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Debate: Are Elective C-sections Anyone's Business

"Yes," by Nola Hamilton: The most basic reason that it's my business that the rate of elective C-sections is rising is that I have a stake in other mothers' and other children's lives.... "No," by Marlee Ryson</b>: I can no more imagine butting into another woman's birthing choices than I can imagine asking to borrow her diaphragm....
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From Brain, Child Magazine
Art by Elizabeth Hannon

Debate: Are Elective C-sections Anyone's Business?


By Nola Hamilton

The most basic reason that it's my business that the rate of elective C-sections is rising is that I have a stake in other mothers' and other children's lives. In a larger sense, I care whether my fellow mothers are hurting or content. I care if their kids grow up healthy and happy and educated. This is why I volunteer at my daughter's elementary school, why I vote the way I do, why I don't look the other way when a child who is not my own falls down at the playground. I'm no saint, but I try to look out for the common good of us all.

And C-sections are not good for mothers and children. Of course, sometimes C-sections are medically necessary, and having one is much better than risking harm to mother and child, but all things being equal and low risk, a vaginal birth presents fewer risks to both mother and child. A C-section is major surgery, after all--which, by the way, takes a longer time to recover from than a vaginal birth. The March of Dimes reports that a C-section will increase a mother's risk of uterine infection, excess bleeding, and blood clots; it will also increase the baby's risk of being born premature (since the due date could have been miscalculated), and the anesthesia can make the baby sluggish. The risks are small, but why take them at all if you don't have to? There's a reason that the Centers for Disease Control and Prevention wants the C-section rate for low-risk pregnant women to go down, and the reason is that, in non-life-threatening situations, C-sections are not the best option for anyone involved, mother or child.

Yeah, yeah, yeah, you might say. But that's your opinion, and it's my choice. Guess what, sister? Your choice doesn't exist in a vacuum either. The National Center for Health Statistics estimates that about a quarter of all C-sections performed are unnecessary. And if more women choose a C-section, it shifts the mainstream birthing ideal and suddenly C-sections are No Big Deal. When obstetricians have to make a call whether to wheel me or my friend or (possibly someday) my daughter into surgery if the labor isn't progressing fast enough, they'll subconsciously factor your elective C-section into the decision. They may say they don't, but it's human to. And every woman who makes the choice to have an elective C-section reinforces that little voice in the OB's subconscious that says C-sections are just another variation on birthing. Because that's essentially what you're saying by scheduling an elective C-section: Major surgery is not a big deal to me. I accept going under anesthesia and the knife as part of birthing.

I don't accept it. It's a Very Big Deal to me.

Yes, I know that I or my friend or (possibly someday) my daughter have other options. We could go through a midwifery practice (although if something goes awry, we wind up in the same hospital situation). We could do it at home, with candles and a big blow-up pool and New Age-y music and bongs or whatever. But having a regular delivery shouldn't have to be some sly alternative. All I want (other than my youthful figure and a good night's sleep) is a regular hospital delivery without the specter of C-sections as No Big Deal.

I have a confession: The one and only time I've given birth thus far, I felt scared and nuts and kept wanting to just call the whole thing off. I was the woman that you see on those birthing videos during childbirth class, the woman who you decide you do not want to be when your time comes. Giving birth was incredibly difficult for me. And even after a few hours of hard pushing, when my daughter finally slithered out with a tiny roar, I didn't feel anything but exhausted. I didn't feel triumphant or impressed with what my body could do. I don't think I could have even formed a debate in my head around the question at that point.

My point is, I understand very well those women who fear that their bodies will not feel powerful during birth, who suspect that their bodies will instead feel battered. Mine did. But I worry that by choosing just to bypass the whole damn thing, by going straight to surgery out of fear, these women are also saying something about women's bodies: My body is not good enough. I'm not even going to try.

It's not the same thing as the rise in plastic surgery, but it's related. There's an ideal--the body that can birth perfectly, the boobs that stand up and say hello, the nose that screams old-money WASP--and most of us can't meet that ideal.

And if that's true, then we have some bigger body-issue problems than just the elective C-section rate. Problems that should be everyone's business.

Nola Hamilton works in catering and lives with her boyfriend, daughter, and dogs.

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By Marlee Ryson

I can no more imagine butting into another woman's birthing choices than I can imagine asking to borrow her diaphragm. Some things are between a woman and her doctor, and how she chooses to give or prevent birth are two of those things. It has nothing to do with me--or anyone else.

