*this is directed at those who would judge women's pregnancy and birth decisions, not at Miriam*

Grr! This frustrates me so much, even though I'm a woman NOT planning to be pregnant or give birth in any foreseeable time.

Women need to be respected for their own bodily decisions. Women who want to have a c-section (for whatever reasons) should be accommodated, as should women who want a fully natural birth with no drugs or hospitals whatsoever. And women who want something in the middle should be able to make the choices about their bodies.

Who cares if a woman wants a c-section so that her vagina will stay tight and so that she can schedule her work around the birth? It's not an option that should be forced on women, but it shouldn't be judged as "not the right way" or "not real childbirth" either. If you don't know the women and haven't lived through their life experiences, you have no call to judge them for whatever decisions they make.

When I tell people that I don't want to have children, partly because I have a hole in my spine (a very minor case of spina bifida) that means that pregnancy and especially child-birth put me at greater risk for paralysis, I immediately get the reaction of "what about a c-section"? Because a major abdominal surgery after a pregnancy that caused me more pain than the average person without a hole in their spine (cause, you know, pressure directly on my spinal cord caused by a fetus); would justify my existence as a woman.

The only reason I ever bring up the whole hole-in-spine+pregnancy=too-high-a-risk-for-paralysis thing is because the statement "I don't want to have kids is not sufficient enough for most people. They always have to ask why. No one asks my boyfriend why he doesn't want to have kids... nope, just me.

So, while there are ways around a vaginal birth that would increase my chances of paralysis (temporary or permanent), I don't care. I don't want children. The idea of being pregnant is terrifying to me (and I realize that there are many mothers who've been through it reading this and I applaud you for your strength, it's just not for me), but that's just not enough for some people. Apparently, neither is the hole in my fucking spine.

Whoa, where did this soapbox come from?

As a woman who has had a baby by c-section, and as a certified Doula, I believe that c-section should not be a choice.

I believe it should be treated like any other major surgery - it should only be done when there is a compelling reason to do so. Due to the fact that it *is* major abdominal surgery and carries all the normal risks associated with that eg. thrombosis.

I can't walk into my doctor's office and demand a gastric bypass, simply because I don't want to make use of diet and exercise to loose weight. Nor for any other major surgery just because I feel like it. Why then is it the case for c-sections?

C-sections are brilliant and completely necessary when complications arise, but in the instance of a healthy pregnant woman who chooses this out of convenience she is putting both herself and her baby at unnecessary risk.

Don't get me wrong, I fully support a woman's rights to do what she wants with both the birth and her body, but I feel this needs to happen within safe parameters. In the country where I live we have a c-section rate of approximately 80% so it's nearly impossible to have a natural birth (as I discovered, despite being well-informed)because it's just too easy for Doctors to push c-sections on the women they are supposed to be caring for. If they were forced to adhere to more stringent criteria for insisting on the surgery, more womens rights would be protected.

I have had a vaginal birth and a c-section. The c-section was completely unplanned. In fact, I had been so unhappy with my previous labor that my midwife and I went into the second birth determined to go naturally.

Obviously, that didn't happen. Luckily, I was able to have a c-section that prevented my child from being "dead or brain damaged" according to the midwife.

As someone whose had one of each, I resent people who assume that a c-section is the easy way out of labor. Buffy Y is right -- it is major abdominal surgery. I would have much preferred a vaginal delivery, which is excruciating but usually ends with a moderately sore body and perhaps a few stitches (and this was after a 10lb + baby) to having your abdomen opened, stitched back closed, being unable to move your legs for a few hours, being unable to sleep in any position except on your back for a few days because of the staples, having to walk hunched over with a pillow shoved in your belly for days, being unable to laugh without pain, being unable to pick up anything heavier than 5 pounds (including the baby, makes life interesting), and having unresponsive belly muscles for weeks/months all on 3-hours of sleep per night while breastfeeding.

A c-section is not the easy way out. In my experience, the medical staff and general media present it as much less painful than a vaginal delivery and for many (not all, of course. I'm sure there are many anecdotes to the contrary) that is not true.

It really is major surgery. I am not against c-sections at all. I am not even against planned c-sections for whatever reason, but people need to understand that it is a serious procedure.

Miriam, that was a very interesting article. It's a shame that it took about two comments to hit one that sent me blind with rage. Anyone who thinks that a woman who manages to care for an infant after major abdominal surgery lacks sufficient commitment is cordially invited to kiss my ass. I stopped taking any painkiller stronger than Tylenol three days after my c-section because they made me too tired to care for my daughter. I stopped the Tylenol a day later for the same reason. This by them is the easy way out.

