Letters

[Read "Cut and Run," by Dana Hudepohl.]

My baby was born via elective C-section on July 1, 2004. He was 10 pounds, 2 ounces, 22 inches long, perfect and healthy. My entire birth experience was positive and wonderful, truly better than I had even imagined. My recovery has been amazing -- virtually painless -- and upon discharge from the hospital five days following my surgery, I was able to hold my baby easily, walk up and down stairs, and do relatively normal activities. My biggest problem was remembering that I had had major surgery, and to not do too much.

I am pleased with my decision, and thrilled with my newborn son. I would definitely make the same decision for an elective C-section again, if I had the chance.

-- Dr. Jennifer Feeney

As someone who went through both a surgical and natural birth, I am baffled by mothers who deliberately seek a C-section. Surgery should always be a last resort, a solution you turn to when the benefits outweigh the risks.

My first pregnancy ended in an emergency C-section. The epidural I had been receiving was cranked up, and soon everything became blurry and surreal. As I was strapped, eagle-like, on the operating table, nausea overcame me. All I remember after that is seeing blue: The cloth that shielded me from my cut belly; the clothes that the doctors and my husband wore. When my son was removed from my stomach, and my husband handed him to me, I desperately strained my eyes to take a good look at him, but couldn't focus.

I was determined to have a vaginal delivery when my daughter was born. And I did. Without drugs. The pain was scary, all right, but once my little girl came out, it was over. I couldn't take my eyes off her. I felt elated, energized even. As she lay on my stomach and nursed for the first time, I couldn't help remembering the searing pain in my abdomen three and a half years earlier.

Surgeries do save lives. But vaginal childbirth is a timeless miracle of nature, one I am so grateful to have experienced.

-- Sylvie Sadarnac-Studney

Late in the article, Feeney describes labor as 20 to 30 hours of excruciating and unpredictable pain, as opposed to cesarean delivery, which she blithely characterizes as a 30-minute, controlled procedure. This characterization of vaginal delivery in contrast to cesarean birth is unfair, to say the least. Has Feeney even delivered other children to be able to make these representations? Her perceptions on the contrasting experiences of vaginal birth vs. C-section are of little value if she has no relevant experiential data to draw from.

-- Robin Wilt

I gave birth to my son in my house as planned with a midwife, doula, and family around, without drugs -- so this puts me on the other side of the bell curve in terms of electing how I wanted to give birth.

That said, I have quite a bit in common with the women cited in this article. Namely, I wanted to be in control of the process (as much as that's possible), and found the idea of a routine hospital vaginal delivery, which I am assuming Donna McDonald has witnessed countless times as an OB nurse, terrifying and abhorrent.

Clock watching, not allowing women in labor to eat or drink, unnecessary immobilization, and unnecessary intervention are all still far too common despite a movement toward empowering pregnant and birthing women. I stayed home to avoid it. Maybe if we can truly change the healthcare system's approach to childbirth for the better, women will feel they truly have options.

-- Amy Callner

Extreme opposition to C-sections in the U.S. is about Americans wanting to worship the Natural -- perhaps because nature is a "gift from God." Meanwhile other countries are looking at how technology and medicine can actually serve people. Including women.

In this, as in other matters -- like HIV, gay marriage, prostitution and medical research -- the U.S. is out of step with too many other nations. When the question of personal choice comes up in relation to the human body, too many Americans lose perspective and resort to ideology -- feminism, Christian morality or nature worship.

There's no absolutely right or wrong way for everybody to give birth. Brazil and Denmark can teach us a lot about how we manage our own bodies. If we are willing to listen.

-- Tracy Quan

I was surprised that Ms. Hudepohl did not mention some of the more interesting benefits associated with vaginal birth. First of all, the squeezing of the baby through the birth canal primes the newborn's organs (like the lungs) and gets them ready for working outside the womb. This process also releases hormones in both the newborn and the mother -- none of which happens if the baby is cut from the body. The most substantial benefit, however, is the bonding time that mother and child experience immediately after birth. You can't do this if you are unconscious on an operating table.

I feel sorrow for those women who don't have to have a cesarean for medical reasons, but who are frightened into doing it or because their doctor feels like it will suit his/her plans. (I know a woman in New York whose doc suggested giving her a C-section because her due date is around his impending vacation!)

We are becoming slaves to medicine. We have taken one of the most beautiful things in the world and turned it into a bloody operation.

-- Noble Smith

As a physician assistant who is about to give birth at home with a midwife, I was struck by Dana Hudepohl's article.

Hudepohl fails to mention that the World Health Organization recommends a no greater than 15 percent cesarean rate in any country. This, because the complication rate is double for a cesarean -- even an elective one -- than for a vaginal birth. Our current rate is 26 percent and climbing.

