Why that C-section Wasn't Really Your Choice

As women, it is not easy to consider the possibility that our own birthing practices are not 100% under our control. As we are bombarded with endless suggestions about Lamaze classes, prenatal diets, and exercise techniques, we are so overwhelmed with choices that we may overlook perhaps the biggest decision we are faced with; how to actually give birth. Although the hospital birth seems to be the safest, mainstream method of birth in the U.S., we must consider the implications that our medicalized birthing system has on maternal and infant mortality rates as well as female empowerment. In the United States, the “Land of the Free,” we might not have as much choice as we think.

Historically, midwifery was the mainstream method of birthing in the U.S. until the 20th century. When using a midwife, a prospective mother is given individual care (usually, at that time, in the home), and she gives birth with her midwife present. In the late 1800s, however, this trend shifted toward hospitalized birth. This is no surprise considering this was the start of the shift toward a biomedical model. Women are now matched with physicians, whom they often times communicate with much less than they do with a midwife. These physicians birth their babies in hospital rooms where they are most often given a multitude of drugs that interfere with the natural birthing process including epidurals, Demerol, and Oxytocin to induce labor. These drugs are usually aimed at quickening the birthing process and making it as painless as possible, which is not only advantageous for hospitals to conserve space, but also for insurance companies to max out on expensive hospital bills. However, Jill Bergman wrote in a 2013 article for the journal of perinatal education that these practices prevent attachment in mothers and newborns. She notes that “The emotional bond and empowerment of to care for her baby are vital to well-being for life.” This emotional bond is simply not fostered within the hospital environment. However, the drive for profit and efficiency continues to reign over the baby’s biological needs.

It is estimated that a hospital birth can cost upwards of $10,000. This is more than three times the amount that an average home birth costs. In our capitalist system, hospitals, drug companies, doctors, and insurance companies make huge profits off of births. Hospitals are a prime example of the perfect business model. Doctors see as many clients as they can, give them as many tests and unnecessary procedures as possible to rack up prices, and send them home wanting or needing more. On top of this, our health care system punishes those who don’t buy into health insurance, even though they already can’t afford to pay. Not to mention the fact that midwives have to fight with insurance companies to actually get paid, which you see so often in Abby Epstein’s The Business of Being Born (2008). It is just that, a business. And there’s no room for women to stand up and take control. What’s troubling, though, is how women are coerced into hospitalized pregnancies and birth in the first place. Within hospital walls, the doctor is king. From a very young age, we learn to trust the legitimate power of a doctor,

even if you might not feel right about it. The amount of us that have been misdiagnosed by doctors who don’t listen will continue to grow. So, doctors already have the upper hand when it comes to making decisions about birth from the very first appointment. After getting bombarded with information on pregnancy and medicine, all while the woman at the front desk is already penciling you in for your first prenatal appointment, no wonder women don’t try to reinvent the wheel. But, despite the enormous strength of capitalism’s force, this is not the only factor in women’s lack of autonomy in their birthing practices.

While money plays a huge part in the push for hospitalized births, there is also something to be said about the views of women in society in general. It is no shock to say that those who have less power in society have less choice, but what’s interesting is why this autonomy is less in the first place. Historically, women have had to fight for rights similar to the ones automatically granted to their male counterparts. Voting rights aren’t the only thing women have had to struggle with, and one of today’s hot-button issues is that of reproductive rights for women. The battle of abortion rages on, and oftentimes the outlook seems bleak in some states, but why are abortion rights even a question? Because women simply cannot be trusted with decisions about their own bodies. From the moment pregnancy begins, a mother is not in control of her child, and this phenomena continues well into her child’s life. After all, children are our future, and they must be raised in a way that advantages those in power. With good morals and personalities. “Child Welfare” dictates every move a mother is to make, even before her child is born. This, however, is a contradiction. On one hand, we control a woman’s choice based on the welfare of the child, but on the other, we do not, and instead we base it off of profit. Clearly, hospitalized births are not always the best thing for a child, but that is what is so heavily pushed onto women in the U.S. The common denominator between both of these choices is the fact that they both take trust away from the mother, and put it into other social forces. Why? Because women are not viewed with equality. Instead, they are pressured into behaving in certain ways when it comes to pregnancy and childrearing by outside forces that seem to know better, when really “Mother Knows Best. “

The argument I am making here isn’t just an issue in the West. This trend is reproduced in other places around the world as well. Women of different environments certainly experience vastly different outcomes based on location and conditions of that environment. It is true that mothers in a place like Liberia might experience more complications that mothers in the United States or the Netherlands, simply because of economic resources and technology. However, there are still parallels when it comes to roles and expectations of women and their experiences of birth.

