No, I’ve no aspirations to become a real published author.  I’ll leave those aspirations to those with far more mettle than I.  But, when an organization to which you belong spouts as one of its philosophies something that you simply don’t believe in, well, submitting an article for publication in their quarterly magazine is just something you have to do.  Test them, if you will, to see if they’ll listen to the other side of the story, or gasp! actually publish it for the rest of the membership to read.

And publish it, they did.

In this month’s issue of International Doula magazine, these fine words (if I do say so myself) appear.  Many thanks to Rebecca, who pushed me to dig a little deeper, and to Jennifer, who helped me uncover something under all that dirt.

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Calling It Like It Is

Words are, without a doubt, powerful.  We use them to express our needs, our desires, our fears, our hopes and our dreams.  Indeed, all of our emotions — if we’re lucky — can be put in to words.  The ability to consciously and carefully choose our words is our fundamental right — and a source of great power. To take our words lightly, then, is to foolishly dismiss that source of power, and to allow others to put words into our mouths is to foolishly allow that power to be used against us.

The first time I heard the phrase cesarean birth, I was taken aback.  The words came from a childbirth instructor advocating for the use of the term instead of the more clinical, cold, and passive cesarean section. Soon, I began to hear it more and more; doulas, childbirth instructors and others in the birth community saying cesarean birth, trying to effect a change with their words.

Certainly, the sentiment behind the selection of the word is pure; the only agenda in the choice of the phrase is to take away the disempowering connotation of the term section and give back to mothers the power and beauty and ownership so inherent in the word birth. This motivation may be pure, but I would argue that the effect of its implementation – particularly when it is used to provide the opportunity for a woman to shape her vision of her own cesarean experience – is far more disempowering than the original term itself. “But it’s still a birth,” a doula offers supportively to a mother adjusting to the news she is about to have a cesarean. “It’s still a birth.”

Is a cesarean really a birth? What a provocative question.

For some women, the answer to that question is undoubtedly and emphatically yes.  So much so, in fact, that to posit that it isn’t would be an affront to their feelings.  Upon hearing the question, Jennifer, mom of three, reacted strongly.  “[I felt] that I’d been knocked in the stomach, actually.  It has never occurred to me that what took place in those operating rooms were anything less than births.  My children were born those days…I associate birth with my children’s entrance into the world.  No matter how it happened, they were born.  I don’t know that I actually delivered that day, but I do know that I gave birth.” For Jennifer, her cesareans are lovingly remembered birthdays.  They are also triumphs over a cancer that required cervical surgery in her early 20s.  Kristen, a mom who underwent a cesarean under general anesthesia for an abrupted placenta, feels similarly. “My body decided it needed to do this.  I had to have outside help – help for me to give birth.”  But, she continues, “without me, without my body, there could be no birth.”  There’s an emotional component to her choice of words, too, stemming from the particulars of her cesarean under general anesthesia:  “[S]aying that I ‘gave birth,’ includes me in on something I so badly wanted to be included in…[I]f I don’t see it as me giving birth, then I have nothing from [the] experience. No memories, no sounds, no smells.”  When these moms speak of their experiences, using the term cesarean birth is an empowering choice, one that reflects their most heartfelt feelings about their birth experiences.

But as surely as there are women who view their cesareans as births, there are others who find the concept decidedly offensive.  A woman who feels this way might think of her cesarean as a loss, a betrayal, an affront, or any other number of things, but not a birth.  Upon reading an announcement sent out on her behalf stating that she’d given birth, Dana reacted bitterly.  “Like hell I gave birth.  I just laid there,” she says.  Bonnie puts it another way, very matter-of-factly.  “She was ?born. I was the vessel. But I didn’t give birth to her, any more than her father did. I, did, however [have] the surgery.”  Perhaps, for these women, it’s an issue of semantics, but, if it is an issue of semantics, it is one wrought with emotion.  They’re not being pedantic as much as they are being true to their emotions.  As Krista explains: “I don’t argue that a baby born by cesarean was [not] born, or that it was [not] the day of his birth.  But for me, the phrase ‘giving birth’ implies active physical participation, and I know that it wasn’t true of my experience. I couldn’t have been less a part of my son’s surgical removal.”  There’s a sense of loss echoed by all of these women.  They would never consciously choose to refer to their experiences as cesarean births, and to be encouraged to do so by a doula, a therapist, or a childbirth educator would be encouraging them to normalize something that, for them, was not at all normal.  These women have the right to choose how they feel and they should also have the right to choose what words they want to use to name their experience.

