The Intersection of Cesarean Sections and the Cross of Crucifixion

Here is the third in our series of “best of” articles for 2011, which first appeared on October.  It was written by one of our editors, Rev. Mindi Welton-Mitchell.  Enjoy!

The nurses called it the crucifix position.  Lying flat on my back, my arms were stretched out like a T, and I.V. lines were running out of each arm and out of my lower back where the epidural line was placed.  This was not what we had planned.  This was not how we imagined our son’s birth would take place.

I had an uneventful pregnancy.  No morning sickness, no complications, I was as healthy as a pregnant woman can be and so was our unborn son.  Every checkup was routine.  The baby was in the right position.  No concerns.

After our due date came and went and we neared forty-two weeks, the “eviction” date set by most obstetricians, I was told I would need a medical induction and that it would be handled by another doctor in the practice, since my doctor was now on vacation.  I was given instructions to call in on Friday morning at 7a.m. with assurance that I would be at the top of the list to come in for my induction.

That Friday morning at 7a.m., I called in to the hospital.  I was told that every room was full and they could not accommodate me at that time, as if I were a hotel guest and not an overdue pregnant mother.  I was told to call back at noon, and when I did, I was told to call again at 2p.m.  By the time we were admitted, it was 3:20p.m.  I was put on monitors and discovered that I was having contractions at this time, and was progressing somewhat on my own.  However, the on-call doctor did not see me until after 7p.m., twelve hours after I was supposed to have been induced.  When she reviewed my charts, it was clear she was not familiar with me or my pregnancy and upon reviewing the size of my baby and she suggested a Cesarean section.

I was a fairly open-minded pregnant mother-to-be. While other friends of mine were telling me how they were going to have a fully natural childbirth or a water birth and had written birth plans detailing what they wanted, I wanted to be open to the process and understanding that I hadn’t been through this before, I wanted to be open to the possibilities of intervention.  The only thing I wanted to avoid was a Caesarean section.  I had never had surgery, and until this pregnancy I had never even been admitted to a hospital.  I was determined I was going to have a vaginal birth, and had been assured previously by my doctor that there was no reason I would need a Caesarean section.

What I didn’t understand at the time was that I was on a clock that had been set from the time I was admitted.  This is common in most hospitals in the U.S.  A pregnant woman in labor is put on a clock in which if certain progress is not made in a certain amount of time, labor is augmented.  If this augmentation does not progress things fast enough, or causes maternal or fetal distress, a Cesarean section may occur.  And every hospital is different—most want you to deliver within 24 hours of your water breaking, and some want you to deliver within 36.  Some doctors say you must dilate one centimeter per hour, others are more relaxed.  Around 7:30p.m., the nurse administered Pitocin, the drug that starts or enhances contractions.  And so the minutes began ticking away.

I labored well until the middle of the night when I realized how tired I was and that I needed to sleep—at that point I had been up for almost 20 hours and knew it was going to be much longer.  I hadn’t expected to wait twelve hours before being seen by the doctor and beginning the Pitocin.  I asked for the epidural, and with my lower body numb tried to sleep.  I did not know at the time, as it was not explained to me by the nurse or the anesthesiologist, but the risk of my blood pressure dropping while on the epidural required that my blood pressure be monitored throughout.  So every fifteen minutes the blood pressure gauge would squeeze my upper arm keeping me up.

Every hour the doctor came back, and every hour Pitocin was increased and I would progress a little more, just enough to keep me ahead of the clock and long enough for a new on-call doctor to come on to the scene.  However, as I labored on until the afternoon after being fully dilated, and after pushing for an hour and a half, falling asleep in the middle of contractions, the nurse looked at me and said, “I don’t think you’re going to do this.”

