Childbirth Is Not Burger King. You Can’t Always Have It Your Way.

Surgeons operating

When I first read about the pregnant Arizona woman whose hospital stopped performing VBACs, prompting her to plan to drive 350 miles to Phoenix to a hospital that would allow her to deliver her baby vaginally, I sympathized. I wouldn’t have made the same choice, but I sympathized.

Now, though, the Daily Beast reports that the woman painted her minivan to say “Page Hospital, enter my body without permission ... Sounds like rape to me.” She’s not alone in her sentiment. The mom at birthtruth.org has an essay titled “8 years later” in which she talks about her “grief” over her C-section and reprints a poem from a mom who discusses her “mourning” over hers. Birthcut.com is full of C-section horror stories. The Daily Beast’s Danielle Friedman writes: “Women who feel violated by the notion or experience of a C-section often feel misunderstood—family and friends can’t grasp why they can’t just get over it and move on.”

Well, count me among the clueless who just can’t understand. That might sound heartless, but I feel uniquely qualified to be judgmental. Many years ago, I was raped by a man who broke into my apartment and threatened to kill me. I have had three C-sections. I can tell you: One ain’t nothing like the other.

Rape is a horrible, disgusting act of violence. Perpetrators are seeking dominance and control over another human being. A C-section is a medical procedure performed by qualified doctors that can save the life of the mother and child involved. Is it traumatic? Yes. Is it violent? No.

The United States admittedly has an inordinately high number of C-sections. Some of them are unnecessary. There are probably doctors who steer women toward C-sections because it’s easier for them. (They can be scheduled! No 3 a.m. phone calls! No 12-hour shifts in the hospital waiting for babies to be born!) But doctors, even those with gruff bedside manners, are generally not trying to take away women’s freedoms. Hospitals are not refusing to do VBACs because they are operating under some Dark Ages mindset that women are silly little things whose opinions and concerns doesn’t matter. To perform VBACs safely—and their job is to keep you safe, no?—they have to have more staff on hand, which is expensive. Up to 40 percent of VBACs result in a C-section, and this article claims that “failed VBACs also accounted for the most expensive total birth experience.”

When I was pregnant with my oldest son, I planned on a normal delivery. When I went past my due date and the ultrasound tech laughed and told me that my baby was measuring at 10 pounds, I didn’t believe her. When the doctor, a female doctor at an all-female practice full of OB/GYNs, nurse midwives, and nurse practitioners, suggested that I have a C-section—“And we almost never recommend that women have C-sections,” she told me—I politely declined and said that I’d rather be induced. And two days later I was. And 10 hours after that, I was wheeled down to the OR for an emergency C-section. I’d come down with a fever, my son had gotten a fever, and that was that. And he weighed 10 pounds.

When I became pregnant with my middle son, my doctor gave me the choice between a C-section and a VBAC. After talking to her and looking at the risks—and there are risks with either method—I decided on the C-section. One of the risks with a VBAC is a ruptured uterus, and I didn’t want to hurt my chances of having more kids. When the third kid came around, I didn’t think twice. I’d had good outcomes with my previous births.

Yes, I was lucky. I had a choice. And I realize that not having that choice can be frustrating. But to compare it to rape is unfair to doctors, hospitals, and—yes—actual rape victims. There are still hospitals that perform VBACs. If yours doesn’t, you can find another one. You might have to find a different doctor, but in the end, it’s your choice. You are prioritizing your chosen method of delivery over your choice of doctor and place of delivery. The fact is, for all our hand-wringing over the different procedures, both are relatively safe. A C-section does have a longer recovery, and I’ll never wear a bikini again, but I’ve got three healthy boys and I remember all of their births just as fondly as if I’d pushed.

There is so much emphasis today put on couples having “birth plans” and making childbirth into a magical, memorable experience. When so much energy is spent crafting an experience, you’re bound to be disappointed if it doesn’t go exactly as planned. But childbirth is momentary. Parenting is forever. And one of the lessons of parenting is that things don’t always go according to plan.

Photograph of surgeons from below by Ryan McVay/Getty Images.

Tags: C-sections, caesareans, childbirth, Rape, VBACs

Rachael Larimore Slate copy chief and mother of three. Addicted to coffee, Facebook, and the Sprout channel.

