Cesarean Birth in a Culture of Fear

By Wendy Ponte
Issue 144, September/October 2007

When I tell someone I am working on a story about the escalating rate of cesarean sections in the US, it often leads to a conversation that goes something like this:

"C-section rates are up to 50 percent or higher in some hospitals," I say. "Doctors often feel they must do a C-section to protect themselves from a malpractice suit. And many of them seem to feel that a C-section is actually better than vaginal birth. A lot of women are being given unnecessary surgery."

"I had a C-section," my acquaintance will say. "But in my case, it was necessary."

"Tell me about it."

"Well, the baby's heart rate started to drop on the fetal monitor, and the doctor was worried that she wasn't handling labor very well. So he said a C-section was the safe thing to do."

It's an awkward conversation, to say the least. I would never want to make any woman feel bad about the birth of her child. Women need to be honored for their birth stories, no matter how those stories go. And having been told by both a doctor and a reliable-looking and expensive piece of machinery that her baby could be in trouble, my acquaintance probably made the best decision she could make in that moment. By the time she reached the point when that decision was made, it could, in fact—after hours of beeping noises on the fetal monitor, the suspense of the hospital atmosphere, and loads of chemicals pumping into her body—have been the only choice available.

And yet I also know what hundreds of other birth activists know. Some percentage of women who think their C-sections were necessary—because of fluctuating heart rates, large babies, failure to progress, previous C-sections, difficult birth positions, and on and on—have actually had unnecessary C-sections.

I know this because the World Health Organization (WHO) says that any time a country's cesarean-section rate rises above 15 percent, the dangers of C-section surgery outweigh the lifesaving benefits it is supposed to provide. ¹In the US, the overall C-section rate has now reached 30.2 percent.²

That conversation, which I have had all too many times with various women, boils down to this: There are too many C-sections being done—unless it is your C-section. Then, it just isn't so clear. That conversation parallels the one that seems to be happening on a national scale. Although the arguments against the use of C-sections, except when there is no other choice, are clear, and although these arguments are supported by plenty of evidence and statistics, doctors and patients do not seem to be using that information to change birth practices. It doesn't seem to matter that, in the US:

1. A woman is five to seven times more likely to die from a cesarean delivery than from a vaginal delivery.
2. A woman having a repeat C-section is twice as likely to die during delivery.
3. Twice as many women require rehospitalization after a C-section than after a vaginal birth.
4. Having a C-section means higher rates of infertility, ectopic pregnancy, and potentially severe placental problems in future pregnancies.
5. Babies born after an elective cesarean delivery (i.e., when labor has not yet begun) are four times more likely to develop persistent pulmonary hypertension, a potentially life-threatening condition.
6. Between one and two babies of every hundred delivered by C-section will be accidentally cut during the surgery.³
7. The US is tied for second-to-last place with Hungary, Malta, Poland, and Slovakia for neonatal mortality in the industrialized world.⁴
8. Babies born via C-section are at high risk for not receiving the benefits of breastfeeding.⁵
9. The risk of death to a newborn delivered by C-section to a low-risk woman is 1.77 deaths to 1,000 live births. The risk of death to a newborn delivered vaginally to a low-risk woman is only 0.62 per 1,000 live births.⁶

Despite these statistics—which are just drops in the bucket of information available about the dangers of cesarean surgery—the procedure keeps being done. Women are not well enough informed, say birth activists. Medical schools are not teaching doctors how to create optimal scenarios in which successful vaginal birth can happen. Doctors are making decisions based on fear of malpractice suits rather than medical necessity. But even though we know all of this, and even though the statistics are compelling, high-tech birth practices continue, and the C-section rate keeps climbing, with every indication that it will climb higher. Why? "In another century, these birth plans will be perfect time capsules of postmodern maternity," says Tina Cassidy in her recently published book, Birth: The Surprising History of How We Are Born, "for if there is one thing that writing this book has taught me, it is that birth always reflects the culture in which it happens."⁷ Which made me wonder: In examining the way we give birth today, what would an anthropologist a hundred years from now learn about our culture?