Thursday, May 13, 2010

The Age of the Unnecessarean


She can take it back
She will take it back
Some day
- Pink Floyd

One of the favourite stories in my family is how my great-grandmother went into labour in the night, and helped by her mother, gave birth to the baby in her own bed. After which she calmly walked out of the backdoor to a nearby stream to clean up, and then went back to bed with her baby. The household woke up the next morning to find a new family member in its midst!

Our grandmothers had midwives attend them in their own homes. Birth was considered inherently safe, as safe as life - no more, no less - and women's bodies were trusted to work just as they had been doing since the dawn of humankind. Midwives drew on a traditional lore of childbirth knowledge, and had they been around today, they might have saved us thousands of surgeries with their innate artistry and patience in handling birth.

Birth started going out of the woman's own domain at the time the generation our mothers belong to had babies. A doctor had become mandatory by then for pre-natal care, and hospitals owned birth. The doctor was accorded a demi-god status - women followed their doctor's orders to the letter and meekly surrendered the birth completely into their hands. What kind of birth experience a woman would have was just a matter of the luck of the draw. If she was fortunate enough to have a doctor who was patient and calm and not so intervention-happy, she might scrape by with a "normal" birth, though attendant with indignities that are inevitable in a hospital setting. If the doc happened to be someone who viewed birth as a medical event to be "managed" and she was unlucky enough for her labour to not follow a textbook pattern, she would likely wind up with a cesarean birth. Still, the majority of women still managed to have a normal birth.

Fast-forward to now - the age of technology and super specialisation - and the cesarean bandwagon has turned into a massive jumbo jet, the quickest and most "convenient" way of arriving at the destination, the unquestioned monarch of the birth scene. In urban India, one in two women will have had their baby by c-section, and in some private hospitals the c-section rate is at a whopping 80%, even though the World Health Organization (WHO) states that no region in the world is justified in having a cesarean rate greater than 5% to 15%.

The word "cesarean" has been bandied about for so long that it has become a neat little label in people's minds as an acceptable way to bring children into the world. Just watch any youtube video of a cesarean and you can graphically see for yourself what a horrifically brutal procedure it is. What a crying shame when it happens unnecessarily, as it does in the vast majority of present day cases!

Dr. Dermot W. McDonald of the National Maternity Hospital in Dublin, Ireland, said it best:
"If one went to the extreme of giving the patient the full details of mortality and morbidity related to cesarean section, most of them would get up and go out and have their baby under a tree."

A woman who has managed to have a normal birth in this scenario is something of an anomaly. People exclaim with wonder when they hear of someone having a vaginal birth as opposed to the standard cesarean. I say vaginal birth and not normal birth, because even those births would have been subject to induction or augmentation or some form of intervention or another, making it a torturous medical ordeal that mother and baby are happy to get on the other side of - making modern hospital birth literally the rape of the twentieth century.

A truly natural undisturbed birth that is allowed to unfold at its own rhythm is not just a rarity these days, it is unheard of. This article by Dr Sarah J. Buckley, in which she eloquently outlines how giving birth in ecstasy is our birthright and our body’s intent, and indeed all her other articles too, should be required reading for every woman (or man, for that matter):
Ecstatic Birth - Nature’s Hormonal Blueprint For Labor

Given the cesarean epidemic that is engulfing our birthing scene, one can't help but wonder what its long-term effects will be on a species that is designed by nature to enter the world "in an ecstatic cocktail of hormones" but is instead entering it in pain, fear and separation. What a heart-breaking gulf between the baby born naturally and immediately put skin-to-skin with its mother, and the baby pulled out through a surgical wound in the mother's abdomen, else evicted forcefully from the womb with violent artificially induced contractions, and then bundled off to be poked, prodded and examined by yet another medical team.

In spite of my relatively enlightened perspectives about birth and all the research I'd done, I ended up letting the OB force a c-section on me with my first child because she panicked when she found the baby had the cord around his neck. Much later, I found out that 1 in 3 babies have the cord around their necks and it is definitely not a cause for surgical birth.

It is easy to make the OBs look like the bad guys in these situations, but the truth is it takes two hands to clap. I don't doubt my OB's sincerity or her motives - she honestly believed she was doing her best for me and would have probably done the same for her own daughter. Most doctors are so entrenched within the patriarchal system of birth management that they might as well have blinders on. The rigid parameters of the textbook medical paradigm they are trained in don't allow any room for variations of normal nor a healthy trust in a woman's body. A woman's body is treated like a ticking time bomb that could go off any second, and consequently it is fear that drives many of their decisions.

Eckhart Tolle observes with his usual penetrating insight, "The psychological condition of fear is divorced from any concrete and true immediate danger. This kind of psychological fear is always of something that might happen, not of something that is happening now." Swami Vivekananda goes even further - "The whole secret of existence is to have no fear. Never fear what will become of you, depend on no one. Only the moment you reject all help are you free."

One lesson that clearly came home to me from my experience was that any decision made from fear will entail suffering and pain as consequences. When you let fear gain a foothold, you lose touch with your inner intuitive wisdom. Then you allow a default decision to be made for you, invariably giving your power away. When you give your power away, you are not response-able anymore, and are at the mercy of the people who will take over that situation to serve their ends. There is no situation more vulnerable to this stripping away of power and the blunting of authentic choice, as childbirth. As women, the more of us that awaken to this realization, educate ourselves, and take back the power and responsibility to birth according to our own deep inner knowing, the better. It is our God-given right to be the keepers of the sacred dimension of childbirth.

It is encouraging to see women building awareness at grassroots level by banding together to support each other in making informed birth choices and trusting their own body wisdom by locally forming groups such as the Bangalore Birth Network and Birth India. May their tribe increase!


  1. Great title, and one of your best posts!

  2. What a beautiful entry. Thank you for sharing.

  3. I agree, great title, and great insights. As I read the post, I was wondering where you were going with this, and had an aha-moment by the time I got to the end - "any decision made from fear will entail suffering and pain as consequences. When you let fear gain a foothold, you lose touch with your inner intuitive wisdom." Well said... awesome!
    -Sai Sravanthi