What I knew before
All through my pregnancy I said I wanted a natural birth. No drugs, no machines, minimal intervention.
I wanted to give my baby a pure beginning—the purest beginning possible, unpolluted by chemicals.
“Why? Why put yourself through that?” my husband demanded. “There’s nothing wrong with taking something for the pain. If it was me, I’d be the first one in line.”
We fought about it.
Our arguments were all about the epidural. We never once argued about a C-section. Chances that I’d need one seemed remote. My mom had five kids. Her mom had seven. My dad’s mom had ten. None by caesarean. Green light!
I also argued passionately with one of my best friends. She tried to explain that there was a really good reason why epidurals were invented. That they were beneficial and not at all to be sneered at. In my arrogance, I shrugged off her good sense; in my ignorance, I couldn’t really picture what kind of help someone else could give me.
At that point, I still believed that birth was ultimately a one-person job.
I thought if I controlled it all, nothing bad could happen. Nobody would have the chance to get in there and fuck things up. Because even though they say there’s no harm in having an epidural, who really knows? Mistakes happen. What if there is an overdose? An allergic reaction? Some other tragic accident? No thank you.
Better safe than sorry. My plan was to just let that baby sail out and let Nature take care of things.
In my defense, there are a lot of stories out there about exactly that kind of birth. I even talked to women, in person, who said they had that kind of birth: incredible, awe-inspiring, full of joy. The kind where everything went right. The kind where, even though there was, technically, pain, (reluctantly admitted), it didn’t really register as pain, because it was just the wonderful strength of the body doing what it was uniquely suited to do.
Growing up, I heard this about childbirth: “Oh, you forget all about the pain. When you see that little baby, you forget everything else.” Always, the woman who said this was laughing. Maybe a bit nervously.
This turned out not to be true at all.
What I knew that day
Not only did I not forget about the Pain, it is the thing I remember about that day. Or rather, the Pain was so powerful it shorted out my senses, so there wasn’t much to remember, except that.
It began on a moonlit night.
At about 1:30 am, the cervical plug—a cork of old blood—came out. Nausea hit. The contractions got harder. My husband was still asleep. At childbirth class they’d said lots of women go to the hospital too early, and then they just have to go back home. I didn’t want to be that woman.
But at about 3:00 am, I woke him, because I didn’t want to be alone anymore. He was upset I hadn’t awakened him earlier.
He drove me to the hospital. The moon was nearly full and the blue-black air was cool on my skin. My baggy old gray Goodwill shirt with the sleeves cut out was practically the only thing that still fit. It was Friday, the first day of October.
I had trouble standing during intake. Soon I was in a bed, and the doula was talking to me about what I could do while I waited for things to get worse. She convinced me to take a warm bath. It didn’t help, but it was something to do.
About 7:30 am, the midwife showed up. The midwife I’d seen throughout my pregnancy; the midwife who was supposed to be my ace in the hole, my key to a woman-centered birth. She did a cursory exam.
“Doing great! You’ll deliver by noon,” she chirped.
I never saw her again.
My cervix dilated to about eight centimeters. And no more.
At one point, a few tears came to my eyes.
The doula noticed. “What is it?” she asked.
“I just want it to stop. I’m tired of the pain.”
She looked at me in disbelief. I don’t remember what she said. I don’t think she said anything. But her expression was clear enough. This is only the beginning, her eyes told me; this is nothing compared to the pain that is to come; you have no business crying now.
And what her eyes said was all true.
After hours of contractions, they said I might be dehydrated. They wanted to put in an IV. The doula reminded me that once the IV was in, I wouldn’t be able to move around.
But I didn’t really want to move around, anyway. I was exhausted.
They put the IV in. Then they wanted to attach the baby to a fetal monitor. I’d been warned that the IV would be the start of the medicalization of my baby’s birth—the westernization of my womb—and it was true: everything followed from that.
That’s about when the Pain began.
My husband told me later that I was drenched in sweat. I was naked and wasn’t even aware of it. I was in agony for hours, but I don’t remember being in agony—I just know that I have almost no memory of that time.
When the Pain was upon me, I could not see. There was no fog and there was no dark. The lights didn’t dim. There was simply no seeing. I was too busy to see.
There was Pain, and Pain was all. The Pain replaced me. It became me. The Pain took the place of my eyes and ears and brain.
A pair of hands reached through. There were knuckles near my eyes, to the right of the bed. I gripped the hands and they gripped mine. How I knew I still had hands was that he held them. His skin was like medicine. It helped me breathe. Skin I knew. Hands I knew.
The Pain was in the room, but so were his hands.
Once—or maybe more than once—I looked up, very far up, and in the sky were his eyes. Worried.
Why is he worried? It was a question I couldn’t answer. I couldn’t think, and I couldn’t speak.
Only later, when I trolled my memory for details, did I realize his hands were about the only thing I remembered from those hours.
I told him, “I don’t remember much. I think there was someone screaming.”
He looked at me. “That was you.”
I think they gave me Pitocin, to see if it would make my contractions more useful—see if my cervix would dilate those last few centimeters.
After hours of that, they said I was exhausted and I should sleep. They gave me morphine.
I liked this idea. I wanted to sleep. But I couldn’t. Something would not release me.
Someone said, “They gave her enough to put a horse to sleep.”
It might have been my husband. He kept telling me I should sleep. He got a little irritated that I wouldn’t. He thought I was being stubborn. He was exhausted, too.
But I couldn’t.
There were murmurings, gentle threats. If I couldn’t sleep, somebody said, I might not have the energy to deliver, and there might be a C-section.
But I couldn’t. And after a few hours of that, something did change.
