Cut and run

An increasing number of American women are choosing C-sections. Is this trend a risky indulgence, or a sign of female empowerment?

By Dana Hudepohl

Several months after Jennifer Feeney, 34, a veterinarian in New Jersey, found out that she was pregnant, she read an article in Time magazine about celebrities such as Madonna and Elizabeth Hurley choosing to have C-sections -- not because they needed them, but because they wanted them. "I thought, Wow! That's something I'd do," she says. At her next appointment, she joked with her doctor about scheduling a cesarean birth. When he was receptive to the idea (while at the same time warning her of the risks) Feeney decided that an elective C-section was the best option for her.

"I absolutely dread the entire thought of laboring and delivering," says Feeney. "I can't see myself sitting around moaning, panting, sweating and screaming while people poke and prod at my vagina. It just seems so unnecessary to me."

Although Feeney is determined to go through with her decision, she's learned to keep her plans to herself. Her husband and doctor are supportive, but other people tell her she's "copping out." "You'd think it was the worst thing in the world to do," she says. Some other expectant mothers she's met online are horrified and have accused her of being ignorant and selfish. One woman even told her that she's going to be a terrible mother because she's only thinking of herself rather than doing what's best for her baby. "I thoroughly researched all the possible complications of C-section versus vaginal delivery and there are possible complications with both," she says. "Believe me, if I had found any statistical evidence that a C-section was worse for my baby, I would not do it."

Feeney is just one of a growing number of women across the country who are asking their doctors to deliver their babies by C-section even when they have no medical indication not to have a vaginal delivery. A study released last week by HealthGrades, a Denver company that studies healthcare quality, found that approximately 88,000 women had elective C-sections in 2002, up from about 71,000 in 2000, an increase of nearly 25 percent. "I think it would be safe to say that this is probably an under-representation of what's actually going on," says Dr. Samantha Collier, vice president of medical affairs at HealthGrades, noting that doctors may not always specify in the paperwork when a C-section is truly elective. "I don't know that it's ever going to completely replace vaginal delivery but I think it will continue to be a growing trend."

For decades, not having unnecessary C-sections was the feminist cause célèbre; can it be that having them -- a decision, like abortion, that is increasingly couched as a woman's "choice" -- is the new feminist cause?

"What the women's movement did was push for women to be able to choose a less medicalized birth, with less risk of having an intervention imposed on them that they didn't need," says Amy Alena, program director of the National Women's Health Network, a group that opposes C-sections except when they are medically necessary. "And that's the real problem with the movement for the C-section option: If it's presented to a woman as, Here are two equal options, it's no surprise that women are going to choose it. But if it's presented in what we would be considered a more balanced way, we think fewer women would be likely to choose it, because there are greater risks [with a C-section]."

According to the latest data from the Centers for Disease Control and Prevention, the rate of C-section is at an all-time high, with more than one out of four American women giving birth by surgery. While the bulk of this number is still made up of C-sections that are performed for medical reasons -- like a baby in breech position or with a dropping heart rate -- more and more women are requesting surgery. Their reasons run the gamut: Everything from the convenience of scheduling a birth to fearing labor, hoping to avoid a marathon delivery with complications or wanting to prevent long-term bladder, bowel or sexual problems that sometimes result from vaginal delivery.

But the optional C-section trend is making some doctors fume. "The outrageous cesarean rate we now have in this country is a national medical disgrace," says Theodore M. Peck, M.D., a perinatologist at the Gundersen Lutheran Medical Center in La Crosse, Wis., and author of "Empowered Pregnancy." "A general principle that we as doctors go by is 'Above all, do no harm.' By offering some anxious women the 'easy way out,' we are in fact potentially doing harm to some of them."

The debate over elective cesareans started publicly in the spring of 2000 when then-president of the American College of Obstetricians and Gynecologists (ACOG), Dr. W. Benson Harer Jr., argued for "maternal-choice cesarean" in an editorial printed in the association's journal. Doctors were forced to pick a side as more patients entered their offices with requests. From 1999 through 2002, the number of elective C-sections provided to women with no previous C-section rose almost 42 percent, accounting for more than 2 percent of more than 4 million deliveries. If more women start getting their way, that number could skyrocket. In an online survey at, a Web site put out by sexual health experts Drs. Laura and Jennifer Berman, when nearly 2,500 women were asked, "Would you opt for a C-section over a vaginal delivery if you had the choice?" 37 percent answered "Yes"; another 9 percent answered "Not sure."

With the recent surge in prenatal yoga classes, midwives and doulas, it may seem strange that some women are opting to medicalize their births. But if a woman can decide what kind of birth control she should use, whether to get an abortion and if she wants an epidural to ease labor pains, why shouldn't she have a say in how she delivers her baby, ask some doctors and women. Proponents point to evidence showing that when healthy women choose to have C-sections, the risks, benefits and costs are balanced between C-sections and vaginal delivery. They conclude that the choice should be the mother's. Critics -- doctors, midwives and women among them -- answer back that a C-section is major surgery with risk of complications, longer recovery and potential problems with future deliveries.

