ICAN 2011: a gathering of drama queens

At the ICAN (International Cesarean Awareness Network) 2011 conference, attendees basked in an atmosphere that emphasized their psychic “scarring” and “mutilation” as inevitable results of C-section. But the truth is precisely the opposite of what ICAN acolytes believe and promote. Their hyperbolic, self-pitying response to C-section is NOT an inevitable result, but rather determined by their cultural beliefs. When it comes to C-section, only natural childbirth advocates are such drama queens.

In the paper Cesarean Birth Outside the Natural Childbirth Culture in Nursing and Health in 1986. Authors Margarete Sandelowski and Rosa Bustamante note that natural childbirth is a philosophy that is not universal, but particular, the product of the NCB subculture. NCB emphasizes process over outcome, and while C-section itself is not particularly emotionally traumatic, it has the power to be traumatic among women schooled in the rhetoric of “natural” childbirth.

Sandelowski and Bustamante describe the philosophical underpinnings of natural childbirth:

There is a new emphasis on cesarean birth as a psychosocial rather than a surgical event. Since the mid-l970s, a small body of literature has emerged describing the negative “soft” outcomes of what is increasingly viewed as the “unkindest cut of all”.

Women experience cesarean birth not only as a somatic wound, but also as a psychic one; women who have cesarean births are literally and figuratively scarred. This psychosomatic wounding of women may impact on infants, fathers, and families.

A notable feature of the literature describing the negative psychosocial consequences of cesarean birth is its emphasis on a particular group of women. Specifically, this literature emphasizes the values, expectations, and experiences of women who belong to what can loosely be termed the “natural childbirth culture”. For women interested in natural childbirth, typically from the middle classes, the experience of birth is an end in itself, and cesarean birth is a devastating interference with nature.

In other words, “natural” childbirth philosophy does not represent universal truths; it is merely a reflection a cultural preoccupation of subset of Western, white, middle class women.

The authors are concerned that “natural” childbirth advocates spend a lot of time studying themselves, as if they are representative of women as a whole. Moreover, the values, expectations and reactions of women outside the charmed circle of NCB advocates (the vast majority of women) are ignored; to listen to the folks at ICAN, those women simply don’t exist.

The study was based on open ended interviews with 50 women who were medically indigent. In contrast to NCB advocates, the interviewees were predominantly African-American, of limited economic means, and of limited educational achievement. When discussing the births, the interviewees were very unlikely to refer to standard NCB tropes like “normal” birth or empowerment.

The women viewed cesarean birth as similar to and different from, as well as better and worse than, vaginal birth… The women described vaginal, or what they called “natural” or “regular” birth in terms of physical features and sensations, normality, and mastery… Only 4 women expressed the normality theme in such comments as: “the way other people have children,” “normal,” “coming out the way it’s supposed to come,” and “more like a woman.” Only 3 women expressed the mastery theme in such remarks as having the baby “by my own body movements” and “having it yourself.”

Not surprisingly, since the women were not particularly concerned with concepts of normality or mastery, their responses to cesarean were very different from those associated with NCB advocates.

… In contrast to published reports of women agonizing over what might have been and blaming themselves for constitutional and emotional flaws, the majority of women accepted the cesarean as fate, and a few managed to display pride in themselves.

The women emphasized the outcomes of birth rather than the process of birth, and frequently rated those outcomes high despite complaints about the process… Childbirth literature, oriented to the middle class model of childbirth, increasingly emphasizes the process of birth as separate from its outcomes. Women suffer when the birth process itself is not as imagined or desired. While failed expectations concerning the birth process is a major theme in the natural childbirth culture, the women in this study had few expectations or clear imaginings concerning birth-giving, and as a consequence were less likely to be disappointed. In fact, neutrality or an “it’s OK” feeling prevailed over intense joy or intense sorrow…

The authors conclude:

Despite its limitations, the study raises key questions about ways of coping and helping in childbirth. The findings suggest a model of childbirth other than the middle class model that emphasizes choice, control, preparation, self-reliance, and nature. Indeed, for the women who equalized vaginal and cesarean birth, natural childbirth is indistinguishable from cesarean birth…

The critical finding of this study is that it is NOT the experience of C-section itself that leads to disappointment, feelings of failure, and psychic “scarring”. Rather it is the expectations encouraged by organizations like ICAN that lead to these negative outcomes.

There is nothing objectively “better” about having a vaginal delivery; only women who have been socialized to believe that vaginal delivery is best are disappointed when the baby is born by C-section instead. There is no objective reason to promote the process of birth as something separate from and equal to, or even more important than, the outcome of birth. Only women who have been socialized to believe that “choice, control, preparation, and self-reliance” are paramount actually believe that those factors are important.

NCB advocates like to say that “trauma is in the eye of the beholder,” but that’s not really true. While feelings themselves are in the eye of the beholder, their appropriateness is not. In many cultures, women are traumatized by the birth of a daughter. There’s nothing inherently wrong with girls, but certain cultures place a tremendous premium on boys and women who fail to produce sons experience tremendous distress. Their distress is real, but that does not make it appropriate. Though these women may feel traumatized by the birth of a daughter, there is nothing inherently traumatic about giving birth to a girl. To observers outside the culture, the solution is NOT to abort girls, but to change the cultural belief that girls are inferior.

Similarly, there’s nothing inherently psychically scarring about having a C-section, but there is something wrong with a subculture that places a tremendous premium on vaginal birth. The distress of the ICAN drama queens is real, but it is inappropriate nonetheless. That’s the genesis of the expression “drama queen.” According to wisegeek.com:

The term “drama queen” … is usually applied to someone … who tends to overreact to seemingly minor incidents. A drama queen often views the world in absolutes, and only has two settings on her emotional control button; zero and ten…

Though ICAN 2011 attendees may feel “mutilated” by a C-section, there is nothing inherently mutilating about a cesarean. Feeling “mutilated” is an overreaction. To observers outside the ICAN subculture, it is obvious that the solution is NOT to encourage overreaction or to demonize C-sections. Rather, the solution lies in addressing the subcultural belief that cesareans are inferior, inherently traumatic and “mutilating.”