Monday, March 26, 2007

Cesarean Sections and SUVs

There’s been a bit of controversy over one of my earlier posts (Four out of Five) and I wanted to write a more lengthy response to some of the recent comments. I unknowingly offended someone and decided to remove the original post with the brief descriptions of the different women’s circumstances. (For new readers, it was a short post about a recent string of cesarean sections among women I know IRL. Of the last 5 to give birth, four had cesareans. I was the "fortunate fifth.")

The intent of the original post was not to pass judgment on the individual women. I included a few brief sentences about the circumstances of their births to give some context to the post. I tried to keep my language neutral because it was not meant as a critique of the women themselves. Judgmental or attacking comments would have read along these lines:

“I can’t believe that X made Y decision. What was she thinking?”
“X was wrong for doing Y.”

In my follow-up responses, I emphasized that I have a problem with our maternity care system in general, because too many women end up with surgeries for their births. I find fault with any birth, vaginal or cesarean, that leaves women traumatized.

Brooke Shields, for example, had such a nightmarish experience with her first child (induction that ended in a cesarean section, followed by postpartum depression) that she chose an elective cesarean for her next child. I feel sad and angry that she had such a traumatic experience in the first place. To choose medically unnecessary major abdominal surgery for her second birth speaks volumes about how traumatic her first birth was. Women deserve better!

I think that some of my readers are equating my condemnation of a general circumstance (our high cesarean rate) with a condemnation of the women who undergo these surgeries. Disapproval of a general situation does not at all translate into judging women who find themselves in that circumstance, for whatever reason. I think Judit summed it up well with her comment: “I simply see no judgmental attitudes here pertaining to the individual women, but I do see this little survey as a comment on the circumstances many pregnant women find themselves in, in general.”

Let me use an analogy to illustrate my point:

I don’t like SUVs or other large, gas-guzzling vehicles. I have made the choice to drive a small, fuel-efficient vehicle (diesel VW Golf) that gets 50 mpg. I also invested a lot of time and money into converting my Golf to run on used vegetable oil. I am concerned about our country’s level of fossil fuel consumption, especially its role in exacerbating global warming.

Let’s say I wrote a post about the number of SUVs and large trucks in our church parking lot (or grocery store, or wherever), and I expressed the sentiment that many of those vehicles were wasteful or unnecessary. I mean, you don’t really *need* an SUV to drive on paved, plowed, and salted roads!

Okay, so I write the post disapproving of a general circumstance (high numbers of fuel-inefficient vehicles). That does NOT mean at all that I dislike or judge the people who own them! It just means that I disagree with a particular practice. I also acknowledge that SUV ownership is a lot more than simply a matter of consumer choice. For example, most passenger sedans will fit only two children in the back seat, because you have to use car seats or booster seats until children are 8 years old. So after two children, you are essentially forced to buy a larger vehicle, and SUVs or minivans are usually the only choices in the States. Consumers don’t have a lot of fuel-efficient options for larger vehicles. This is partly the fault of auto manufacturers: in France, for example, there are loads of small minivan and mini-SUV type cars that get 40-50 mpg. It’s also partly the fault of our government for not establishing stricter fuel economy standards. And it’s partly the fault of American consumers for not demanding more efficient choices.

Let me tell a story about how appearances don’t tell the whole tale: a dear friend of mine drives an SUV. Waving hi, since you probably are reading this post! Turns out, her parents gave it to her and would be incredibly offended if she didn’t drive it. Does she like driving a gas guzzler? Nope. Would she prefer a fuel-efficient compact car? Yep. But she has to balance her environmental principles with her family relationships.

To wrap things up:
I don’t like cesareans; in particular, I don’t like our national cesarean rate of 30%. Am I glad they exist though? Yes. As Judit remarked in response to another post: “If I felt like I had no access to an emergency c-section in the event of a real emergency, I would be a lot more apprehensive of birthing anywhere.” Do I hope I never need one? Yep. Do I condemn our maternity care system that leaves the majority of birthing women with some sort of scar (episiotomy or C/S)? Most definitely. Do I condemn those who have cesarean sections? Nope.

My defense rests.


