by Kathleen McNamara

It’s late March, 1936, on a farm in Wald, Switzerland, a village in the canton of Zürich. A thirty-one-year-old woman, nine months pregnant for the first time, begins to feel a warm pulse of back pain snake around her hips. This is the start of labor: contractions that require silence to bear, amniotic fluid dripping to her ankles. Then silence gives way to the animal desire to crawl into darkness and solitude, the need to vocalize shock wave stabs pulsing through her. The midwife arrives, helps her change positions. She walks, then sits with her legs open in butterfly, then flips onto all fours, etc. Neighbors knock on the door to buy milk or honey. Perhaps they pretend not to notice her. Perhaps her husband or the midwife gives her a shot of gin. Perhaps she believes them when they tell her it is working: encouraging her to push again, try harder. Her heart rate slows, then accelerates. She is sweating, then shivering. It becomes night, then day again, then night again, then day again. Her own mother died like this—in the throes of inexorable pushing. The baby perished too, and she, at six years old, the eldest of five, suddenly motherless, was crowned the woman of the house. She tries to focus the mind: do not think about that now. Do not acknowledge the ghost of your mother, hovering over you. When March ends and it is April, when she is emptied of effort and perhaps even of the belief that she and her child can survive this, they will load her into a horse-drawn buggy and take her to a pink building on the top of the hill that says Hospital. A doctor will give her a mask of ether, drip her with morphine, then cut her open from ribs to pelvis, tracing the linea nigra with his blade. Remove the child. If she ever becomes pregnant again, says the doctor, she will die. But her first and only child, a baby girl, is alive, even healthy. The ether leaves her nauseated for days, the incision drawn down her body excruciates, the morphine and the pain keep her half-asleep, dream-awake, her daughter dangling at her nipple. The baby girl has red hair and is yellow with jaundice. They joke that she resembles a canary.
      This is how my grandmother entered the world. It seemed to me another family story intractably sutured to the past, like the ether they used to subdue her mother. I mean that to say that it did not seem like it could actually matter nearly a century later, in the United States. But the past doesn’t just live in memory—it lives in flesh and bone.
      Investigations conducted by NPR and Propublica over the last year found that a mother giving birth in the United States is about three times as likely to die as a mother giving birth in Britain or Canada. And for every American woman that dies in childbirth, 70 more come terrifyingly close to it.1 I knew this before I went into labor. I read numerous books on the science of pregnancy. I attended every minute of a twelve-hour childbirth class, where an extremely dedicated nurse, nearing retirement, mimed passing a constipated shit on three separate occasions, hoping it would serve as a reference point for all the first-time moms like myself who did not know what to expect when labor began. It is impossible to prepare for the birth of your first child. Still, I did not expect this. Perhaps I inherited my great-grandmother’s pelvis. Or perhaps my son inherited my grandmother’s head circumference and tendency to live with a flair for drama.
       “You tried basically every way there was to have a kid,” said a friend, a few days after my son was born. “Except for dying.”
      That’s true. I did not die. I did not, like too many women, hemorrhage, or find myself in a medically-induced coma weeks after the fact. The anthropological record of the human race assures me of one fact: I lived. My baby lived. Therefore, we are lucky.
      The idea of giving birth “naturally”—that is, unmedicated—is appealing. The use of the word “natural” makes it sound as though you are choosing between organic tomatoes and ones coated with pesticides. I know some of these women—American women who have given birth in their bathtubs. They radiate with positive energy about their experiences. It sounds magical, primordial. “The baby just slipped out!” Though I notice, sheepishly, that these particular women do not work outside the home. One hires a hypnosis coach, another a musician who will craft a labor album of ambient music that will echo off the exquisite Moroccan tiles that cover every inch of her dome-ceilinged bathroom. I am not saying this is true of all American women who give birth at home, only that this is true of the women I know who gave birth at home. They do not, like me, teach five classes a semester at a public university in a state where education funding is so inadequate that the kids in my community have a four-day school week. Their plumbing does not rely on a forty-five-year-old septic tank. When you give birth at home, I wondered, who cleans it up? Still, they had a point: pain is a mental experience. That sounds right. I read books by Ina May Gaskin, America’s most eminent midwife. She writes convincingly about the “true capacities of the female body.” Birth is ancient, she says, and you were built for this. She isn’t wrong. On the other hand, there’s my obstetrician: a tall, older man with white hair who my mother says, after she meets him for five minutes, seems “competent.”