Lack of control over one’s own birthing experience is reproduced in several different countries. Certainly this lack of control manifested in different ways for women in the U.S. vs. a place like Liberia, but Lori and Boyle’s (2010) piece on birthing practices in post-conflict Liberia shows that one common factor was still the same. Women suffer from a lack of autonomy when it comes to their own health outcomes. For instance, Liberian women are taught from a young age that they are simply too “little” to make decisions for themselves, so they often leave medical decisions in pregnancy up to their husbands. Instead of learning to trust our instincts and bodies, we are taught that another, more knowledgeable person, whether it is a man or a doctor (or both), know better than we do. This often leads to mistreatment and sometimes (too often, in my opinion) death in mothers and infants. In this society, women are controlled by their fathers until they are turned over to their husbands. Being called “Little One” their whole lives, they lack the ability to become empowered as women, which creates poor birthing outcomes as a byproduct.

Women in the U.S. also relinquish their control to medical professionals who treat patients in a methodical, impersonal way. Without an individual approach where women can safely identify their concerns, desires, and needs, women are often silenced. This silence can lead to anxiety, fear, and a lack of real knowledge about what their bodies are going through. Liberian women, on the other hand, cannot make decisions to be taken to the hospital if necessary, or how many prenatal check-ups they can go to, without a man or elder’s approval. Even though a woman might feel she needs help or medical attention, she is discouraged from including the man until it is absolutely necessary. Waiting until this threshold is met is so damaging, which is clear in the amount of deaths upon arrival to hospitals that were observed by Lori and Boyle. There are two factors at work here. The first is the societal belief that women are not equipped to make these crucial medical decisions, which is more overt in Liberia, but still present in the U.S. The second is women’s internalized belief that they are in better hands than their own, and that they are not in-tune enough with their own bodies to know what is best. Unfortunately, this is the reality we face in the U.S. and many other places in the world, but it does not have to necessarily be this way. This is what the Netherlands shows us.

Taralyn Johnson et al.’s (2007) article about Dutch women’s perceptions of birthing practices has something else to say. With a maternal death rate of seven per 100,000 live births compared to 14 in the U.S., the Netherlands are outdoing us with flying colors. Here, home births account for approximately 30 percent of births overall, and women report feeling more comfortable and empowered by their birthing experiences. Not only do these women have the opportunity to get to know a midwife in a comfortable, personalized way, they have more of an opportunity to educate themselves on pregnancy and prenatal care. This educational factor is key. With more of an opportunity to educate oneself on the choices one has in their birthing experience, women have the chance to take things into their own hands more confidently.

This is why that c-section might not really be as much of a choice as we thought. Here, I use the idea of the caesarian section as the ultimate form of medicalized birth. In theory, a c-section is meant for high-risk pregnancies only, and has saved countless lives of mothers in need of the procedure. The National Vital Statistic Reports estimated in 2015 that the rate of c-sections in general in 2014 was 32.2 percent of all births in the U.S. This number is huge compared to a rate of 7.7 percent in the Netherlands. This is not even the disturbing part. You could probably have guessed that caesarian sections are rising in the U.S., but the rate of c-sections for low-risk pregnancies are rising too. In 1990, 22 percent of births were caesarian sections performed for low-risk pregnancies. This number increased to 26 percent by 2013. My point here is that c-sections are being performed on women who don’t need them, and all signs point towards what I’ve mentioned here. The strong hand of biomedicine paired with an intense capitalist orientation makes hospitals and doctors push for procedures on women that cost more. How do they do this? By taking away education, autonomy, and perceived control.

If more education was made available to pregnant women seeking objective information on pregnancy and the natural birthing process, I have to believe that more would choose the home birthing option. With today’s ideologies about biomedicine and the power of the hospital, it takes true courage and empowerment to go the way of the natural birth, but many industrialized societies simply don’t foster that empowerment in women. Certainly women in the Netherlands have the option to choose a hospitalized birth, and many often do. The importance is the aspect of choice and perceived control.

