“Prior to the 14th century, Caesarean operations were nearly exclusively used to preserve and baptise the surviving fetus of a departed woman. The surgical approach was considered better for facilitating the baby’s access to air, being a superior alternative to earlier methods that involved ‘keeping a woman open’ from mouth to genitals. A similar surgical strategy was proposed for extracting a deceased fetus from a living woman, replacing former recommendations of inducing sneezes or vigorous shaking.
The concept of a Caesarean where both mother and fetus survived caused much debate at first, with advocates ardently expressing their views on each side. One supporter, François Rousset, began his 1581 manuscript endorsing the surgery with a poem that likened a surgeon’s role in childbirth to Alexander’s fabled work of untying the Gordian knot. He dedicated his writing, purposefully drafted in French instead of Latin to increase accessibility, to the countless poor women who passed away during childbirth due to absence of surgical intervention. Conversely, a critic named Jacques Marchant challenged the effrontery of a surgeon attempting to extract surgically something nature intended to be expelled naturally.
In recognition of Caesarean Awareness Month, as a recent recipient of a Caesarean delivery, my media streams are overflowing with posts validating the operation. Frequently, writers recount the hardships of surgical birth along with the derogatory remarks they’ve had to face. Commonly, they assert that a Caesarean is ‘not the simple escape route’. I resonate with this viewpoint yet also contest it. I concur that Caesareans aren’t an escape route at all. Procreation, by any means, feels like a fundamental acceptance of responsibility. I also agree that it’s seldom easy. Caesarean recoveries mirror recoveries from any significant abdominal surgeries (and are often worse since many are emergency interventions). The range of experiences is vast, akin to vaginal deliveries, each with considerable variance in delivery and recovery experiences.”
Considering a contrasting perspective, my experience with a Caesarean section was nowhere near as challenging or distressing as my first birth, which happened naturally. My recovery following the operation was also less complicated than expected, despite the temporary moment of severe pain I experienced, which I feared was my appendix bursting. Nonetheless, my recovery held no significant surprises. For me, this mode of delivery was an easier option. This made me ponder, if for many others, a caesarian section is also less strenuous, then why is it considered regrettable? Why are we so resolute to revere the difficulties of reproduction?
Fortunately, the notion of being ‘too aristocratic to bear the strain of labour’ has thankfully dwindled somewhat over time. The reference to ‘aristocracy’ is connected to the extreme difficulty of securing an elective Caesarean section within the public health care system. My own public Caesarean came as a result of a difficult first birth and subsequent ultrasounds revealing a typically large-headed Irish infant. A more fitting phrase might have been ‘too privileged to risk genital trauma’, as concern is not placed on the effort of pushing, but rather the potential pain, unpredictability, and physical harm. One need only imagine the significance of this.
Currently, our society is ensnared in an unhealthy association of motherhood and personal sacrifice. To be a good mother is to prioritise your child above yourself. This was made painfully apparent when I heard about a friend who unfortunately received her epidural too late. Her observation that people often praised her rather than expressed sympathy for her anaesthetic-free delivery was both baffling and telling.
If theoretically, scientific advances lead to the possibility of making the processes of childbirth and motherhood significantly less strenuous with limited or no associated risks, would we permit ourselves to experience greater ease and enjoyment? It seems we are more accepting of science that aids conception for couples who would otherwise face difficulties. However, whilst parents who have had a child through surrogacy have been overlooked by Government policy, our suspicion of science aiding fertility is slightly less severe than in the past.
The history of Western philosophy, predominantly male dominated, tends to overlook the concept of a “good birth”, instead skirting it with discussions on “good deaths”. With birthing primarily being the realm of women, it is bitterly ironic that Émilie du Châtelet, one of the early modern period’s most venerated female philosophers, succumbed to complications from childbirth.
The significant increase by 50% in Irish Caesarean births since 2000 may shed some light onto the need for reevaluating our notions of a “good birth”. Ideally, a “good birth” should comply with personal values and preferences, ensure the safety and welfare of both mum and baby, and be a non-traumatic experience. That suggests a broad spectrum of birthing methods, ranging from wholly natural home births to optional Caesareans.
For quality care and options that align with family preferences, it is evident that there’s a need for proper funding of maternity services. There’s no valid reason to keep defending Caesarian births. It is erroneous to assume that an essential aspect of motherhood is relinquished when the birth canal is not engaged during birth. A Caesarean birth can offer as much spiritual fulfilment as a home birth, and its routine nature does not diminish its miraculous essence.
My most recent Caesarean birth, in the National Maternity Hospital, was an illuminating experience that helped me reconcile with trauma from a previous difficult birth. The birth went off flawlessly in a bustling surgical theatre under the watchful eyes of empathetic, thrilled professionals, and resulted in a chubby, boisterous baby. What was the most rewarding was the sense of control I felt in being a participant in the decision-making process of the birth.
– Dr Clare Moriarty is an Irish Research Council postdoctoral fellow at Trinity College Dublin.