C-sections and vaginal births: Not the same thing

—Theresa Morris

On December 15, Kim Simon posted a piece on Huffington Post entitled, “10 Ways C-Sections and Vaginal Births Are Exactly the Same.” I saw this posted on Facebook and many people seemed to applaud it, but I have to say I am disturbed by it, especially the title. Simon’s argument boils down to the assertion that women shame each other over birth and fail to embrace the notion that birth, regardless of how it is accomplished, leads to motherhood. Who can argue with that message?

I will, because equating C-sections and vaginal births is problematic. I have conducted research on the high U.S. C-section rate in the U.S., and I can say unequivocally that giving birth by C-section and giving birth vaginally are not the same for babies or for moms.

The 2013 C-section rate of 32.7 percent is over double the World Health Organization’s maximum recommended rate of 10-15 percent. Women are 3.5 times more likely to die in a C-section than in a vaginal birth. This helps to explain why a World Health Organization report finds that the U.S. maternal mortality rate has been increasing since 1995 such that now the proportion of deaths among women of reproductive age that are due to maternal causes has more than doubled since 1995. There is no doubt that C-sections contribute to this trend and that women are unnecessarily dying. If this is not the canary in the coalmine indicating our current birth practices in the U.S. are harming women, I don’t know what is. I agree with Simon that women are shamed for how they give birth and they shouldn’t be, but making that a central issue draws our attention away from the structural causes of the high U.S. C-section rate and perpetuates the notion that women are the problem.

Simon’s third point in the blog, “You’re in charge,” really shows the illusion of the blog’s argument. Women are most certainly not in charge, although I agree that woman should be. Doctors and nurses are bound by strict protocols that determine how women will be treated. Can women eat during labor? Probably not, because a nurse will only give her ice chips and clear fluids. Can she walk around during labor? Maybe—that depends on whether she has an epidural (most women do), whether the nurse insists on continuous electronic fetal monitoring (most nurses do), and whether the hospital has a functioning telemetry unit to remotely monitor the fetal heart (many hospitals do not). In other words, women are not in control, even if we agree that they should be.

This point is drawn home with two telling examples, both of which indicate how many women are not in charge of their births. First, 91 percent of women in the U.S. who give birth following a C-section have a repeat C-section, even though as many as half would like to have a vaginal birth. Why? This happens because hospitals and providers deny women a chance to have a vaginal birth and condemn them to another C-section. The risks of C-sections accumulate with each additional C-section, including the risks of secondary infertility, hemorrhage, and an unplanned hysterectomy. Second, some women are forced to have C-sections—read about the recent case of Rinat Dray. This can even approach a legal mandate. When women refuse a doctor’s recommendation to have a C-section, doctors sometimes bring in lawyers and judges, and women are court ordered to have C-sections. For an example, watch Laura Pemberton talk about her experience. These women were not in charge of their births.

In short, C-sections and vaginal birth are vastly more different than they are the same. No, women should not be shamed about their births, but focusing on this as the most important issue around birth draws our attention away from the harm of a high C-section rate and how many women do not have a choice in the matter.

Theresa Morris is Professor of Sociology at Trinity College in Hartford, Connecticut and the author of Cut It Out: The C-Section Epidemic in America. She is the mother of two children, the first born by c-section and the second by vaginal delivery.

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