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.
