Pat MacEnulty

Pat MacEnulty
Location
Charlotte, North Carolina, USA
Birthday
December 31
Bio
Writer and teacher. My most recent book, Wait Until Tomorrow: A Daughter's Memoir, is about taking care of my elderly mom. Published by The Feminist Press in 2011. I also give writing workshops on transformative writing.

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JANUARY 20, 2012 10:12PM

C-sections: Not Always Necessary, Not Always Safe

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Ina May Gaskin, author of Birth Matters, is dismayed by the high rate of cesarean births in this country, and in her new book, she takes the medical community to task for putting women’s lives in dangers by these often unnecessary operations. About one in three women in the U.S. have c-sections instead of giving birth vaginally, but the World Health Organization says that “The best outcomes for mothers and babies appear to occur with cesarean section rates of 5% to 10%” (Childbirth Connection). Gaskin asserts that maternal mortality in the U.S. is rising along with the number of c-sections.

In 1990 I was one of the many women in South Florida who had a c-section to deliver my baby. I was happy to have a healthy baby, but I also felt that my baby and I had been cheated out of the full birth experience. Simply put: my birth experience sucked. I want better for my daughter. 

After reading Birth Matters, I drove to Tennessee to interview Ina May for the Sun Magazine. Ina May lives in an intentional community called The Farm that she and husband Stephen Gaskin established in the 1970s. The Farm is home to a birth center where women -- even women who have a baby that is breach -- choose to have a completely natural childbirth. The philosophy at The Farm is that love, compassion, and humor are the best drugs you can give a woman in labor.  

Ina May told me that many obstetricians have no idea that a breach baby can be born vaginally but that it is actually common in the Amish community, where the doctor who taught her and the other midwives on The Farm learned it. 

“But,” I told her, “my baby wasn’t breach. Why did I have to have a c-section?”

This was her answer: “Many women like yourself ended up with C-sections because of perceived or real stress on the baby from their medically inhibited labors. In the seventies the use of electronic fetal monitors became routine in most hospitals. Electronic monitoring usually doesn’t work well unless the woman is flat on her back. Women used to be up walking around the maternity ward, which makes most labors move along faster. 

“Once you have the woman lying flat on her back, she’s in a lot more pain. If she moves to get more comfortable, then the monitor indicates the baby is in trouble, and the nurses get upset with the mother for moving. This painful back-lying position can also be dangerous because of the weight of the uterus on the major blood vessels, which can interfere with the circulation of blood between the mother and the baby. Sometimes a baby can go into distress because the mother is in that position instead of on her side. Because lying flat causes more pain, women quickly opted to get epidurals as soon as possible. One of the side effects of the epidural is that it slows labor. If given early, it can double the length of labor.” (Full interview in The Sun Magazine, January 2012)

I thought I was well informed when I went into the hospital to give birth. Like a lot of other would-be mothers I had laughed and said, “Yeah, give me drugs!” even though I dutifully went to my Lamaze classes. I had no idea how the medicalization of childbirth had transformed what should have been the most natural thing in the world into a nightmare.

What struck me most about my conversation with Ina May was her emphasis on treating a laboring mother with loving kindness. When I was pregnant, I was on my own. I had no husband at my side. I went into the hospital a week early thinking my water had broken but I was wrong. They sent me back home. When I came back the next week and my water really had broken, the nurse sneered at me and said, “Are you sure this isn’t just another false alarm?” Later the anesthesiologist spoke to me in a voice dripping with disdain about my lack of pain tolerance. My doctor was on vacation so a doctor I didn’t even know came in to deliver the baby. A girlfriend came with me but she’d never had a baby, and she was as clueless about the whole process as I was. So we were bullied by the hospital staff, and although my cervix was fully dilated, the baby stayed firmly put. There was no encouragement to try to have the baby naturally; instead they strapped my arms in a crucifix position and cut me open. 

I can’t help but wonder what the outcome would have been if I’d been in a warm, comfortable environment surrounded by encouraging women who would let me eat food and drink water and who would laugh with me and hold my hand during the hard parts. One woman I met at The Farm told me she’d had an orgasm while giving birth. An orgasm!? Other women have spoken about the spiritual transcendence they’ve experienced during childbirth. They acknowledge that there is pain but nature gives us ways to cope with it. 

