I did it. I chose a primary elective C-section. In a culture heavy with pressure for “natural” births – I chose the opposite.
It’s complicated, but let me try to explain.
Birth IS amazing. I revel in it and always have. It is a huge part of why I chose Obstetrics & Gynecology as a career before switching to Emergency Medicine. As someone who has “caught” a lot of babies, I can honestly say that no birth is the same; each one IS special. No matter how many times you’ve seen it/done it – the moment the baby delivers is always a miracle.
I believe that women are so very strong and that their bodies are ever so capable of bringing life into the world in a completely “non-medical” way. BUT I have also seen birth go so very wrong. I have experienced the pale-faced, cold-sweat fear of every single person in a delivery room when nothing is going as planned: a head that was so beautifully crowning and then doesn’t budge, long labors that produce gray, limp babies – bleeding that will just not stop covering the floor and the bedding in crimson.
I have seen women brought in from home after more than 24 hours of labor with no fetal heart tones and heard their anguished wails of loss. The sound of soul-shattering pain is different from the sound of physical pain. You learn the difference if you spend enough time in the Emergency Department or on a Labor & Delivery floor. Most nurses and doctors are calloused to pain cries, but I still jump when I hear the cry of loss. It makes my heart beat faster and my hair stand on end.
Ina May Gaskin, perhaps the most famous midwife of all time, has written and talked about fear during birth. She educates women about fear preventing the progression of labor and increasing pain. It is a brave thing to choose a natural birth, but I have seen brave natural mothers turn away sound medical advice due to fear of medicine.
There’s a fair amount of fear-inducing material out there about anesthetics and surgery and hospitals. I have had up-close experience with some natural-mamas who resisted necessary C-sections with resolute defiance and then spent their time after birth visiting their previously totally healthy babies in the NICU. Hypoxic-ischemic brain injuries are pretty much one of the most depressing things I can think of. Natural birth proponents rightly teach not to fear the pain of labor, but should also teach not to fear medical intervention.
Trust me, everyone celebrates a good natural birth, but no one can possibly know if that will be your story. Of the women who plan natural births, only some of them will “make it” and deliver without anesthesia. Others will eventually accept an epidural (and often tout its wonders immediately) and some will ultimately go on to have a C-section. It is disheartening that a C-section (or epidural) is sometimes perceived as some kind of failure.
A C-SECTION IS NOT A FAILURE!!
Let’s get really nitty-gritty about this for a second. What makes a successful natural birth more likely?
- Smaller babies
- bigger pelvic outlets
- and higher number of prior successful vaginal deliveries.
Should a woman with a narrow pelvis who grew a healthy 9 pound baby be less proud of her accomplishment than a woman with a gynecoid pelvis who grew a healthy 7 pound baby? Of course not!
Little pelvis + really big baby = probably not going to happen naturally. But there is no reward to be lost or gained from “making it” without interventions. The reward for any good birth is a crying baby.
Ultimately, these are my reasons for electing surgery over nature:
- Scheduling was paramount. I was a working mother and as a resident physician, my maternity leave started the first day of my next rotation regardless of whether or not I had a baby. Days waiting for labor would have been days of maternity leave wasted without an infant to bond with and care for.
- The odds were not in my favor for an induction. The baby was still floating out of my pelvis and my cervix was “long/thick/closed.” There’s nothing that guarantees a natural birth and for me the absolute least ideal situation was 30 hours of labor followed by a necessary C-section.
- I was able to plan and feel much more in control of a completely uncontrollable process.
- I’d rather have a scar above my pubic bone than a 4th degree tear (vagina to rectum) any day. I don’t think I need to explain the importance of pooping normally. There is all kinds of literature out there about preventing tears, but the truth is: they happen.
- I want to avoid the Depends aisle if I can. There’s some evidence that women who’ve had vaginal births are at higher risk of pelvic floor dysfunction. (Pelvic floor dysfunction is a euphemism for peeing yourself unexpectedly and for having your vagina or uterus ‘fall down/out’ – none of which are desirable things.) See this study out of Johns Hopkins on “Pelvic Floor Disorders 5–10 Years After Vaginal or Cesarean.”
- From my perspective, there was less risk of birth trauma for my baby. While there are serious risks with a C-section – they tend to be more for the mother (increased pain, bladder trauma/puncture, post-op infection, etc.) with low risk of infant morbidities like brain/brachial plexus injury.
- I knew the only reward for any good birth is a healthy baby.
Two C-sections later I can honestly say that I have no regrets. Both of my children were over 9 pounds with double nuchal cords (their umbilical cords were wrapped around their necks twice). While neither of these things would have absolutely necessitated a section – I am so thankful I didn’t have to be rushed to the OR when things went bad (and they probably would have).
I heard Ina May interviewed about her first delivery (a C-section) and she felt (and still feels) that having a C-section prevented normal bonding and negatively affected her relationship with her daughter forever. Forever is a big word. I just want to go on record that the number of people who would stand by such a statement is incredibly small. My C-sections did not interfere with bonding or nursing for me at all – not even a tiny bit.
I don’t want to paint a perfectly rosy picture of C-Sections. After the first one, I puked violently and wanted to scratch my skin off from the long-acting morphine they put in a spinal. I fought to not have it with my second and subsequently found myself in pain like I had never experienced. In spite of all of this, I honestly have happy memories of my deliveries. I remember the smiles and overall happiness that filled the entire OR suite when they let out their first cries. I remember meeting them and holding them and making small talk about TV shows while they sutured me closed. The births of my children were great births.
I am not advising anyone to choose a C-section, but it was the right choice for me. Natural birth promoters support a woman’s right to make choices about birth. A C-section was my informed choice and I’m proud of my birth stories.
If a C-section was not your initial choice, but you chose it when you needed one to have a healthy baby, you are brave. You got cut open and suffered to bring a new life into the world. Way to go, Mama! Whether your baby is welcomed into the world through your vagina or an abdominal incision, it’s a miracle! Be proud and celebrate!
If you are considering a primary-elective C-section, you may be met with some resistance. My advice is to do your research and be able to articulate your reasons clearly. ACOG had previously endorsed this choice, but has recently updated their position. You can read it here.
Photo credits: Helen Pickens Murphy