My choice to have a home birth was also met with astonishment and judgment, so I can understand the position of these women who are "going it alone" in their choices. I believe, however, that it is our medical establishment (of which I am proudly a part) that is partly responsible for convincing women that they are not capable of handling the normal pain of labor and childbirth. In a way, it is the hallmark of a patriarchal society that convinces its females that we are not powerful enough to handle this process for which we are so uniquely designed.

It is my firm belief that our bodies are designed to create a labor and delivery that is not only tolerable, but rewarding. My friends who have had home birth say it was the most amazing thing they have ever done. You won't get that answer from a woman who's had an elective cesarean. If we were not designed to handle labor, our species would simply not be here after so many millennia of natural childbirth.

The answer is not in denying these women their right to choose a cesarean, but to create an environment in which every woman feels empowered to deliver naturally. We should all view cesareans as a necessary evil, and reserve them for emergencies. Ms. Hudepohl speaks of countries that have even higher rates of cesareans than we, but she doesn't mention countries like Holland, which has a 30 percent home-birth rate, a cesarean rate of below 10 percent, and currently ranks lowest in the world in perinatal morbidity and mortality. Compare that to the U.S., where we supposedly have the most sophisticated medical system in the world. Our perinatal morbidity and mortality rate ranks an abominable 20th.

Frankly, the data supports that natural childbirth is the safest and healthiest choice for mothers and babies. Rather than persecuting these women who choose elective C-sections, I would like to see our country move toward adopting more hospital support for natural childbirth and more obstetrical support for the same.

-- Megan Foss, PA-C

I'm appalled that Dana Hodepahl's article "Cut and Run" did not offer a single point of discussion about how an elective C-section might impact the baby.

There was no discussion about how anesthesia can impact a baby's breathing, or contribute to low Apgar scores. The baby is not benefiting from the natural stimulation and pressure that movement through the birth canal provides. Some babies may experience trouble breast-feeding due to anesthesia. While these can be accepted complications of C-sections that are medically necessary, there is no justification for leaving what's best for the baby out of the decision-making process for birthing plans.

Becoming a parent means that someone else's needs often have to take priority over your own.

-- Carol Maltby

In 2003 I gave birth to my son who weighed in at 9 lbs. 11 oz. The weighing in, however, came only after several terrifying minutes of resuscitation. During the end stages of my labor (yes, excruciating is an appropriate description), he was born a sad white-blue color and wasn't breathing. For no known reason, he had gone into distress just before I started trying to push him out.

The NICU doctors were able to bring back his breath, thank God, and now, at 15 months, he is a completely normal, thriving little boy.

Though the umbilical cord blood was apparently oxygenated enough to feed his brain during those five minutes before we heard him cry, it took several days, or even months, before we were pretty sure he hadn't suffered brain damage.

We are eternally grateful to have a healthy, lovely child now, but I do not want to, will not, go through those minutes again when we didn't know if he would survive. When I give birth to his sibling, I will have a C-section, for myself and for my baby.

-- Angie McCullagh

This seems like a bunch of hype about not much. I scheduled a C-section for my second child, born a few months ago. My first child was delivered by emergency C-section four years ago, so I wasn't hassled about my decision; in fact, my doctor initially suggested it would be a safer bet.

I got a few raised eyebrows from the natural-birth mom brigade -- among them my good friend who'd had a VBAC for her second delivery and thought I should, too. But guess what? It's a personal decision. I did a risk analysis, and decided to make it a planned event instead of going through labor again and then possibly having to have a C-section anyway. I knew what I was in for on the recovery; we could arrange for our daughter to stay with friends (no family nearby to help out for four days) instead of waiting for labor to occur and being stuck with no help. The four days in the hospital were a welcome break, although I was glad to go home.

The health risks of either vaginal or cesarean delivery are very small; women should be allowed to make their own informed decision and tell everyone else to butt out.

-- Mary Owens

One issue that this article failed to address is cost. An elective, uncomplicated C-section costs significantly more than a spontaneous, uncomplicated vaginal birth. For women with insurance, this isn't an issue, but perhaps it should be. Dr. Bost argued that women are allowed to have various forms of plastic surgery, which are riskier than elective C-section, but failed to note that these women are paying their own way if they choose these surgeries. I have no problem with my health insurance premiums reflecting the higher cost of C-sections when they are medically necessary; I do have a problem paying for what amounts to elective surgery for women who simply don't want to sit around "moaning, panting, sweating, and screaming" as the rest of us do.

-- Joy Woller

The biggest problem I have with the recent articles and news mag shows about elective cesareans is the simple fact that the average person with insurance through an employer will not be able to get full (or any!) coverage for a C-section that is elective, because it is not medically necessary. Most insurance companies will pay for the surgery if there is documentation that a vaginal delivery won't happen, will harm mom or baby, i.e., making the surgery medically necessary.

The people most often quoted (celebrities, etc.) can afford to pay these charges without the need for insurance! This is an extremely dangerous picture to paint for the average woman in America, who cannot make this financial choice.

