Cesarean Awareness Month

It's funny they would have a month for a surgical operation. I have the same feeling about Black History Month. Like, if it's important, shouldn't we learn about black history every day we learn about history? Like, shouldn't the history books be rewritten? They're certainly biased....

I digress. Let's deconstruct history another way:

Pithiviers, France, is remembered by some French Jews as the place where their relatives or friends of the family were sent after the Nazis occupied France. There was an internment camp there where families were separated and the adults were sent to Auschwitz to be killed.

We also remember Pithiviers as the place where Michel Odent was head of the maternity ward from 1962 to 1985. Here, he fashioned his notions of natural birth, by creating an environment where women could give birth in an undisturbed way. He provided singing sessions during the prenatal period, birthing pools, and skin-to-skin contact after birth.

Years ago, I was part of a group of birth workers who brought Dr Odent to Montreal to speak. I remember being so shocked when he suggested that there was a causal relationship between the murder and violent crimes rates in some cities in the world, and the cesarean rates. Effectively, he was suggesting that if you have your baby by cesarean, then they are more likely to become a violent criminal. I immediately took a dislike to him and his silly ideas, and, more importantly, I asked myself why there was a whole room of healthy, young women absolutely worshipping his words? There he was, a shrunken old white guy, talking about how babies needed to go through the vagina and arrogantly proclaiming that women who have cesareans are going down the path to hell, and dragging their newborns along with them.

Fast forward a few years and I was up on the stage. We were doing a little panel about VBACs. A woman stood up from the audience and said that she was newly pregnant with her second, hoping for a vaginal birth after a brutal c-section with her first. She wanted advice from a midwife on the panel. This is what she got: "If you want to give birth vaginally, you have to put your big girl panties on and fight for what you want."

And I remember teaching a class to a group of doula students, and the woman teaching with me said that, generally, women who have repeat cesareans have a lot of unprocessed resentment to deal with, and if they dealt with it their chances of VBAC increases. 

So, in a nutshell, three birth professionals said: women who birth their babies by c-section are driving up the crime rates because their children are more likely to be criminals (also, in an article he wrote in 2008, Odent suggested that cesarean birth may produce more male homosexuals); that women who want a vaginal birth after a previous c-section should somehow grow up so that they can achieve this; and that women who have c-sections may be dealing with repressed feelings, and that repression or other negative feelings such as resentment could be the reason for the surgeries.

If we look at these criticisms from a feminist perspective, they seem very similar to the rape dilemma - don't wear provocative clothing, don't go out at night alone, don't drink, or you will become a victim.

There's a feeling amongst the "natural" birth movement that a woman can have a "natural" birth if she wants it hard enough. We can read of powerful, transcendent, wild, free births where a woman moves through portals to meet her child. These are lovely, indeed, but not everyone can have or would want to have that experience.

In my opinion, giving birth is a very private act. It is so varied, the ways in which we birth, almost as varied as, for example, the shapes of our noses, or the leafiness of our labia. Some women want to birth alone, or just with their partner present. Others want their children there too. Some want a doula or two, and a midwife. Other women prefer a physician, and they want to be in a hospital. Some want to have a midwife follow them, and they want a water birth in the birthing centre.

All of these possibilities should be respected as valid, informed choices. So why are they not? Because, often, if a woman chooses to be followed by a medically trained midwife or a doctor, she ends up giving up her right to informed choice and she gets put on a conveyor belt where she is no longer the central person in this sacred, primal event, and she gets things done to her. The birth process gets put on a schedule; the body is examined time and time again; this or that intervention is done until finally all the options have been exhausted and she is wheeled into the operating room.

Yes, having a doula present will decrease your chances of c-section by a decent percentage, especially if you are a mid- to high-income woman living in an affluent country (https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003766.pub6/full) 

Women choose to go the hospital to have their babies for many different reasons, and none of these reasons are an excuse for an unwanted and unnecessary c-section. What could these reasons be? 