If it seems like a medical community divided, it is. It hasn't helped that ACOG, which represents more than 45,000 physicians, left the issue open to debate when, last October, its ethics committee issued an official opinion on elective C-sections. After more than a year of deliberation, the group concluded that it is ethical to provide an elective C-section if the doctor believes it is in the best interest of the woman and her fetus and if he has advised her of the risks involved. If the doctor believes a C-section would be detrimental to the health and welfare of the woman and her fetus, he is ethically obliged to refrain from performing the surgery. If the patient and doctor cannot agree on a method of delivery, he should refer the woman to another doctor. The ACOG cautioned that evidence to support the benefit of elective cesarean is still incomplete and that there are not yet extensive morbidity and mortality data to compare elective cesarean delivery with vaginal birth in healthy women. In other words, the jury is still out.

Without conclusive evidence, where does this leave women who decide they want a C-section? They have little idea of how their wishes will be received by their physicians. Stories are sprinkled throughout Internet pregnancy message boards of women who have learned that they have a right to choose, but when they ask their doctors for C-sections, they are denied. It's no wonder: A recent Gallup survey of 301 female OB/GYNs showed that even women who take care of other women are sharply split. Thirty-six percent said they would not perform a C-section if a woman asked for it, 32 percent said they would, and 28 percent said it would depend on the woman's circumstances.

"I had to actually leave my OB in my last trimester to find someone who would do [the surgery], says "Millie," a contributor to the message boards. "The entire practice I was in -- all 8 doctors -- refused to do an elective c/s for me and I would have been forced into a vaginal delivery if I had stayed there. It really does suck to be faced with no choice in how you give birth."

Risks of C-section surgery include excessive blood loss, infection, anesthesia complications, bowel blockages, and uterine adhesions that could lead to dangers in future deliveries. "C-sections are incredibly safe, but bad things can happen during medical procedures," says Dr. Jerome Yankowitz, director of the division of maternal and fetal medicine at University of Iowa College of Medicine, who is against elective C-sections unless a patient has been thoroughly counseled. "It can be unnecessary surgery analogous to liposuction. Most people have no complications, but then there are a few who do. Afterwards people think, 'Why did they do that? They weren't that heavy!'" Yankowitz says he knows of many cases of bladder damage in the mother, bad wound infections and bowel injury as a result of C-sections. Many doctors advise against elective C-section if a woman plans on having more than two children since subsequent surgeries become riskier. "Our concern is when C-sections are done a second, or third, or fourth time, you're working on a scarred area," says Marion McCartney, a certified nurse-midwife and director of professional services at the American College of Nurse-Midwives. Her organization issued a statement last fall against elective C-sections, stating that "purported benefits of cesarean section on demand are unproven and the known risks place the woman's life and reproductive future on the line."

Supporters of elective C-section acknowledge that there are risks and that a woman must be fully informed before making a choice, but that doesn't mean she shouldn't be able to choose. "There's less morbidity from C-section than there is from breast implants," says Brent W. Bost, M.D., a gynecologist in Beaumont, Texas, who has published research on elective C-sections. "We'll let women have a breast augmentation, plastic surgery and liposuction, which all have risks involved simply to look better; why will we not let them choose cesarean section?" The C-section risk data doesn't apply to elective C-sections, adds Bost, who performs about two dozen elective C-sections a year, since it comes from lumping together all C-sections. There is a difference between scheduled surgeries performed on healthy moms and those done on moms in less stable condition (for example, who've gone through hours of labor first or who have endometritis). "You've got to remember that elective C-section is a different animal," he says. "You have to compare apples to apples."

The fact that no large-scale studies have been done to compare apples to apples is what concerns nurse-midwife McCartney. "Before physicians jump in and say there are no problems with C-sections, I'd like to see a study comparing a healthy vaginal delivery to a healthy C-section," she says. "Most people think the study has been done already and it hasn't. Women think they're having an opportunity to make a choice, but what they're really getting is their provider's opinion."

Donna McDonald, a 31-year-old obstetrical nurse in Lexington, Mass., says she felt like she had all of the information she needed when she decided to schedule a C-section for her first baby last year. As a nurse, she had seen postpartum women with urinary incontinence, hemorrhoids and protruding uteruses from pushing, rectal tears, and episiotomies that had been sewn too tight. But what influenced her the most was witnessing her sister's traumatic labor and delivery, which included three hours of pushing and an episiotomy. "After I saw what she went through, I said my experience has to be very different," she says.