The focus on women who choose to schedule a c-section around their schedule is a complete red herring. As the article said, this is only 2% of c-sections. Yet this is what gets talked about in the press, as though it was a major movement. The media just likes to focus on things that cause controversy, and there is nothing like stirring women up into holier-than-thou fights over who is a better woman.

My doctor told me I could have any type of birth I wanted. He did admit that he is pressured by the hospital and his insurance company to do c-sections. His malpractice insurance goes up if he does "too many" vaginal births.

So what is relevant is this: the medical system pushes doctors to do c-sections to prevent lawsuits, hospitals push doctors to do c-sections to make money, doctors push women to have c-sections because it is far easier to control the risk variables (in their opinion). Women then judge each other for whatever happens.

As women, we should be judging the broken medical system, not each other. How we give birth is irrelevant.

That, Mama Mia, sounds like some feminism.

so, if you choose a c-section, you get judged for wanting the "easy way out" or for not being natural enough or woman enough but if you don't want a hospital birth with an ob/gyn, you have to fight for that, too. it's the same old nonsensical idea on both sides--that women aren't capable of choosing what is right for themselves and their own bodies.

the reality check article was great--thanks for cluing us in, miriam!

as friends and family members in my life get to that age where they start having children, i've seen a startling number of c-sections and i've known several women who didn't want one, but ended up choosing to have one under considerable duress. i believe this has to be a widespread problem and ultimately it comes from the same place that judging those few women who DO choose a c-section because it is more convenient or whatever for them. women can't win as long as someone else--a doctor, a spouse, a parent, a newspaper columnist, a random internet moron gets to dictate the standard for what is acceptable reproductive and sexual behavior.

Wow. The comments over there are really worrisome--all the belittling and gender-loaded "mommy wars" and "internet mommy brigade" stuff, the weird fighting about whose birth counts the most and whose choice is most endangered and judged, the lack of distinction between actual, evidence-based arguments and defensive anecdote-swapping, etc., etc. Oh, and all the commenters who clearly hadn't read the article. (Awesome article, by the way--and it's refreshing to read the thoughtful comments HERE.)

Given the often-extreme lack of genuine choice and informed consent in childbirth, and the enormous societal and familial pressures on pregnant and laboring women, that quick slide from an article about real issues to meaningless name-calling is truly frightening to me. These are reproductive rights issues, people, and they are issues of the popular (mis)representation of women and of our culture's construction of femininity and maternity.

Also, few things raise my hackles like the implication that I'm (just) a "mommy." Mother. I am, among many other things, a mother.

Mama Mia: He did admit that he is pressured by the hospital and his insurance company to do c-sections. His malpractice insurance goes up if he does "too many" vaginal births.

This sounds like it's worth looking into. If anyone has a solid grasp on the statistics of a situations, it's usually the people selling insurance for it, so this makes me wonder if vaginal births are more risky, or, if they're not, if patients are for some reason more likely to sue due to complications from vaginal births than for complications from c-sections.

Alice, my understanding is that lawsuits are more common after a vaginal birth. In fact, a friend of my family gave up delivering babies after he was sued by a woman who had used cocaine during the pregnancy and delivered a disabled baby. The hospital forced him to settle rather than defend himself and he just decided to get out of the business.

I don't know why there are more lawsuits, however. Perhaps doctors who do surgery seem more godlike and less to blame? Who knows?

And Peepers, you made my day. I came to Feministing after some painful comment slams on another feminist blog. The young feminists over there had a hard time reconciling motherhood and its many forms with feminism. So here I am!

Alice: My admittedly non-expert understanding is that doctors (not just obstetricians) are more likely A) to be sued and B) to lose in court for NOT doing something than for DOING something, even when the risk of the active choice (in this case, cesarean) may be higher than the risk of the passive one (in this case, allowing labor to progress and taking a wait-and-see approach). In other words, if I think 'Dr. X did everything medically possible for me and my baby, and there was no helping [bad outcome],' I'm a lot less likely to sue than if I think 'why did s/he just stand by and watch as this problem developed?' And our culture values action; not so much quiet patience.