      “You’re not less of a woman if you get an epidural,” says the obstetrician. “Think of it this way: if you got a root canal, would you ever say, ‘No numbing medicine, please?’” How does my son fit into this analogy? Is he the root? A filling? When I was nine, the dentist said I missed needing root canals on my two front teeth by a millimeter, after a summer afternoon at camp when a boy stuck out his foot and tripped me on a racquetball court while we played Butts Up. I can still feel it in slow motion: my face smashing the glossy wood, my brand-new grown-up teeth bouncing into the air. I caught one in my hand. Shock and the penny-taste of blood that for a moment blunted the pain of exposed nerves. Is my son the lacquered floor? Or is he the boy whose name I have forgotten, who thought it amusing to find out if I might trip when he shot his leg in my path as I ran to touch the wall?
      The way pregnancy is typically treated in the United States—the insistence on the hospital, the comparison to a root canal—follows a long and troubling tradition of pathologizing women’s bodies, as though a normal pregnancy is a state of perpetual illness. For too much of the twentieth century, women in America were shackled and drugged to unconsciousness while their babies were pulled from them by episiotomy, a process that became known as “twilight sleep.”
      “Your birth canal is a little narrow,” says my obstetrician, like a mechanic explaining that I probably need new brake pads. My obstetrician has very large hands. “You have a prominent bone here,” he says, as he pushes on my pelvis from inside me. “It should work, as long as you don’t have a ten-pound baby!” He laughs. I do not.
      “If it were me,” he declares, “I’d get the epidural.” But it is not him. It will never be. Of course, he knows this.
      I am not against doctors or hospitals. I am the daughter of two physicians. My parents met in medical school when they were assigned to adjacent cadavers in anatomy lab. In a very literal way, I owe my existence to modern medicine. I am not the only person I know whose parents met standing over human dissection like this. There must be something about staring death in the face that makes you reach for the nearest warm body and say: you. Let’s cheat fate. Get married and procreate. So that flesh of my flesh of my flesh can inherit the earth.
      My mother is a retired anesthesiologist. An anesthesiologist is a guardian of almost death—arbiter of the space in between awareness and absence, between breathing and not breathing. Her voice rises in a panicked way when I tell her I am touring a natural birth center: “Birth is painful,” she says. “Don’t you understand that you can die in childbirth? When things go wrong, they go wrong fast.” I want to protest that according to the Ina May Gaskin school of thought, birth can be serene, pleasurable, even orgasmic, but I don’t because my mother is always sure that she is right. My father, an oncologist, scoffs: “Their selling point is that they’re half a mile from the hospital?” He is incredulous. But it is not their selling point, it is what I tell him to convince him this idea is not crazy. According to the CDC, less than 2% of American babies are born outside of hospitals.2 A disproportionate majority of these babies are born to non-Hispanic white women, like myself, women less likely to suffer pregnancy complications, women who either live too far from a hospital or have the privilege and resources to choose to opt out of this rite of modern American motherhood: the hospital birth. Still, my parents’ voices churn in my head when I tour the mansion–turned–birthing center in the flagship city forty-five minutes from the Arizona mountain community where I live. A rejection of the hospital is a rejection of them. Perhaps that is part of its appeal.
      The midwives at the birth center are friendly and knowledgeable. The place offers acupuncture and yoga and massage. “Hospitals aren’t supposed to be spas,” says my mother. “Hospitals are there to save people’s lives.” In the end, breaking up with my obstetrician, redirecting my insurance coverage, seem like obstacles I am creating for myself without purpose.  At seven months pregnant, I am already experiencing a strange, persistent throbbing on the left side of my lower back.
