Photo-Illustration: Josiah Whitfield; Photos: Getty
I spent much of my first pregnancy learning about ways to avoid having a C-section. The books I read advised doing everything possible to try for a vaginal birth and were full of recommendations: Hire a doula, consider using a midwife instead of an OB, avoid hospitals with high C-section rates, have the baby at home (or at least labor at home for as long as you can), and don’t let them induce you with Pitocin. When I was diagnosed with gestational diabetes, I avoided refined carbs and sugar, testing my blood sugar after each meal so the baby wouldn’t gain too much weight. As my due date approached, I did modified versions of downward dog, hoping gravity would encourage the baby to flip.
But as the weeks went on and my daughter’s head continued to press stubbornly into my rib, my doctor told me I should think more seriously about scheduling a C-section. A baby ending up in the wrong position isn’t uncommon: In about 4 percent of pregnancies, the fetus remains breech. It’s just one of many reasons why doctors may recommend a surgical delivery, some more questionable than others. Currently, nearly a third of babies in the US are born via C-section, a number that has climbed in recent decades and is more than twice the rate recommended by the World Health Organization — hence the proliferation of advice on how to avoid having your doctor pressure you into an unnecessary one.
From my research, I gathered that having a C-section was freaky and unpleasant and that afterward just about everything would hurt. If you asked me my biggest fears about any kind of surgery, I would probably say waking up and feeling the procedure as it was happening. Both are regular occurrences with a C-section. In the majority of cases, women are conscious as surgeons make the incision. Most C-sections are done under regional anesthesia, which numbs the lower part of the body; I was told it wouldn’t be painful but that I would feel tugging and pressure as the surgeons pulled the baby out. The diagrams illustrating how the doctors would part my skin and abdominal muscles made me queasy. Even worse was the much-discussed 2008 documentary The Business of Being Born, which includes extended footage of women being cut and yanked open. Emily Oster’s Expecting Better notes the increased risks, including infection and complications in future pregnancies, and stresses the “far worse” recovery. “For weeks, you may have pain with any movement that uses your abdominal muscles (sitting up, lying down, standing, rolling over, walking, etc.),” she writes.
Once I came to terms with the fact that I was probably going to need a C-section, though, scheduling it was a relief. Part of me was sad that I wouldn’t get to experience labor for myself, but I also felt like I had been given a cheat code. Birth had always seemed like a huge unknown. It was comforting to have a plan.
My doctor slotted me in for surgery at 39 weeks. My husband and I showed up at the hospital with an embarrassing amount of luggage, clothes, and other supplies to last a few days. “Are you ready to have a baby?” the nurse who led us to our room asked cheerfully, as if we were checking into an all-inclusive resort. Once they confirmed the baby was still breech, they hooked me up to an IV and shaved off the top of my pubic hair, where the incision would be.
I was feeling relatively calm until they led me to the OR. The room was brightly lit and freezing, filled with people in scrubs swarming around. I was shaking as I sat on the edge of the table, hunched over so the anesthesiologist could thread the needle through my spine. The OB was holding my hands, telling me I was doing great, but I wanted my husband in the room; I wanted to cry; I wanted to ask if they could please slow down.
The anesthesiologist inserted various needles into my lower back, tapping on my thighs and asking, “Can you feel that?” I wasn’t sure and was terrified of giving the wrong answer. Eventually, they decided I was sufficiently numb and laid me on my back. Suddenly I was starfished, my lower body paralyzed, and someone was rooting around my genitals to insert a catheter. They had put a screen up so I couldn’t see what they were doing, but I could definitely feel it. The next thing I knew, my husband was there, grinning in a surgical cap.
They told me it would take about three minutes to get the baby out. I could hear them talking and feel them doing something to my abdomen, but I tried to dissociate, like you do at the dentist when you are praying for them to please just finish already. They told me to brace myself as they pushed on my stomach. Then I heard someone say, “Mom, look!” They held up the baby and I felt disbelief. Who was this little creature, her face scrunched up, her body covered in blood and vernix? It didn’t feel real that she had been inside of me.