Lying in the crucifix position, exactly twenty-four hours after I had been admitted at 3:20p.m., I was cut open, my son taken from me, and when I did not hear him scream and kept asking questions, they knocked me out with narcotics.  My son AJ ended up in the Special Care Nursery for a few hours, as he was not breathing regularly, and there were a few other concerns.  My husband was almost completely silent as he was not sure what was going on, if his son was fine or if his wife was going to survive.  After an hour I was wheeled into a recovery room all alone, no husband, no son, just a nurse checking in on me.  While I was in recovery I later learned my entire family was able to go into the Special Care nursery and see my son but I was left alone, until I  was finally taken to my postpartum room and they released my son at the same time.  Not only was this “birth” traumatic, frightening and shocking more than normal, after all of that, I ended up with an infection and was back in the hospital a week later, having my incision reopened and later placed on a vacuum machine for a few weeks.  It took me twelve weeks for my incision to heal, when the normal recovery for a C-section is about 2 weeks.

Since AJ’s birth, I have questioned what happened to me in the hospital, not only asking my doctor questions about what went wrong from my point of view, but also talked to friends who had traumatic C-sections and have done some research online.  I viewed the documentary The Business of Being Born (2007), which questions the way the United States has handled birth in the last century, making birth more institutionalized, where birth becomes more of a medical/surgical procedure, rather than a natural process that has been happening to women for as long as human beings have walked this earth.  Produced by Ricki Lake, Business reviews how the hospitals, fueled by insurance companies, attempt to speed up the process of birth artificially as a way of moving women through Labor and Delivery to keep beds open, and how many of these “sped-up” births require Cesarean sections in the end.   The documentary also interviews obstetricians who admit that many of their colleagues will recommend C-sections because it is more convenient for their schedule, at the end of the day or before the weekend begins.  I have read of obstetricians performing them in the late evening before midnight, as it is one less patient during the overnight hours to worry about.

In the months before AJ was born, I had attended childbirth classes and had read several different books on childbirth and some of the medical interventions that might take place, but I had known so little about what would happen once I was admitted to the hospital, how the doctors and nurses would make decisions that I would not understand.  I did not understand the power dynamic that would take place in my role as a patient, how helpless I and my husband would feel in the hospital system, where we were given as little information as possible.

Since I gave birth and recovered from the infection, I have researched labor, delivery, and Caesarean sections.  TheUnited Stateshas the highest Caesarean section rate in the industrialized world.  As of 2006, the C-section rate in the US was 31% of all births, or about one in three.  The risk of a C-section doubles for a first-time mother when a medical induction occurs.  The World Health Organization recommends that countries have a rate of 15% or less, and countries with rates higher than 15% are at greater risk of soaring maternal and fetal death rates.

There are times C-sections are necessary: when the baby is presented breech and attempts to turn the baby fail, when there are risks to the mother’s health such as preeclampsia (high blood pressure), or risks to the baby’s health such as premature placental detachment, or prolapsed cord (when the cord emerges first in the birth canal).  However, there are many more C-sections that are made necessary due to standard medical practice in hospitals that are drawn on artificial conclusions, such as “the clock.”

The convenience of C-sections for doctors and/or hospitals is that C-sections are quick: from the time it takes to prep the room to the time the patient is sewn up and off to the recovery room is less than an hour and a half.  The procedure itself takes about twenty minutes.  Because every woman labors differently, from a few short hours to days, C-sections end the need of doctors and staff to constantly monitor the mother and baby’s health and progress.  In facilities with limited number of beds in a maternity ward, the need to turn over rooms can sometimes compromise the need of time for the mother to be in labor.  Things have to be sped up.  The clock is set.

Time ticks away.  Pitocin is started, increasing the strength and intensity of the contractions.  The contractions increase and the pain and intensity often become too much to bear, so the mother is given an epidural to numb the effects, but also makes it difficult, if not impossible, for the laboring mother to change positions to help the baby move further down the birth canal.  Often the epidural calms the effects of the Pitocin to a point that it slows down the labor, and so Pitocin is increased again.  This cycle continues, with the epidural or other pain-relieving drugs administered at a greater measure to combat the intensity of the contractions, all the while creating an environment in which a baby undergoes great stress.  That stress can manifest itself in drops in heart rates or other vital signs, causing an emergency which requires a C-section to save the life of the child.  And if that were not enough, after twenty-four hours of labor most women are taken in for a C-section anyway because “the clock” has wound down from twenty-four to zero.

