The Conversation About C-Sections We Haven't Been Able To Have... Until Now

Judy Batalion was alone among her friend circle in not wanting a vaginal birth. But she found that even among “similarly educated, feminist, intellectual and artistic” friends, admitting that she preferred a c-section was taboo. As soon as she found out she was pregnant, she knew she’d opt for a Caesarean — and not at full term, or mid-labor, as the c-section tale went for so many others. That opened her up to judgement.

Batalion's elective c-section was not for convenience or cosmetic reasons, nor maternal disempowerment and coercion, but her health history. As a tween, debilitating acute ulcerative colitis caused her colon to disintegrate. After three corrective surgeries she was “cured, liberated, elated.” Her associations with the operating room were positive; others were quietly appalled.

Her choice came down to the personal risks associated with c-sections and vaginal birth. She was not interested in purposeful pain, or the trials of labor, but what felt safest and most in control. Privately comfortable with her decision (and pregnant with her third CBAC), the current anti-c-section trends made her an anomaly. Where would the narrative of her birth be welcome or validated? Where can any of ours that defy the tale of blissful unmedicated heroism?

I met Batalion, currently expecting her third, at the launch of My Caesarean: 21 Mothers On The C-section Experience And After, edited by Amanda Fields and Rachel Moritz, at KGB’s Red Room in New York City. The audience (which included my 9-month-old, who had just learned to clap) turned out to hear the many possible c-section narratives, running from uplifting to disappointing, destructive, and devastating.

This collection offers critiques of c-sections, but does not take sides. Rather, the collection is meant to open up a place for more complex conversation reflective of women’s experiences and questions.

For a long time, c-section rates have been rising in this country, now the delivery mode for an average 32 percent of births per the CDC. This is well above the WHO recommendation of 10-15 percent, the point past which outcomes for mother and baby are not improved. But the conversation about the c-section experience has not expanded similarly, and these silences, like most silences, hurt birthing people as much as the knife and tug of birth itself.

C-sections are distinctive in that they instigate and mark a permanent identity transformation.

As much as we need to cap the c-section rates, and interrogate legally and ethically the practice of coercive c-sections, we also need to understand the breadth and depth of birthing people’s actual experiences. We need first-person information (and provider compassion) about the challenges of healing — and to legitimize all ways of giving birth.

We cannot do this without listening to birth stories that reveal a more nuanced view of c-sections. My Caesarean: Twenty-One Mothers on the C-Section Experience and After, an anthology of birth experiences, throws the mono-narrative out with the used chucks pads. The stories re-center mothers' perspectives, giving them autonomy and authority, and providing a model for healthcare workers.

In fact, birthing people often know very little not only about Caesarean surgery — its nuts and bolts, which organs go where, how sutures are handled — but also about what comes after, the process of self-repair, and post-surgical mothering. Though c-sections are equated with other surgeries, something for which you are prepped and recover in a set amount of weeks, c-sections are distinctive in that they instigate and mark a permanent identity transformation (becoming a parent to one, two, or more). It is not just the physical scar which doesn’t fully fade. Women leave with pressing, painful questions.

When we put more realistic portrayals of birth out into the world, we decrease the potential negative effects on mothers, babies, and families. We also encourage more nuanced and truthful conversation between patients and birth workers (even doulas, unfortunately, may unconsciously judge their clients’ preferences).

The stories show how perplexing it is for partners, friends, and loved ones when they cannot fathom the birthing person’s emotional response to a birth where “Everything was OK” (define “everything,” again?). Imagine if our menu of options was less fraught with judgment, and we could find support and company in not being okay, along with trust that we can be some day. Could greater understanding of the emotional component better reduce the high rates of morbidity — of collateral damage like depression — that accompany c-sections?

Reproductive psychiatrist Alexandra Sacks M.D. underscored these themes in a recent op-ed in the New York Times, “Overcoming Traumatic Birth.” In healing from a disappointing birth, she suggests allowing yourself to grieve, but encourages the mother to: “Confront idealization. Your birth may not have matched your perfect vision, but what in life actually does?”

And additionally: “Make sense of your narrative. The way you give birth is largely controlled by biology and luck; what didn’t go as planned wasn’t your fault.”

My Caesarean is all about mothers making sense of their narratives, but doing that is not as clean or uncomplicated as it may sound. Some narratives won’t ever make complete sense. Sometimes, a mother must make peace with the fact that she may never understand or accept what happened to her, the choices she did or didn’t make, and the actions of the people — including partners — who were supposed to help her. The diversity of stories helps us puzzle out the unfinished business of a birth that is “over,” without rushing anyone to “get over it.”

Postpartum, our job and right is to make meanings we can live with out of the birth experience. These stake a claim for the larger culture. The sharing of stories can help us live with our sense of ourselves, as mothers and patients, amid lingering trauma, shame, isolation or self-doubt. These stories also give us reference points for solidarity and action, rather than muddied and muted tales we fear will be dismissed.

At the book launch, which saw many of the writers read aloud their stories, there were commonalities: the surgical curtain, the heartbeat too loud or too quiet, the scrubs, the lights. But there are also moments of great confession from the contributors who read out their stories: Rachel’s self-loathing when listening to other mother’s natural births, Nicole Cooley feeling far from heroic or athletic, the sense of eerie distance from events. LaToya Jordan observed, “Judgments were made about me based on preconceived notions about black women.”

“I want too much; I want all the wrong things... I know I am a bad mother,” Nicole wrote. Perhaps other mothers entertained these damaging truisms. Or maybe our OB wept when she pulled our baby free, like Robin Robin Schoenthaler's did, having shepherded her through the perinatal death of her firstborn. Or, like Sara Bates, we are “chronically exhausted and eternally grateful” as mothers. Something may ring a bell, cause a tingle to our scars (I too am an emergency c-section mother, due to cord prolapse), or offer women who have not yet given birth a place to see themselves.

The book’s inception was a thread on social media, in 2014, that brought together Fields and Moritz, the editors. As the conversation evolved, they put out a call for submissions, aiming for diverse representation. “I still worry that we didn’t do justice to the topic, because it’s so hard. It’s just one book,” Fields says.

One book, but many voices. The editors were concerned with intersection of birth with a range of identities, including (among others) a transracial adoptee, single mother by choice, queer mama, and sexual trauma survivors.

It seems the c-section, though statistically probable, is still an afterthought in how we prepare.

The editors also found healing in the essays. “I had felt the c-section was my fault, I should have asked more questions, or had a better plan. I didn’t think to do basic things like hold the baby after she was born, I was so full of medication and shaking to even do that,” Fields recalls. “After reading the essays, I realized I hadn’t done as much wrong. I had less uncertainty.”

We need better education. Compared with the number of books out there on vaginal and unmedicated birth, there still is not much literature available for women on c-section and recovery. Nor is much time devoted to this in your typical birth class. My own childbirth ed was mindful in every way but visualizing a c-section patient: a topic covered via brief mockup with dolls in a 7-week class. It seems the c-section, though statistically probable, is still an afterthought in how we prepare. As recently as nine years ago, when Moritz was looking, there was only Michael Odent’s The C-section, more medical than experiential (and written by a man, no less).

Books like My Caesarian this help us acknowledge the many versions of birth and, as Bates put it to me, “manage expectations.”

Our health metrics might improve when we support mothers in narrating what happened to them, with objectivity but not objectification; with emotion, but not overwhelm. As Jordan told me, “I felt like my story mattered.” And frankly, to improve outcomes, we need more of that.