Let Them Eat Dirt. B. Brett Finlay
she thought, “I won’t be able to deal with the pain.” Elsa’s husband, Paul, had previously volunteered to monitor her contractions. He had an app in his phone that would time contractions, and allow them to give each one an intensity score from one to five. As soon as Paul noticed the first contraction he reached for his phone and started to record its duration. Excited, he then asked Elsa: “How would you rate that contraction, babe?” With her gaze and voice lost, Elsa slowly opened her hand and showed him five fingers. “A five?” Paul said, “That can’t be, we just got started!” And with the look that so many husbands have experienced during their wives’ labor, Elsa just said, “Drive!”
By the time they reached the hospital, Elsa was already dilated five centimeters (halfway there) and in intense labor. “Forget the *&#^$ plan!!” she yelled. “I WANT AN EPIDURAL NOW!!” The nurse strapped a monitor to Elsa’s belly to measure the baby’s heart rate and Elsa’s blood pressure. On the next contraction (they were coming three minutes apart now) the nurse noticed that the baby’s heartbeat had dropped, not a lot, but enough to bring the obstetrician in to have a look. Then, just as the nurse was about to put an IV in Elsa’s arm, the baby started squirming around, causing Elsa even more pain. Worse yet, the baby’s heart rate dropped significantly. The obstetrician monitored the baby during the next sets of contractions and surmised that the baby must be pinching the umbilical cord. “We have to get him out now,” the doctor said.
In what felt like hours but was only a few minutes, Elsa was rushed to the operating room and given spinal anesthesia for the C-section, after which they allowed Paul in the room. Elsa and Paul were both terrified.
However, very soon thereafter they heard the sweetest sound of their baby boy, Elijah, crying. A pediatrician and nurses quickly took Elijah to make sure he was all right (he was). After weighing and measuring him, they brought him to his parents, who were crying with relief, excitement, and love. “So much for the best laid plans,” said Paul. Their cries turned into laughs as they realized that nothing had gone according to plan. It didn’t matter . . . their baby was here and everyone was okay. Paul pulled out his phone, took the first picture of Elsa and Elijah, and sent it to the proud new grandparents, just over two hours after Elsa’s water had broken, back in their bedroom.
Cesarean Epidemic
Although births come in different circumstances, durations, and outcomes, they have two things in common. First, just like with Elsa and Paul’s experience, they seldom go as planned; births are unpredictable. Second, no one ever forgets when, how, and what it feels like to give birth. No other event in life compares in intensity and emotional impact. Biologically speaking, having a baby is the pinnacle of our existence, yet the human birth experience is very painful and often risky. In fact, compared to apes, human birth is longer and more perilous. Elsa’s labor was unusually short at only two hours, but most first births average ten hours, and many are even longer. In addition, about 1 in 250 mothers carry a baby with a head too big to fit through the birth canal, requiring a cesarean section (C-section). One would think evolution would have favored easy deliveries, yet our bodies have not greatly improved on the process. Before the development of modern obstetrical medicine, there were about 70 deaths per 1,000 births. Those statistics have improved, but still, to this day, 500,000 women die annually worldwide from complications during childbirth. Why is human birth such hard and hazardous work?
Scientists believe that our births are more complicated because of the “human condition”: we walk on two legs and have very big brains. Walking on two legs was truly advantageous to our human ancestors; they had their arms free to reach for fruit and other foods, they could carry items (babies included), they could hunt and craft tools, and they could look above the vegetation by standing upright. However, this advantage came with the anatomical price of narrower hips in order to achieve better balance and support the body’s weight on two legs. Another aspect that makes humans unique is the large size of our brains. Thanks to our developed brains, humans can do math, build skyscrapers, and read books. Big brains (and, consequently, big heads) plus narrow hips? Any human can do this math: this causes the level five painful contractions Elsa was feeling and the medical need for C-sections.
C-sections are a medical miracle in terms of their ability to save the lives of so many mothers and babies. Try to imagine how much scarier Elsa’s birth would have been had a C-section not been an option. Elijah’s umbilical cord had twisted, preventing him from getting enough oxygen and blood flow. Elijah could have suffered a serious brain injury or even died from asphyxia if a trained doctor hadn’t been able to pull him out surgically. A hundred years ago, dying during birth was a lot more common for both mothers and babies and modern C-sections played a pivotal role in changing this.
The history of when and where the first C-sections took place is a bit murky, but there are accounts of C-sections dating as far back as Ancient Greece. It is commonly believed that the name of this surgical procedure originates from the birth of the Roman emperor Julius Caesar. Regardless of whether this is true or not, Roman law decreed that all dying or dead birthing mothers had to be cut open in an attempt to save the child. Unfortunately, mothers rarely survived these early medical procedures and they were performed only as a last resort. Once anesthetic and antiseptic practices became the norm, C-sections became a much safer procedure and were used to save many lives. At the beginning of the twentieth century, for every 1,000 births, 9 women and 70 babies would die during childbirth, compared to 0.1 women and 7.2 babies today. That’s more than a 90 percent reduction in mortality, a true triumph for modern medicine.
Still, for many decades C-sections were performed only when it was medically necessary: if the lives or health of the mother and/or the baby were at risk. However, towards the last quarter of the twentieth century, C-section rates skyrocketed. In 1970 the C-section rate was 5 percent in the US, rising to almost 25 percent by 1990 and to 33 percent in 2013. It has gone from a rate of 1 in 20 babies to 1 in 3 babies in the span of forty years. Canada’s C-section rate is slightly lower at 27 percent, but it has still experienced a 45 percent increase since 1998.
Unlike the initial decrease in mother and infant mortality, the surge in C-section rates experienced in the past thirty-five years did not bring an improvement in mortality or morbidity (disease) rates. On the contrary, a C-section performed without a medical indication, also known as an elective C-section, is riskier than a vaginal birth. A C-section is a major surgical procedure that poses an increased risk of blood loss and infection for the mother. Also, any mother that has birthed via C-section can attest that healing takes much longer than a vaginal birth, not to mention the limited mobility of the new mother, who must let the incision to her abdomen heal; it’s harder to hold the baby, to get up to change diapers (wait—maybe this is a plus), and sometimes even to breastfeed. Since 1985, the World Health Organization (WHO) has determined that the ideal rate for C-sections should be between 10–15 percent. Newer studies show that the number is likely closer to 10 percent. When C-sections rates approach 10 percent in a population, mortality surrounding birth decreases. But when the rates rise above 10 percent, mortality does not improve.
There are many explanations for this unnecessary but widespread increase in C-sections, and discussing them and their complexities are probably the subject for an entirely separate book. Suffice it to say, C-section rates are still increasing, and they are becoming epidemic and an emerging global health issue. Many experts disagree with this view and support the current rate of C-sections, because even if they are riskier than natural births, they are still very safe procedures. Modern obstetricians are extremely skilled in this surgery, and most complications that result from it, which are rare, can be treated with good outcomes in a hospital setting. There are maternal advantages associated with an elective C-section as well, including a reduction in urinary incontinence (loss of bladder control), avoidance of labor pain, reduction of fear and anxiety related to labor, and the overall convenience of planning the timing of birth. To some, the idea of a planned, painless birth is a dream come true.
On the baby front, C-section supporters claim that the health complications for babies born by elective C-section are rare and usually treatable. Babies born via C-section do look a bit different than babies born through the vaginal canal (their heads don’t get squished), but after a few days they all look the same. However, while C-section advocates may be correct that severe