As doulas, it would be contradictory to our purpose of support to subtly encourage, by our simple choice of words, a perception that runs entirely counter to a mother’s thoughts or experience.  Whether we’re talking to a mom about her previous cesarean experience, or to a mom facing the prospect of a cesarean, offering the term cesarean birth as a salve can inadvertently sting worse than the cut itself.  Doing so doesn’t necessarily provide her an opportunity to reshape her own experience; it can, in fact, show extreme disrespect for her experience and her very legitimate, normal feelings about her cesarean.

What to do, then?  The term section is disempowering.  Reverting to its usage is a step backward to the days of deliveries, a word so egocentrically focused on the care provider that the mother is left out of the experience entirely.  But substituting the term birth clearly has its drawbacks as well.  The solution, in my mind, is to simply leave the choice up to each woman individually. We never know how a woman feels about her experience, unless she tells us.  So let her.  Cesarean. When we use the term without a modifier, mom gets to make a conscious choice without having any words put into her mouth for her.  Talk about empowering.

Writing this article has been a bit of a transformative experience for me.  I will admit that prior to beginning this article, the term cesarean birth was a little more than unpalatable to me on both a personal and professional level.  Hearing doulas and childbirth educators advocate for the language change was an affront to my understanding of our mutual passion.  When we choose to use the term cesarean birth in general conversation, in our writing and in our publications, I believe we’re propagating the myth of cesarean normalcy.  As the cesarean rate continues to unjustifiably rise in the U.S. and other industrialized nations, I’ve always felt that we in the birth community must take a stand – in ways both big and small — to ensure that cesareans are not viewed as “just another way to give birth.”  To do otherwise would be to materially participate in a phenomenon we are working so hard to counter.  This, I still believe.

But as I spoke to women regarding their personal cesarean experiences, I found within me a place where I understand that sometimes the term cesarean birth does make sense.  Initially, I wanted simply to advocate for those, like me, who cannot describe their cesarean experience as a birth.  I still want to give voice to that opinion.  But, I now understand that those who feel the opposite feel so just as passionately.  In the end, I believe this understanding strengthens the argument for choice even more.  We don’t want to inadvertently hurt a woman by implying that her cesarean was a birth any more than we would want to hurt a woman by implying that it wasn’t a birth.  That is a distinction each woman should have the power to make for herself.

I’ve never understood the adage sticks and stones may break my bones, but words will never hurt me. Words can hurt. As doulas, we must take care not to use words that can have this effect.  But words can also move mountains.  It is part of our job — and our passion — to empower women.  Perhaps the most important support we can give to the women we touch is the mountain-moving power of their own words, consciously chosen, to reflect their own experiences.  Let their voices be heard.

I can remember, clearly, one day when I was a teenager and was sitting in my father’s office. A man walked in. Immediately, I felt uncomfortable. Cold. Severe. And Evil. These were my immediate reactions to this man. My intuition was screaming viscerally, and I could not ignore it. Something, I knew, was not good about this man. I had never been so sure about something in my life as I was sure that this man could not be trusted.

Later, while speaking with my father about it — the incident had chilled me that much — my father confirmed my intuition. As it turns out, this man was well-known to be untrustworthy, with legendary acts of dishonesty and unscrupulousness under his belt. “Wouldn’t trust him any more than I could throw him,” he’d said.

Through the subsequent years, I’ve heard my intuition speaking to me many times. Usually, she’s speaking kindly, letting me know I’ve found a friend and a kindred spirit. Other times, she gently tunes me in to things of which I should be aware. Rarely, though, does she scream and yell and kick and holler like she did so long ago. But when she does, I listen.

