What the increase in cesarean section on birth in the US reveals

After Rachel Somerstein was rushed to the operating room for an unplanned C-section, her doctor made the first cut. “I felt that,” she told him. “You will feel pressure,” the doctor responded.

But, horrifyingly, Somerstein “felt everything: the separation of my rectus muscles; the scissors I used to move my bladder; the scalpel, with which he 'incised' my uterus.” When her daughter was born, Somerstein was so traumatized that she couldn't hold her baby. She screamed to be removed from the room.

Friends encouraged Somerstein to file a lawsuit; others resisted, doubting that he could have undergone major abdominal surgery without anesthesia. The overall message for mothers experiencing a traumatic birth in this country is to get over it. “How long did it really take,” a lawyer asked the author, “five minutes?”

It's a common refrain: be glad you have a healthy baby. The dangerous and potentially unnecessary interventions of medicalized childbirth are never called into question when the pain and trauma of the birthing person are invalidated. Somerstein quotes two health and science scholars: “Something is visible [only] when someone recognizes it as relevant.”

Driven by Somerstein's own experience, “Invisible Labor” is a comprehensive investigation of childbirth practices based on misogyny, racism, and other forces contrary to the well-being of mothers.

Somerstein illuminates the capitalist drive to speed up births in American hospitals facing infrastructure and staffing shortfalls: “Compared to vaginal births, C-sections are more efficient. Especially if they are scheduled, a hospital can do many more… in a day.”

The medicalization of childbirth, including cesarean section, undoubtedly saves lives. But the dehumanization of those who give birth and the elimination of their well-being and experience harms everyone. As “Invisible Labor” shows, the lack of attention and communication in the hospital setting can be fatal.

Somerstein delves into the history of the cesarean section, which was devised to help save both mother and child. However, enslavers quickly adapted it in “an effort to bring in more slaves. In the United States, most early cesarean sections were performed in the South, and are still performed today; a disproportionate number of black and enslaved women constituted the subjects.”

The history of American births becomes a means to address the history of slavery, racism, and eugenics. Once cesarean sections were in practice, doctors realized they could also sterilize women of color and those considered disabled without their consent. “'The song finished,' said a woman sterilized at Los Angeles County Hospital in the 1970s. “My song is over.”

Drawing on essential feminist texts such as Adrienne Rich's “Of Woman Born: Motherhood as Experience and Institution,” Somerstein amplifies the role of the midwife and her withdrawal from the delivery room, eliminating the value of a library of knowledge about childbirth and the people giving birth and placing them in largely inexperienced male hands.

“Just as land is colonized, so is knowledge,” Barbara Katz Rothman, a sociologist, told Somerstein. “By reclaiming birth, medicine established limits on who has the authority to assist it.”

Surprisingly, Somerstein's research shows that electronic fetal monitoring technology used in hospitals, known as EFM, is “notoriously unreliable.” It often reports a drop in fetal heart rate or stalled labor when the baby and mother are perfectly healthy. But it allows doctors and nurses to care for many patients, rushing from room to room and leaving them alone. Doctors and nurses are trained in the technology rather than the skills of midwives, who know what to look for thanks to their extensive experience.

“When used on mothers who have not previously had a C-section,” Somerstein writes, “according to one study, EFM makes a person up to 81 percent more likely to have a C-section than mothers monitored intermittently.” .

The C-section rate has gone up and up (to about 1 in 3 births in the U.S.) and “a mother who performs a C-section is about 80 percent more likely to have a serious complication, such as needing a blood transfusion.” blood or an emergency hysterectomy.” Women of color and, in particular, black women are more likely to have C-sections.

Speaking to Rei Shimizu, a social work researcher, Somerstein relates: “There is an assumption in the healthcare system… that non-white female bodies cannot safely give birth without intervention.”

“Obstetric racism is because white doctors are racist, but it's also about doctors, white, black, whatever, when you express your concerns, they just don't listen to you,” said Nicole Carr, a professor who spoke with Somerstein on losing her baby after her concerns about her pregnancy were ignored. “It's a system that makes it so that when you come in and talk about your concerns, it's almost like you're not an expert on your own body.”

“Invisible Labor” does not claim that doctors or even medicalized birth are the problem. Rather, it is a system that decenters our humanity and relies on technology and statistics.

“We believe this visual omniscience will solve the problem,” Somerstein writes. “And we dismiss or forget that events take place outside the frame, including what subjective, embodied knowledge can reveal.”

Women who experience a traumatic birth are much more likely to suffer from postpartum depression, anxiety, or both. Perhaps “attention to women's pain could be rectified by the simple but radical decision to ask them how they feel and listen to the answer,” Somerstein writes. Instead of telling her, “You'll feel pressure,” when she made the incision, her doctor could have asked, “Do you feel pressure?” or, better yet, “Are you in pain?”

On the other hand, what do we expect from a country whose Supreme Court annulled women's bodily autonomy? As things stand now, an unborn fetus has more rights than a woman or girl in many states. To create a better birth system for mothers, we have to believe that the rights and indeed the lives of pregnant people matter.

“Invisible Labor” clearly and compassionately combines scientific research and reporting with the personal stories of Somerstein and other women. Childbirth is painful, but with the right care, it can also ground us in our humanity.

Some of the most moving stories about childbirth in “Invisible Birth” come from women who had the support of a doula or midwife. When Somerstein writes that “every woman deserves the touch of a midwife,” she is communicating that every person deserves someone who will listen to and validate her experience. This should be the first standard of care.

Jessica Ferri is the owner of Womb House Books and the author, most recently, of “Silent Cities San Francisco.”