Choosing a C-section gave McDonald, a self-described "control freak," a sense of, well, control over the delivery. "I was concerned about birth trauma and wanted to avoid forcing my baby out," she says. "I felt the safest thing for my baby was a C-section where my doctor, who I completely trust, could be in control." The surgery went smoothly. Even the recovery, which so many people had warned her would be painful, was easier than she expected. "People told me I was crazy -- that the recovery was going to be so much harder -- that I would be laid up and need help, but I found it the opposite," she says. "When my husband and I got home I was a little bit sore and I couldn't do laundry and vacuum -- I pretty much stayed on the couch -- but I think that every postpartum woman needs relaxation time the first couple of weeks anyway."

Not all women look back on their scheduled C-sections so fondly. Many women who are forced into a C-section for medical reasons have found the recovery so painful that they question why a woman would choose to have the surgery. Stephanie Higgins, 24, had planned to have a drug-free natural delivery, but when her baby was three weeks late and estimated to be over 11 pounds, her doctor recommended that she schedule a C-section. "I feel like I missed out on an easier, more natural process," says Higgins, who couldn't get out of bed or pick up her newborn -- who, it turned out, only weighed in at 8 pounds, 15 ounces -- for days because of the pain from her cut stomach muscles. More distressing than the soreness was that she had difficulty nursing. "Since my body had not gone through labor, it took longer for my milk to come in," she says. "My baby was hungry and I had nothing for her for a good five days. It was a really difficult experience." While Higgins believes that women should have a choice how they deliver, she wishes she had been able to stick to her original birthing plan. "People say, 'I wouldn't want to go through the pain of childbirth,' but there's a lot of pain with a C-section -- and I had an uncomplicated one. The recovery was much more difficult than anyone I knew who had a vaginal delivery."

Proponents of elective C-section are more interested in talking about the mother's long-term health than the weeks after the baby is born. "The first few weeks after you have the baby is a lot different than the rest of your life," says Bost. Studies have associated vaginal delivery with higher risk of lasting consequences, including pelvic organ prolapse and urinary or fecal incontinence. "In a vaginal delivery, you stress the vagina out of proportion and then expect the muscles to come back and respond, but they may not," says Bost. "Some of us are beginning to suspect that vaginal delivery may also damage the walls of the vagina and decrease vaginal lubrication for intercourse and may also damage the nerves in the vagina that make arousal for women more pleasurable."

No one is more familiar with these distressing repercussions than the doctors who treat them. Last August, Dr. Kathleen Kobashi, a Seattle urological surgeon, told the Seattle Times that she chose a C-section because she didn't want to risk the pelvic floor problems that she fixes in other women. UCLA urologist Jennifer Berman wrote a detailed account on her Web site about why she chose a C-section with her second child. After delivering her first child, Max, she completed a reconstructive surgery fellowship and saw women who suffered from incontinence and prolapse -- where the uterus can fall through the vaginal opening -- as a result of vaginal delivery. "Had I seen patients with such problems before Max was born, I would have elected to have a C-section with him, too," she writes.

Just because a woman delivers vaginally does not mean she will experience long-term problems. But a new study of 363 women from Tel Aviv University does show that elective C-section can have a protective effect. The prevalence of urinary incontinence one year after women delivered vaginally was 10.3 percent, but for women who had an elective C-section with no labor, it was only 3.4 percent. (It was 12 percent for women who had a C-section after laboring). Dr. Alison Weidner, an OB/GYN at Duke University Medical Center who sees women on a day-to-day basis suffering from childbirth-related pelvic problems, decided she didn't want to take that risk when her doctor predicted her unborn child would weigh more than 10 pounds. "Twenty percent of women who attempt a vaginal delivery risk ending up with a C-section anyway and a C-section after labor is more risky than doing it before," she says. "The most common cause of complications following C-section is infection, including infection of the uterus and wound infections, which is highly associated with prolonged labor and prolonged rupture of membranes. By definition, if the section is performed electively, these two situations of prolonged labor and rupture of the amniotic membranes don't exist, substantially decreasing the likelihood of infection after delivery." Weidner also points to the fact that it's estimated that overall morbidity is reduced from 24 percent to less than 5 percent when C-section is performed electively, as opposed to in labor. "This is a very touchy topic," she admits. "But in my mind, it should be an individualized decision between a patient and a doctor. When you need treatment for, say, prostate cancer, you have options. I don't understand why delivery of an infant is any different."

Scheduling birth is a not a uniquely American phenomenon. In Brazil, the overall cesarean delivery rate is 50 to 60 percent and climbs to 90 percent among wealthy women delivering in private hospitals. South Korea has one of the highest C-section rates in the world, with almost half of Korean women delivering by C-section (up from 6 percent in 1985 and 21.3 percent in 1995). In Denmark, nearly 40 percent of OB/GYNs agree with the woman's right to request a C-section. But recent media coverage of Hollywood's elective C-section trend with headlines like "Too Posh To Push" (Time) have given the issue a sense of elitism. For example, actress Denise Richards told People magazine in April that she scheduled her delivery around the television taping schedule of her husband, actor Charlie Sheen. Critics are concerned that all of the hype blurs the reality of what women having surgery have to go through. "It's like any fad out there," says Meg Ferrante, a natural-childbirth instructor near Atlanta. "It sounds great and easy and fast and painless and some women enter into it excited, like it's a day at the spa."

