly…here’s level number 1, so sorry you just missed purgatory, but you are a member of the most innocuous level of c-section hell! You might belong in this level IF: you labored for quite some time (say, over 15 hours) and then an event occurred that made you have to have an emergency c-section. Then said event (such as fetal distress or placental abruption) happening was of no fault of your own and you should be pitted for the outcome of your birth but exhaled because you tried to have a natural birth to begin with. And with this added effort you were awarded with placement in the most esteemed level of c-section hell: an emergency c-section, level 1.
Levels 2 through 6 are very subjective. Say you had an emergency c-section with pregnancy number 1 and with your second pregnancy you opted for a repeat c-section rather than trying for a VBAC. Well, bad health decision missy! You would wind up anywhere from the 2nd to the 6th level of c-section hell, depending on what medical conditions or justifications you could list to your berater to make your decision appear not as evil in their eyes.
Let’s just get to the good stuff already, the ninth level of c-section hell, the level where anyone and everyone can paste the scarlet “C” on your breast and hold you up as the evil woman that you are! Yeah! Welcome to my level ladies!! Yes, I reside in the level reserved only for the lowest of the low and vilest of the vile: elective c-section mommas! Dun, dun, dun!!!! Also known as a c-section advocate, supporter, proponent. Yes, I am one of those “supremely selfish” women who would rather have a c-section than push one out! Call me crazy, and heck I guess everyone does!
Yes, I’m a bona fide member of the “too posh to push” crowd. But the funny thing is: unless you actually are Posh Spice, you can’t just elect to have a c-section. Under any employer-provided health insurance plan there has to be a medically-necessary reason to have a c-section. Yes, even under state Medic-Aid programs, they won’t just let you opt for a c-section. And that’s good business on the part of insurance companies, since c-sections cost more than vaginal births. Sorry, unless you can shell-out for the c-section out-of-pocket, you’re just going to have to be a good little girl and have your baby the way every woman is supposed to.
So, how did I end up getting the c-section of my dreams? Well, I had a medically necessary reason with the onset of hypertension and preeclampsia around the end of month 7. But even before that, my naive-first-time-momma self though I could just decide the way I wanted to give birth to my son, the way I felt most comfortable. Isn’t that how it should be? C-sections made me feel more comfortable because I was familiar with them. I was a c-section baby, my twin brothers were c-section babies and when my grandmother was born in 1926 she and my great-grandmother almost died during childbirth, leaving my grandmother with a disfigured jaw for the rest of her life. I also though about my own body. As a woman, my “hoo-ha” (a.k.a. “woman parts” or “vagina”) was one of the only parts of my body I liked “just the way she was!” She didn’t have to loose weight or be bigger or smoother, or does she look lopsided?! And the thought of a mini human barreling down through there made me know that she would never again be the same! “Aha!” you might say! That is a purely selfish reason for wanting to have a c-section! And I would say, “You don’t get to the 9th level of c-section hell for nothin’!”
ARE YOU SCARED TO HAVE A C-SECTION?
Now, here I am with pregnancy number two, and I had another decision to make: go for the VBAC or do a repeat c-section because now I had a built-in medically necessary reason that I could elect to have a c-section. Needless to say, I am going for the repeat and it’s less than two days away. Am I scared to have another c-section? Of course! As a self-professed hypochondriac in surgery is the last place I want to be! But to think that there are not great risks with having a natural birth is to be supremely naive. It’s just that the media and medical community don’t like to talk about the risks of vaginal deliveries (it’s bad business for the insurance companies after all), it’s far easier to point the finger at the more exotic c-section as the source of everything wrong when it comes to increasing maternal death rates.
If you came across this article because you are scared of having a c-section it makes perfect sense that you are scared. We are made to be scared and do everything in our power to avoid having a c-section because, especially in the last 15 years, there has been a major smear campaign going on regarding c-sections.
MISINFORMATION & PROPAGANDA ABOUT C-SECTIONS
My neighbor’s, “Are you sure you want to do that?” screams out to me “misinformation,” and oh-boy is there a ton of misinformation and just plain propaganda out and about regarding c-sections. Here are some of the classic pieces of propaganda you’re likely to encounter: you are at greater risk of death when having a c-section, you won’t “love” your baby as much if you have a c-section, you are more likely to have postpartum depression if you have a c-section, breastfeeding will be more difficult if you have a c-section.
Then you have the societal implications: you are selfish if you elect to have a c-section, you are not as good of a mother if you have a c-section, you are not as strong of a woman if you have a c-section, and you will have a big, bulgy scar if you have a c-section.
Now, I’m not going to dismantle each and every bit of propaganda out there, just the ones that bother me the most. I’ll start with the biggest one and address some of my other favorites in later posts.
IS THERE AN INCREASED RISK FOR MATERNAL DEATH WITH A C-SECTION?
It is very difficult to find statistical data that compares the maternal death rate or vaginal deliveries vs. Cesarian deliveries. Many articles say there is “a three-fold increase” or any other ridiculous range, without providing one shred of evidence. The best I have found is a study from The American Journal of Obstetrics and Gynecology. In this study, data was collected from 1.5 million deliveries between 2000 and 2006. The study found “[n]inety-five maternal deaths occurred in 1,461,270 pregnancies (6.5 per 100,000 pregnancies.) Leading causes of death were complications of preeclampsia, pulmonary thromboembolism, amniotic fluid embolism, obstetric hemorrhage, and cardiac disease. Only 1 death was seen from placenta accreta. Twenty-seven deaths (28%) were deemed preventable (17 by actions of health care personnel and 10 by actions of non-health care personnel). The rate of maternal death causally related to mode of delivery was 0.2 per 100,000 for vaginal birth and 2.2 per 100,0000 for cesarean delivery.”
So, there is an increased risk, but it’s not as dramatic as the media, blogosphere and especially insurance companies would have you believe. And there are underlying reasons why this up-tick in percentages actually occurs. The more important question to ask here is WHY is there an increase? Usually C-sections are preformed when there is a health concern warranting it. As we discussed, you have to have a medically necessary reason to even be able to have a c-section. So, no wonder there are more deaths during c-sections because you’re dealing with a group of women who already had health complications to begin with or who are encountering distressing events in natural childbirth. Women who are obese or have preeclampsia or heart disease. These women are already at a higher risk of death weather they delivered vaginally or via c-section. The other huge contributing factor is pulmonary thromboembolism, or deep vein thrombosis. In fact the study’s conclusion states “[g]iven the diversity of causes of maternal death, no systematic reduction in maternal death rate in the United States can be expected unless all women undergoing cesarean delivery receive thromboembolism prophylaxis. Such a policy would be expected to eliminate any statistical difference in death rates caused by cesarean and vaginal delivery.”
Sorry to break it you you, but c-sections are not the devil. And they are also not responsible for the supposed recent increase in the U.S. maternal death rate. In fact, c-sections dramatically improved the U.S. maternal death rate from the 1900s thru the 1980s, check out this history of Cesarian Section by the National Institute of Health. One of the biggest reasons for an increase in c-sections is the focus on the welfare of the fetus, which is actually a more recent emphasis of care. It is also important to note that the average age of women having babies has risen as well. In my next post I will go over the history of c-sections and how they helped decrease the maternal death rate for over 200 years!
Feel free to comment, but please keep it classy 🙂