There is a misperception that a cesarean section be a quick, manageable, somewhat pain-free way of giving birth. They are often considered by patients, hospitals, and doctors (especially in the US) to be a low-risk, practical alternative to vaginal birth, since c-sections be planned and managed with more certainty. “No one gets sued for doing a c-section,” is a common refrain in the world of obstetrics; obstetricians are some of the medical specialists most likely to be sued, and have to pay for costly malpractice insurance.
C-sections, however, are serious surgeries, and come with their own set of risks. Compared to vaginal delivery, c-sections are more likely to result in blood clots, prolonged recovery, and a heightened risk of developing placenta accreta in subsequent pregnancies, among other potential complications. The seriousness of c-sections are made bracingly apparent by a detailed description of giving birth to twins using the surgical method written by none other than Beyoncé. In the cover story of the new September issue of Vogue, one of the world’s biggest performing artists recounts:
“I was 218 pounds the day I gave birth to Rumi and Sir. I was swollen from toxemia and had been on bed rest for over a month. My health and my babies’ health were in danger, so I had an emergency c-section. We spent many weeks in the NICU. […] I was in survival mode and did not grasp it all until months later. Today I have a connection to any parent who has been through such an experience. After the c-section, my core felt different. It had been major surgery. Some of your organs are shifted temporarily, and in rare cases, removed temporarily during delivery. I am not sure everyone understands that. I needed time to heal, to recover.”
What Beyoncé describes isn’t unusual. Toxemia, more commonly known as preeclampsia, is when a mother’s blood pressure raises to dangerous heights during pregnancy. It occurs in about 5% pregnancies, making it the most common complication of pregnancy. Preeclampsia, especially when combined with bed rest, is associated with heightened risk of blood clots, which can be deadly.
In some cases, of course, c-sections are life-saving and necessary. But because they are often thought of as easy, they are not treated like major surgeries. For example, women who undergo c-sections aren’t always put on anticoagulant medications or other measures (like compression socks and exercise routines) to prevent blood clots after the procedure. That risk of clotting tends to be overlooked as the focus shifts on the wellbeing of the child, often ignoring the mother.
That was the case of another human wonder, Serena Williams, who risked dying after her delivery: In Williams’s case, though she had a history of blood clots, her complaints of shortness of breath after delivery didn’t raise the due alarm, showing the kind of superficial attitude often given to medical treatment of new mothers.
This, like Beyoncé astutely notes, is linked to the common underestimation of how invasive a c-section can be. Women who have had a c-section know that it involves having your insides literally moved around, a long recovery, and can leave the abdomen permanently altered. Many of them report not knowing that was to happen before the surgery, and mothers who deliver through a c-section, on average, don’t have a follow-up visit with their OB-GYN until six weeks after leaving the hospital.
Largely due to the inaccurate framing of c-sections as an easy way out, rather than major surgery, nearly 32% deliveries in the US are through c-sections, over twice the incidence recommended by the World Health Organization. They are now the most common surgical procedure in the US, and one major reason America has the highest maternal mortality rate of all industrialized countries.