      I know from years of snorting late-night abuse in Brooklyn bathrooms a decade ago that I am not opposed to drugs. Yes, unmedicated birth can be magical and primordial. It can be something close to a spiritual awakening—a gateway that opens the deepest corners of human experience. But mostly, I want a nap and a glass of Brunello. I want to lace up my hiking boots without losing my breath. I want to wake up in the morning and be able to move my hands without feeling a tingling in my knuckles that makes them pop in and out of alignment when I try to make a fist. I want—desperately, viscerally—to be made uninhabited, and then to hold my son in my arms.
      June in Arizona: the hottest, driest month of the year. Temperatures climb to 115 and higher. At thirty-five weeks pregnant, I wake up one morning and find I can breathe again. My obstetrician says the baby has dropped into my pelvis. I’m at thirty-seven weeks when he begins to suggest an elective induction. My son’s head circumference, he says, is measuring in the 90th percentile. He says it again: your pelvis is narrow. When I ask why not just wait for labor to occur on its own, he points to an NIH-funded study3 suggesting that inducing at thirty-nine weeks reduces the incidence of caesarean delivery. In 2016, at the yearly meeting of the American College of Obstetricians and Gynecologists, two male obstetricians debate this point and come up with the same conclusion: inducing at thirty-nine weeks is better for mother and baby, and reduces the need for a caesarean. “Nature is a terrible obstetrician,”4 one of the doctors is quoted as saying. The implication, again, is clear: women’s bodies require active intervention. Do not assume they can function as intended. Her body is an incubator. It is the doctor’s job to “rescue” the child from the trap of the female body, which is hazardous by design. My doctor seems to agree.
      I arrive at the hospital at four in the afternoon, three days before my son’s due date, on the eve of the summer solstice, having acquiesced to induction. It is the opposite of “natural.” Throughout the night, every four hours, a personable nurse with digging acrylic nails wakes me from shallow sleep and inserts a prostaglandin suppository into my cervix to speed up “ripening.” I am accustomed now to this prodding. Someone is always checking to see if the meat is cooked. I am connected like a marionette to the IV pole. My husband is asleep on a fold-out cot.
      When the astringent sun of the Arizona morning gleams through the windows, we are rolled into the delivery room. The nurse attaches a bag of Pitocin to my IV. It is the synthetic form of the hormone oxytocin, designed to strengthen contractions. I do not know what is the right way to feel, if this is what it’s supposed to be like. When I blink, exhaustion grits like sand in my eyes. Each time another gloved hand reaches into me, I am scraped raw, unpacked and rearranged, my body no more sacred than a suitcase banging through customs.
      “You’re smiling,” says the obstetrician, when he walks into the room, morning fresh. I am not actually smiling—he uses this phrase to mean I am not writhing in pain. “That means it didn’t work.” He sends us home.
      At home, I feel the aching pressure of my son’s cramped movement against the drum of my skin. Returned to my bed, I cry. I try to read, but I am distracted by the pain in my back, and the par-for-the-course humiliation of the night before. I search the Internet for commiserative articles on failed induction. I learn that the “ripening” prostaglandins were likely derived from pig semen. As a vegan, this is doubly difficult to stomach. I feel abused. I blame myself.
      A pregnant woman’s body is in the public domain: at the doctor’s office, at the grocery store, at a restaurant when you have a sip of wine and are shot the side-eye from across the room. A stranger asks how much weight you’ve gained. A coworker wonders from the shape you’re in if you might actually be carrying twins. A doctor wants to hear the story of the tattoo you regret but cannot hide in your hospital-gown condition. To them, this is small talk. To you, this is your life laid bare, cut open, hung on the laundry line to dry.
      Then sometime in the late afternoon, I sit up in bed and feel a pop, as sure and quiet as the memory of a straw puncturing a juice box during a childhood summer on a lakeshore. I stand and a puddle follows me to the bathroom, then back to the bedroom, then to the living room where my husband sits reading.
      “My water broke.”
      He jumps from the couch. He is more surprised than I am. We zip our overnight bags again, and hurry to the car. This is the way it happens in movies.