Comments

Me Me Me

By: claireific | Wed, 10/21/2009 - 14:36

What's so infuriating about all of this is that it's incredibly self-centered. I thought you were supposed to be self-sacrificing mothers now. What's more likely? That this woman's OB/GYN is recommending a procedure that is safe, practical and affordable based on the hospital's limited staff and means, or that the doctor is secretly salivating at the opportunity to chemically sedate her and slice her open while she wails in protest, all while cackling manically? To think that the doctor is doing a c-section TO YOU is to give yourself entirely too much credit. As long as you, the patient, deliver with minimal complications and stay healthy, the doctor otherwise doesn't care about you. Let that sink in for a moment. Doesn't care. About you. Shocking, I know. This woman is essentially throwing a temper tantrum because she can't get the exact birthing procedure she wants. Helping her plan her wedding must have been AWESOME.

Not to mention that comparing a c-section to rape is outrageously insulting to rape victims. Until said OB/GYN creeps into your house at night, holds you down and forces the c-section upon you, you still have options.

C-section is whaaaa?

By: drmom | Wed, 10/21/2009 - 14:17

My pregnancy was flawless (not sick, gained 11 lbs) and I was fit and active thruout. Thus, I anticipated a birth on par with the pregnancy. I had a c-section when after 1.5 days, my child was in cardiac distress and my water had been broken for that long, increasing risk of infection. Also, my child's head exceeded the width of my pelvis (cephalopelvic disporportionation) so it was physics...she was too big to pass thru me. That is ok. I am glad someone chose to help me retrieve her another way instead of letting me tear and have fecal incontinence issues forever. My hubby has zero complaints, too, by the way.
For the record, because I cannot take opioids/opiates and cannot have common epidurals, I had a c-section with locals and pure stamina. Then, I went home less than 12 hours later with staples in my 4-inch incision and no meds. I was running and lifting weights within 2 days, and I have not stopped since (11 years). My scar is virtually invisible, I wear a tiny bikini, and I would not re-do my experience for anything. I understand the visceral response I read here, but I wonder...when do you put down the torch of anger over these things? Yes, I fully, fully expected to direct my birth as I do all areas of my life and my laboraory (I am a scientist who TEACHES medical and pharmacy students...so I am not uninformed but I am aggressive and decisive...so what).
Even a birth that begins "in control" can go awry...and it is no one's fault. I would never buy into the rhetoric that I "cannot give birth" Horsesh*t. I did. So, there. I am also a fabulous, strong woman who had a fabulous, strong baby girl. Let's take this issue as women and treat it like women...stand strong where you can, accept what only you must, and them prove em all wrong by doing more, doing better, and living WITH a c-section with class, style, and sophistication. Yes, we are women who can give birth, and there are a few ways to do it, Thank goodness. C-section or not, you gave birth, and it is no less a miracle and grand process. Also, think about it...you are a woman and you can handle a hell of a lot more than those boys...right?!

VBAC

By: donnap | Wed, 10/21/2009 - 10:05

I have to disagree with the assumption that more staff are necessary for a normal, uncomplicated VBAC than for a C-Section. With my first VBAC, I had to have an epidural and yet there were only 3 staff members in the room. It was my OB-Gyn, a nurse and the anesthesiologist. Considering the situation (not really normal or uncomplicated), he could have gone for a C-section, which would have made it much easier for him, but he respected my wishes to deliver my child as naturally as possible. For my second, the birth came so quickly that the anesthesiologist never made it to the birthing room until after my daughter was born and was not even necessary. The logical assumption for a C-section would be that you would have to have at least the doctor, a nurse to assist and an anesthesiologist to adminster and observe reactions to the ansethesia. Doesn't sound any different than my first VBAC.

Seriously?

By: brenjsmith | Tue, 10/20/2009 - 21:26

How is this hospital equipped to handle births at all? They've stated very clearly that they can't handle a potentially emergency birth situation. What about the fact that 1 in 3 women in this country end up having a c-section? How on earth are they going to handle that?
This hospital should not be doing births at all.

Oh and as someone who has been both raped and had a c-section, I can assure you that although they are nothing alike, both are incredibly traumatic. I felt the effects of my assault for years. So far it's been a year since my child was born and I'm still pretty traumatized.

Context is everything...

By: arwen73 | Tue, 10/20/2009 - 17:53

You said:

"and this article claims that “failed VBACs also accounted for the most expensive total birth experience.”"

Your statment implies that the results of the study summarized in the article support repeat cesarean delivery. In fact, nothing could be further from the truth. The article itself is titled "Elective repeat cesarean delivery has worse outcomes than vaginal birth after cesarean" and if you had read the study itself (available here http://journals.lww.com/greenjournal/Fulltext/2009/06000/Neonatal_Outcom...) you would know that the planned VBAC group had lower costs overall than the planned cesarean group, even including failed VBACs in the statistics, and that the authors of the study say they were unable to account for the full cost of cesarean delivery because they were unable to track post-surgical complications. The planned VBAC group also had lower rates of maternal and neonatal complications, even including failed VBACs in the statistics.

