Even before it was imperial, the C-section was associated with divinity. The Greek god of medicine, Asklepios, was born by cesarean, rescued from his mother’s body as she burned on a funeral pyre. In Shakespeare’s “Macbeth,” the cesarean-born Macduff famously arrives as the answer to a riddle: Although the witches have promised that “none of woman born shall harm Macbeth,” Macduff turns out to be exempt from the prophecy because he “was from his mother’s womb untimely ripped.” Macduff’s exceptional birth grants him a singular power, but its exceptionality also carries a whiff of monstrosity: “Untimely ripped” doesn’t exactly summon the epidural and the blue tarp.
Why do we want so much from our birth stories, anyway?
During the medieval era, some babies born by cesarean were called “the fortunate” or “the unborn,” deemed miraculous not despite being born from corpses but because of it. They were proof of hope and possibility salvaged from the jaws of death, emblems of life plucked from wombs growing cold. Cesareans were understood as both miraculous interventions from saints — the so-called apertura mirabilis, or “wondrous opening” — and unholy abominations. The birth of the Antichrist was sometimes depicted as a cesarean; in one 15th-century woodcut, a winged demon clutches the new baby by his wrist while the mother looks away with her head cocked from exhaustion, or horror, a gaping wound still furrowing her stomach. As one widely circulated medieval account of the birth of the Antichrist put it: “The devil will go down into the womb of Antichrist’s mother and fill her completely, possess her completely inside and out, so that she will conceive by man with the devil’s assistance, and what is born will be completely foul, completely evil, completely ruined.”
Now, 500 years later, the “greatest of all operations” has become one of the most common surgeries in America. By 2019, almost one-third of American births happened by C-section, more than double the share that the World Health Organization considers the ideal rate to reduce maternal and infant mortality (10 to 15 percent). In some countries, the rate is even higher: In the Dominican Republic, about 60 percent of all babies are born by cesarean, and in Brazil, the so-called C-section capital of the world, cesareans account for almost 85 percent of all births in private hospitals, where women throw parties around their planned C-sections. One “presidential suite” in a São Paulo maternity ward includes a balcony and a minibar; another ward has a videography wing where women can get blowouts, manicures and makeup before being filmed with their newborns.
But the rise of the C-section has brought with it a powerful backlash, in which legitimate arguments against the procedure’s ubiquity have become Trojan horses, carrying within them age-old ideals of motherhood that fetishize sacrifice and pain. The dismissive, often unspoken critique of the C-section understands it as birth without labor, birth without pain, birth without sacrifice. If a mother is supposed to do anything, she is supposed to sacrifice herself for her children, and pain in childbirth is the earliest barometer of that sacrifice, the punishment God bestows upon Eve in the Book of Genesis: “I will greatly multiply thy sorrow and thy conception; in sorrow thou shalt bring forth children.” A cesarean often involves pain, but it’s unnatural pain, and it’s typically medicated away. Even when a C-section isn’t elective, it still means a woman doesn’t undergo that supreme, heroic effort of pushing a baby through the birth canal.
Although the cesarean backlash arose from an impulse to empower women, it has perversely also become another way to shame mothers, or make them feel inadequate, as soon as they’ve given birth. When the British doctor Grantly Dick-Read coined the term “natural birth” in his 1933 book “Natural Childbirth,” he meant childbirth without any intervention that would disrupt or change the process of labor. In “Childbirth Without Fear,” his internationally best-selling 1942 manifesto, he wrote that childbirth is “nature’s first hard lesson in the two greatest assets of good motherhood. Children will always mean hard work and will always demand self-control.” The woman who has a C-section is a woman who doesn’t learn those lessons.
I can still remember the sheer awe I felt in birth class when a lovely woman holding a plastic pelvis explained the interlocking stages of the process: how the pressure of contractions pushing my baby’s head against my cervix would stretch it, prompting my body to produce more prostaglandins, making it more receptive to oxytocin, which would thin the cervix and help it dilate; how my endorphins would carry me through the pain and my adrenaline would surge for that final push. It struck me as almost beautiful, how all these parts fit together like jigsaw-puzzle pieces. It was less like the hydraulics of a machine and more like the choreography of a dance.