      I am strapped to a hospital bed: IVs, fetal monitor, a blood-pressure cuff. I can tell the beginning and end of a contraction now. This is labor. The nurse with the digging acrylic nails has returned for her third night shift in a row and attaches a bag to the IV pole above my head. She is herself eight-and-a-half-months pregnant. I can see the blue word scrolling across the attached monitor: Pitocin. I want to know why this is necessary when I’m already in labor.
      “The doctor wants your contractions to be more regular,” she says. Again, the implication is that my body cannot do this on its own. I am not sure if they are right on this point. Within minutes, the contractions, once manageable, become violent. My brain is emptied of all but the sensation of this pain, which appears like white light in the landscape, blinding as salt.
      “I want an epidural,” I say, and before long, the anesthesiologist appears. It is the same anesthesiologist who spoke at the childbirth class where the nurse mimed constipation. “The uterus is the stupidest muscle in the human body,” he said then, when someone asked how an epidural affects labor. “It will keep contracting no matter what.” I could not help but notice that the “stupidest” organ was the one he didn’t have. Never mind that it can build a human being, cell by cell. “I usually ask people if they’re ready to get comfortable,” he said, when he explained what happened during an epidural. It is the preview to the film I am now living and it is exactly what he asks when he walks in the room. The suggestion seems impossible.
      “Please,” I say, which is not quite an answer. The back of my gown is untied. I am told to lean forward on a food tray propped with a pillow, to make space between my vertebrae.
      “First, I’m going to give you the fentanyl. You may feel a little jolt in your leg.” And before he finishes his sentence, an electric shock rages down my thigh, into my heel. My leg kicks involuntarily. Suddenly, the world that was for a time reduced to its bleached-white core returns. I see my husband in the room, looking worried. The anesthesiologist is smiling. It is the same smile I see on the faces of so many doctors, the one that says: “We’ve outsmarted the body. You’re welcome.”
      The relief I feel is in fact immeasurable. “No wonder there’s an opioid epidemic,” I say. The pregnant nurse laughs. They hand me a consent form.
      “Sign this to say it’s okay to do what we just did to you.” I do as I’m told. I have received a combined spinal/epidural. The anesthesiologist continues: “Your pain must have been at about a ten.” It is probably true, though in my now placid state, it is possible for me to imagine worse. What comes to mind is the man from 127 Hours canyoneering in Utah, forced to amputate his own arm with a pocket knife after getting caught under a boulder. “And how do you feel now?”
      “I feel nothing,” I say, and it is both true and not true, in the way that “nothing” is a substitute for “everything.” But my body is numb.
      He hands me a button connected to the IV tower, which is covered with so many tangled tubes and bags (catheter, antibiotics, Pitocin, anesthetics) that it reminds me of Christmas lights pulled out of storage. “Press this to control your pain.”
      I’m at four centimeters.
       It is dark in the room when a new nurse appears. She has sure hands, silvery hair in a long braid, and seems then like an angel from the Ina May Gaskin school of midwifery. Babies, when left to be born the way nature intended, have long been trained by evolution to arrive in the middle of the night, when it is easier to hide from predators, when the clan is sure to have returned to the cave from the day’s hunting and gathering and will be available to usher this new life into the world.5 At this moment, I trust this nurse more than anyone. I am sure, in my delirium, that she has done this very thing for me in a past life, that we have danced this dance before, that we were somehow destined to replay it now.
      “The doctor says we are working with a big head and maybe a small pelvis, so what we’re going to do is move you.” Well into the night, this is what we do, she moves my numb body from side to side, birthing ball between my legs. We are trying to help my son descend.
      Around midnight, I am checked again. “Good job, mama,” she says, “you made it to ten centimeters.” I can tell from her voice that she is as surprised as I am. It has happened as though in a dream.
      A younger nurse joins us and follows a protocol to prepare for delivery. She is happy for me. “Looks like this baby will be born the right way,” she says, and when the pushing starts, I am optimistic. This is what I have been waiting for: the final stage, the part where I believe that physical strength and a willingness to endure will matter. These are capacities I have. My husband says that when I push, my entire body shakes. When I’m not pushing, I vomit water into blue bags.