As word spreads and more women jump on the C-section bandwagon, healthcare specialists worry about the consequences. On average, C-sections are twice as expensive as vaginal deliveries. Can maternity wards handle a rising demand for elective C-sections? Yes, says Bost, since those numbers don't apply to elective C-sections. His research, published in the Journal of Obstetrics and Gynecology, found that when you factor in nursing, medication, and monitoring during long labor, the costs of vaginal deliveries and elective C-sections balance out. He concluded, "Adopting a policy of cesarean on demand should have little impact on the overall cost of patient care."

Feeney, who is scheduled to become a mom this month, is hoping her personal choice will help pave the way for other women. "I am thrilled at the thought of planning the birth of my baby, of knowing when he'll come and being totally ready," she says. "I embrace the medical technology that will turn what could be 20 or 30 hours of excruciating and unpredictable pain into a 30-minute procedure that will birth my baby for me, with some predictable discomfort during recovery. I would not have it any other way."


Birth Rape

Posted on by Kathy

Continuing in Dr. Rixa Freeze’s Born Free doctoral dissertation, starting on pg 118 of the pdf (pg. 104 of the dissertation), Rixa begins a discussion on “Birth-rape,” which is of course, highly troubling. Some women will choose to use the word “trauma” instead of “rape,” but the idea is definitely conveyed — outsiders doing things to a woman (specifically her genitals) against her wishes, and sometimes even against her explicit objections. The discussion goes on for several pages, and I think everyone involved in birth needs to read this, so that they can be more attuned to the concept — that some women feel traumatized by past births, or can become traumatized by future ones; that sometimes doctors and nurses can cause or contribute to those feelings; and that these things are real. Several women that were interviewed for this paper described previous birth experiences as either traumatic or “rape” — and this wasn’t restricted to hospital births attended by male doctors, but included births attended by female doctors and midwives in the hospital, as well as home births attended by a midwife. These experiences were so bad for these women, that the only way they could feel safe in birth was to go unassisted, since they could no longer trust medical personnel not to abuse their power as “professionals” or their office of trust.

One midwife who later came to believe that she had participated in “birth rape” said:

As I learned to be a midwife, I did horrible things to women in the name of education. I have held women’s legs open (“to get the baby out”). I have pulled placentas out (“to learn how to get one out that needs help or if the mom is bleeding”)….I have done vaginal exams on women who were screaming NO! I have coerced women to allow me into their vaginas for exams….I have manually dilated a cervix on a woman having a waterbirth (and I wasn’t wearing gloves) and got her cervical flesh under my fingernails.

As a doula and student, I stood by and watched as women screamed to be left alone. I watched midwives with 3 inch fingernails shove cervices from 3 to 10 [centimeters] in a few minutes. I watched as women had Cytotec inserted into their vaginas secretly….I have seen and heard women be screamed at to shut up, grow up, that she asked for it by opening her legs 9 months ago, that she gets what she deserves. I have seen a woman slapped by a midwife.

Rixa goes on to say, “Because such practices have become routine, few maternity care givers consider them abusive or inherently inappropriate.”

This is unfortunately all too true. You don’t have to look very far to find stories of women who were yelled at, sneered at, made to feel bad somehow (even stupid), forced to lie in bed, physically moved from a comfortable position into an uncomfortable one simply for doctor convenience, given unnecessary vaginal exams, given rough vaginal exams, cut unnecessarily, sutured unnecessarily, not given anesthesia for the suturing, etc. And this can happen even with “nice” midwives and “nice” nurses and “nice” doctors, which is the most troubling fact.

And this is why some women leave medical care and go unassisted — because they don’t like the way they were treated. After all, if you got raped when you went to a bar, would you go back to that bar again? I wouldn’t. And maybe not just that bar, but any bar, because that’s (obviously) where the rapists hang out, since one was hanging out there and raped you.

Average care in the early part of this century is better than average care in the 50s — there is more patient autonomy (no mandatory general anesthesia, major episiotomies, forceps births, etc.); but just because it’s better than it was doesn’t mean it’s as good as it can ever be, nor as good as it should be. Just as hospitals looked closely at their policies in the 70s with the advent of the “natural birth” movement and reemergence of midwifery, in order to keep women satisfied with giving birth there (not requiring general anesthesia any more, allowing husbands to be there when giving birth, making hospital rooms more “homey”), even so hospitals ought to look at their policies of today and address areas of discontent that many women have — including the area of loss of autonomy which the woman may process like rape.

