Earlier this week, faithful reader, commenter, and sister blogger Knitting Clio and I got into a tussle over Cesarean Sections, and the feminist critique of the overuse of the procedure canonized in women’s health books like Our Bodies, Ourselves. (She is a historian of medicine as well as a women’s historian, with a specific interest in women’s reproductive health issues, so this is right up her alley.) She noted the overuse of this procedure and argued (along the lines of the traditional feminist critique of allopathic obstetrics) against the medicalization of childbirth. Here’s KC:
Short version — the enormous rise in C-sections over the past half-century has really not improved maternal/child health and is really more a product of malpractice litigation than medical science. Also, it’s a lot easier for a doc to make his/her tee time if s/he schedules a C-section rather than a vaginal delivery.
And, she is right about that (although perhaps a little flip about the convenience for doctors–I don’t know any OB/GYNs who golf, but wev.) For those of you who are interested in the history of the standardization of practices in obstetrics (and who isn’t?) see this article by Atul Gawande in The New Yorker from October, 2006. He writes about how the C-section rose in popularity among a subset of physicians who needed to improve their results and teach large numbers of students a standardized procedure for childbirth, and multiple artful uses of forceps–while elegant–are difficult to teach and standardize:
But if medicine is an industry, responsible for the safest possible delivery of millions of babies each year, then the focus shifts. You seek reliability. You begin to wonder whether forty-two thousand obstetricians in the U.S. could really master all these [specialized forceps delivery] techniques. You notice the steady reports of terrible forceps injuries to babies and mothers, despite the training that clinicians have received. After [the] Apgar [test], obstetricians decided that they needed a simpler, more predictable way to intervene when a laboring mother ran into trouble. They found it in the Cesarean section.
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This procedure, once a rarity, is now commonplace. Whereas before obstetricians learned one technique for a foot dangling out, another for a breech with its arms above its head, yet another for a baby with its head jammed inside the pelvis, all tricky in their own individual ways, now the solution is the same almost regardless of the problem: the C-section. Every obstetrician today is comfortable doing a C-section. The procedure is performed with impressive consistency.
However, I argued that the traditional feminist critique goes too far in pathologizing C-sections, and that it makes the same mistake that OB/GYNs did in the bad old days of pushing one rigid model of a “good” childbirth (i.e. no anaesthetics, no cutting, “all natural,” midwives and doulas only, etc.) Aside from the fact that many–if not most–C-sections are medically necessary, I argued that
Women are all different, and for some, it’s important to push a baby out the old-fashioned way. For others, it’s not an option unless they’re OK with mutilation and/or delivering a blue baby. For still others, “natural” is not an option they would consider in the first place. So, clearly, it’s too rigid to insist that there’s only one “correct” or “authentic” or “feminist” way to give birth.
The woman whose torturous labor supplied the plot line for Gawande’s article, Dr. Elizabeth Rourke, wanted to do it the all-natural way, without anaesthesia or serious medical or surgical intervention. Although an allopathic physician herself, like many women who read up on childbirth and plan to take an active role in directing it, she was whipsawed by the pressure she put on herself to have the “ideal” birth, a pressure I think is exacerbated by the Our Bodies, Ourselves depiction of the wonders of so-called “natural” childbirth. At the conclusion of the article, she said of her childbirth experience,
“I felt like a complete failure, like everything I had set out to do I failed to do,” Rourke says. “I didn’t want the epidural and then I begged for the epidural. I didn’t want a C-section, and I consented to a C-section. I wanted to breast-feed the baby, and I utterly failed to breast-feed.”
However, Historiann must admit to KC and the entire world that she was mistaken about her memory of her edition of OBOS (1984). Its treatment of C-sections was pretty even-handed, and starts with a quotation that calls them “a sometimes useful and needed technique presently utilized in an undocumented, unclarified and uncontrolled manner,” p. 384. (A little heavy-handed at the end there, but the editors then immediately describe the operation as “life-saving,” p. 384, so no harm, no foul.) Where Historiann’s memory was correct was the dim view OBOS takes of anaesthetics and other pain-killing drugs taken in labor and delivery. That section (on p. 387) starts with the sentence–italicized for urgency–that “every single drug given to the mother during labor crosses the placenta and reaches her baby,” and goes on to say that “no drug has been proven safe for mothers and babies,” p. 387. (By the way, the two studies they cite as proof of this are dated 1966 and 1970. I’m pretty sure that things had changed a lot in anaesthesia by 1984, let alone 2008!) But–guess what? No drugs have been proven unsafe either! But they don’t tell you that–they go on to warn grimly that “some infants whose mothers received analgesia and anesthesia during labor and delivery have had retarded muscular, visual and neural development in the first four weeks of life.” So have a lot of other kids whose mothers had the ideologically correct birth too–because some kids just turn out that way anyway.
This was the crux of my critique of the dominant feminist vision for childbirth: why does it have to hurt? Childbirth is the only major (or minor) medical event in the life of the human body where we shoo people (all women, natch!) away from anaesthesia and analgesia. What’s up with that? Shouldn’t feminists open up to the ways in which medicine has improved childbirth since Eve bore Cain and Abel? If you wouldn’t think of getting your teeth drilled or stitches on a cut without at least a little lidocane, why would you think that attempting drug-free childbirth is a really great plan? Why is it only this medical event, and not the routine minor surgery on men’s genitals, the vasectomy? Why isn’t there a cult of masculinity built up around having that done “naturally,” without pain relief? Why is it only women who are asked to prove their womanhood by suffering extreme, incredible, sometimes days-long pain? (Let me tell you a little about something they don’t tell you about in “prepared childbirth” classes, called “latent labor.” I call it “all of the pain, none of the progress!” Dr. Rourke’s latent labor lasted only two days–but I know someone who was in latent labor for five days! And man, was she pissed off that they didn’t just cut her on day one!)
So, my apologies to KC, and to the editors of my now ready-for-the-rare-books-room copy of OBOS. The treatment of C-sections was much fairer than I remembered, although the presentation of pain relief during labor was rather one-sided. But, I’m going to get the newest revision of OBOS–1984? That was a long time ago.
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