  1. From a woman who had an UNWANTED c-section, thank you. I never felt judged when I read your last post- I felt like you were sympathizing with the women who went through this. C-sections don't just leave physical scars, they often leave emotional ones that many women keep to themselves. Even elective c-sections are often out of fear, of a traumatic birth, pain, or complications. It is telling when a woman has a successful VBAC that they mention feelings of healing or empowerment. My son had respiratory distress because he was born by c-section, and I did not get to hold him for 4 hours. I was in too much pain to nurse- and my breast milk with pain meds sedated him to where it took me an hour to wake him up. I suffered postpartum depression, and pain for 6 weeks afterwards. I feel it also would be wonderful to see the c-section rate decrease, and I feel that increasing ACCESS to and knowledge about out of hospital birth is one of the best ways to do that. Liability drives many OB's to a quick c-section (they do get sued quite frequently) whereas that is not as much of an issue at a home birth.

  2. defensiveness usually occurs when someone sees truth that they don't like. :) don't worry about the disclaimers - just speak your truth!


  3. Ooh, is it THE Pamela Hines-Powell who just posted? (jumping up and down with excitement) I follow your comments on MDC, and your blog, with great interest! If I needed to hire a midwife, you'd be exactly the kind I would want.

  4. Hey, I'm excited to see you here too, sage femme!

    I am truly sorry Rixa that one of the women whose birth you mentioned was offended. While I don't hold you directly responsible for their feelings, I do truly empathize with how that couple feels. And it does not at all surprise me that something like this eventually happened. ...sigh... It's all so complicated.

    As for disclaimers... and what offends and who's defensive... I have a confession to make here. I have been searching, but I regret that I have yet to find a common language with those who are not home birth advocates. This means obviously most people I know, and I simply don't enjoy feeling alienated, for one. But I also wonder if not always speaking my mind is a form of dishonesty.

    Being 8 months pregnant and looking at least as much... I have many personal experiences offered to me these days. Just an hour ago someone told me how she wishes she could have avoided having both of her kids by surgery. I offered compassion and said I am grateful to have been fortunate so far. I have been. What I didn't share is that I have been playing with loaded dice. What a cheat!

    She doesn't know I have been indulging in a lifestyle that is proven to result in unbelievably low c-section rates: simply the lifestyle of staying away from obstetrics while taking excellent care of myself.

    To tell someone that I've just been lucky is a lie. I lied today. (To such a nice woman too, she just gave me hand-me-down maternity clothes!) I feel sort of embarrassed, but I just wasn't feeling up to controversy today. I never know who will take my opinions as a personal indictment about their choices.

    If I could convince myself that defensive reactions are productive and in the listeners' interest, I might be willing to stick my neck out more often, but as it is, I don't see how.

    Well anyway I'm glad you do stick your neck out Rixa and do keep it up while you address any personal difficulties that will inevitably arise.

  5. Judit,

    Yes, I agree that it's misrepresenting things to attribute good births to "luck." I'd say about 95% of what happens at a birth has nothing to do with luck, and everything to do with planning, preparation, and education beforehand.

    Well, actually I'd say that's true for home births. When you birth in institutions, there are a lot of forces you can't control that have significant effects on your birth experience.

    I like Kim Wildner's book "Mother's Intentions" on how we largely create our birth experiences. I have it in PDF if anyone wants a copy.

  6. I'd love a pdf of the book whenever you get a chance!

  7. send me your email to stand dot deliver at gmail dot com

  8. Very well said Rixa. (seems like I am always saying that, but it's true!) I too had an unwanted C-section but I didn't feel any ill will towards you with your infamous post. I agree that it's a travesty that the sacred ritual of birth has degenerated into a surgical procedure. I can never understand why a woman would choose to have one done, but hopefully someday they can get over that fear, or whatever else is holding them back from a normal birth.


  9. I'm a new reader to your site. I'd love a copy of that PDF. I have had three babes all under different circumstances - induced hospital vaginal birth, home water birth attended by midwife, and a UC. I really applaud all the information you are providing. I also agree with Sage Femme.

  10. See, Tasha-rose, it's not making people angry per se that I don't care for. I'm totally with you on the usefulness of anger to affect change.

    It's defensiveness (misdirected anger) that I want to avoid. It's how defensiveness inevitably compels people to bring up traumatic and dangerous birth experiences which don't even apply to my situation. Especially, the spirit in which these experiences are shared: not always for sympathy, but rather as a cautionary tale, a (usually unintentional) subtle threat.

    Not this lady who brought me maternity handmedowns by the way, she was really just looking to commiserate about the rough times she had.

    I wonder if I could have just let her speak more: ask if she thinks it could have turned out differently ("But hey, what can you do? Hmmm... actually, is there anything you would change if you could go back in time?")

