The Scarlet Letter C

If you have had a cesarean, you have been branded with a scarlet letter C.


It doesn’t matter what the reason for your cesarean was. It doesn’t matter if you had a cesarean (or even two) due to a true life-or-death emergency. It doesn’t matter if your cesarean resulted from a failed induction that triggered fetal distress. It doesn’t matter if your cesarean was due to your doctor not wanting to miss his golf game.

The reason does not matter.

If you have had a cesarean, you have been branded with a scarlet C across your forehead for any and all subsequent births. You are no longer a patient evaluating her options. You are now a liability, a risk and a nuissance. The majority of midwives cannot take you as a patient due to legal restrictions on their licenses, most of these restrictions being based on outdated research and information. While the majority of midwives can’t take you, even if they wanted to, the majority of obstetricians won’t take you unless you agree to go under the knife once again. If by some “luck” (and I say that loosely) you find an obstetrician willing to take you and “allow” you to attempt a trial of labor, you will likely be given a laundry list of conditions you must meet in order for them to support you in your attempt at a vaginal delivery. Conditions such as going into labor naturally before 38 weeks, agreeing to an epidural immediately upon admission to the hospital, laboring no longer than x amount of hours, a baby weighing no more than x pounds as determined by ultrasound (which is highly inaccurate), and many other ridiculous conditions, all of which set women up to fail.

Don’t get me wrong. There are physicians out there who support a woman’s decisions relating to her birth, regardless of her surgical history, however, those physicians are few and far between and are often faced with professional repercussions and absurd hospital politics should they choose to go against hospital policies in their support of patient autonomy. I’ve seen it happen and it is an ugly, ugly battle that often ends in a truly honorable physician choosing to no longer care for these pregnant women.

Only in America would hospital policy be of more importance than doing the right thing.

Only in America would hospital policy be of more importance than respecting the educated and informed decisions of a patient.

Midwifery, for most of these scarlet-lettered mothers is not an option. In most regions, midwives are not legally able to attend the birth of a woman who has had a prior cesarean. Midwives who do so, are subject to losing their license to practice and may even face criminal charges. While lay midwives may be willing to attend the birth of a woman who has had a prior cesarean, obtaining these services can be tricky and costly, as a lay midwife would not likely be covered by insurance. Some women are fortunate enough to live in states that allows midwifery care for women with a prior cesarean, while this is a step in the right direction, these women are subject to a long list of conditions they must meet in order to qualify as a “good candidate” for midwifery care, the definition varying by state and often not aligned with other current criteria.

Because midwifery is, for the most part, not an option for these scarlet-lettered women, the services of an obstetrician are often sought. Unfortunately, the majority of obstetricians are not well-educated on vaginal birth after cesarean, and even among those that are, most are unwilling to support a woman wholly in their choice because it is a sacrifice on their part. A VBAC is a tremendous sacrifice on the part of the physician and takes a toll on not only the physician but his family and personal time, often due to hospital policies, insurance policies and even laws requiring specific presence and proximity when a patient is undergoing a trial of labor. These physicians are forced to spend more time (much of which, the necessity could be debated) and energy on a VBAC, and are paid less for a successful VBAC than a scheduled cesarean. Even the best, most committed and supportive physician would burn out given enough time. Unfortunately, the vast majority of physicians do not want to be bothered with this level of commitment and simply won’t take a VBAC patient. Some physicians might take a VBAC patient, but on their own conditions (see above) and these conditions often leave women high and dry, with little chance of success and no true support. They are telling you, “I will let you have a VBAC but only if you make it easy for me.” This does not help the large majority of these scarlet-lettered women.

So what options are left for you, Ms. Prynne? What can you do besides sit down, shut up and take what our government and medical establishments deem you worthy of?

Beyond midwifery (or the lack of) and a (likely unsupportive) obstetrician, you are left with one final option; go it alone. Give birth unassisted, without a midwife or physician, in your own home, with just your own knowledge and capabilities. This is, for most women, a very frightening idea. What is even more frightening, is that this is often the best option. Unassisted birth is an amazing thing, but what is not amazing, is that we live in a society where that scarlet letter C often leaves women with unassisted birth as their only option to avoid an unnecessary cesarean. Yet, despite being stuck between a rock and a hard place with this decision, women are still villified for utilizing this option, being told they are reckless, endangering their baby and in some extreme cases, have even been investigated by social services and had their children removed from their custody because they made the only decision they felt they had. Because they made the decision that they felt was ultimately, in their and their baby’s best interest.

People who argue against unassisted birth will often state that they are “all for homebirth being safe and accessible for all women,” but this sentiment has abslutely no value to those women who need those options NOW. This sentiment, while an admirable goal for our society, does not make the situation any better. It does not magically give these women who are due next week, next month or even next year the options that they deserve to have. This sentiment does quite the opposite, condemning the very difficult choices that have been made by these scarlet lettered women who refuse to sit down, shut up and take the scraps that have been thrown to them. These women have been denied a choice, denied options, and now, denied support from the very communities and groups of women that were established for just that purpose.

And that is the problem.

We live in a society where support, and even respect for a patient’s autonomy is conditional. It comes with stipulations. If you bear that scarlet letter C, your entire experience and how you will be treated is held together by thousands of tiny threads; each one a condition you are expected to meet, not only by care providers, but from your family, your friends, your neighbors, your peers, even the cashier at the grocery store. And if even one of those threads is missing, then you are reckless, selfish and ignorant. You are no longer worthy of support. Your thoughts, your opinions and your desires are no longer valid, even among others like you, bearing that scarlet letter C. You are wrong for wanting better. You are wrong for standing up for yourself and your baby beyond what is deemed “acceptable.” You are wrong.

And you should just sit back, shut up, take what you are given and be grateful for it.


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I am Samantha. I am twenty years old, and have a gorgeous little girl, and a baby boy who I am expecting in May. I am married to my best friend in the entire world. I am a full time student, and am torn between pursuing a career as a midwife, or going to medical school to become an obstetrician.

2 thoughts on “The Scarlet Letter C”

  1. Interesting post. I had a lecture on VBAC in my obs & gynae placement and from my understanding, women are often given the opportunity to opt for it after their first and even second c-section. Also, if a woman decides to give birth at home, I’ve been told that a midwife has to assist her, by law, even if it goes against all recommendations.

    1. I don’t know about the UK, but in the United States, unassisted birth is NOT illegal anywhere and there are no requirements in that regard. The government cannot FORCE you to pay for care you do not wish to receive. I know the UK doesn’t have the financial setup that America does when it comes to maternity care, so that may make it different. In the majority of states, a VBAC patient cannot obtain midwifery care at all. It just isn’t allowed, and usually, for outdated and ridiculous reasons. Alaska, for example, has not changed midwifery laws since the 70’s, despite women with one of two prior cesareans being classed as “good candidates for a VBAC” by the American College of Obstetricians and Gynecologists in July of 2010. Some states allow midwifery care for a VBAC, but often with restrictions, and in some states, they even require a sign-off from an OB. Unfortunately, most OBs are NOT VBAC-friendly. They just don’t like them. They’re longer. They require more attention. They get paid substantially less for them. Why would they like them when they could just schedule a cesarean instead? They directly benefit in both time and money when it comes to scheduling cesareans instead of promoting VBAC.

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