Your use of this one line, taken out of contex, significantly weakens your argument that hospitals are somehow looking out for their patient's safety when they ban VBACs. Even for women without previous vaginal deliveries (whether VBAC or not), the risks of repeat cesarean can be greater than the risks of VBAC. And for women *with* previous vaginal deliveries, VBAC clearly seems the safer choice. Yes, hospitals ARE treating mothers as if we "are silly little things whose opinions and concerns doesn’t matter."

It seems to me that you are allowing your offense at this woman's characterization of an impending court-ordered cesarean as "rape" to cloud your own judgment on this issue. The hospital is not banning VBAC for anyone's safety, they are banning VBAC because of malpractice insurance rules. There's even a term for it: "defensive medicine." If we continue down this path there will soon be a day when a woman like Szabo won't have the "choice" of driving 350 miles to deliver vaginally- she'll have the "choice" of lying down to be cut, or delivering unassisted and praying nothing goes wrong. And that isn't much of a choice.

Really?

By: MargaretLH | Tue, 10/20/2009 - 16:14

Really? You can't see why the hospital threatening this woman with a COURT ORDERED Cesarean is a threat of physical assault? This woman already had one VBAC...her chances of another success are extremely high... at least 85%. Not to mention that her chance of uterine rupture is very low since she already had a successful VBAC. In her case another cesarean is likely to be more harmful to her and her baby than another attempt at vaginal delivery. Should she really accept that risk just because the hospital claims to not be able to provide immediate surgical services (although they still allow other women to deliver there, at least 1-2% of which will likely need an emergent csection due to placental abruption or cord prolapse etc.) How can this hospital claim to be a safe place for all patients in case of emergency, but not this one mom? The hospital likely doesn't want to pay higher premiums to allow VBACs.

No woman should be forced onto the operating against her will. It is no surprise that some women will feel raped by the experience. I had a csection which I was fine with, however I am attempting a VBAC this time. If my hospital threatened ME with a forced cesarean, I would probably make a whole stink about it too.

I think many of the comments reflect this idea that a cesarean = vaginal birth in terms of risk and outcomes. Multiple cesareans can place a tremendous burden on the mother's body and make future pregnancies very unsafe. Look up placenta accreta or percreta to see what I mean. Cesareans are life saving and wonderful, but lets not pretend that they are just the same as giving birth vaginally in terms of its effects on one's body. What happens to a woman in one of her early births can greatly impact her reproductive future, especially given the systematic attempt to wipe out VBACs.

Honestly this has very little to do with trying to have a birth "your way". It's about patient dignity, autonomy, and, unfortunately, insurance and money.

Cesarean Rape?

By: Drpauline | Tue, 10/20/2009 - 14:29

I am a rape overcomer. I gave birth naturally to three children--never had a cesarean. I am a doctor of psychology now who helps women overcome birth trauma. I am not now, and I never have been, offended by women comparing their unnecessary cesarean experiences to rape. Is cesarean violent--absolutely. Any time you cut into the human body it is violent. No one should be offended by anyone else's trauma experience or interpretation of their experience. The first criteria for a person to develop a trauma response is that they went through an experience that involved death or threat of death to themselves or someone else. Any woman would gladly lay down her life for her child--but to make that sacrifice, be horrified at doing it, and then find out you really didn't have to...how can anyone judge someone else's experience. How would the author of this article feel if she was told that her rape did not count. Truly only about a 1/3 of rape victims develop long term PTSD. About a 1/3 of women subjected to a cesarean develop PTSD. Let's not argue about the traumatizing factor. Lets just listen to and respect each woman's pain as her own, and that it needs to be listened to, understood and cared for.

Pathetic.

By: JJL | Tue, 10/20/2009 - 13:54

I have no sympathy whatsoever for women who take home healthy babies and then go on to whine endlessly about how the birthing process didn't live up to their expectations. Because guess what? It's not about your "birth experience", it's about have a beautiful, healthy baby who goes on to grow up to experience life's joys.
--
I had a C-section, because my baby was too sick to endure labor. I then watched helplessly for four months while my little boy endured unspeakable suffering in the Neonatal ICU. Then he died. The closest he ever came to seeing the sun was the day we buried him.
--
He was my only child, and I mourn him every minute of every day. So you know what? I don't want to hear about how hard it is to have an operation. I would have given birth standing on hot coals if it would have meant my son could have lived to see the sky, the ocean, the trees. If it would have spared him his hellish time in the NICU.
--
Anyone who cannot say that she would do the same does not deserve to be a mother. So can we stop whining about our "birth experiences," please?