Because hospitals so often implement routine constant rather than intermittent fetal heart rate monitoring, too, there's this (to doctors/insurers) scary record of every single little irregularity in the heart rate. Although constant monitoring doesn't provide better outcomes than intermittent (as in, more live & healthy mothers & infants), it does provide more points at which I could later say 'Look; there's a record of a potential problem; why didn't you perform a c-section?' I can't really point to it and say 'why did you suggest [or require] a cesarean?' in the same way.

Molly, you probably know stats that I don't, but I do know that if it weren't for constant monitoring of my daughter's heartbeat during the birth, we would very likely have lost her.

But that's just one experience, albeit a pretty powerful one (for my wife and I).

There are other places in the world where the rates of primary elective c-section are way higher than in the US - brazil is one, and also in China, where there is apparently great interest in having your children on 'auspicious ' days.

anyway, back to the US. As an ob in training, this is something we wrestle with every day. we practice under the constant spectre of bad outcomes and resulting lawsuits. we watch fetal monitoring in labor (of course, no evidence that this helps us in anyway) and are tortured by bad tracings and the decision to intervene. The fact is that most babies with 'bad' heart rates who do end up in c-section are fine - we end up doing more than we need because we can't really tell which babies NEED the c-sections and which don't. But no body wants to be the person who sits on a bad tracing and does nothing, because then you live with the guilt of maybe having caused the harm - and the possibilty of the lawsuit. So why don't we just ditch the monitoring? The same reason - it is standard of care to have it, so if you have a bad outcome when you didn't use it, you might be screwed. Even if the patient requests not to be monitored, they can still file suit - even if it gets dismissed, it shows up on your record and can ruin your life for 1-2 years.

Most pregnancies are normal, and most have normal outcomes. Women who deliver with midwives or at home don't often face these issues. Women who make the choice to go that route will be les likely to blame a practiioner for a bad outcome, though, and less likely to sue. They know they have chosen a 'riskier' way to deliver and a desire to blame someone else would likely be shut be considered indefensible. But women who choose to deliver with an ob, in a hospital, often has a different expectation for her care, and can always state that she assumed her OB would ensure that baby was fine, even if she made choices that limted the ability of the OB to assess the fetus.

all this to say we work under alot of pressure, often in a catch 22 situation of trying to do what is best for our patients, but also always being aware that we are not all-knowing, cannot always know what is best to do, and that we do have to think about protecting ourselves as well.

Very interesting article. And timely. I recently found out I'm pregnant with my third. The first one was done with a doctor. The second with a midwife. The first was vaginal, with many many interventions. The second was a c-section, after many hours of labour. It was hell.

Now, I'm trying to decide what to do for this one. My history makes me consider an elective c-section, rather than vbac (gigantic heads, the both of 'em. 2nd was 41cm!) Both of them presented face up. I liked the quality of pre-natal care with the midwife, aside from personal issues with her (she was as paternalistic as doctors, but in a different way - she even called me "kiddo" *sigh*)

So timely. And interesting. I'd like to see some Canadian stats on this.

Mama Mia-- Thanks for bringing up the insurance concerns of doctors. OBs have the highest insurance rates of almost any other specialty. This will affect they way they practice. And as rjm mentioned, it can be difficult (if not impossible) to distinguish between a baby whose heart rate drops as part of the natural rhythm/cycle of labor, and one whose heart rate drops because of distress. So doctors will err on the side of caution, and do the c-section.

So it's not just the doctors being pressured to do c-sections because it's more convenient for them, or more profitable for the hospital. It's doctors knowing that if, just once, they *don't* do the c-section when they "should have known to," one law suit could end their careers, either because they lose the law suit, or they settle and their malpractice insurance payments balloon to a level that they can't afford. And in such law suits, it's hard to have a more sympathetic plaintiff than a pair of grieving parents holding a picture of the baby they never knew.

Sorry to ignore the main point of the article, but I had to respond to Rachel. I too, am not the least bit interested in children. People absolutely will not accept that coming from a female. Most commonly, I get a comment about my biological clock, and how apparently, in ten years or so, it'll begin ticking so loud that it keeps me up at night until I run right out and create some offspring.

I'm shocked by how hard it is, in 2008, for people to accept a woman not wanting children. Mere acquaintances feel the right to tell me that I'm wrong about how I feel towards children. Now that my sister's pregnant, I feel the pressure more than ever. I'm supposed to like baby clothing, mommy and me scrapbooks, and talking about pregnancy. I don't, and I feel guilty for it. Also a bit angry, because no one expects my brother to care about any of those things. Just me. Because I'm a woman, and that's what women do.