(anti- cesarean site)


Let's be honest about childbirth

Having a baby? Don't believe the false promises, says Emily Woof. The gulf between natural birth and the medicalised approach puts mothers in an impossible situation. And she should know

[Emily Woof: 'I laboured for 36 hours. There is no describing the agony.' Photograph: Linda Nylind]

I remember being at a party when I was eight months pregnant with my first child. I got into conversation with three experienced mums. They looked at my round belly, and smiled conspiratorially as they unleashed their birth stories. They divulged everything – the baying, the blood, the fear, the chaos, the agony. They seemed to want to outdo each other's horror and as they talked they were transformed into electrified, possessed creatures. I was terrified. The adrenaline rush sent my baby into back flips inside me.

I have never talked about the births of either of my two children. There are plenty of reasons. Most of them are pragmatic. Birth pitched me into motherhood. Suddenly there was no time, certainly not for dwelling on the past. The births were behind me, the children ahead.

At least it's what I tried to tell myself. I had given birth twice. Each had produced a beautiful, healthy boy. Why linger on them? People went through far worse. It seemed churlish to brood, especially when so many women were unable to conceive. But my experience remained locked inside me, refractory and unexamined. If birth came up in conversation, I would stay mute hoping the subject would move on.

I knew that writing this article would be hard. I would have to face raw memories and all the old unanswerable questions. Above all, it would mean describing the actual births. I wondered whether the article should have a subtitle: not to be read by expectant mothers.

I asked my mother about her births and she said she never talked about them to anyone. She said the reason was obvious (my mother's second pregnancy ended with a stillbirth, and the unspoken grief still lives inside her after 50 years): birth was so dreadful that it had to be forgotten, or no one would go through it more than once. I don't believe women forget their birth experiences. I certainly haven't forgotten mine. Many women do talk about their births. Plenty of my friends recount them openly, especially if they went well, and I've noticed that even among those who had difficult births, talking about it can be a way of coping with the trauma. There are a multitude of responses, but mine, like my mother's, has been silence: not because of how dreadful the births were, but because at some level I couldn't acknowledge my feelings about them. I felt ashamed. I felt I had failed because both of them went "wrong".

It was the due date for my second child. The birth of my first had been by emergency caesarean, and I was keen to try for a natural birth. We had chosen a female obstetrician with a good reputation and discuss VBAC (vaginal birth after caesarean), which she was confident I could have. My husband and I arrived at her surgery for a cervical sweep, whereby a doctor or midwife uses a finger to stretch the cervix to stimulate labour. My consultant cheerfully inserted a finger. "Push against me," she said. I did. It hurt. It hurt a lot.

"Ah," she said, smiling, "I've broken your waters!"

She pulled out her hand. Her face went pale with shock.

My skirt was drenched in bright red blood. I couldn't understand where it had all come from.

"It's frank blood," she said. "Where's your car?"

We ran red lights all the way to the hospital. I was put in a birthing room and strapped up to various monitors. The bleeding subsided. A slow flow of clear fluid ran between my legs. It was amniotic fluid, my consultant reassured me – a good sign. She went back to her surgery to see more patients. When she returned four hours later, I had started to have mild contractions. She asked me to stand up and move around the room. As I stepped from the bed, I suffered a huge loss of blood. I had been haemorrhaging internally since the sweep. The blood had merely collected inside me. The clear fluid was not amniotic fluid but serum from still, separating blood.

I remember a blur of green gowns, a drip in my arm, the hospital corridor rushing past, my husband's terrified face, the bright coldness of the operating theatre, the mask going over my nose and mouth.

My husband waited in the corridor. After five minutes, a nurse emerged with a baby. He put it under his jumper to keep it warm and waited for three long hours. The memory still makes him cry. The doctors were too busy to tell him what was going on. He remembers someone rushing out and shouting, "We need blood!". He thought I was dying. I suppose I was. Only a massive transfusion saved me.

I have struggled with hundreds of questions about it ever since. Why did it happen like that? Looking back, I can also see that I had put myself under enormous pressure to have a normal delivery. Why? Why didn't I choose an elective caesarean? The answer is that in having one with my first child, I felt I had somehow let myself down.

On the internet, women chatter anxiously about every aspect of birth, from pain relief to whether an epidural can affect the baby's brain, from cultural differences in birth methods to whether having a caesarean can save your sex life. The voices seem uncertain: dismayed by choice, and fraught with the worry about getting it right.

The previous generation had no such choice. My mother's first birth was a lonely and scarring experience. My father was not allowed to be present. She was strapped to a bed on her back, her feet hoisted into stirrups. She was given ether for the pain and the baby was yanked out of her birth canal with metal forceps. Her vagina ripped badly, and she felt alone, ashamed and frightened. She said she was treated like an animal. Her baby was taken away to a separate room and only brought back to her when the staff deemed it necessary.

It is not surprising that after such experiences the natural childbirth movement sprang up. Women wanted control. Birth was a natural process, they said, and a joyous one. They wanted the sense of community that could surround a woman giving birth: midwives, partners, doulas. The hospitalised degradation our mothers had suffered was a thing of the past. Birth should be a positive experience.