She screamed like hell the other day.

The man walking in to the room, to whom my intuition was reacting so strongly, was my client’s obstetrician. Uncomfortable. Cold. And Evil. There was no mistaking it. This man could not be trusted. And over the course of the next few hours, my intuition was proved entirely correct.

First, there were the sly comments from the nurses. “He’s in business alone for a reason,” one of them said. “I’m going to have a hard time convincing a nurse to take you on at the shift change. No one likes to work with your doctor,” said another. These comments, on the surface nothing short of unprofessional, were strong signs my intuition was right. These nurses felt an obligation to warn their charge, even at the risk of being unprofessional.

There were other things, too. There was the hand extended in a simple gesture of polite greeting that he refused to take, offering only the flimsiest of explanations for his rudeness. There was the gruff — not joking — remark about his patient’s labor’s inconvenient timing, coming on the heels of a sleepless night with sick kids. There was the open rudeness with which he treated all of the nurses, belittling them into an annoyed submission. And then there was the episiotomy, cut after only a few minutes of pushing, with no regard for mom’s wishes, and with a deeply disturbing sly smile on his face. All of this, evidence that my intuition was right. The term misogynist crossed my mind more than once.

But the final blow? The final sign that brought the gavel down with a resounding crack? It was an action so subtle that many in the room missed it. The baby born, he held her close — not to perform any medical tasks — but to be the first to rock her and coo at her and be next to her. He taunted the parents, if only for a minute, holding in his hands, their child. I’m holding your child and I’m not giving her to you — yet. One of the most intimate moments that can belong to a mother and father, stolen from them. Stolen, not by circumstance, but by calculated, cold, and heartless arrogance. Power. There is no doubt in my mind this doctor knew what he was doing. It was a clear, conscious action. And unconscionable.

My reactions to this birth and to this series of events were intense. Shock. Horror. Disgust. A sense of being violated, just from being witness. And a deep, soulful mistrust — even hatred — for the man responsible. Its taken me a while to process the strength of my emotions. Was I reacting to my own sensitivities? True, I am sensitive to the importance of those first newborn moments, and to the importance of respectful care. I really had to question myself. I needed to understand how much of this was about me, and how much of this wasn’t. I believe my intuition speaks to me for a reason; in this case, I believe she was warning me — trying to protect me. That I reacted as intensely as I did gives merit to the fact that I needed that protection. The intensity of the reaction is about me.

I have been asked, more than once, how the parents felt about this series of events. It is an important question, one no doubt aimed at redirecting my place of concern, turning my focus away from me. Interestingly, the answer to this question has revealed the other half of my own query; that is, how much of this is about me, and how much of it isn’t?

You see, I argue whether the parents noticed or cared is really not of consequence. Certainly, if they do care, it makes these actions all the worse. But if they don’t care, or if they didn’t notice, it does not excuse this physician’s actions. A midwife once described the moment of catching a baby as “like heaven into my hands.” She wasn’t being arrogant about being the one to receive a child into this world as much as she was being respectful of the enormity of the moment. So enormous is the moment that to take away Mom and Dad’s first touches, first coos — without reason or purpose — is nothing short of reprehensible, nothing short of cruel.

I’ve heard “integrity” defined as doing the right thing, even when no one would notice you doing the wrong thing. Regardless of whether Mom or Dad or anyone else in that room cared or noticed that that sweet baby girl belonged in the arms of her parents at that moment, it would have been the right thing to do. At the very least, then, this physician’s actions lacked integrity. Of course, my intuition told me as much — and more — the minute he walked in the door.

With a full week of school under our belts, we’re beginning to get our sea legs. The subject “we” is very much appropriate here, because despite the fact that only Zoe is attending school, it’s clearly the case that everyone in the family is affected by her newest milestone. There are changes in the morning routine, requiring a far-more efficient use of time than here-to-fore. There are papers to be signed, and car-pools to coordinate, and lunches to pack, and money to send, and, and, and. All of it, affecting our lives as much as (more than!?!) hers. And most, I must admit at this stage, are stressful changes. Most.