Historically, women’s reproductive systems have been controlled and weighed-in on by outside forces more than by women. This is an issue recently touched on by Amy Schumer in one of her hilarious comedy sketches, often touching on the problematic role of society on women’s self-perception and autonomy. In a sketch where she is at a doctor’s office for a routine pap smear, she is met by a hoard of men in suits who, when asked if they have any medical training, claimed “We’re the House Committee on Women’s Health, so I think we have a better idea than a bunch of sciency nerds.” While this is meant to be satire, it is not entirely untrue. Although women’s rights should be in the hands of women themselves, the issues often fall in the realm of politics, which we all know is dominated by men. With a precedent of political control over personal autonomy for women, there is undoubtedly a feeling that those in power know best. For instance, Crawford writes about the evolution of doctor’s orders when it comes to pregnancy guidelines (2006). While the guidelines used to read things like “Women should not drive while pregnant,” they now say “Women should not be promiscuous.” These are both acts that, in their times, showed female autonomy. This translates to birth experiences as well. If a woman grows up her entire life only learning of and being exposed to hospital births on television and in school, how is she expected to know of alternative strategies? If a woman spends her whole childhood hearing what is “right” and “normal” in giving birth from people like teachers, doctors, and her favorite actors, how is she supposed to truly make the choice for herself? Certainly women have the right to choose home births over hospital births, but are they being encouraged to, or being informed that they can do so? The answer is no.

Before we implement more education, though, we need to seriously reevaluate the ways in which societies around the world view women and their roles. The Netherlands has a great reputation for home birth rates and education, but they also have a reputation for being a generally more equal society. Not only are women viewed more equally, but there is also more support for maternity leave and health insurance in general. In a society that is more aware of the issues women face in the workplace and community and how to address those, you will inevitably see more support for the autonomy and empowerment of women.

As we continue to make strides within the Feminist Movement, it is my hope that women will continue to push for more opportunities for autonomy and empowerment within the realm of birthing practices. I am

not in any way asserting that if all women had the knowledge about home births and the natural progression of pregnancy that they would be running out to find a midwife. However, I think it is imperative that every woman has that choice. Could you imagine if in Liberia women and their families knew more about the natural birthing process and its possible complications? That knowledge coupled with the empowerment to take control could save so many lives. Opening up the opportunity for dialogue and education allows people to understand their own bodies and their own needs. It is no secret that Women’s reproductive health is a touchy subject, and is spoken about on a hush-hush basis. God forbid you say the word period in front of a room of teenage boys. Reproductive rights are only discussed on a large scale when it means controlling the rights and liberties of women, especially if they are breaking societal norms (i.e. getting an abortion alludes to personal autonomy, but also promiscuous behavior.) So, my suggestion is, let’s talk about it! Instead of dismissing midwifery as an antiquated practice, let’s teach people that it is a valid and mostly successful option. After all, its ridiculous to assume a person can make the right decision for themselves, in any area, if they aren’t adequately educated on all of their options and what those options mean.

References:

Bergman, Jill. 2013. “Whose Choice? Advocating Birthing Practices According to Baby’s Biological Needs.” The Journal of Perinatal Education 22(1): 8-13.

Crawford, R. 2006. “Health as a Meaningful Social Practice.” Health 10(4): 401-420.

Epstein, Abby. 2008. “The Business of Being Born.” DVD. New York: Barranca Productions.

Johnson, Taralyn R., Lynn Callister, Donna S. Freeborn, Renea L. Beckstrand, and Katinka Huender. 2007. “Dutch Women’s Perceptions of Childbirth in the Netherlands.” American Journal of Maternal Child Nursing 32(2): 170-177.

Lori, Jody R. and Joyceen S. Boyle. 2010. “ Cultural Childbirth Practices, Beliefs, and Traditions in Postconflict Liberia.” Health Care for Women International 32(6): 454-473.

­­­Osterman, Michelle J.K., and Joyce A. Martin. 2015. “Trends in Low-risk Cesarean Delivery in the United States.” National Vital Statistics Reports 63(6): 1-16.

Image Credits:

Graph- Overall cesarean delivery and low-risk cesarean delivery: United States, final 1990-2012 and preliminary 2013 retrieved from http://www.cdc.gov/nchs/data/nvsr/nvsr63/nvsr63_06.pdf

Image of home birth retrieved from http://indybirthphotographer.com/lila-marys-home-birth-indianapolis-birth-photography/

Graph- Maternal Mortality Ratio per 100,000 live births retrieved from http://data.worldbank.org/indicator/SH.STA.MMRT/countries/US-NL?display=graph

Image of twin home birth retrieved from http://www.twiniversity.com/2014/04/a-babies-story-i-had-a-twin-home-birth/

Image of hospital birth retrieved from http://www.arthurhaines.com/blog/2014/5/13/when-did-pregnancy-become-an-ailment