Ten years ago and pregnant with my first baby, I found myself caught up in that idealisation of birth. My friends were the same. We practised squatting, breathing, and massaging. We were encouraged to indulge our bodies. It was a special time. Not least because we felt we were discovering a new faith; in nature, and in ourselves.

My husband and I sat on bean bags in the National Childbirth Trust (NCT) class, taking copious notes on an A4 pad. We learned that drugs could harm the baby. They could make it sluggish, and slow to feed. We heard horror stories about epidurals. We learned that the increasing rates of caesareans were due to doctors fitting them into their shifts. Birth had become over-medicalised and modern women were becoming "too posh to push".

The NCT offered an attractive alternative. Birth was not just a matter of having a baby, it was about remaining in control. I made my birth plan. No pain relief, it said. The teacher took my husband to one side. "Make sure she sticks to her plan," she told him. "When she's screaming for drugs, it's not what she really wants, it's what they want." He dutifully made a note of it.

We were both suggestible. I was hormonal. We became so convinced of the evils of hospital we decided to side-step them altogether and opted for a home birth. We paid for an independent midwife. She came to the house and showed me a video of a Brazilian woman giving birth. The woman got down on her haunches by a tree and pushed. The head of the baby crowned between her legs and it slipped out, easy as a pea from a pod. I am relatively small in stature and my bump was enormous. "I'm worried my baby is too big," I said. "You must trust in nature. Babies cannot be too big," the midwife retorted, as though I had dared question the faith.

We had candles, mood music, a birthing pool. We knew how to breathe. We had massage oils. We were ready. My waters broke at night and I went into labour. My contractions were fierce. I was soon 10cm dilated. The contractions came every 30 seconds, pain grinding down my lower back. I felt I would crack open. My baby did not slip out like the Brazilian woman's. I laboured for 36 hours. There is no describing the agony. The midwife put her hand inside me to turn the head, but still the baby did not come. I didn't want candles or massage or music. I just lay on the bathroom floor and wanted to die.

My husband told me that the midwife had stood in the kitchen at a loss. By midnight on the second night, he insisted we went to hospital. Within three minutes of arriving, I had been given an epidural. Fifteen minutes later, the duty doctor told me that the birth was not progressing and I was exhausted. He would deliver the baby by emergency caesarean.

The independent midwife didn't stay. This would not be a natural birth. Following standard procedure, the surgeon cut my skin through to the layer of fat until he reached the fascia, the shining inner skin that supports the abdomen. He made a small incision and widened the cut. He parted my muscles underneath and pushed through a sheet of tissue using his finger. He stretched the hole open and cut carefully into my womb, just enough to allow the baby's head through.

The sight of my baby suddenly lifting above the curtain and screaming loudly with flailing limbs, is scored into my memory like a sunrise. I reached for him, despite the surgeon telling me to lie still. The nurse laid him on to my breast, and the instant he touched my skin he was quiet and still.

Lying in the hospital ward afterwards, my body swollen with fluids, and the pain in my abdomen severe, I became deeply depressed. I was in a busy ward. My husband was not allowed to stay. I remember staring at my baby in the clear plastic tub next to me. I wanted to lift him but I couldn't move. A nurse reprimanded me. Why had I not bothered to put a nappy on baby? I was disoriented and could barely understand her. She stormed off and got a nappy and wipes. She dumped them on the bed beside me and passed me my son, streaked with meconium. I cleaned the molasses-like excreta from his perfect skin and cried through the night.

Perhaps with birth experiences like these it's not surprising that I wrestle with the idea that birth is one of the most natural things we do. I was told afterwards that my first son had the umbilical cord wrapped tightly around his neck. If he had come out normally, he would have been strangled. He would have died or suffered severe brain damage. I had always prided myself on being in tune with my body, fit and strong, and this felt like a dire failure.

I'm not sure whether birth is comparable to other "natural" things that we do. Unlike other mammals, our babies do not have a straight trajectory into the world. Evolution dictated that our pelvises became narrow in order for us to walk upright, but at the same time our craniums were growing larger to accommodate our burgeoning brains. For a baby to be born, it must turn as much as 40 degrees so that its large head can squeeze through the birth canal. It is a difficult manoeuvre. I recently read a book about the Piraha people in the Amazon. There was a description of a woman going into the forest alone to give birth. The baby got stuck and she cried out in agony all night long. No one went to help her. She was found lying dead by the river, the next day, her baby still inside her. The book says that no one mourned her. I'm not sure I can believe that, but it certainly seems true that for the Piraha, death in childbirth is simply an unavoidable fact of life.

Death has always shadowed birth. In the 1600s, if the baby didn't emerge, doctors drilled into their heads to make their bodies easier to extract, piece by piece. In the 19th century, women preparing for birth were routinely told to pray and beg forgiveness in readiness for death; 19th-century novels are littered with mothers dying in childbirth.