But there’s been one very pleasant surprise in all of this chaos. And, all of the pleasure is mine.

Each afternoon, just after two thirty, I head out the door. I drop Evan off at a neighbor’s house, and I drive to the school to pick Zoe and our neighbor’s other son up in the carpool lane. As I approach the school, cars are lined up around the block. I take one look at the line careening down the block and out of sight, and I smile. I smile because lying next to me in the seat is a book or a magazine — one destined to be my companion during the wait. It’s not a long wait. Ten, maybe fifteen minutes on a bad day. But a bad day in the carpool line is a good day, indeed. A few extra minutes in line is a few extra minutes in words and dreams and tears and shock and everything else bundled between the covers of a good read. A few moments to read, undisturbed, in silence, in the middle of the day. Nothing, nothing can beat that pleasant surprise.

It used to be, when I was nursing my children, I found a selfish indulgence in the ritual of providing food and love for my children. Sure, there was the time spent close and intimate with my child. Time spent snuggling and laughing and in awe at the wonder that was my child. But, Oh! The Reading! I devoured books while I was nursing. Devoured them, as if their intake was a crucial part of the extra nutrition required by the very task of nursing a child. A few minutes here, a few minutes there — each time my child paused his busy life of exploration to quietly drink in his love, I paused, too, to drink in a page or two or three of a book.

I certainly wasn’t expecting to re-discover that kind of personal joy in the sterility and mechanicalness of the suburban carpool line. No, not at all. But, I have. In the last week, there’s been the most recent issue of Brain, Child, devoured lovingly, article by article. And then, there were the last few pages of a clever, imaginative and surprising book of Faeries. Next week, Elephants, and then ugly Americans. After that? Who knows! It doesn’t matter, really. Representing a few moments of quiet, a few moments of serenity — right smack in the middle of the chaos that is the day — whatever text it is that sits next to me on the ride to the school occupies a sacred space. For, directly behind the mini-van with the mom droning on her cell phone and in front of the Volvo with its driver blankly enduring the interminable wait is a quiet little spot where words float from a page and get caught — every last delicious one of ‘em — by a most adoring and appreciative mom.
Yep, ten minutes, maybe fifteen on a “bad” day.

Welcome to Kindergarten, Zoe. I’m thrilled to be along for the ride.

The difference was apparent immediately.

Yesterday, she’d bounded to the car, filled with glee, unable to contain her excitement about the day. “I loved school, Mom!” she’d proclaimed before she was even half-way in the car. Today was a different story entirely. Hardly half-way in the car, and she tearfully said she’d really missed me at the end of the day. Voice cracking, she could hardly keep it together. And then, through choking sobs, the explanation for all the tears: a yellow card.

A yellow card. In the world of kindergarten’s rules and consequences, the palette of green, yellow, red, and then finally an ominous blue, marks a child’s behavior for the day and the week. Displayed on the wall for all to see, my daughter’s yellow card might as well have been a scarlet letter. The offense: talking out of turn, after repeated warnings. The yellow card her ticket to tears and hurt.

Certainly, she made a mistake. She broke the rules, and she must pay the consequences. Today, no green stamp. And this week, there will be no trip to the treasure box. These are real consequences to her. I believe she’s learned her lesson.

But there are other lessons to be learned which will be much harder to grasp. I’m certain of — and saddened by — this reality she unwittingly faces. Her deep, deep hurt broke my heart today. The tears, the self-disappointment, the anxiety — all of it, all too familiar. She was her own worst critic. And I recognized it immediately. My empathy for her was borne from my own tears. As much as, no, more than I wanted to make sure she understood what she’d done, I wanted to let her know, kindly and gently, that we all make mistakes. All of us. And we must be kind to ourselves when we do. Honest and fair, but kind, too. Because, too often, no one else will. Faced with the puddle pouring into the car this afternoon, I knew that was the lesson that was of import at the time.

Talking out of turn? I’m pretty sure she’s got that one licked at this point. Showing one’s self compassion and kindness? Somehow, I doubt that starting over tomorrow with a green card will be the end of that lesson. If only it were that easy.