Cesarean Awareness Month: Why We Should Care

April is Cesarean Awareness Month , sponsored by the International Cesarean Awareness Network (ICAN). Founded in 1982 by Esther Booth Zorn when the cesarean rate was in the range of 16-20%, ICAN’s mission is to “improve maternal-child health by preventing unnecessary cesareans through education, providing support for cesarean recovery, and promoting Vaginal Birth After Cesarean (VBAC)”—all the more relevant now that the National Center for Health Statistics reports an all-time high cesarean rate of 32%. This grassroots organization, along with many others, has given a voice to the growing number of women who have experienced their cesarean surgery as frightening or even traumatic because it was complicated, unexpected, or unwanted. In the same way that many women have experienced stigma that prevents them from talking about their experiences with abortion, women who have suffered traumatic births may sometimes feel silenced, feeling as though the trauma they experience—which may even rise to the level of Post-Traumatic Stress Disorder —means that they are ungrateful for their babies.

To be sure, cesarean surgeries have saved many lives of both women and babies. I, for one, am grateful to live in a country where most of us have access to lifesaving obstetrical interventions. However, self-report by women who have given birth suggests that many women may not feel like their providers are fully engaging them in the decision-making process or respecting their wishes, and that some women are unaware of some of the major risks of cesarean surgery. Furthermore, evidence is beginning to reveal that heroic interventions, which were never intended to be used on a routine basis, have diminishing returns and may even pose unnecessary risk when overused. In fact, as Amnesty International recently reported , the rising cesarean rate has not improved outcomes for American women.  Women who deliver via cesarean surgery are exposed to surgical risks (embolism, unintentional laceration to surrounding organs, anesthesia complications) in addition to the usual risks of childbirth, and are more likely to experience morbidity, such as abnormal placentation, in future pregnancies. Perhaps most troubling among those risks is the risk of facing another cesarean section, whether or not she wants it and irrespective of the opinions of ACOG and the National Institutes of Health that VBAC is a safe option for most women. According to ICAN, 2009 VBAC Policy Survey, women are unable to access VBAC in over 40% of U.S. hospitals , with 824 having an official ban on women delivering vaginally and another 400 lacking any provider who will attend a VBAC.

The ugly history of gender subordination has certainly reared its head in women’s health care, from the most recent use of women’s reproductive health as a bargaining chip in the realth care reform, back through coercive sterilization of women of color and poor or mentally ill women and mistreatment during obstetrical/gynecological care, documented in the 1958 Ladies’ Home Journal article titled “Cruelty in the Maternity Wards.” As Henci Goer points out, however, not much has changed in the maternity wards since 1958.

From a feminist perspective, maternity care matters. Whether or not one ever plans to bear children or co-parent with a partner who will, careful attention to how women are treated when they interact with medical institutions illuminates their position in society at large. In this context, the fact that childbirth now carries with it a nearly 1-in-3 chance of major abdominal surgery is troubling indeed.