There are many risks involved with a C-section, which are rarely explained because there isn’t time, though the patient is given a waiver to sign.  It is up to the patient to ask questions.  I was not informed that the C-section could actually cause great risk to the baby as well as me.  I was not told that one of the outcomes may be that my child would have difficulty breathing, as my son did.  I was not told about the risk of infection, nor was I ever told that one out of every two C-sections has complications.  However, as one doctor friend of mine said to me off the cuff, “No doctor has ever been sued for performing a C-section.”

I believe in the end, my C-section was necessary.  The second on-call doctor during my labor who delivered AJ said the reason for the C-section was my fatigue at the end, not his size.  I had labored for almost 24 hours after being up for 36 hours, and I was utterly exhausted after the Pitocin and the epidural which was supposed to help me relax.  I was falling asleep between pushes.  Once AJ was born it was clear he was having trouble breathing.  The C-section ended up being necessary, and I was left with an infection and a twelve-week recovery.

All in all, as the saying goes, if I only knew then what I know now.  If I had known all the risks of the medical induction process, I would have asked to delay my induction.  At my last ultrasound, there was no cause for concern.  If I had known that my induction would be delayed by twelve hours by the hospital, I would have asked to come back the next morning.  I cried when the doctors began the C-section because I felt set up.  I do believe my C-section was necessary, but I also believe it was entirely preventable.  It ought not to have happened.

Jesus’ death by crucifixion was also necessary, and it should not have happened.  When I prepared for Holy Week the spring after my son’s birth, I found myself wrestling with these questions with a wrench in the stomach feeling: Why did Christ have to die for our sins?  Why did Christ have to die on the cross?

Perhaps I had been reading the story wrong.  I remember going to camp as a youth and being explained in a formulaic way, that Adam’s sin caused God to put Christ on a cross, which equals our salvation.  At the same time I remember at the same camp learning the verse by heart:  For God so loved the world that he sent his only Son, so that whoever believes in him may not perish but have eternal life.  There seemed to be more to it than a simple equation of sending Jesus to die, much more than I could understand at that impressionable age.

It is clear in the Gospels that Jesus is innocent.  Jesus is falsely accused, there is no basis for the accusations, and Pilate even wanted to release him, but for fear of the crowds hands him over.  Jesus has done nothing to deserve death.  Jesus’ death does not appease a wrathful God but rather appeases the bloodthirsty crowd that demands his blood.

Jesus tells a parable during the events of Holy Week about the owner of a vineyard and his tenants (Mark 12:1-9). The landowner has sent servants who have returned beaten and abused.  It is clear that the landowner did not willingly send his son to die—that was not part of the plan of the landowner—but sent him because it was the necessary thing to do, the only thing to do, so that some would listen to him.  God sent Jesus to the world so that the world would learn and have relationship with God in a new way.  God knew, however, that our sinful ways would cause us to kill him.

When Jesus entered Jerusalemon that day, he knew what his end would be.  But the same crowds that would shout “Crucify him!” did not know this; they shouted “Hosanna!”  The same disciples that would flee from him, deny him and even betray him did not know this, they accompanied him.

Joseph was told in a dream to name the child Jesus because he would save his people from their sins.  What we forget so often is how many times Jesus healed people, restored people, and said, “Your sins are forgiven.”  It did not require his death to forgive our sins, but through Jesus’ death on the cross, death was conquered forever.  The paradox is that Jesus’ death was entirely preventable, but entirely necessary.  He was innocent and yet his death subdued the violence brewing between the Romans and the people; it quenched the blood thirst of the crowd that was not satisfied with Barabbas.  We remember that it was only after Jesus was handed over for death that Pilate and Herod became friends.

Jesus died in a system of violence resolved by violence.  The priests wanted him arrested but didn’t want to be responsible for his death, so they handed him over to Pilate.  Pilate didn’t want to be responsible for this innocent man’s death, and in Luke’s Gospel he tries to send him back to Herod, but eventually hands him over to the soldiers to be crucified, to please the crowds.  No one wanted to claim responsibility, but they all wanted him to be killed, to be rid of him.  To bring peace to the crowds, the priests, and the government, an innocent man was killed.