      “You have good control of your legs,” says the younger nurse, and so we try every position that we can. I am on all fours, opened up to the world. I have no use for modesty or dignity. Sharp pain radiates from my back. I am trying not to push the button that will deliver an extra dose of medication through the needle in my spine, because I’m afraid this will mean I will lose this muscular control I have just been praised for and fall on jelly limbs into the pillow. It is already unclear to me when a contraction is happening because the throbbing I feel surges as constant as an electric current.
      After three hours of this, the obstetrician arrives. He checks me, then goes somewhere to sleep.
      “The doctors prefer to join us when the work is over,” says the nurse. “They just want to catch the baby when he falls out.” I am still pushing, then vomiting, then pushing again.
      “You’re doing great,” say my husband and the nurses, over and over they search for words that sound meaningless to me. I am irritated by their calm voices. I do not believe them.
      “Is it working?” I ask. They all promise me it is but I am sure that it is not.
      “He’s moved this much,” says the silver-haired nurse, holding her fingers up to show what cannot be more than an inch. The pain in my side is so harrowing that in between pushes, I need my husband to rotate my left leg in wide circles, trying to relieve it. When he lets go it flops on the bed like a dead fish.
      “The baby is pressing on a nerve in there,” says the nurse. I am losing the will to push. It’s one thing to understand, intellectually, that labor and childbirth can sometimes result in maternal and infant death. This fact is a permanent feature of the human experience. In Aztec mythology, the spirits of women who died in childbirth were considered divine—known as the Cihuateteo—and were revered as warriors who had died in battle. But it’s entirely different to understand this fact on a physical, spiritual, and psychosomatic level, when you seem to enter a state of acceptance of the in-between nature of your life. You are caught in a tunnel, in between the light and the world, pulled back and forth. The voice inside asks: where to?
      I’ve been pushing more than six hours when the obstetrician returns to the room. He reaches into me.
      “I can’t even feel ears,” he says. “I can push him back up easily,” and he does so, and I want to scream at him for the work he has just undone, but I cannot. I have nothing left. “This is what I feared,” he says. And when he tells me I need an emergency c-section, the outcome I was trying hardest to avoid, I say yes, please, anything to wake up from this dream.
      “We do the cut low, so if you’re a bikini woman, you can keep being a bikini woman,” says the obstetrician. The suggestion that looking flawless in a bikini is what’s important to me at this moment or at any moment is ludicrous, as is the implication that you shouldn’t wear bikinis if you have a visible scar. It’s repeated minutes later by the anesthesiologist. They are trying to be reassuring, but none of the female nurses who are rushing around prepping me for surgery repeat this assurance, and what I feel is the same clawing male gaze I felt at thirteen, and at sixteen, and at nineteen, and at twenty-two, etc., etc., and what strikes me is that even in your thirties, your body expanded by pregnancy, then twisted in agony, you do not escape the assumption that what matters in the end is the way men assess and evaluate your body, eventually deciding it’s time to cut you open. But I don’t say that, because my life, and my son’s life, are in the hands of these men, and I too play my part. I nod; I say please and thank you; in this suffering, I still work at being pleasant and polite. These are the male saviors that populate our films, our advertising, our popular fictions: saving the virgins and mothers, and punishing the whores. In this moment, all I want is to be one of the saved.
      “I’ve run a marathon,” I say, still trying to prove something. “I’ve backpacked the Grand Canyon three times. It wasn’t as hard as this. Can we turn the epidural back on now?”
      “It’s been on the whole time,” says a nurse. This seems impossible to believe.
      As we are wheeled into the operating room, I think of my mother’s mother’s mother, who almost died like this, and her mother, who did. I want to live, but in this state, I realize, I would accept death. I can see perfectly well now how it might happen. I am splayed on the table as if on a cross. More nurses and a midwife appear. They are playing seventies rock in the sterile room, a fact that my mother complains is true of eighty percent of American operating rooms. All over the country, every day, men and women are being cut open to the sounds of Foreigner and Bad Company. During the surgery, the anesthesiologist talks to me in a calm, conversational voice. He lifts my oxygen mask and cleans my face when I puke on my shoulder. I am sure the whole time that I am about to fall off the table, though he assures me that I am not. I feel my body move as if floating on a wave when they try to extract my son.
