A Personal History of the C-Section

It would be a lie — or at least an incomplete truth — to deny that some part of me yearned for natural childbirth as a threshold of redemption. I had never fully treated my body as an ally. I had starved myself to whittle it down and spent years drinking myself to blackout and various other perils. Pregnancy already felt like a more redemptive chapter in this fraught relationship between body and spirit: I was taking care of another tiny body inside my own! Everything my body ate was feeding hers. All the blood pumping through my heart was flowing through hers. Giving birth to her would not only be the culmination of her nine-month incubation but would also be a refutation of all the ways I abused or punished my body over the years, all the ways I treated it as an encumbrance rather than a collaborator. My mind resisted this logic, but I could feel — on a visceral, cellular, hormonal level — its gravitational pull.

“Silent Knife: Cesarean Prevention & Vaginal Birth After Cesarean,” an influential anti-cesarean manifesto published by the writers Nancy Wainer Cohen and Lois Estner in 1983, insists that what it calls a “purebirth” is “not a cry or demand for perfection,” though the definition ends up sounding a little … demanding: “Birth that is completely free of medical intervention. It is self-determined, self-assured and self-sufficient.” The unstated tension of the entire book is also the unstated tension embedded in the broader backlash against C-sections: between recognizing the trauma of a C-section and reinforcing or creating that trauma by framing the C-section as a compromised or lesser birth. A section called “Voices of the Victims” quotes women traumatized by their C-sections: “It felt as if I was being raped,” one woman says. “I couldn’t do anything but wait until it was over.” A father says: “A c-sec is one of the worst mutilations that can be perpetrated on a woman as well as a denial of a fundamental right of a woman to experience childbirth.”

Inspired by Ina May Gaskin’s famous pronouncement that “you can fix the body by working on the mind,” Cohen and Estner argue that our wombs are cluttered with “unaddressed stresses or fears” that obstruct the birth process, but that they can be swept aside through self-awareness to “clear a passageway for normal birth.” The implication is that, conversely, emotional baggage could be “blamed” for a cesarean. Reading the book 38 years after it was written, I immediately dismissed this notion. But another part of me — the part that had been conditioned for my entire life to feel accountable to impossible ideals of motherhood — wasn’t immune to this magical thinking. In secret, I had indulged my own pet theories about the possible psychological causes of my C-section: my eating disorder, my abortion, my maternal ambivalence. Had I mistreated my body so much that it refused to give birth naturally as an act of retaliation? Had I been more attached to the idea of being a mother than I was prepared for the actuality of being a mother? Was my labor stalling out — as my baby’s heart rate dropped — a sign of this subconscious unwillingness?

If “Silent Knife” was written to restore agency to women by pushing back against the tyrannical paternalism of C-sections, then there’s a different tyranny embedded in its ostensible restoration of agency, a tyranny that abides today: a script of self-possession that can become another straitjacket, another iteration of the claustrophobic maternal ideals. Expressing compassion for a woman who feels like an inadequate mother because she hasn’t given birth “naturally” can easily slide into implying that she should feel that way. Many of the ideas that “Silent Knife” made explicit years ago are still deep forces shaping childbirth today, even if people might be less likely to confess to them: the notion that birth by C-section is less “real,” that it might imply some lack of willpower or failure of spirit.

Motherhood is instinctual, but it’s also inherited: a set of circulating ideals we encounter and absorb. The fact that we are constantly shaped by external models of an internal impulse makes women intensely vulnerable to narratives of “right” or “real” motherhood, and all the more susceptible to feeling scolded or excluded by them. A woman’s right to state her preferences during the birth process is increasingly prioritized, and rightly so, but it’s easy to fetishize these preferences as the ultimate proof of female empowerment, when they are, of course, shaped by societal forces too. It’s a kind of partial vision to hold up a woman’s desire for natural birth as a badge of unpolluted female agency, when that desire has been shaped by all the voices extolling natural birth as the consummation of a woman’s feminine identity.

As my daughter has grown from newborn to infant to toddler, I have been daydreaming about getting a tattoo on my abdominal scar. There are entire Pinterest boards full of C-section-scar tattoos and Instagram hashtags devoted to them (#csectionscarsarebeautiful): angel wings, diamonds, draping pearls, blazing guns. Ganesh, the remover of obstacles. A blue rose unfurling into cursive: “Imperfection is beautiful.” Bolder Gothic script: “MAN’S RUIN.” A “Star Wars” scene of two snub fighters approaching the Death Star. A zipper partly unzipped to show an eye lurking inside. A pair of scissors poised to cut along a dotted line, inked beside the scar itself. A trompe l’oeil of a paper clip piercing the skin, as if it were holding the abdomen together across the line of its rupture. My favorites are the ones in which the scar is intentionally incorporated into the design itself. A low transverse cut becomes the spine of a feather or a branch bursting with cherry blossoms. These tattoos don’t try to hide the scar from view but instead put it to work as part of a larger vision. I have started to imagine, on my skin, a row of songbirds on a wire.

The fantasy of this tattoo has been part of a deeper reckoning with the question of whether I want to narrate the birth — to myself, to others — as miraculous, traumatic or simply banal, a commonplace necessity. Around the time I started to consider a tattoo, I read a memoir by an Oregon writer named Roanna Rosewood called “Cut, Stapled and Mended: When One Woman Reclaimed Her Body and Gave Birth on Her Own Terms After Cesarean.” My inner Sontag (“Illness is no metaphor!”) bristled at the endorsement from a mother on the front flap: “I blamed my midwife for my failure to progress but secretly knew it was me; my lack of confidence led to my failure.” Though I resented what I interpreted as the book’s veneration of vaginal birth as the only “real” kind, I could recognize — if I was honest with myself — that my resistance also rose from the fear that I had missed out on an extraordinarily powerful experience. When I read Rosewood’s declaration that a “clean and passive birth resembles an empowered one in the same way that an annual exam resembles making love,” it made me feel deeply foolish — as if understanding my daughter’s birth as the most powerful experience of my life (which I did) was somehow akin to mistaking a Pap smear for an orgasm.