-- Lena

Oh my God, having babies is so hard and dirty! It sounds like a bunch of teenagers complaining here. I mean, how dare the medical community expect you to give birth the way in which nature intended?

If these women knew that childbirth was the least of it then they might reconsider the whole thing. Child rearing is not for the selfish or the faint of heart. If you can't even deal with the delivery, then God help you with the rest!

-- Kirsten Eyles

Dana Hudepohl's piece on elective C-section is full of sadness. We associate feminism with the "pro-choice" movement. However, if choosing to have an elective C-section is a feminist's cause du jour, then I guess I am no longer a feminist. Choosing an abortion or liposuction necessitates choosing a medical procedure because it is a means to an end -- an end that would otherwise be unachievable. Choosing elective C-section is quite different, simply because the female body was designed to give birth, a fact that a large number of women and doctors have obviously forgotten.

The women interviewed in Hudepohl's article describe labor as an excruciating, barbaric act where they are not in control -- all characteristics of a "medicalized" birth. These women do not seem to realize that there are alternatives, and instead run blindly to medicine to "cure them of their pregnancy." It is unfortunate that many women still do not appreciate the power in their bodies and do not want to experience the natural miracle of bringing life into the world.

-- H. Straw

I think the writer missed one important driving factor for this trend: For which do physicians get reimbursed the most -- a vaginal delivery or a C-section? Of course, the C-section brings higher reimbursement. Same goes for the hospitals in which they practice -- the O.R. suite brings in more money than a simple labor and delivery room. Health economists kindly call these sort of thing "perverse incentives." It scares me to think about what's next.

-- Liz Madigan

I believe women should always be given a choice in how they give birth, just as women should always be given a choice of whether to end a pregnancy.

But here's what an elective C-section circumvents: one of the few chances a woman has in her life to experience a deep and profound wildness. I had an extremely complicated twin delivery with one of my children a full breech while the other had a complication with a high mortality rate. I deliberately changed doctors in my 20th week of pregnancy, sought out a teaching hospital with a world-class perinatal practice, and gave birth vaginally.

Had these doctors told me a C-section was necessary (and in 99 percent of all other hospitals without these doctors' skills, a C-section would have been a preemptive move), I would have done it without hesitation. I labored for 24 hours. It hurt, it wasn't fun, and I would do the same thing again. I'm not a hero, but I did choose to fall deep into the experience of childbirth and see what turned up. For me, experiencing my body as not being under my control was a revelation, and oddly, a relief. My body knew what to do, and how and when to do it. Some deeper intelligence was at work, and I am very grateful to have had the chance to experience it.

-- Dayna Macy

I blame Hollywood for images of pregnant women "moaning, panting, sweating and screaming while people poke and prod" at them, and I blame the medical community even more for not easing women's fear. It's self-serving for doctors to, if anything, encourage women's fear of childbirth: If women saw it as a natural physical process, shaped by millions of years of evolution and undergone without incident by who knows how many women every day, they might just question whether they really need quite so much medical intervention or whether they should be paying quite so much money to be treated oftentimes worse than a farm animal. Shame on women for failing to do their homework and electing to have C-sections in the bizarre belief that major abdominal surgery is going to be a snap. The saddest thing of all is that these women call themselves feminists. As Ms. Feeney herself says, "It just seems so unnecessary to me."

-- Leslie Claire

When I was pregnant with my first child seven years ago, I read extensively on the subject of natural vs. C-section deliveries. The issue was important to me, because I am under 5 feet tall, and my husband was over 10 pounds when he was born, so I knew I had a statistically higher chance of needing a C-section. I broached the subject many times with my OB/GYN, but her response was always the same: "It's better for the baby to be born naturally."

This same doctor induced my labor, and 17 hours later, my daughter was born by emergency C-section, clinging to life because of a deadly blood infection she contracted during my prolonged labor. The hypocrisy of inducing a labor that was supposed to be better for my baby but actually endangered her life was infuriating. Fortunately, my daughter made a complete recovery, but it makes one wonder exactly what "first do no harm" actually means.

-- Stephanie Littleton

I had my first child "naturally" -- no meds, nothing -- and my second with a C-section, as she was a breech birth. They were both big babies, at around 9 pounds each. With the first birth, I got to feel everything -- the pain, the joy, the adrenaline rush. With the second, I got the pain, the gas, the constipation. Why anyone would willingly choose major surgery is a mystery to me.

Thinking that you can be in control of every second of your life is an illusion. My son had his own timetable, and I found out the moment labor started that he was an individual, not just an extension of my body. My second child, with her refusal to turn around in my uterus, was and is just determined.

I would have been overjoyed to deliver her the same way her brother was -- recovering from abdominal surgery was horrible. I felt more like a patient and less like a new mother. If I'd had a C-section the first time around, I would never have known how great my body's natural responses were.

-- Kate Coe