Sherry Chandler

Fashions in Childbirth

On May 10, 1794, at the height of the Reign of Terror, Mary Wollstonecraft, author of A Vindication of the Rights of Woman (1792), gave birth to her first child, her daughter Fanny Imlay, at LeHavre in France. She eschewed the medical doctors of the day with their forceps deliveries and lying-in hospitals where mortality rates were sometimes as high as 80%. She had a well-trained French midwife, and she was on her feet the following day. She had just turned 35. On May 20th, she wrote to her friend Ruth Barlow:

Here I am, my Dear Friend, and so well that were it not for the inundation of milk, which for the moment incommodes me, I could forget the pain I endured six days ago. —Yet nothing could be more natural or easy than my labor—still it is not smooth work—I dwell on these circumstances not only as I know it will give you pleasure; but to prove that the struggle of nature is rendered much more cruel by the ignorance and affectation of women.

— as quoted in Lyndall Gordon. Vindication. A Life of Mary Wollstonecraft (HarperCollins 2005)

I am often blindsided by the pendulum swings of American society. When I was a young woman, things were loosening up for women: divorce was easier, birth control was easier, even the dreaded pantyhose were a vast improvement over girdles and garter belts. Tampons were a major breakthrough. And women were throwing off the shackles of OB/GYNs with their twilight sleep and forceps and taking control again of their childbirth experience. Lamaze classes were all the thing and so was the LeBoyer birth method. The high rate of Caesarean sections was considered a disgrace and women were discovering that they could have natural childbirth after C-section. They were fighting for that privilege. So, I thought, that’s settled now and I went on about my life.

Imagine my shock then over the last few days to read that women are now opting for elective C-section. According the the AP, in 2004, 29.1% of 4 million births in the United States were done by Caesarean, a 40 percent rise since 1996. It is estimated that tens of thousands of those were elective.

So what’s the lure if it’s not medically necessary?

Convenience plays a role for busy women. Mothers might need to schedule delivery so relatives can visit to take care of older children, or they live far from a hospital and worry about arriving in time. Or they fear something will go wrong and they’ll wind up with an emergency Caesarean, considered far riskier than a planned one, especially if performed by a tired doctor.

Others worry that vaginal deliveries can cause incontinence, although some studies dispute that.

I don’t even know how to begin to rant about this.

I’m not one to say nature’s way is best. I don’t intend to go blind with my cataracts because nature didn’t provide plastic replacement lenses. Nor would I want those of my friends who struggle with clinical depression or bipolar disorder to go without medication. And nobody should give up their birth control.

C-sections have saved the lives of countless mothers and babies.

Nor am I arguing that every woman should opt for a midwife and home birth.

But I’m not sure why anybody would opt for a major abdominal surgery, especially in an era rife with hospital-borne, antibiotic-resistant bacterial infections. According to the March of Dimes:

Cesarean birth carries greater risk for both the mother and the baby than a vaginal delivery. Some of the increased risks for the mother include possible infection of the uterus and nearby pelvic organs; increased bleeding; blood clots in the legs, pelvic organs and sometimes the lungs; and, in very rare situations, death. For babies, there is the risk of being born prematurely if the due date is not accurately calculated. This can mean difficulty breathing (respiratory distress) and low birthweight. The baby also may be sluggish as a result of the anesthesia. A cesarean birth also is more painful, is more expensive, and takes longer to recover from than a vaginal birth.

I’m a little frightened of the kind of woman who would choose major surgery over vaginal delivery as a convenience but I guess I shouldn’t be surprised. I should get used to the fact that I live in an age when women consider surgery just another form of cosmetics. Some people I’ve heard can get addicted to surgery. We really do hate our bodies. The problem is that after C-section, recovery time for the mother is so much longer and more painful. So whose convenience are we considering here? What quality of life has been gained? And why add a surgery scar to the stretch marks?

It is a form of self-determination, I suppose, but if you’re thinking of having a Caesarean as a way to stay in control, well, I guess you’d just as well go ahead and do that. Because it’s probably the last time you’ll be able have that much control while raising children or even while parenting grown children. Some things in life just can’t be managed with a PDA. A little go-with-the-flow is essential.

So what about that fear of incontinence, the dreaded Depends. I think I understand that the best prevention for incontinence is a well-toned pelvic girdle – Kegel exercises! crunches! – so why would anybody want to have a muscle-weakening major incision in the abdominal wall? Many fixes for incontinence, especially that caused by prolapse, can be done endoscopically or even endovaginally, as an outpatient procedure, so why trade a major incision for a minor one? The American College of Obstetrics and Gynecology estimates that 30-50% of adult women suffer from urinary incontinence. However, they also say that family history is a better predictor of incontinence than vaginal birth. No one can predict which women will have problems and which won’t, and it’s just not that much a bugbear. It’s a highly treatable condition.

In September of 1797, back in England and married to William Godwin, Mary Wollstonecraft died of sepsis after giving birth to a daughter. This daughter was also called Mary Wollstonecraft but is better known to us as Mary Shelley, wife of the poet and author of the world’s most famous monster story, Frankenstein. A major theme of Frankenstein is the horror of scientific detachment from the birth process.

Wollstonecraft also chose to have this second baby at home attended by a midwife, even though the English midwives were not as well trained as the French. She still did not trust hospitals or doctors who considered women’s bodies ill designed for the task. Unfortunately, the placenta did not deliver. But this failure did not kill her. The cause of death was infection introduced by the doctor who was called in and who spent four hours tearing the placenta out of Wollstonecraft’s body without disinfectant or anesthetic.

Of course no modern doctor would do such a barbaric thing. So why bring Mary Wollstonecraft into this? Because studying her life has made me remember that the medical profession is not always friendly to women and led me to realize that we just keep having to fight these battles over again as the next wave of medical fashion hits.

1. Vindication Revisited
2. Vindication: A Life of Mary Wollstonecraft
3. Carnival of Feminists
4. Who will someday write novels
5. The Emigrants

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