I have sat down to write this particular post several times. Each time I’ve spent more than half of the post justifying why I had an emergency c-section, and the steps I took to avoid a c-section in the first place. But that’s not the point I actually want to make. I think it says a lot that in a post that I’ve intended to be about how we can support mothers no matter how their children came into the world, I felt the need to justify that I really wasn’t “too posh to push.”

First, I’d like to take the entire concept of “too posh to push” off the table, because statistically it’s not a thing. If anything it’s “I’m posh, therefore I push,” with white women of higher socioeconomic status having a significantly lower c-section rate than other groups. *

But, again, that isn’t the point of this post.

Having an emergency c-section was the single worst experience of my life. It was physically and mentally traumatic. After having an epidural administered approximately 20 hours earlier, its effects had started to wear off by the time the decision was made. For the safety of my son they couldn’t give me any more pain medication in the operating room. The anesthesiologist called a time out, concerned that I wasn’t adequately numb.  I remember the OB saying “we have to go” and then feeling the incision. Let me be clear, I was in pain. I felt everything. Once my son was safely out I asked to be completely knocked out, but not before the stitching began.   I don’t regret the decision to be completely sedated.  I would not wish an emergency c-section on anyone.

I did find it difficult to bond with my son after my c-section, but NOT because we’d been separated for the first 30 minutes of his life (we’d been separated when I requested to be completely sedated). It was because the trauma of his birth was so overwhelming that I had a hard time reconciling this round-headed, chubby-cheeked cherub with how he had come into the world, and that made it difficult for me to bond with him.

Leslie in labor.

Leslie in labor somewhere around hour 18.

What I’ve found since my son’s birth is that my experience was not unique. If you ask any woman who has had an emergency c-section, she will likely tell you that they wouldn’t wish the experience on anyone. An emergency c-section is not the easy way out as it is often characterized. It is traumatic, it is painful, and it is scary. It is an emergency life-saving procedure where the comfort of the mother is secondary to ensuring mother and baby survive.

In public health we’re all acutely aware that private decisions often have public consequences. When I told colleagues that I had an emergency c-section, I was typically reminded of the increasing c-section rate, and then asked to describe in minute detail what lead up to the procedure. They were trying to figure out if my emergency c-section was truly an emergency, or if my OB simply wanted to go home and catch The Daily Show at 11pm. I became another data point, which as a data nerd I understand to a certain extent, but sometimes in public health we can forget that our data points are people.

When I told friends how my son was born, I received one of two responses: 1. Empathy and commiseration from other women who experienced an emergency c-section or 2. Disdain from those who have given birth the old-fashioned way or who felt their c-sections were medically unnecessary. From the latter cohort, I’ve been told I did birth wrong, I gave up too soon, I wasn’t fully informed of the risks, I was taken advantage of by the medical profession. The most common and hurtful was that I took the easy way out. Let me assure you, after 26 hours of labor and feeling each individual stitch being made in each individual layer of my body, I can assure you that an emergency c-section is NOT the easy way out.

I have been in tears more than once after a well-meaning conversation with a friend or colleague who needed to tell me how badly I birthed my son. Something Julia and I say over and over again on this blog is that language matters. When we tell women that they didn’t do birth the right way, it breaks motherhood into two tiers: those who are “Mom Enough” and those who are not. The research shows that this judgment of mothers who have had c-sections is ripe among women, with mothers even judging themselves for giving birth the “wrong way.”

Perhaps the most stinging phrase I’ve heard since my son’s birth is one that mothers heap on themselves: their bodies failed them. This is usually accompanied by cries that their bodies let their babies down, fears that their children won’t love them as much because they weren’t able to birth them the “right way.” It breaks my heart when I hear women say it, because it says that their bodies were somehow less natural than other women. It says that at a base, biological level one woman is fundamentally less “female” than a woman who is able to give birth naturally.

This language cuts and we must stop using it against each other and ourselves.

Leslie and her son minutes after he was born.

Leslie and her son minutes after he was born.

It took me well over a year to mentally come to terms with my c-section.  I didn’t set out to do that.  In fact at one point I wasn’t sure I’d ever reconcile my birth experience, what others told me about it, and whether or not I had the mental fortitude to go through it again.  But several events eventually lead me to make peace with my son’s birth.

The first events were unfortunately tragic. A friend of a friend had a labor similar to mine, yet refused to consent to a c-section when it was recommended by the OB on-call. She was convinced the doctor was motivated to perform the c-section for selfish reasons. By the time she consented, her son was stillborn and couldn’t be revived. My friend reached to ask how she could support her friend who was wracked with guilt and grief. My only advice was to not judge her, because whatever my friend thought of her decisions, her friend’s own judgment would be ten times of what anyone could heap on her. The second event involved an acquaintance from high school who had a labor similar to mine. While she consented to a c-section promptly, the procedure was delayed and her son was also stillborn and could not be revived.

To be clear, these events were personally transformative, and that’s why I mention them here.  I don’t mention them to scare women into c-sections.  If you can safely push that baby out, then push that baby out! More power to you!  And it obviously goes without saying that c-sections and specifically emergency c-sections carry risks above and beyond a vaginal birth.  I say this because I know there is a contingency on the web that will be quick to accuse me sharing these two stories in an attempt to scare women into having unnecessary c-sections.  If that’s what you think, please re-read the third and fifth paragraphs of this post.

But, these two tragedies caused me to reframe my son’s birth from something I viewed as traumatic and less than ideal to “there but for the grace of god goes I.” These tragedies reframed birth in my mind from an end in itself, to a means to an end.

The next two events happened in close succession. I switched OBs during my current pregnancy and requested a copy of my medical records. When I read the c-section report it was like reading a hidden history. The first half read as I’d remembered the day progressing, but many of the details leading up to the procedure and the procedure itself I hadn’t been aware of. Those details made me realize the situation was much more serious than I’d been aware of at the time.  It also put my OB’s comment, “we have to go” into better context.  I’d always thought that his comment had more to do with wanting to keep to hospital policy and in/out times, but after reading the report I realized he meant that my son had to come out now, not five minutes from now.  Despite the trauma of the experience I’m grateful that he made that call.

Shortly after reading the report, and with the knowledge that I was pregnant again, a friend began to lecture me on how I couldn’t let my OB take advantage of me again in this delivery. She repeated the phrases I’d heard before, that I could do it right this time, that with more time and patience my body could do what came naturally.  This time, instead of focusing on the other person in the conversation and trying to validate what they were saying, I stood up for myself. I let them know how her language made me feel, how I felt about my birth, and that their judgment was extremely hurtful.

I expected the friend to get angry, to tell me how she was just trying to empower me to stand up to the medical profession, but what I got instead was a sincere apology. I think the moment was a bit of a wake-up for her as well.  I don’t think she’d realized how much the language she was using to encourage vaginal birth actually stigmatized women who’d had cesareans.

This issue around the language and ranking of birth doesn’t just extend to women who have had caesarian sections, but also to women who became mothers through surrogacy, adoption, or by step-parenting. We must stop defining each other by how we came to be mothers and instead value each other as partners in a shared, wonderful, maddening, frustrating but joyful journey.

Leslie, her husband and son when he was only a few months old.

Leslie, her husband and son when he was only a few months old.

* To be clear this is a vast overgeneralization of the issue. There are many, many factors that go into both an individual’s risk of having a c-section as well as traits and behaviors associated with demographic groups including access to prenatal care, nutrition and underlying medical conditions.

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Categories: Mental, Emotional, + Behavioral Health, Pregnancy, Birth + Family Planning