    Like one time... a VBA2C mom was telling me how much she hated her cesarians, then asked me about my birth experience... I was bracing myself as usual... but she gave me a high five! Turns out, she was so angry with doctors she was ready to ditch them. So we talked! And a couple months later she hired a homebirth midwife!!! And had her VBAC! The things that can happen when you're not in denial, wow. We're good friends now.

    I just wish I could have that productive conversation each time. I don't hope to convert everyone to homebirth, but I do wish for more open dialogue.


  11. I too thank you for your writing about c-sections. My husband and I had planned on a home birth for our daughter, who was born still on March 3rd...our beautiful little baby girl Birdie. We were transported to our backup birth center after 24 hours of labor, as Birdie's heart rate dropped and it was dangerous...I ended up having an emergency c-section...and a dead child. This was absolutely the furthest experience we wanted to have, but we have had it. It has been very hard to heal physically and emotionally, I got hit really hard, you know what I mean? I am scared now for what could happen next time, to some I am now a high risk some I am not.
    Things will never be the same for me when I am in labor and give birth, my innocence has been stripped of me. I do hope very much for a VBAC...I know that I can do it, after 24 hours of laboring I know I can! It's just the scariness and thought of losing another baby.
    We are lucky to have great midwives, who are now family and nurse midwives at the birth center, where we plan to have our next baby (we hope in the next year). We are so close to them, and they know how badly I want a VBAC, they will do everything to support me to make it happen.

  12. Hi Erin,
    Thank you for your post. I have been following your blog and my heart goes out to you. Your little Birdie is so beautiful. I hope you can do a lot of good with your stillbirth advocacy.

    Hugs to you and your husband...

  13. This is a wonderful site with fabulous resources to help women create the birth they want!
    I noticed that my book, Mother's Intention: How Belief Shapes Birth is suggested reading. I'm very happy that people find it helpful.
    I would like to remind anyone who may be passing along free electronic copies that this labor of love was not free for me to produce. I borrowed tens of thousands of dollars to be able to publish this work. I am a stay at home mom and while I do a lot of birth work for free, this is one project that must pay for itself. Every time a book is given away by someone who does not own legal rights to the intellectual property, which is in itself illegal, it's one less book or eBook I sell. What that means is that I'm at a place now where I may have to take a 'real job' to make the money to pay the bills. This work was supposed to be a tangible way to pay for what my husband calls my 'expensive hobby'.
    I'm sure people don't realize how much it takes to get a book out there. I didn't. I thought if I self-published I'd be making 100% profit and I'd be able to repay that money in no time. That's not the way it works. There are innumerable expenses people just don't think about.
    With a trusting heart I've given a few electronic copies away. I believed that they'd find their way to those who truly couldn't afford to buy the book, and those who could would support the effort. I hope that is the case here. I know that in one instance, someone was giving eBooks away on a doula list that had thousands of members!
    For anyone who would like to donate funds, you can do so through PayPal using the email of, or click the donation tab on my website at
    I do give away a lot of material for free on my sites. This project, however, is in danger of dying if I have to direct my energies to helping to feed my family instead of working for better birth. I'm almost out of paper books, and while I'm editing and updating Mother's Intention, if I don't pay off the first debt, I won't be able to republish the new and improved work.
    I never wanted to ask for donations. I wrote this book so I could earn money to support my birth work. But if people give it away instead of buying it, that can't happen. Please support the effort. Thanks.

  14. Hi Kim,

    I obtained the book when it was being distributed for free, and I didn't realize that the situation had changed. I apologize and if anyone else requests your e-book I will suggest that they purchase it from you or make a donation. Thanks for letting me know about this.

  15. Thanks!
    I know most people are just innocently trying to help women create better birth. I can tell from your site that's your intent! That's why I'm not angry. It was my choice to distribute the free books in the beginning. I had no clue then that there would be people who distributed it illegally and that I'd have to tell them apart from people like you who have squeaky clean karma! :-)
    That's why, although there have been some that suggest I get cranky and issue cease and desist orders and other unpleasant things, I'm not. I take responsibility for my own actions (I try to walk the talk!) and it's too hard to know who is being naughty and who is being nice. If I had the resources, I would make it available to everyone for free myself! (In fact, I'd also give a copy of Thinking Woman's Guide by Henci Goer and Marsden Wagner's Born in the USA to every single pregnant women!)
    I appreciate that you find value in the work. By all means, talk it up! The new edition is far better, and if there's lots of 'chatter' there is greater likelihood that a real publishing house will pick it up and I can get back to doing what love to do.
    You have a fabulous site here, and I thank you for all you do! Will your be sharing any of your dissertation on the blog?


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