In Praise of the C-Section: I'm Not Sorry I Didn't Have a Natural BirthTova Mirvis
When I was pregnant with my third child, I accidentally wandered into a conversation in which two mothers I’d recently met were extolling the virtues of homebirths and water births, midwives and doulas. When the well-meaning moms asked about my birth plan, I told them I was having a scheduled C-section. Their faces conveyed self-righteous disapproval and my mind was immediately awhirl in disclaimers: I was having the scheduled C not because I wanted the convenience, not because I was afraid of labor, not because I didn’t want to miss my manicure appointment.
“My oldest son would have died if I didn’t have a C-section!” I said instead.
It was unfair to pull the “my kid almost died” trump card, and if I hadn’t skulked off in annoyance and then embarrassment at having reacted so defensively, I could have told them about my first pregnancy and the months of bleeding, followed by the morning at thirty-two weeks in which there was no kicking; then the hours on the monitors where the heart rate was at first fine, then shockingly not fine, which provoked the careening stretcher; the epidural which didn’t have time to take effect, so instead the general anesthesia and the intubation. It was birth as highly medicalized and impersonal as critics of the C-section claim, one in which I had no voice and no control.
I also could have admitted that I’ve occasionally felt a twinge of loss that I’ll never give birth more naturally. Having never experienced labor, I sometimes feel like a little girl eavesdropping on the grown-ups’ tales of childbirth. I pore over pictures my husband took during one of my C-sections, to convince myself that this was my body, my baby. When I watched a friend’s video of her home birth – in water, no less – I felt as I do when watching Olympic figure skaters: as much as I would love to do that, it’s never going to happen.
But that loss is nowhere near what I would have felt had all those highly-interventionist, medical-establishment doctors not been exactly where I needed them. After a month in the NICU, when we were finally ready to take our son home, the resident who’d been on call the night of my C-section told us how blue our baby was. He held his fingers imperceptibly apart and told us we’d come “this close.”
Those words followed me for the four years in which I worked up the courage to get pregnant again. I went back to the same OB, who warned me I would be closely monitored. But this pregnancy was so uneventful that by my third trimester, my doctor raised the possibility of a VBAC. I was aware of the spate of newspaper articles decrying the increased rate of C-sections and moved by a relative’s joy at having a VBAC. Mostly I was tempted by the opportunity to prove to myself that I could do it. My mother used to tell me about her paternalistic male OB who, in the days of twilight medication and fathers in the waiting room, had instructed her to “lie back, sweetheart, you don’t have to do a thing,” to which I’d always rolled my eyes, confident of my physical capabilities and glad for all that had changed in the world.
If I’d tried, and all went well, perhaps this would be an essay in praise of VBAC. But that of course would only be evident in hindsight, when the result of the birth was cradled in my arms. Not yet having crossed over to that safe other side, what my prior experience taught me most starkly was that birth was not a process that I could control. The incision scar fades after a year or two, but the scars of near-tragedy are etched more permanently, making it hard to care about the experience, rather than the result, of birth.
My scars also make it hard not to hear a tone of triumphalism on the part of some who are lucky (because that, after all, is what it is) enough to have the birth of their dreams. Or to hear narcissism at the wishful fantasy that it is simply a matter of “trusting my body,” or to hear folly at the idea that what matters most in a birth is your own experience of it. Surely the current obsession with the process of birth comes in response to the many years in which women were told to lie back and do nothing, yet it reminds me of the bride fixated on the wedding, not the marriage, the bride bedecked with a breathtaking array of flowers, as if the abundant beauty can serve as a talisman against the harsher realities that lie ahead.
For me, the question of VBAC was easily decided when at thirty-seven weeks, my doctor saw a heart rate deceleration. While this wasn’t necessarily cause for alarm, she wanted to do a C-section that evening. Was this the much-maligned elective C, which I was choosing because I was distrustful of my body? Was this the voice of the medical establishment, belittling my capabilities, trampling my rights? Was this an example of a doctor rushing to surgery, for fear of malpractice? What I heard was the voice of my doctor, wise, capable and kind, who had saved the life of my first child. My desire for a certain experience, my image of who I thought I was or wanted to be, mattered least of all.
Was it the birth of my dreams? Hardly. During my third pregnancy, with a different OB in a different city, there wasn’t a conversation about VBAC. November 26, 8 a.m., was penciled in on our calendars, though given a variety of complications, it seemed unlikely I’d go to term. But the weeks passed and the baby grew, until the date loomed before me, and I remembered more viscerally the physical pain of my previous C-sections. When I told my doctor how afraid I was, his nurse happened to repeat the same sentiment my mother once heard. “Lie back, he’ll take care of everything.”
Beautiful words, those were. Because a C-section is a scary thing in which I was glad to take no active role. Even when it’s planned, it doesn’t necessarily go according to plan. This time, I knew the date so far in advance that I made sure to complete a major project beforehand; the night before, I packed a few days’ worth of school lunches and laid out my kids’ clothes. Most of all, I concentrated on not letting my mind wander to the netherworld of all that could go wrong. Yet no matter how much I’d prepared myself, I still felt terror at being wheeled into that operating room. Despite the fact that I’d had every test and an inordinate number of sonograms, the moment my baby was lifted out was unexpectedly fraught with worry as the neontalogist present was concerned about a possible malformation. While my baby was examined across the room, I had to wait helpless and terrified until I was told she was going to be fine.
Was it the birth of my dreams? Hardly. Do I wish it could have been different? Sure. But compared with the result – my daughter, Liana, little sister to my sons Eitan and Daniel – I really don’t care. If I’ve learned anything in ten years of motherhood, it’s that the way our children are brought into the world means very little for how they live in the world. Nor do the intense hours in which we become mothers shape the months, years and decades of our actually being mothers. And if the experience of childbirth is in fact a crucial process, then let it be the process of teaching us that our children will emerge in ways varied and complicated, not necessarily in times or manners of our choosing, neither made in our image nor as proof of our prowess. Let birth remind us that, with children, so little goes according to even the most well-drawn plan.