Ok, I know this is frivolous, but can any one here tell me how vaginal birth versus C-section affects a woman's ability to have enjoyable sex after the birth of her child?

Some women I know have told me, based on their experiences, that if I ever want to have good sex again after having a baby, I should have a C-section, because vaginal birth destroys vaginal sex for them. Others have told me that C-section incisions cut relevant nerves so that you can never have an orgasm again at all.

Now obviously I know that having a baby totally changes your life, and gives you a lot of other things to focus on more important than sex, and makes you too tired and busy to have much sex anyway, but, as some one who does hope to raise a child someday, it's important to me to know that there is some way to continue to have good sex after having a baby. (disclaimer: I know there are lots of ways to have good sex other than PIV, but I enjoy PIV sex and would like to maintain my ability to enjoy it.)

It's interesting. Anti-choicers often use rhetoric that claims that women are influenced by Planned Parenthood doctors and thug boyfriends in their decision to have an abortion. As feminists, we decry this kind of thinking as evidence that this patriarchal society treats women like they don't know any better and just make decisions on a whim. However, I don't see the linked article as any different- once again, dumb women- unable to understand the miracle of a vaginal birth, influenced by evil doctors- make the "wrong" choice.

Sara-
Most of my friends have had vaginal births and have not complained about having a problem. I had a c-section and have not had a problem. I have a scar right at the bikini line under my belly that does not have feeling, but it doesn't affect anything else. For a vaginal birth, it will take longer for healing and you might not feel up to it as soon as a complication-free c-section, but a c-section is major surgery and also takes time to heal. Having an episiotomy (where they snip some of the opening of the vagina) definitely increases the recovery time, and I have read these are in most cases unnecessary.

I would say this is an understandable worry, but it doesn't need to be too high on your list either way.

I

Sara: I second Mama Mia's sentiment that--while your concern is not at all frivolous (good sex is important!)--neither vaginal nor cesarean birth should affect sexual sensation in the long term. You can find scary anecdotes about virtually anything involved with childbirth, but it's really unlikely that you'd sustain permanent injury to any relevant nerves/tissue/etc. either way.

The length of recovery time varies wildly within both vaginal and cesarean births. You may find it cheering to know that I was having super-satisfying sex two weeks after my son's (vaginal) birth (NO claims to being representative, and I fortunately didn't tear at all and therefore had no healing to do, but back when I was contemplating pregnancy, I would have liked to know that was even a possibility). I gather that it's not uncommon for orgasms to feel sort of ... different ... for a while, but not forever. Sometimes postpartum depression, lack of sleep, the sudden huge amount of touching throughout the day, etc., etc. interfere with sex, but that stuff can't be avoided by a particular route of birth, unfortunately ...

I think it's great to be able to think of yourself as a mother and as a sexual woman at the same time, given how tough our culture tries to make that combo! Cheers.

An episiotomy isn't such a bad thing if it's done to prevent tearing. It would heal more easily than a tear.

Molly - I just wanted to point out that studies have shown that tearing heals more quickly (and better) than an episiotomy.

Info on episiotomy - http://www.efn.org/~djz/birth/obmyth/epis.html

One of the best sources of information on c-section vs vaginal birth is:

http://www.childbirthconnection.com/article.asp?ClickedLink=274&ck=10168&area=27

Childbirth Connection is possibly the best resource for studies-based information if you are really wanting to make an informed decision about your birth. There is even a section entirely devoted to information regarding the c-section rate in the US.

I think the thing that annoys me most about this issue is the inevitable "mommy wars" - the women who preach to us that the only way to have a baby is all natural labour and that anyone who does otherwise is weak, undeserving of being a parent and not a true appreciator of the miracles of life, blah, blah, blah. Currently, there are choices and choosing one method over another does not make you any better or worse.. It's shameful that women are being pushed into all different corners of viewpoint, most of the time by other women.
I guess the biggest thing is that, in the end, everyone wants a healthy mother and baby. If a doctor can see that medical intervention (drugs, a c-section, etc) whether an emergency, or months in advance, is the better, safer option, then that's what should be done and that should be free of criticism. Obviously, insurance companies pushing the matter is another thing entirely and they really should be ripped into little pieces for it.
I'm a c-section born baby. I'm one of three. I was born that way because of a heart defect, and the other two (elective c-sections), would have died had they been born naturally. It's childbirth and just like birth control, just like abortions, just like bikini waxing - it is immensely private and (provided one has considered all the facts, options and risks and allowing for times when experts have to step in) and ought to be non-attackable.