      “Jesus,” says the obstetrician, more than once, “he’s really stuck; push harder,” and the midwife, her hands inside me, braces her body weight against the circle of fetal hair that will not budge. My son is squeezed in there, sunny side up, and at an angle. When “Take it Easy” by the Eagles starts playing, I can see my husband start to laugh behind his surgical mask, and when we hear “I’m standing on the corner in Winslow, Arizona,” so do I. It is Arizona’s favorite song and to hear it now feels like some magnificently orchestrated joke. In northern Arizona, the towns have finite borders and empty frontiers between them. On the map, they look as distant as stars in a far-flung constellation. Winslow, built on the Little Colorado River, with a view of the Painted Desert and the sacred Hopi Mesas, is not far from here by those standards. Since they built Interstate 40 to replace Route 66 as the main thoroughfare of the West, bypassing the center of town, the entire modern economy of Winslow is dependent on this one Eagles lyric; the biggest attraction is to “stand on the corner” with a statue of front man Glenn Frey, and this is the verse that is playing when they lift my blood-covered son over the paper veil, his arms in the air. My laugh turns to weeping.
      He doesn’t cry at first; he is out of it. He did not want to let go and some of his skin has been ripped from his hand and arm in the extraction process. He is seven pounds, two ounces, and long and skinny. We are back in the recovery room when I hear a nurse say across the room that he endured a traumatic birth. I want to hold my son. I am not sure how much time passes before I do. He is perfect.
      Four million babies are born every year in the United States, and one third of these are delivered by c-section, which means that every year, there are over a million American women who are not only caring for newborns (sleep-deprived, sticky with breast milk, wearing a light spritz of eau d’infant shit), but who are doing so after having their midsections sliced open—first skin, then fat, then rectus sheath (the coating outside your abdominal muscles), then the muscles themselves, split along the grain like wood, then two layers of peritoneum, a membrane that supports the vessels and nerves of your abdominal organs, then finally the thick walls of the uterus. During this method of delivery, after the child is extracted, your uterus is exteriorized from your body and brought into the sterile, glowing room with your fallopian tubes attached, so it can be sewn back together. In the course of this process, painful gas becomes trapped inside your body. It’s over in twenty minutes. Welcome to motherhood. You’ve got a baby and seven layers of stitches.
      The next few days in the hospital are the most painful of my life, despite the IVs of painkillers, the mega-Motrin and the Percocet. Mere hours pass before the anesthesia has worn off and a nurse is ramming her hands down on my stomach, trying to force the uterus to shrink. I cannot prevent the plea that escapes my lips. I beg her to stop, and she says “one more.” I am sure that I sprained my shoulder while vomiting on the operating table but they tell me it is gas trapped in muscle. My son wants only to be held, but even his tiny frame against the incision is unbearable. My blood soaks the hospital sheets, the gown. It drips down my legs in viscous slow motion.
      When my parents arrive, I start to weep. My dad’s eyes are watering, and at first I am convinced that he too is crying for the pain I am in, and for the joy of seeing his grandson for the first time. I am touched by this display of sensitivity. But soon it is clear that he is distracted by these tears, and not immediately interested in the details of my ordeal, and when I ask him if he’s okay, he says he has sunscreen in his eyes.
      My father and my husband escape to the main floor of the hospital, looking for eyedrops and food.
      “The hardest part,” says my husband, “was watching her in pain.”
      “Well, that’s just the way it is,” says my father. I love my father, but when I hear this, a feeling of invisibility comes over me, as though I am stuck in a dream mouthing a silent scream, and I realize that my father and my obstetrician, by virtue of their bodies, the privilege implicit in their bodies, and their blindness to that privilege, are completely removed from my condition. They would probably make excellent golfing buddies.
