10.17.09

The C-Section Backlash

As the rate of Caesareans skyrockets, women are fighting back with angry blogs and public protests. Some are even calling it rape.

Last month, after weeks of fighting with her local hospital, a seven-months-pregnant Arizona mom made the personal public when she created a sort of mobile picket sign—declaring on the back windshield of her purple minivan that being forced to have a Caesarean section is akin to sexual assault.

In bright-yellow paint, Joy Szabo wrote: “ Page Hospital, enter my body without permission... Sounds like rape to me.” She began driving that minivan around her small, rural town as often as possible—attracting the attention of her local paper, and this week, the country.

For Szabo, 32, already a mother to three young boys, scrawling the message marked a breaking point.

To make a long, complicated story short: In June, Szabo’s hospital adopted a policy prohibiting women who had prior C-sections from delivering vaginally—from having what’s technically known as a VBAC, for “vaginal birth after Caesarean.” While two of Szabo’s kids were born vaginally, her second child was delivered via emergency C-section.

At one time, vaginal delivery was deemed too risky for women who’d had C-sections. Today, the American College of Obstetricians and Gynecologists officially supports VBACs, but stipulates that an OB and an anesthesiologist must be in the hospital during the entire procedure. As a result, many financially strapped or small hospitals—like Szabo’s—can’t offer VBACs. And that has many moms and natural-birth advocates up in arms.

Szabo says that in meeting after meeting with the hospital—the only one within five hours of her home—she pleaded not to be put at risk for complications of a medically unnecessary surgery. She says the hospital’s CEO told her that if she were to arrive during labor and refuse a C-section, the hospital would seek a court order to overrule her. A spokesperson for the hospital declined to comment.

“I was very, very angry—and very, very scared,” Szabo says. She began having nightmares that she was on the surgical table being cut open against her will. That’s when she picked up some lemon-hued acrylic paint and graffiti-ed her van. “I’m not a big whiner, but I really, really wanted everyone to know that I was in emotional turmoil.”

To most people, the notion of a C-section being like a rape is shocking. But lately a growing subculture of women has expressed similar views, opting for blogs and message boards, therapy and support groups. On BirthTruth.org, the author posts raw essays about the emotional trauma following her C-section, with titles like “You Should Be Grateful” and “8 Years Later.” The tagline for BirthCut.com—which features graphic poetry and blog entries—is the African proverb, “The ax forgets, the tree remembers.” The anonymous creator of the haunting Web site Cesarean-Art.com displays images of women gushing blood from their lower abdomens. When Szabo’s story hit the Internet, women like these championed her as a hero.

For many women, having a C-section “feels out of their control—like there’s nothing they can do, and it doesn’t matter if they say no,” says Desirre Andrews, president of the International Caesarean Awareness Network, known as ICAN, an advocacy group that helps moms have VBACs. Over the past six years, the number of ICAN support groups has ballooned from fewer than 30 to 112 chapters, in 43 states. “I think that’s why, to them, it feels like an extreme physical assault.”

One reason this subculture is growing is because, over the past decade, the percent of all women given C-sections has skyrocketed. The procedure is now the most common surgery performed in the U.S.—more common than getting your tonsils or appendix removed. And for the past 11 years in a row, the rate has gone up: About one in three American women give birth via C-section today, up from one in five a decade ago. Yet the World Health Organization says that the country’s rate shouldn’t be above 15 percent, which suggests that more than half of U.S. C-sections are medically unnecessary.

Many women who equate having a C-section with a type of rape describe feeling a profound lack of support or even antagonism from hospital staff during the surgery, and a lack of control over their own bodies. That was the case for the creator of BirthCut.com, Michele Demont, 28, of Greenwich, Connecticut, who underwent a C-section for the birth of her first child almost three years ago. She had hoped to deliver vaginally, but after laboring for hours, her doctor explained the need for surgery. Lying on the surgical table, she felt herself spiraling into a panic. As the procedure got under way, the hospital staff did a poor job communicating with her, she says—instead, they were gossiping about a colleague. She describes feeling like a piece of meat being sliced open. “I felt like I was going to die,” she says.

After Demont returned home with her husband and baby son, she sank into a deep depression. Whenever she passed by her hospital, her heart raced. When she saw pregnant women, she felt shaky. Eventually, she created her Web site, on which she documents her ordeal through poetry, artwork, and blog entries. One poem, titled “Birthrape,” begins: “On the bed/you are tied down/your legs apart/as a hand is thrusted (sic) inside/then another....” Others include “When I Was Torn” and “Broken Machine.” The process was therapeutic. But it wasn’t until the birth of her daughter last April—in the living room of her apartment, with the help of a midwife—that she felt fully recovered.

“Healthy babies matter, of course, but mothers matter, too,” Demont says. “We’re not just vessels for babies to be born.”

For most women who have C-sections, even if the experience isn’t wholly positive, the joy of embracing their baby trumps feelings of disappointment with the birth experience. Yet for this reason, women who feel violated by the notion or experience of a C-section often feel misunderstood—family and friends can’t grasp why they can’t just get over it and move on. So they seek out other moms who feel as they do, and who sometimes can provide practical support. In Szabo’s case, after her C-section with her second child, she reached out to the members of ICAN to help her plan for her next birth. And since news of her situation has gotten out, a representative from the group has been advocating for her in Arizona, helping her find a provider, negotiating with Medicaid on her behalf, and working to publicize her case.

Just six weeks away from giving birth, Szabo is now interviewing doctors in Phoenix, a five-hour drive from home. It’s her only option, she says, aside from having an unassisted home birth, which she isn’t willing to risk. She isn’t thrilled about the distance, but she now feels in control of her own body. “It all just comes down to choice,” Szabo says. And she’s confident that a birth on her terms will provide her child a happier entrance into the world.

She’s also scheming up a new message to paint on her windshield, she told us: Permission to use your vagina: DENIED.

Danielle Friedman has worked as a nonfiction book editor for Hudson Street Press and Plume, two imprints of Penguin Group. Her writing has been published in the Miami Herald, the Seattle Post-Intelligencer and on CNN.com. She is a graduate of the Columbia University Graduate School of Journalism.