• they want the security of being in a hospital
• they wanted to have a midwife follow them but couldn't find one
• they don't have health insurance and/or can't afford a midwife
• they don't have a home that is suitable for a home birth (think abuse, living with a lot of other people who aren't supportive, and those kinds of things)
• they don't know their options
• they are forced to because no one will attend them at home because they're carrying twins, or have had several c-sections, or they're obese, or are substance abusers
• they are followed by a midwife but get transferred to the hospital because of government regulations (labour too long, pregnancy too long, suspected this or that)
• covid-related issues reduce their choices

Any number of these women could end up being part of the 25-30% of women who give birth in the hospital who end up with a c-section. The WHO suggests that 15% is a reasonable rate. I insist that here in our affluent country, a c-section rate of 5% would adequately save the lives that have to be saved by obstetric surgery.

How can you avoid an unwanted c-section? Ask questions. Hire a doula, or find one for free. Contact me and I will do my very best to connect you to the people you need. Find a midwife. Get a doctor who hears what you're saying. Say no. Don't do anything that seems wrong. 

Let's work together to put the Cesarean section back where it belongs - in the realm of emergency surgery!

Women's Bodies and Other People's Values

In Quebec, we are experiencing an interest phenomenon. A provincial politician is trying to be Le Pen. She is stirring up xenophobic and racist emotions rather effectively with some doublespeak that pretends to be about secularism and feminism. The target? Religious Muslim women. The fallout? Pretty well everyone who is not .. erm .. well, let's just say that anyone who looks a little different has experienced annoyance if not rage at this political acrobatics.

I am used to people using women's bodies as a battleground. From my days as a sexual abuse counsellor - and a direct action activist - to my days working in hospitals with birthing women, I have been witness to the phenomenon of the woman's body being argued over, manipulated, commodified, objectified, ground up and spat out.

And it has grown up, this violence against women. Back in the seventies, as a rape crisis worker, it was pretty clear what was happening. If you were a woman, and you were alone at night, or walking home from work, you were a target and you could be raped. If you were a prostitute or an indigenous woman, you could be raped AND killed. Simple. Violence against women.

But today, the violence is coated in pretty words. What do you call it when someone puts his hand into a woman's vagina without asking her or looking her in the eye? Its called rape. Birth rape. Doctors who manhandle and abuse women when they are giving birth say that they are saving lives. They are not. They are exercising their power.

Politicians who make silly rules about what women can or cannot wear may say that they are doing it "for the women" (yes, in South Africa they say that rape is "for the women" too, when they are raping a lesbian to convince her to change her preferences). They say they are doing it for the Muslim women's enlightenment and freedom. 

They're not. They are also exercising their power.

I suggest we ban the type of clothing that overweight, middle-aged Quebecoise women wear, when they should know better. Oh, the tight T-shirt over a middle-aged belly! Oh, the tight jeans over hips that should be covered! Oh, the dyed blond badly-styled hair! The polyester double-knit suits! The shoes that Cinderella's sister wore!

But it's different, you argue. Those badly-styled garments do not speak of a deeper moral code - a code that oppresses women (we are speaking of Islam here). They are just off-the-rack, cheap garments, bought without a shred of moral judgement or thought. Yes, you're right. It heralds the victory of the mediocre fat lady; the no-brainers; the thoughtless violence; the amoral assholes who parade as sensitive do-gooders.

I went to a birth once with a lovely student of mine who wore a see-through spaghetti strap tank top and a fake leopard-skin miniskirt. It was a Montreal summer - hot and humid. In the greyish hallways of the hospital she looked like an angel from heaven - hot, sexy, and happy. The birth was a lot of fun: the birthing mother didn't take any shit from anyone and she gave birth on her hands and knees, even if the physician couldn't handle seeing her vulva "upside down". After the birth we ordered sushi.

Another of my fondest memories was a birthing woman who was dressed completely top to bottom: hat, wig, robe, undershirt, bra, panties, stockings and socks. She removed the panties and stockings to give birth but everything else remained. Her husband, who was not allowed to look at her, sang throughout her labor, and told jokes. She laughed that baby out. The room was full of love.

I have seen women's legs held down, women's bellies jumped on, women yelled at and berated. I have listened to doctors, nurses, and midwives tell women what to do; what to say; what to feel; how to move.

When will we rise up against this banal mediocracy?