C-sections vs choice to birth safely

The Caesarean section has become synonymous with pregnancy and newborns in urban India today. It has also become so ubiquitous that Union Minister of Women and Child Development Maneka Gandhi asks for hospitals to open their records on normal and c-sections deliveries, so that those doctors who promote c-sections over normal deliveries can be ‘named and shamed’.

Ideas regarding pregnancy and childbirth are culturally contextualised, even though medicine has increasingly held ownership of both the practices. Let’s begin with an example of assisted reproduction and commercial surrogacy. Interestingly, and in the absence of records and hard data, the surrogate pregnancy ‘always’ leads to birth through C-sections. There are various theories regarding why normal birth is avoided in case of the commercial surrogate, but most explanations have very little to do with the safety of the unborn baby and the surrogate.

Reportedly, when foreign couples were allowed to come to India to have children through surrogacy, the C-section would help time the delivery according to the parents’ arrival and departure. The other reason, whi­ch is far less acknowledged, has to do with preventing an attachment between the baby and the surrogate—which might grow through the normal birth and through breastfeeding the baby.

The point of invoking the above example was to reflect upon the kind of ideas and practices that accompany birthing and pregnancy within medical practice, which inhabit a culture of their own. Why is there shock and anguish over the increasing number of C-sections in hospitals? The C-section has always been hailed as a game changer for the maternal and infant mortality rates. What has happened to the understanding of birthing that the C-section has now become a maligned practice?

It is imperative that we recognise that the idea of the C-section has moved away from its original premise of an emergency intervention into a delivery gone awry. It has now become the ‘new normal’. This is problematic in many ways, but it also challenges us to think about bodies, choices, and how commerce defines the choices we make about our bodies.

Statistics point to the alarming rise in C-sections, especially in urban India, with some states like West Bengal and Telangana clocking at 70-75% rise in the past decade. This increase flouts UN norms that list specific life-threatening situations as the reason to undergo a C-section during a delivery. However, women are seeking to opt for these surgical procedures at the behest of medical advice and due to a negative perception regarding pain and normal births.

It is important that we revisit the culture of birthing before Western medicine entered our collective conscience and health practices. The aim is not to eulogise them, for many of them were extremely harmful for the health of the mother and newborn — but to understand how the community and women themselves were the best adjudicators of bodily changes.

Banishing midwife
Take for instance, the midwife. We have banished the midwife from medical practice in India, even though she has become a very important part of the hospi­tal birthing system in countries like the UK. In fact, she is seen as antagonistic to the hospital birthing system in her representation as a figure of irrational, folk practices. But the relationship of trust and safety that ens­ures normal deliveries is very much part of the midwife rhetoric — at least in contemporary understandings of birthing ac­ross the world, except in India.

Then, are we suggesting that the C-section is representative of the kind of clinical experience that has increasingly come to build on our distrust of doctors? Scholar Emily Martin, in her book, The Woman in the Body, challenges Western medicine for its inherent bias against women’s bodies.

This she finds marks the ways in which obstetricians and gynaecologists are taught to ‘read’ women’s bodies as being inherently pathological through proc­esses of menstruation and men­opause. The practice of birthing, similarly, is positioned in a negative way within medical disco­urse by actually disregarding the labouring woman’s discomfort.

But the above script has chan­ged in many parts of the world to create a more enabling environment during the labour that respects and honour the wom­an’s understanding of her body. In many ways, the minister’s intervention is a signal to change — to go back to a system of recla­iming choice to birth safely. This is not necessarily a regression to older problematic ways, but a form of new engagement with bodies, choice and medicine.

(The writer is Assistant Professor, Department of Liberal Arts, IIT-Hyderabad)