However, before we get to death, there is another birth we speak of in the Christian story.  When Nicodemus came to visit Jesus, he was told that no one could see the kingdom of God without being born from above.  Nicodemus said to him, “How can anyone be born after having grown old?  Can I crawl back into my mother’s womb?”  Jesus told him he had to be born not only of flesh, but of Spirit.  There is another birth that happens, a birth that has no death, and that birth is triumphant because the cross conquers death.

I was exhausted when AJ was born.  I had slept very little in thirty hours and at the end, the Caesarean section was necessary for him to be born.  Despite what I went through and because of the research I’ve done I still believe it was necessary at that point, to give my son life.  But it ought not to have happened.  It was not at all what I expected when I became pregnant or when I prepared for the induction.  In the end, I have my son, born alive and healthy.  There are many women who have uncomplicated pregnancies that end up with Cesarean sections, surgical procedures that ought not to have happened, but because of the medical interventions that occurred, the artificial clock set up of the hospitals, the introduction of Pitocin and epidurals, many of those mothers and babies end up with complications requiring a life-saving Cesarean section, though not without its consequences.

All too often the decision to have a Cesarean section is made as a life-or-death decision.  It has to be made almost right away.  It has to be made to save the life of the child and/or the mother.  The responsibility of saving the life ends up upon the family caught in the process of birth, for ultimately they must sign the paper to give consent, even if not all the risks are shared.  However, had the hospital not put the laboring mother on a clock, had the doctor not decided that the contractions were not fast enough based on insurance policies and not medical necessity, had the anesthesiologist given all the risks to the patient ahead of time, perhaps a number of Cesarean sections would be avoided, and the health risks for both mother and baby could be reduced dramatically.

My hope is that as the World Health Organization puts pressure on the medical institution in the prevent unnecessary cesarean sections, to get off of the artificial clocks placed by insurance companies and hospitals.  Perhaps in the future we will have learned from our past C-sections.  It is time to end the systemic way women and children are put in danger, created by an artificial clock placed by hospitals and insurance companies in a system more concerned about turning over beds than the risks involved.

My hope goes beyond the operating room in Labor and Delivery to the side of the hospital bed.  The entire time I was recovering from surgery in the hospital, I was never seen by a chaplain.  I was never asked the question, “Do you want spiritual support?”  My hope goes beyond the side of the hospital bed into the churches and homes where friends and clergy will ask how you feel, but rarely want to hear what you feel, especially if you have any negative feelings about the birth process.  “Well, your baby is healthy, that is all that matters.”  “Your son is alive, you can thank God for that.”  Those statements, however true, are hollow and empty and allow the caregiver to ignore the feelings of the mother.  And I have barely mentioned what my husband went through in all of this.  My hope is that pastors will learn how to reach out to mothers who have given birth by Cesarean section or who have had other traumatic birth experiences to understand that not every birth results in a happy experience.  My hope is that clergy will recognize the emotional pain and trauma that has occurred for all parents involved, to not only recognize but honor and give validity to the multitude of feelings surrounding birth.

I cannot tell the story of the birth of my son, Anselm John, without telling the story of my C-section.  There are many women who can identify with the experience of Jesus on the cross, when their arms are strapped down in a T, when they are told this must be done to save a life.  They, too, are caught in a system where responsibility is pushed off, where a scapegoat is created, whether it be the mother for not making quick decisions earlier, or even the child, for not descending the birth canal fast enough.

We cannot tell the Christian story without telling of the crucifixion of Jesus.  We cannot tell the story of God’s love for the world without the sending of his only son and his death on the cross, a scapegoat for the system of violence.  I am reminded of what theologian Mark Heim once said: “Jesus’ death saves the world, and it ought not to have happened.”  That is exactly how I feel about my C-section: it saved AJ’s life, and it ought not to have happened.