I am deeply grateful that I live now, when medical intervention has kept me and my children alive. I also know how important it is that the NCT and similar organisations exist to support and empower women. But in my experience, the division between health practitioners who advocate the natural way, and those who encourage a more medicalised route presents its own danger. It carries with it a sense of good and bad, a gulf in which women can get caught. It is part of our culture to want choice and to be in control, but with birth, this is probably impossible.

My friend Georgia, who was pregnant at the same time as me, was induced three weeks early because of preeclampsia.   Her cervix did not dilate and she was forced to have an emergency caesarean. I asked how she felt about the whole experience. She said she was fine, just happy to have a healthy baby. From the start she had never expected the birth to be anything but a nightmare. Sceptical by nature, she had stopped going to her antenatal classes because she disliked all the false promises about perfect births. She chose not to make any kind of plan. As a result, when things went wrong she did not feel any disappointment. It made me realise that, in some way, my silence was about mourning the birth experience I had wanted so much but was unable to have.

No doctor can predict how a birth will turn out. It's hard to know how best to prepare. To misquote another novelist, there are as many different birth experiences as there are babies. It has taken a long time for me to understand that it was not that my births that were wrong, but my expectations.

My birth stories are extreme but they are part of who I am. It is good to acknowledge them but I still feel drawn to silence. I don't know why, exactly. It is not about shame or feelings of failure any more but perhaps because ultimately birth, like death, is so intimate, so ordinary and yet so epic that it is beyond our expression.


13 March 2010 3:43PM

Was medical science so advanced in 1600s, when doctors drilled into the heads of unborn dead children to extract them? That procedure is being routinely used in late term abortion. Abortion became legal in the US only in 1973, and in some of the other countries not much earlier than that.

Yes, it was.

I would have thought death during childbirth was the exception rather than the rule. So how could every woman have been asked to prepare for death, as being alive after childbirth was the exception rather than the rule? Sure praying for a good delivery is normal, but not with the desperation as if death was the more likely outcome.

Estimates for the 17th century suggest women had a 7-8% chance of dying in childbirth. Women themselves anticipated death at every childbirth and virtually every women would have known of someone who died in childbirth - the figures are almost 1 in 10. They were indeed encouraged to pray beforehand and there is a slightly macabre tradition of women sewing their own winding sheets before childbirths. Accounts in women's diaries stress their fears of dying in childbirth, dread of incompetent doctors and midwives and of long, painful labours (100% drug free). There are also a couple of seventeenth-century bestsellers which were books ('mothers' legacies') written by women for their unborn children in the expectation (correct as it turned out) that they (the mothers) would not survive the birth.

When you read these accounts nothing seems more glorious than the advances in pain relief and medical training. I don't know if mothers or expectant mothers find it comforting or dismaying to know that their fears are echoed down the centuries but it seems strange (to me anyway) that women would feel guilty for not having 'natural' births when they have been a source of so much terror for so long.


13 March 2010 3:52PM

Thank god someone is brave enough to "out" the NCT mafia, this is just the latest way to make women feel shit, I have too many friends who felt total failures after their natural birth went wrong because they believed this new age nonsense. They needed counselling and found it difficult to bond with their babies. If you want to give birth on bean bags with the orb playing in the background good for you, but let the rest of us mere mortals have our epidurals or even dare I say it elective caesarians if thats what we want.

Before anaesthetic if you needed a limb amputated you used to go to the barbers who did it with a hack-saw, we don't do that anymore, neither do we have to suffer in child birth. Hallelujah for progress.

And yes, I do have a child and yes I did give birth naturally but with the aid of an epidural. The best thing that happened was the epidural. Had I been offered an elective caesarian I would have grabbed it with both hands. That was 15 years ago and the experience has put me off for life, child birth sucks and it makes you pee yourself when you laugh or cough no matter how many pelvic floors you do.


This is so powerfully honest and heartfelt and such a mighty trigger of my own harsh memories of that oxymoron - a natural hospital birthing - that i hardly know what to say except THANK YOU, Ms. Woof.

Thank you for shining a bright light on a reality that invariably begins with a patronizing glossing of our sensible hopes and fears, only to end up making us feel more stupid and scared for it during labor, as we come to understand neither our bodies nor people can help us.

Toxaemia is natural, ff. Rhesus incompatibility, gestational diabetes, jaundice in the newborn - they're all natural, but we take considerable trouble to prevent and/or treat them with all the available technology and drugs. Why single out the birth process itself?

I had a friend who married a doctor who had practised in Africa. He was a pretty laid-back guy, but he got incandescent with rage when she got pregnant and started parrotting the "natural" birth stuff - look at all those primitive women in China and Africa - squat down, one push and it's out! Bollocks, he said. Just look at the figures for perinatal death in the bush, he said.

Thank you for this article. I have one child whom I now love beyond the mere telling of it; but he's an only child because of the horror of childbirth and the appalling way I was treated in hospital and afterwards by the visiting midwives. I just could not put myself through that again, and through the misery of failing to bond with my son for a very long time afterwards because of it.

