Before the 14th century, Caesarean birth was almost exclusively about saving and baptising the surviving foetus of a dead woman. Surgical extraction seemed a better way to give access to air than one previous option, which involved “holding a woman open” at the mouth and genitals. A similar surgery was suggested to remove a dead baby from a living mother, replacing the previously recommended methods of induced sneezing and violent shaking.
Initially, the idea of the procedure as one involving a living mother and living foetus was controversial. Passionate advocates railed on either side. A proponent, François Rousset, opened his 1581 treatise promoting the procedure with a sonnet comparing a surgeon’s work in childbirth to Alexander’s work on the Gordian knot. He dedicated his text — written in French rather than Latin, for accessibility — to the many poor women who died in childbirth without surgical intervention. A critic, Jacques Marchant, questioned the audacity of a surgeon trying to surgically remove something for which nature has suggested a natural way of exit.
This is Caesarean Awareness month. As a woman who recently birthed by Caesarean, my media feeds are brimming with posts defending the procedure. Often, authors explain the demands of surgical birth and share unpleasant commentary they’ve endured. Repeatedly, they write that a Caesarean is “not the easy way out”. I agree and disagree. I agree: Caesareans are not a way out at all. Reproducing, by whatever means, seems a clear instance of metaphysically opting in. I also agree that it’s not especially easy. Caesareans come with the kind of recovery you might expect from any big abdominal surgery (often worse, since many are emergency procedures). The spectrum is broad, as it is in with vaginal deliveries, which admit an enormous amount of variation concerning delivery experience and recovery.
[ Various factors behind sharp rise in Caesarean sections at Rotunda HospitalOpens in new window ]
Now to disagreement — my Caesarean was much less fraught and arduous than my previous (non-Caesarean) birth, and the aftermath was indeed easier. The surgical recovery was no cakewalk — at one point, I was sure my appendix was bursting from the pain of my uterus contracting. And yet, that was one blip in a predictable recovery. For me, at least, this was definitely the easy way. And it put me to thinking: if, for others, a Caesarean is also easier, then what is so bad about that? Why is that shameful? Are we really so adamant to worship at the altar of reproductive discomfort?
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The “too posh to push” narrative has mercifully dissipated somewhat. The posh part refers to the near impossibility of getting an elective Caesarean in the public system. I “earned” my public Caesarean with a disastrous first delivery and scans showing another classically giant-skulled Irish baby. “Too privileged to prolapse” might have been a better slogan anyway, since nobody’s worried about the pushing — they’re worried about pain, unpredictability and genital damage. Imagine that.
[ ‘Too posh to push’ or ‘too poor to choose’Opens in new window ]
We live under a pathological conceptual entanglement of the ideas of motherhood and sacrifice. To mother well is to mother despite oneself. This became particularly clear to me recently when a friend had the misfortune of receiving her epidural too late. She remarked on her bemusement that, upon telling people, she was more frequently congratulated than commiserated. Kudos on the involuntary analgesia-free birth.
Hypothetically, if science finds risk-free/low-risk ways to make childbirth and mothering much easier, will we allow ourselves to enjoy that? We’ve found our way to cheerleading science that helps people conceive that would otherwise never have managed it, even if parents by surrogacy have so far been shamefully left out in the cold by Government policy, the suspicion of science in fertility is at least less maligned than it once was.
Given the gender dynamics, it’s perhaps unsurprising that the history of western philosophy has little to say about the concept of a “good birth”. There’s plenty on “good deaths”, but for most of history, birthing has been women’s business, and for most of philosophy, there have been few women foregrounded. It seems a cruel irony that perhaps the greatest woman philosopher of the early modern period, Émilie du Châtelet, died of complications following childbirth.
[ Number of Irish Caesarean births up 50% since 2000Opens in new window ]
Probably, a good birth is one that at the very least is safe and nontraumatic, in line with one’s values and wishes and has good biomedical outcomes for infant or infants. It’s obvious to me that honouring this admits a whole range of styles of obstetrical approach, and a precondition would seem to be that maternity services need to be better funded so that resources are less of an issue in trying to provide families with the kinds of births they want, which should include robust support for everything from totally unmedicated homebirths right up to elective Caesareans.
We should stop feeling a need to defend Caesarean births or acting like some vital part of motherhood is missed when the birth canal is bypassed. These births can be as spiritually meaningful as any homebirth. My last one was a profound experience and in many ways healed me from damage that I didn’t realise my last difficult birth had done. It took place in a surgical theatre in the National Maternity Hospital with kind, excited people who would probably go on to perform the same routine miracle for a further 10 people that day. The result was a big, ruddy, noisy baby placed on my chest and a very welcome sense that I had known a bit more agency in deciding how it came out.
- Dr Clare Moriarty is an Irish Research Council postdoctoral fellow at Trinity College Dublin
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