Ina May Gaskin’s book should be on the nightstand of every woman who is or ever will be pregnant. It should also be required reading for obstetricians. One of the most famous lines from the movie Gone with the Wind is Butterfly McQueen’s statement: “I don’t know nothin’ bout birthin’ no babies.” Maybe it’s time we learned.

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The science behind Gaskin's recommendations goes back to 4000 B.C. Ancient Egyptian women used to give birth squatting on two rocks. If we jump to the modern era, many breech presentations were corrected manually and externally. Some physicians like to use this as an example of "...when we used to PRACTICE medicine." There are so many new rules and protocols that actually prevent many physicians (including obstetricians) from giving the best medical advice for fear of getting sued. Excellent piece. R
Pat, I too had a c section in the 70s. I was giving my (only) son up for adoption. I am kind of glad that I had one, because I was mentally and emotionally not up to a hard labor. Also my son was forehead presentation. I do believe what Ms. Gaskin is saying, though. I'd like to add one other important point - the way doctors generate income in this country is to perform procedures. I used to manage a hospital and doctors' office building, and I know how they operate - no pun intended. Procedures produce a big bill and a big payoff. This is another very powerful incentive for doctors to require more and more c-sections.
I'm sorry you had such a thoroughly unpleasant experience when you gave birth to your daughter. I've had four kids at three different hospitals and each time the staff was nothing but kind and caring. I can only speak from my own experience (4 c-sections; 3 of them planned) but with my first one, I went through something like 18 hours of labor and still wasn't dilated enough. Went to the hospital twice, was sent home twice, then insisted on them letting me stay (I was out of my head with pain and exhaustion). When I heard the words "failure to descend" and had to have an emergency c-section, it was scary but also a relief. I could not wait to get that baby out. The next 3 were elective. I think the decision should be between the mother and her doctor, and the risk of maternal mortality is very low w/c-sections. Giving birth vaginally is not always a "transcendental" experience and I certainly don't regret it. Most women barely remember it or they only remember the pain. There's other ways to feel that way regarding your baby, including breast-feeding which is so important, and has long-term benefits for both mother and child. As far as the anecdote about a woman having an orgasm while giving birth - it kind of makes me queasy. Maybe if you're really into pain, but I'd rather have mine without a crowd present - or a baby popping out.
I think the idea that you should have a "great birthing experience" is bunk. Look into all societies and history and you find a consensus that giving birth is painful (although maybe not so much for kid #5 or higher).

To me, the real problem is that few women have any real experience of childbirth before they do it. We don't see our sisters, mothers, aunts, friends give birth. It's never happening in a bedroom upstairs.
So, women read about the few who had orgasms giving birth and don't automatically class it with the women impregnated by martians.

The two hospitals where I gave birth were both staffed by kind, attentive, knowledgeable staff. In the first, my doctor went off duty before I gave birth (and no, I didn't want her delivering the baby after a 30 hour vigil) and in the second, the baby came before my doctor arrived.

A friend planned a home birth delivered by a midwife, which subjected her terrified son to mysterious moans behind a closed door and then the sight of an ambulance taking his mother away to a hospital which could deal with her dangerously skyrocketing blood pressure. (She delivered a healthy baby and recovered.)
Isn't it incredible? I know of 8 people who gave birth this year, and all 8 had c-sections.

On Good Morning AMerica, about 6 years ago there was a three part series with a female ob Dr. that had chosen to have one.
The story was a compelling piece saying how much easier it was on her body etc. I was angry and talk to a couple of dr. friend sof mine, women, and THYE AGREED with the doctor.

What about what is good for the child. C-section births are harder on the baby because fluid is left in the lungs.
ANd I apologize to anyone that HAD to have this procedure for what I am about to say, but I cannot imagine bonding with my child as close as I did if I was having my stomach stiched closed and could not immediately hold and breastfeed my child.

This is so irresponsible.

I was breach as was my sister. The dr. turned us both around in the womb (we were born 10 years apart). That's what they did. C-sections were the LAST retreat. Now they are an option?

About the orgasm, I thought everyone knew that. It was in almost all of the birthing books. And neer say, it was my first. )baby and orgasm). But it could aslo have been the wonderful feeling of going from the worst pain in the world to the most elation.
Isn't it incredible? I know of 8 people who gave birth this year, and all 8 had c-sections.

