After a traumatic C-section, journalist takes on the medicalization of birth

When journalist and professor Rachel Somerstein had an emergency C-section with her first child, the anesthesia didn't work. She says she could literally feel the operation as it was happening. Later, after her daughter was born, Somerstein remembers a practitioner blaming her for the ordeal.

"[They] came to my room and told me that my body hadn't processed the anesthesia correctly, that there was something wrong with me," Somerstein says.

Somerstein considered suing the hospital, but since neither she nor her daughter suffered long-term consequences, she was told she didn’t have a case. So instead of pouring her energy into a lawsuit, she decided to write a book. In Invisible Labor: The Untold Story of the Cesarean Section, she writes about her own experience with childbirth, as well as the broader history of C-sections.

Somerstein notes that the earliest C-sections were performed on women who died in labor or who were expected to die in labor. The intention was to give the baby a chance to live long enough to be baptized by the Catholic priest. It wasn't until the late 1700s or early 1800s that the procedure was seen as a way to potentially save the mother's life.

"One thing that's so interesting about this history, to me, is that it shows that the forces promoting C-sections have always had something to do with an external pressure," she says.

C-sections account for approximately one in three births in the United States today — despite research that shows they’re 80 % more likely than vaginal births to cause serious complications. What's more, C-sections are associated with having fewer children. Though she did eventually have a second child, Somerstein says her experience giving birth to her first definitely impacted her family size.

"I think that I would have had a third baby if I hadn't had this birth," she says. "I love my children so much. They are the absolute joy and sunshine in my life. I think that I wish I'd had one in between my daughter and my son and I didn't."

Interview Highlights

On the physician who practiced on enslaved women

[François Marie] Prevost, the slave master and physician who was educated in France and came to the United States, he practiced the procedure on enslaved women. And he did that in cases where the labor was obstructed, like ... the baby wasn't coming out. But when we look at the records of who had C-sections in the United States during this period of time of the early to mid-1800s, it's disproportionately enslaved women because they had no agency. They couldn't say no. ... And he would do this without anesthesia.

On physicians removing women’s uteruses without their consent in the 1880s

The biggest risk at the time to people who had a C-section was the risk of infection or hemorrhage. That's what would kill you. And by removing the uterus, that meant you're much less likely to have an infection and to hemorrhage. So in that way, it was a good, pioneering medical development.

But even later, when there were other techniques that would conserve the uterus, known as the conservative section, some providers would still remove people's uteruses. And there's a few ways to read this. On the one hand, you could say it's a horrible, patriarchal thing to take away somebody's reproductive power without their consent or knowledge. But at the time, there was no reliable birth control, and C-sections were so dangerous to the mother's life, you probably wouldn't necessarily want to go through one again. And you could see from the perspective of a physician in the 1880s that he believed he was doing the right thing for his patient.

On why women of color are more likely to have C-sections in the U.S. today

The simple answer is racism. There's nothing biological about women of color that makes them more likely to have a C-section. So that's the most important thing to put out about these disproportionate rates. And if we break it down, that happens because of so many different kinds of racism. So we can think about, for instance, the social determinants of health. So that's everything that shapes your health before you get pregnant, even. And, of course, during pregnancy, whether you have insurance, what kind of community you live in, how much money your family has, where you go to school.

And it includes also access to midwifery care. ... When we're talking about particularly caring for people who are low-risk in their pregnancies, [midwives are] a way to ensure a better outcome and also promote vaginal birth. … And Black women have less access to midwives than white women. And that's not because of lack of desire. There's not enough midwives, period, for the demand in the United States. But the gap is largest for Black women's demand versus availability. And that is a social determinant of health. If you have no choice but to see an OB who, by dint of training, is more likely to do interventions that are more aggressive, perhaps, than a midwife who has a different kind of training and a different kind of professional ideology, then you might end up having a C-section that, with a different provider, could have been avoided.

On what childbirth was like in the 19th century when midwives were at the center of the experience

Childbirth was much more social and community oriented. I'm speaking here about free people, not enslaved women per se. But you'd be attended by a midwife. You'd be attended by the community of women in your town, the women in your family, your friends. And these were women who had a lot of knowledge about babies. ... So anything from massages or helping people into positions that would help ease the baby down, singing, bringing in teas or balms.

There was food. You think about now, the majority of people in the United States have a baby in the hospital. And one thing you're told most of the time is you can't eat right throughout the entire birth. ... And the reason is in case you need to be intubated. If you have a C-section and you need to be put under general [anesthesia], that's why you're told not to eat. It's safer if you have an empty stomach. But again, at the time people would make things called groaning cakes, to eat and to share. I should say at the time, the majority of midwives were Black or immigrant or indigenous women. Today midwifery [has] transformed into a profession that is predominantly white, although that's changing and it's perceived as being for white women, even though midwifery is for everybody.

On the impact of her C-section

I developed PTSD. ... It's gotten a little better, but I get really nervous when I go to the doctor, and especially if it's a new provider who I don't know, I have a hard time trusting people in medicine. I try to remind myself of all the providers who've helped me before I go see somebody, because there's so many people I've seen who've taken really good care of me and helped me and listened to me. I used to have a really hard time around my daughter's birthday, and that's really finally improved. She's 8.

Thea Chaloner and Joel Wolfram produced and edited this interview for broadcast. Bridget Bentz, Molly Seavy-Nesper and Carmel Wroth adapted it for the web.