The tunnel or the knife

c-sectionsI want to preface this by saying that for some, this could be a little uncomfortable and graphic, as I’m talking about birthing. As women, we shouldn’t have to talk about birth in hushed tones, but the reality is that it is a bloody, painful process that may make some uncomfortable. So if gore and descriptions of childbirth make you uncomfortable, I might recommend skipping this post.

The bedsheets streaked with sweat and blood, the light dim and oily, the curtains drawn back to let in the cool night air.The stars reeled above, but she could only see them dimly through the window.

Elizabeth’s neck was sore from craning forward and tightening her abdomen to push the baby forward, but she felt some sort of blockage between her hips. Her sister assured her that she was wide open and ready for the baby to come, but something was still in the way. She felt it.

Her husband was out getting the hot water. He’d said something to Dr. Humphreys about a procedure that could save the baby, something he’d seen done in Europe. The doctor’s voice had peaked, saying he could never do something that dangerous. Racked by a contraction, Elizabeth gritted her teeth so tightly she thought they would break. She felt blood oozing from between her legs and tried to stave off panic, hearing her sister’s voice faintly through her buzzing ears.

Please, let our baby come now. Please, God.

When she opened her eyes, the doctor was gone. Her husband’s beloved face appeared over her, his lips moving, saying something about an operation. The baby was stuck, he said; to save her life and the baby’s, he was going to cut open her stomach and pull forth the child. Her ears began to buzz as she nodded, lost in the pain and heat, and her husband gave her a glass full of thick liquid that smelled of laudanum. She drank and the world blurred. Her sister held her hand, and she leaned back.

Dr. Jesse Bennett performed the first Cesarean section operation in colonial America on his wife in 1794. Both she and his newborn daughter survived, a rare occurrence for surgery in the 18th century, where there was little antiseptic, little painkiller and few sterilized tools. For Dr. Bennett, who was likely emotional over the birth of his first child and the bloody body of his young wife, it was almost a miracle that his family remained intact.

Today, C-sections are commonplace. One of every three babies in the U.S. is delivered by C-section, some of which are medically necessary, others of which are preferential. However, the risks are still many, and some gynecologists are becoming concerned that the ease and availability of surgical childbirth is becoming too common. A paper published in the Deutches Arzteblatt International highlighted the increased rate of C-section procedures and raised concerns about post-operative infections, uterine prolapse and internal bleeding.

C-sections are an old procedure. This image from Uganda shows a surgeon preparing to make the incision on a woman in labor. Travelers in the Great Lakes region of Africa reported seeing the operation done regularly. Original image from Wikimedia commons.
C-sections are an old procedure. This image from Uganda shows a surgeon preparing to make the incision on a woman in labor. Travelers in the Great Lakes region of Africa reported seeing the operation done regularly. Original image from Wikimedia commons.

The proliferation of alternative methods of birth highlights another question: How much do we really know about childbirth as a physical process?

We know it’s gross. Childbirth is still a warning label on many movies. Facebook came under fire last year for removing photos of childbirth from its website. Sex education in most schools makes no mention of the childbirth process. And one study that emerged this past June highlighted a little-known muscular control that contributes to contractions.

The study, published in the journal Nature Communications, focused on the potential reason for higher rates of C-section procedures among obese women. Directed by Helena Parkington of the Monash University at Melbourne in Australia, the researchers identified a gene called human ether-a-go-go related gene (hERG), which controls the strength and length of contractions during labor. For labor to begin normally, the gene channel must be “switched off,” allowing beta-inhibatory protein to express itself.

In normal-weight women, the gene is able to switch off. In obese women, it appears, the gene is unable to switch itself off, making labor much more difficult and necessitating C-sections for a safe delivery. The researchers linked high BMI to higher likelihood of difficulty in fertility, pregnancy and delivery.

It’s often a burned-bridge situation with C-sections as well: Once a woman has delivered via C-section, she will often deliver all subsequent babies via C-section as well. The risk is that the incision from the previous surgery will reopen during the trauma of vaginal birth and cause internal bleeding. It’s not unlikely: During vaginal birth, the woman’s abdominal muscles cramp and contract repeatedly, placing stress on the tissue around them; when the fetus is moved downward, the skin around the cervix is stretched tightly and sometimes tears, leading to bleeding. When the infant’s head presses against the cervix, it can cause extreme pain, called back labor. The stress on the woman, both physically and emotionally, is intense.

The physicians from the Deutches Artzblatt paper recommend that unless a C-section is deemed medically essential, all women try to give birth vaginally. It conserves resources and removes the potential for additional complications.

The additional attention on women’s health is always helpful as well. While deaths in childbirth have decreased exponentially over time, many women still do not understand the process of what is happening to them in reality when they are pregnant. Folk cures are still rampant, especially among teenagers, to prevent pregnancy or make it easier. Only when we can more openly talk about it does science become a more regular part of the conversation and women become safer. It was the same with contraception, and it should apply to the rest of the birthing process as well.

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