Some hospitals and midwives are, no doubt, wonderful. Some of my friends have beautiful stories to tell of their experiences. I don't know whether they're in the majority or the minority; I just know that from my point of view, the experience scarred me enough to prevent me ever doing it again.


After a traumatic first birth, for number two I decided I would skip the candles and go straight for the epidural. The biggest challenge was getting rid of the small gang of midwives who seemed intent on telling me this was a bad idea - until I mouthed the words 'formal complaint!'
For four hours I read a newspaper and chatted to my partner whilst listening to women around me screaming in pain. Not a tweak did I feel at any point. Like over 90% of women who have an epidural for a second or subsequent child, I did not need an instrumental delivery nor was I psychologically traumatised as I was with the first 'natural' birth.
I got what I wanted - not everybody's choice but we are all individuals. What bothered me was that to achieve my perfect birth i had to have a shouting match with the midwives who were intent on imposing their idea of what a perfect birth should be!


Birth Rape Is Real

Posted by Christie Haskell

on November 10, 2010 at 3:15 PM

People who blame the victim in rape cases are instantly rebuked, and counseling is suggested for the women so they can cope, find ways to work through the ordeal and the post-traumatic stress, and have support.

No one would dream of telling a woman who was talking about her feelings about her rape, "Stop complaining and just be grateful that you're okay." And yet for as many as one in every twenty women who suffer from PTSD from birth trauma and birth rape, that's exactly what they're told: "Shut up and just be grateful you and your baby are healthy."

We are treating mothers in ways that we wouldn't dream of treating rape victims, though often the trauma and lasting effects are quite similar.

One woman talks about how her birth ended up resulting in her severe PTSD, of her body without her consent and despite her objections. She was told she had postpartum depression, but didn't feel that was quite right. A psychologist pointed to PTSD -- she was relieving the scene in her head constantly, having flashbacks and crying spells, feeling stress when she thought about it, trying to redo it in her head repeatedly.

This kind of thing happens all the time. Like I said above, as many as one in every twenty women had such a negative birth experience that they are left with post-traumatic stress disorder, and in more severe cases, are able to honestly use the term "Birth Rape." After all, the definition of rape is unwanted, forceful sexual actions against a person, correct? But people react strongly against women who claim to have PTSD or birth rape trauma. For some reason, people insult women who have traumatic experiences by telling them they're exaggerating or shouldn't feel that way.

The intent was not likely malicious; you solicited the services of the doctor willingly; it is not sexual; it denigrates ‘real’ rape; you got a healthy baby at the end of it; you should have said ‘No’ more clearly; you should have been more educated; be glad you’re alive -- women used to die in childbirth all the time; if you didn’t want hands or instruments up your vagina, you shouldn’t have gotten pregnant in the first place; it was for your own good.

These are all things told to women who are suffering after their birth and find the phrase "birth rape" to be fitting for their own personal experience. As one brilliant woman said, they're telling women "it's not RAPE rape ..." as if that explains it.

But another brilliant woman also shows that the same argument is used against women who claim to be raped by their spouse or significant other -- that it's not the same, it's not rape, it's her fault. What about when the definition of rape extended to being raped WITH something, such as items? People said then too that it's not rape ... as if somehow being assaulted with an object is somehow less traumatic? Where people get off telling a victim that what SHE feels is incorrect and that THEY can better define her experience for her, I'll never understand, and it makes me angry that people even try.

If you can't understand what kind of things can cause this type of feeling, let me give some examples:

  • During a cervical check, my midwife suddenly announced she was going to do a membrane sweep. I said no, but she did it anyway, and I started yelling, "No no OW OW OW!" and was kicking up the bed to get away from her and the pain, but she ignored me.
  • Her midwife rammed a hand up into her vagina to manually dilate her cervix. Even as Lynsey squirmed and screamed, “No get off me”” while dealing with the excruciating pain of another monster contraction, she was laughed at and mocked for being a “bigger baby than the one she was trying to push out.” Desperate for the attack to stop, she lashed out and tried to kick the woman away, only for another midwife to firmly hold her feet down.
  • She inserted her hand into her uterus and without any warning or offer of anaesthetic and began scrapping blood clots from the side of the uterus. “She reached deep up inside and started scooping them out while pressing really hard on my uterus. The resident insisted I was feeling pressure not pain.   " She entered very roughly over and over again. The experience was so painful that she experienced flashbacks to an earlier sexual assault.

And those aren't even some of the worst. A healthy mother and a healthy baby are the outcome everyone hopes for, but there is so much more to it than just physical health. The mother's MENTAL health is incredibly important and absolutely should not be dismissed. To tell a woman that she should be grateful because she has a healthy baby is to tell her to shut up and suffer in silence. She IS grateful for her child, but is now trying to deal with postpartum normal emotions while sorting out emotions from an abusive situation. We cannot keep dismissing what happens to women, and sweep it under the rug, and blame the victim.