This is the weekly Amplify newsletter. If you’re reading this on the web or someone forwarded this e-mail newsletter to you, you can sign up for Amplify and all Globe newsletters here.
On the day my third son was born, my OB/GYN offered me a pain-control option that had never crossed my mind. I was about to be induced. I knew I wanted an epidural. Would I like the epidural first, my doctor asked? Heck yeah, I replied.
My name is Kelly Grant, and I’m a health reporter with The Globe and Mail. I got to thinking about my blissful third delivery – and about women’s birthing choices more broadly – when the Society of Obstetricians and Gynaecologists of Canada (SOGC) abandoned its long-held opposition to on-demand C-sections last month.
The doctors’ group used to say C-sections should be reserved for cases in which the health of a mother or baby is at risk. Now, it says that as long as doctors explain the pros and cons first, women should have the power to choose a scheduled C-section, even if they don’t need one. Obstetricians who disagree have a duty to refer their patients to another doctor, the SOGC says.
The SOGC’s about-face a week after my colleague Carly Weeks wrote about a new Canadian study that found a surprising increase in the rates of obstetric trauma when doctors used forceps or vacuum to pull out the baby. In the quest to lower Canada’s C-section rate, it seems OBs without much hands-on experience were reaching for the forceps more often, leaving more new mothers incontinent. (Training is key, and more of it is on the way for OBs who use forceps.)
What are we supposed to make of all this? As a health-policy reporter, I’m always thinking about how best to spend the limited money we have to care for the sick in this country. C-sections are major surgeries that usually require an extended hospital stay. They cost the health-care system more money than vaginal births. That fact shouldn’t be ignored, nor should the risks that can accompany elective C-sections. But our system prioritizes patient choice in plenty of other areas. Why not this one?
I’ve never had a C-section myself. As a woman and a mother, I’m fascinated and sometimes enraged by how we talk about our birthing experiences. If a woman chooses a C-section, she can be dismissed as a wimp, a princess who wants to treat her delivery like a spa treatment that can be booked in advance.
Even women who undergo emergency C-sections can be made to feel as though they’ve failed some elemental test of their womanhood. Pain is the price we are supposed to pay for our prize – our precious newborns. (That said, women aren’t spared criticism when they lean too far in the other direction either. When I wrote this story about the opening of Toronto’s first public birth house in 2014, my inbox was filled with notes accusing the mothers I interviewed of putting their babies at risk by having them outside a hospital.)
I’m guilty of feeding into this valorization of painful deliveries. I love to tell the story of the birth of my second son, who came so fast that my husband and I barely made it to the hospital. I squeezed out all nine pounds and four ounces of him without painkillers. I was back on my feet half an hour later. I felt Amazonian. But why? It was terrifying to feel the baby’s head crown while I was in the front seat of our car, and the birth was excruciating.
Two-and-a-half years later, I jumped at the chance for a pain-free delivery. When I was induced with my first son, I didn’t get an epidural until the pain was unbearable. This time, the anesthesiologist slipped a needle into my spine before I felt a single contraction. My husband and I proceeded to watch Law and Order reruns while I fell in and out of sleep. I remember asking the nurses to slow my progression so I could have a longer break from the four-year-old and two-year-old boys waiting for me at home. It was heavenly.
I still wonder why this option is not offered to more women. Perhaps it will be, as Canadian OBs and hospitals strive to give women more of a say in how they deliver. The SOGC’s new position on elective C-sections is just one example. Here are two more: A Markham, Ont. hospital has just opened a unique midwifery unit, while other Canadian hospitals are supporting family-centric, “gentle C-sections,” according to this story in Today’s Parent.
What else we’re reading:
I’ve always been moderately disturbed by Thomas the Tank Engine, the little blue train who loves work and order and “very important jobs” with a Bolshevik fervour. So I felt seen when I came across New Yorker writer Jia Tolentino’s investigation of “The Repressive, Authoritarian Soul of Thomas the Tank Engine and Friends.” Tolentino’s dissection of life on the fictional Island of Sodor, where the Fat Controller (nee Sir Topham Hatt) runs his railway with an iron fist, is wry and hilarious. The piece sent me burrowing down a satisfying rabbit hole of Tolentino’s other work, including this rib-tickler about her visit to New York’s first FaceGym (which is exactly what it sounds like) and this barbed essay about the motivations of “incel” men.
Inspired by something in this newsletter? If so, we hope you’ll amplify it by passing it on. And if there’s something we should know, or feedback you’d like to share, send us an e-mail at amplify@globeandmail.com.
Kelly Grant