Tears streamed down my face as I lay there, watching them carry her across the room to weigh and clean her. I felt both overwhelmed and relieved: She was here, she was alive. I had spent so long imagining what it would feel like to hold her on my chest, but when they brought her to me, it was awkward. The doctors were still sewing me back up, and I couldn’t fully move my arms. It was thrilling to watch her mouth instinctively search for my nipple, but as she squirmed, I felt like I needed two extra hands to support her head and hold her in the right position. I had the urge to hand her back to someone more competent.
I spent the next 24 hours in bed. I had been uneasy at the idea of a catheter, but after being pregnant for nine months, going a full day without having to get up to pee felt luxurious. Still, I was afraid to sit up, let alone to look at my incision. I was scared it would hurt when they massaged my uterus or removed the catheter and staples. I was dreading having a bowel movement, which I’d heard would feel like my intestines were falling out.
Much of my recovery is a blur, probably because as soon as the baby was born, I had a lot of other things to think about. I don’t want to sugarcoat it: Aside from trips to the microwave to warm up my heating pad, I didn’t walk around much that first week after giving birth, and when I did stand for more than a few minutes, my incision started to burn. I was grateful to the friend who had told me to take stool softeners and ask for the good pain meds. I also enjoyed having doctor’s orders to take it easy. It felt appropriate to rely on my husband to bring me a glass of water or a sandwich as I breastfed. My daughter’s arrival completely upended my life, but I came away feeling like nothing about my C-section was as bad as I’d been led to believe.
The majority of literature on childbirth, with a few exceptions, still operates under the assumption that a C-section is an inferior way to give birth. Much of what I read seemed intended to convince me I shouldn’t want one. Encouraging women to educate and advocate for themselves in the delivery room is clearly well intentioned. There’s evidence that doctors are incentivized to perform C-sections for profit and efficiency even when it’s not in a patient’s best interest. But reading many popular books on childbirth, it’s easy to come away with the impression that it’s a woman’s responsibility to avoid being subjected to a cascade of unnecessary medical interventions, even as her doctor is advising otherwise. “Part of giving birth in the twenty-first century involves gaining an understanding of two categories of cesareans: those that are needed for medical reasons and those performed for other reasons,” writes the midwife Ina May Gaskin. There are plenty of good reasons not to want a C-section. But talking about surgical deliveries primarily as a worst-case scenario that should be avoided — despite the fact that more than 30 percent of American births happen this way — perpetuates stigma and fear. Leslie Jamison observes that “although the cesarean backlash arose from an impulse to empower women, it has perversely become another way to shame mothers, or make them feel inadequate, as soon as they’ve given birth.”
None of this negates the experiences of those who have found having a C-section traumatic. If I had felt pressured or rushed into surgery for murky reasons during the course of a delivery, as many do, my feelings would probably be far more complicated. The medical profession has also made some efforts to improve the experience: It’s now more common for a mother to hold her baby soon after surgery, and many doctors allow patients to use a clear screen if they want to watch their baby being born (as with a vaginal delivery). I also wish my doctor had talked to me through everything that would happen more thoroughly in advance. For me, the worst part was not knowing what to expect.
I came away from the experience feeling cheated not because I’d had a C-section but because I’d been made to feel so bad about it. A C-section was the safer and more realistic option for me, though sometimes when I hear women including Gaskin talk about how transcendent giving birth “naturally” can be, I still feel like I missed out. The truth is my birth was an out-of-body experience, too. Even if I was lying on an operating table with half of my body paralyzed, it was still the most intense and unreal hour of my life. In the end, I got what I wanted, which was a healthy baby. Now, more than a year later, my scar is still oddly numb to the touch, a detail I take a perverse pride in telling people. It’s not that I like it, exactly, but it feels like part of me — and part of me and my daughter’s story. Even if I could do it over, I wouldn’t change it.