On Good Morning AMerica, about 6 years ago there was a three part series with a female ob Dr. that had chosen to have one.
The story was a compelling piece saying how much easier it was on her body etc. I was angry and talk to a couple of dr. friend sof mine, women, and THYE AGREED with the doctor.

What about what is good for the child. C-section births are harder on the baby because fluid is left in the lungs.
ANd I apologize to anyone that HAD to have this procedure for what I am about to say, but I cannot imagine bonding with my child as close as I did if I was having my stomach stiched closed and could not immediately hold and breastfeed my child.

This is so irresponsible.

I was breach as was my sister. The dr. turned us both around in the womb (we were born 10 years apart). That's what they did. C-sections were the LAST retreat. Now they are an option?

About the orgasm, I thought everyone knew that. It was in almost all of the birthing books. And neer say, it was my first. )baby and orgasm). But it could aslo have been the wonderful feeling of going from the worst pain in the world to the most elation.
"ANd I apologize to anyone that HAD to have this procedure for what I am about to say, but I cannot imagine bonding with my child as close as I did if I was having my stomach stiched closed and could not immediately hold and breastfeed my child."
It is not about the way we give birth, whether we breast or bottle feed, or do none of it at all that makes us bond with our babies. I know adoptive moms that would make a great argument for this...
This was fascinating! My third child was a c-section in 1988 in Broward General Hospital located in southern Florida. After I got pregnant with my fourth child, my doctor (KCMO) said I probably wouldn't be able to have a vaginal delivery since I already had a c-section. I told him I wanted to try. My fourth vaginal delivery went fine, as did the fifth and sixth vaginal deliveries after that. I've read that the reason c-sections are pushed is because the doctors make more money and they can be scheduled.
I have often wondered if as a nation we have become too posh to push.
Why the high rate of c-sections? Profit.
I did not have a C-section but I came quite close. I had an unnecessary induction and an epidural, because I truly hadn't educated myself enough about my choices and about the birth experience. I was terrified of giving birth, and because of that my OB actually suggested that I have a planned C-section. I opted for an induction instead, hoping that would give me some sort of control over the process. The idea of going into labor in the middle of the night and making the 40-minute drive to the hospital scared me. I was a week past my due date, but my son didn't seem to want to come out. I wish I hadn't made him come out before he was ready, though he was a big baby and he was fine. But after an hour and a half of pushing and an episiotomy, I was told that I had been on the verge of needing a C-section. If he hadn't come out after the episiotomy, they would have cut me open. I'm thankful that didn't happen, but I wish I'd known better about the whole experience.
Takes me back. 2 babies, 2 c sections. The first in '88 I had wanted a home birth after learning about it from my mid-wife friend. But water broke, neither OB or mid-wife had figured out the baby was breach, which at 9.6 on a small woman, how did they not know? Please... then an unfortunate hospital experience. Then a better doctor and a life experience, still ended up a c section when he was firmly stuck and I was exhausted. But a means to an end and what an end! Voila! Beautiful children! Loved this piece, it shows how much we have de-personalized and profited over women at our most vulnerable.
Thanks for all the thoughtful comments. Of course, in a short piece like this I can't go into all the pros and cons. Thanks, Margaret, for your comment and insights about the orgasm. (LOL -- let's hope hers wasn't a "When Harry Met Sally" style orgasm.) I know I was definitely able to bond with my baby in spite of having a C-section. Breastfeeding was incredibly important to me, but I realize not all women have this option. The point I really hope to make is that love and support for the laboring woman, no matter what course she needs to take for the health of the baby, can make a huge difference.
What Thoth said... and a little more..
I see it as a question of mainly liability for the obstetrician. C Section gained in popularity commensurate with the " wrongful birth" lawsuit industry.
Trauma is far less a factor for baby's brain with the incision method. I see above that fluid in the lungs is a C section problem.. Vanity and the women's all important lifestyle / career schedule is another reason for the procedure's popularity.
Baby can be hacked out of the womb as a matter of convenience instead of the old time consuming natural way.

Women should really consider infection as a down side to elective C section. I know a women that will battle the effects of MRSA for the rest of her life.
I only have 1 birth experience and I will always be grateful for the observant OB nurse & quick-on-his-feet Dr. They performed my c-section when the nurse discovered that the cord was wrapped around my son's neck & prolapsed. We had prepared for a normal birth, but as the Stones say " ...you can't always get what you want. Sometimes you get what you need."