Birth Rape

By: AngelaZ | Tue, 10/20/2009 - 10:59

Rachel, you said: "Rape is a horrible, disgusting act of violence. Perpetrators are seeking dominance and control over another human being. A C-section is a medical procedure performed by qualified doctors that can save the life of the mother and child involved. Is it traumatic? Yes. Is it violent? No."

My cesarean was not physically violent, but it was emotionally violent.

I was forced into having a cesarean that I didn't need or want. When I protested, I was told, "no, no honey. The OR is already ready for you. You HAVE to." I was told, "Sorry, you already signed the consent form." I felt attacked. My BODY was being controlled by authoritative figures who could care less about what I had to say. My cesarean was NOT life saving. My daughter was born with 10/10 APGARS. I am not a stupid person. I could see with my own two eyes that as soon as the pitocin was turned off that her heart rate was fine and continued to be fine. I said NO. They did not care.

I suffer from PTSD due to the birth of my daughter. Clinically diagnosed PTSD. I've utilized EMDR therapy, counseling, desensitization therapy...you name it. I liken my experience to rape because for all intents and purposes my mind reacted as if I had been raped. Does that lessen the experience of somebody who has actually been raped in an attempt for sex/power/etc? I don't know. All I know is that somebody exerted control over my body, without my permission, against my express statement of "DO NOT TOUCH ME, STOP, NOO!!!"

Please do not invalidate my feelings and my history because you are ok with your cesarean surgery.

I never would have seen it that way either, but then...

By: MrsZ143 | Tue, 10/20/2009 - 10:44

Seven years ago, I was battling the woes of horrible morning sickness, and swapping pregnancy tales with friends who were either further along in their pregnancies or not as far, or anticipating when they might be pregnant. If someone had told me that their birth was like a rape, I would have rolled my eyes too. If someone told me that their doctor was placing there own interests in front of their patients, I would have said, "I'm glad MY doctor is not like that." I didn't plan any particular kind of birth - I just wanted to come out of it like all women do - safe and healthy, with a safe, healthy baby. How I got there was left in the trust, care and guidance of my OB.

This is why I was so disillusioned afterwards, when I sank deeper and deeper into depression after my cesarean. I had nightmares where I would fight off my husband in my sleep, leaving him bruised and battered and me with no recollection of it. I would hurt myself. I would zone out and have flashbacks of the surgery. Why, why, why? I'd had no expectations!

I remembered something my OB said to me when I tried to give him my birth plan (which I thought was pretty flexible - "I would prefer not to have an epidural, but I may change my mind." "I would rather avoid surgery, but understand that sometimes it may be lifesaving." He said (angrily and defensively), "I hate these things," then proceeded to tell me how he'd delivered hundreds of babies and I hadn't delivered any, and that I could do whatever I wanted so long as I stayed out of his way.

I left that appointment crying, and came back the following week crying again. I didn't know better, but did think I should have *some* say, after all, this was MY body, and I thought we were supposed to be a team in this.

So when I had the cesarean, I truly felt victimized. No, I didn't fight him off of me or even protest, but I felt like I'd laid back and taken it like a "good girl", hoping it would just pass.

It took me a long time to be able to openly say how it made me feel like I'd been raped. I didn't want to take anything away from women who'd suffered that kind of trauma. I've never been a victim in that way, but when I put the pieces together, it wasn't the picture that we normally expect to see when we talk about rape, but it sure felt that way. Not all rape is violent - some is much more insidious, like date rape. Most experts say rape is a sexual act that is about power and control - and him telling me he would do whatever he wanted to do to me, and then effectively doing it, felt that way to me. The only difference to me is that he didn't break any laws to do it. I wish he had.

I didn't ask to feel this way, but allowing myself the freedom to describe it in this way has opened the door to an understanding about how I came to sink so deeply, and allowed me the ability to come back out. I still have nightmares from time to time. My baby, who was supposedly in great peril at the time the decision to cut me was made, was born with nearly perfect APGARs (8/9), showing no distress whatsoever. I'm grateful that she was born healthy, but this surgery left me both physically and emotionally scarred, and wondering if it was even necessary to begin with.