Birth Matters

What's In a Name?

Words are powerful, words define events and people, words give or take meaning just by their very existence.   One of the oldest stories around is the story of Adam naming the animals.  Creation was pretty much finished and Adam was lonely so he looked at each animal, named it and then went on to the next one, looking for a suitable companion.   I’m no expert on world religions but I suspect that there are variations of this story to be heard the entire world over.  Names are powerful but more than that giving name to something demonstrates the power of the namer (in many cultures, the naming ceremony for a new baby is a very big deal for the entire community).  Being nameless, or even worse, having your name changed or taken away (ever had a nickname you detested?) is a loss of identity, a loss of power. 


I’m part of a community of women who’ve had cesareans.   Almost exclusively, for differing reasons and to differing degrees, we didn’t want to have one (and don’t want to have another one).  Some of them were life-saving, some of them were “prudent” and all too many of them were at best avoidable and at worst, completely unnecessary.  Having power to name the cesarean is integral to the process of integrating it.  I’ve been thinking about two different yet related ways that naming a cesarean is important.


What to “call” a cesarean is a hot topic in my community.  The question “was your cesarean a birth?” results in passionate answers and the odd thing is you can’t predict how any given woman will answer that question, even if you know all the details of her experience.  Some women labor for days, some don’t labor at all.  Some have complicated pregnancies, most don’t.  Some have complicated recoveries, but many others don’t.   The necessity or non-necessity of the surgeries isn’t predictive of how a woman answers that query.  So of course, for some women, the answer is an unequivocal yes, I gave birth to my child.   For others, even those who had extremely similar experiences, the answer is a violent no, I did not give birth, I had surgery.   So I see answers to the question “what do you call your cesarean” along a range from cesarean birth, cesarean section, cesarean surgery, abdominal delivery to surgical fetal extraction, with qualifiers like “empowered” or “coerced” to refine the definition.  Ultimately, there is no one acceptable way to name the process by which a baby is born surgically.  The important thing isn’t to find some name we are all comfortable with but rather to let go of the notion that there even is such a name.


Why?  Because giving women the space to name their cesareans means we are giving them power, power over an event that for many represented an acute loss of power.  It really doesn’t matter what she names it, the important thing is that she names it.  Personally, I don’t consider my cesarean a birth but I don’t have any argument with a woman who does.  I’ve let go of the notion that my name for my cesarean needs validation from anyone other than myself or that how someone else describes a similar experience has any sort of power over my experience.  It is very powerful to no longer be defined by an outside voice, but rather to trust myself enough to know that my name is the truest name for my experience.


This leads to the second facet, one which I find both more difficult to accept and more frightening, the growing tendency to use the term “Cesarean Birth” instead of the more traditional “Cesarean Section” in general and popular discussion.  What I have no problem at all accepting and respecting from another woman is deeply offensive to me when it’s institutional.  Why?  Obviously, I don’t want anyone, including society as a whole defining for me something that is uniquely personal.  But even more, I worry about what substituting the word “birth” for “section” actually represents.  Lest you think I’m a complete conspiracy nut, I do believe that many people who use the term are well-meaning.  I often hear the term “Cesarean birth” or “C-birth” from doulas or midwives, 2 groups which are arguably more likely to be sympathetic about what a surgical outcome could mean to a woman whose plans were quite different.  The motive is a good one – to blunt feelings of failure or inability by muting the differences between a “vaginal birth” and a “cesarean section”.   However, the results are sometimes quite different – a woman feels trapped into a particular way of viewing her experience and ultimately, loses even more power over it because someone else has defined it for her.  I’ll give a bit of unasked for advice to anyone who supports women having babies – don’t name it at all.  Let each woman tell you what her experience was.  Give her the gift of her own voice, since she is much more likely to hear about how fundamentally unimportant it was than to receive any real compassion about what she’s feeling as time goes on.  Set aside whatever you may be processing in your own experience to give her the freedom she needs.


There is, however, a facet of the “C-birth” movement that is both more insidious and much less innocent.  We live in an age where the surgical delivery of babies for any and no reason at all is becoming more and more common and more and more acceptable.  It is even touted as a preferable “choice” in some circles (including much of the OBGYN community).  It is rapidly becoming “just another way to have a baby”.  As anyone who has given an honest and thorough look at the literature can tell you, keeping in mind both short- and long-term repercussions, surgery is not just another way to have a baby.  Women are ill-served in two ways:  it makes it even harder for a woman who isn’t happy about a surgical outcome to find any support at all for her feelings and it misleads women who don’t know what surgery entails into “consenting” to a procedure they don’t understand.  Ultimately, this will lead to more unnecessary cesareans and more damage to women and their children.  I unequivocally oppose anything that normalizes cesarean surgery because I believe to do anything else is ethically and morally questionable.


So for me, there’s a vast difference between individuals and the culture.  There is all the space in the world for each woman to define her own experience.  And there is no room at all for prettying up something that isn’t pretty at all, just because it makes some people more comfortable or more pliable or more willing to follow an agenda that has nothing to do with what’s best or healthiest and everything to do with funding, staffing, money and litigation.  It is about power – giving women back the power they don’t know they have and taking it away from those who shouldn’t have it. That’s what’s in a name.


June 8, 2006