The Centers for Disease Control and Prevention keeps track of C-section rates in the U.S. It recently issued a report on the rising rate of C-sections, which now stands at twenty-nine percent. A close look at the data shows that the increase is due not to more at-risk pregnancies or emergency births but to more C-sections being scheduled--in other words, more elective C-sections. This has prompted a hue and cry from groups like Lamaze International and a vow by the CDC to reduce C-sections by fifteen percent by 2010.

Why the fuss? It's not as if the CDC were reporting failed C-sections or more dangerous C-sections being performed, after all--just more C-sections. Normally, you'd think the increased deployment of an advanced, safe, and humane medical technique would be something to celebrate. But apparently we can't leave women alone with their choices, in case they exercise one we don't approve of.

Ever since Queen Victoria chose anesthetic gas to ease the pain of her eighth birth, public busybodies have felt that they have the right to condemn certain childbearing choices as selfish and unnatural. Those who condemn elective C-sections seem to feel the same way.

Hidden behind a scrim of concern for mothers who (supposedly) are being deceived about the danger of C-sections is a patronizing disapproval of women who make certain trade-offs. These women may be happy to trade the mystery of the date of their child's arrival for the certainty of a pre-set day and time; the pain of labor and vaginal delivery for the pain of recovery from abdominal surgery; the rush of endorphins some women feel during natural childbirth for reduced anxiety about what passing a seven- (or eight- or ten-) pound baby through her vagina will do to her sex life or her continence.

So what if some people care more for certainty than mystery? So what if the prospect of moaning and sweating through labor doesn't appeal to them? Who cares if they would rather risk adhesions from the surgery than take a chance on diminished sensation in their lady parts? These are not issues anyone should get to vote on. If a woman understands the risks associated with each option, I say, stand back and honor her choice.

Especially galling is the way opponents of elective C-section use raw data gathered on all C-sections to fashion their arguments against elective ones. An elective C-section for a healthy mother and child isn't comparable to an emergency C-section after a long labor or a C-section that's required by a medical problem with the mother or child. So far, the data on elective versus medically necessary C-sections haven't been broken apart. So it's not right to cite such things as C-section babies' lower average birth weight or higher incidence of respiratory problems as evidence that elective C-sections are a public health issue. They're not; healthy, full-term babies, doctors will tell you, fare well with C-sections, owing in part to fewer risks of umbilical cord compression, heart-rate irregularities, limb dislocations, or injuries from forceps or vacuum extraction.

If the CDC's vow to reduce C-sections is actually a commitment to attacking underlying health issues that may cause a mother and child to have to undergo C-section, fair enough. But if it's really about meddling with a private choice, shame on them.

What about the cost to public coffers, you ask? Isn't a C-section major surgery that requires the mother and child to spend more time in the hospital than a vaginal delivery would? Isn't it more expensive? Once again, the jury is still out. Many women labor for hours on end, requiring the time and attention of several shifts of doctors and nurses. (And upwards of twenty percent of them will undergo a medically indicated C-section at the end anyway.) The woman who has a scheduled C-section, on the other hand, needs little attention before the birth, but more afterward. Studies say the average C-section costs twice as much as a vaginal delivery--but once again, those figures are lumping together medically necessary and emergency C-sections with uncomplicated elective ones. There isn't good evidence that one is always more costly in the long run than the other, says a recent study in the peer-reviewed Journal of Obstetrics and Gynecology.

In any case, if a woman's insurance company won't cover elective C-sections, she's got to pay the tab herself. Even if I thought elective C-section was a frivolous choice--which I don't--I don't see how it's my business to tell someone that she shouldn't have one. It's her body and her money. If my friend buys herself a closet full of Manolo Blahnik shoes or a boob job, sure, I may think she's spendthrift, but I'm not going tell her she should shop at Payless or suck up her desire for a show-stopping rack. And I'd hope she'd do the same for me.

No, elective C-section is not the most "natural" choice for giving birth. But neither is using pain medication, fetal heart monitors, birthing chairs, hot tubs, or hospitals, for that matter. Unless you're willing to argue that a woman shouldn't have access to those choices either, it makes little sense to wind yourself up about whether or not she chooses to have her baby by C-section.

Marlee Ryson lives with her husband and two (vaginally delivered) children in New Jersey.


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