Somebody said, “The baby is not recovering between contractions.” Somebody showed me jagged lines. They said, “Look here, the baby is not getting enough oxygen.”
That I remember—the piece of graph paper with peaks and valleys, and the statement that he was in danger. That reached me.
My husband told me later that doctors and nurses were massing in the hallway, and eventually pulled him out of the room to talk to him. They told him he had to convince me to agree to a C-section. And they sent him back in.
My husband said to me, “We need to get him out of there. That’s the most important thing, that he’s healthy. Right? We want him to be OK. We want our baby to be safe. And he’s not so safe right now. He’s not doing too well in there, so they have to go in and get him out of there.”
I whispered—of all things—“But you won’t be disappointed in me?”
That shocked me. Until I said it, I didn’t know that thought was inside me. I didn’t know I cared that he might think I was weak. Which was totally illogical. He had tried for months to convince me to have an epidural; he clearly hadn’t wanted me to endure any of this.
“No.” He shook his head. He was, perhaps, a tiny bit amused. He told me I was brave and strong. He told me I’d done all I could do. It was time.
So I agreed.
I don’t remember my friend sobbing at my side when she realized that, after all our late-night arguments, I was going to have to have a C-section.
Into the wilderness came a man with a needle.
I had to sit up. Barely conscious, limp with pain and fatigue, drenched in sweat, I had to sit up because the spine must be vertical for the epidural needle to enter properly.
I understood this. The only way out of Pain was to sit up.
So I did it.
I didn’t feel the needle going in.
Then I could see. Suddenly there were colors. I could see. I could hear. I could talk.
The world was the world again.
I looked around for the miracle worker. The anesthesiologist was standing behind me. I twisted all the way around, still sitting on the bed.
“Thank you,” I said, shaking his hand.
Before the birth, I’d read about epidurals. They sounded horrible. Who wanted a giant needle jammed into her spine? And the possibility of things going wrong—what if they gave me too much, and it harmed me—or the baby? And the fact that it didn’t take all the pain away, but only 60 to 80 percent, made it seem not worth it.
I hadn’t read anywhere that an epidural can pluck you from nothingness and give you back your speech and your sight and make your brain work again. Nobody had written that about it.
Then I was in a big room. There was a lot of blue-green cloth. My friend was next to me, taking pictures.
Then there was a pause. And a clump of doctors and nurses at the far end of the room. I sensed they were done with me. They must have eased the baby out. But there was no cry.
“Is the baby okay?” I asked. “Why isn’t he crying?”
Nobody answered. I felt the beginnings of panic.
“What’s wrong? Is the baby okay? Why isn’t he crying?” Why wasn’t anybody talking?
Later I found out they were giving him oxygen and rubbing his chest.
And then . . . a wail. A lovely, spidery, scratchy yowl. My friend said the doctor slumped, visibly relieved.
Sometime later I was in a small room, and that’s when I got to hold him. He had on a little hat—blue and pink and white. He was all there, and he was out of me.
That’s when they told me what happened. The cord had been wrapped around his neck twice, and as a consequence, it was too short. He would not have made it out of the birth canal.
What I knew later
I knew that a C-section saved my life and my baby’s life.
I knew that pain can wreck a person, physically and mentally.
I knew that my failure of imagination had put me at risk.
I knew that the reason people help during childbirth is because the pain can disable the mother; because they can see things she can’t; because they can do things she can’t. It’s nothing like the movies, where everyone else in the room is incidental and the woman huffs and puffs until the baby pops out.
I would not be sitting here, writing this, if we’d let Nature take care of things. My son would not be asleep in the bedroom. We would be just memories now. Memories and bones.
We think of the caesarean as a modern invention, but it’s not. It’s been around longer than books. C-sections were performed in China 3,000 years ago; in India 2,000 years ago; in Iran about 1,000 years ago. African tribes routinely performed C-sections in the 1800s, and most probably long before that. Roman law required that a baby be rescued from a dead mother’s womb. So, the first, and for a long time, only, use of a C-section in Western civilization was to save a baby whose mother had died, either in childbirth or from some untimely accident. It took centuries for Western doctors to figure out how to do a C-section on a living woman; even longer to figure out how to do it so that she remained alive when it was over.
In many Indo-European languages, the name for the operation translates as “emperor’s cut.” (In German, for example: Kaiserschnitt.) Oddly, though historical records show that Julius Caesar himself—whose name the procedure carries—could not have been born by C-section.
Recently, C-section rates in many developed countries (China, Brazil, the US, Australia, and much of Europe) have skyrocketed. In some regions, C-sections are more common than vaginal birth. However, the increase in C-sections is only half of the story. Each country’s C-section rates are highest for the richest part of the population and lowest for the poorest people. In other words, women have unequal access to C-sections. Some women have to fight to avoid the procedure, while others cannot get it—including millions for whom the operation would be life-saving.
The World Health Organization did, at one point, declare that the optimal rate for C-sections was 15 percent. However, in 2015 they did a 180. Now their official statement reads: “Every effort should be made to provide caesarean sections to women in need, rather than striving to achieve a specific rate.”
Of the estimated 18.6 million C-sections performed globally in 2014, about one-third are thought to have been medically unnecessary.
Far more tragic are the estimated 3.18 million that were needed, but not performed.
When I think of a C-section, I think of light.
Because the next day, I got to go outside. Yellow-gold sun shimmered around the wheelchair as my husband pushed me along the sidewalk. The breeze kept yanking my hospital gown open over my thighs.
“You might want to, uh . . . ” he said, gesturing at the flapping cloth.
I laughed. I held down the edge of the gown for a little while, but really, I could hardly be bothered. The air. The sun. The grass. The wind. All delicious.
My baby was asleep with the nurses and I was rolling along the banks of a great river.