      During my son’s second night of life, I wake up in the dark, shaking with cold. Surgery has left me more swollen with fluids than I ever was in pregnancy. Compression sleeves pump my calves like engine pistons day and night, trying to prevent blood clots. When a nurse answers the call button, it is the silver-haired angel of labor, returned for another night shift. I have a fever; my blood pressure has shot up fifty points. Every time I move, it is as though I am being cut open again, then seared shut with a cattle brand. I cry at the familiarity of this stranger’s face. She covers me with a warm blanket as I shiver, and I wonder then if I am blood-poisoned, if I will be one of those who die after the fact. Stories of postpartum hemorrhage, coma, sepsis grip my exhaustion. I steel myself for every possibility.
      “It’s not that big a deal,” says my mother, a week later, when I am discharged from the hospital but still cannot walk more than a few minutes at a time. My mother can see nothing but her own joy at becoming a grandparent. Perhaps when your entire adult working life has been spent in a room where the internal organs of a stranger are visible to you, it does not faze you much when your daughter is some other doctor’s patient on a sterile table. But it is more surgery than she or my father have ever endured.
      My mother does not hesitate to tell me what would have become of me and my son had we lived a hundred and fifty years ago: “Dead. You’d both be dead.”
      I am sitting here, at the computer, my five-week-old son asleep on my chest, when I read a headline from USA Today: Hospitals know how to protect mothers. They just aren’t doing it. “Women are left to bleed until their organs shut down. Their high blood pressure goes untreated until they suffer strokes. They die of preventable blood clots and untreated infections.”6 Despite the generous nursing attention I received, this does not surprise me. My insurance has been billed more than fifty thousand dollars for my maternity care and the hospital stay. A c-section is both a major abdominal surgery and the most common surgery in the United States. How did we become this? The caesarian rate at The Farm—Ina May Gaskin’s midwifery center in Tennessee—is 1.4% over a span of forty years. The Farm also has a 96.8% rate of successful vaginal births after caesarian section, something the hospital where my son was born does not even try. What would Ina May Gaskin have done about my small pelvis and my son’s large head? Perhaps the practiced hands of a skilled midwife could have shifted his position before he dropped. Perhaps, without the inducing power of the pig semen suppository, my son would have waited, squirming into a better position before signaling to my body that he was ready—the “right” way. Or perhaps not. Perhaps, as the obstetrician said, “this kid was never coming out.” By his estimate, I would have been like my mother’s mother’s mother: pushing for a week, then told to never again have children. Or, worse: like her mother, dead in the process. Nature, says the man in the white coat, is a terrible obstetrician. And being cut open, dug into, rearranged, sewn up, says my mother, is not that big a deal. This is the wisdom we have.
      It is commonly believed that the etymological origin of the term “caesarian section” is due to the fact that Julius Caesar was believed to have been born this way. But at the time, a hundred years before Christ, this type of delivery was reserved only for women who had already died in childbirth, in an attempt to save the baby, as Roman Law would not allow mothers to be buried pregnant. We know that Julius Caesar’s mother, Aurelia Cotta, lived a long and fruitful life, so it is unlikely that he is the progenitor of the term. The more likely origin of both the word and the dictator’s name is the Latin caedere, which means “to cut” or “to kill.” Sui caedere is the root of the word “suicide.”
      The rope of scar tissue between my hips now alternates between itching and complete frozen numbness—flesh that never quite awoke from anesthesia. It is like having a new joint in my body. This is a small price to pay for a healthy child—but only if that cost is non-negotiable. I am writing this now to try to excavate some thread of truth: was my life saved by medicine or imperiled by it? I know what my obstetrician would say, what my mother and father would say. They are like lumberjacks hacking down trees to create a path through a dense forest. What troubles me, weeks and then months after the fact, is that in every forest untouched by man, there is still a trail that wildlife use, carved into the earth over millions of years of evolution. Could my son and I not find it? Was no one willing to show us the way? Or did we blindly follow whatever road was put before us, like livestock on the assembly line, until we reached the edge of a cliff, and fell into the large hands of a white-haired doctor, who smiled as he caught us? You’re welcome, says the man in the white coat, you cheated death.

1 Montagne, Renee. “For Every Woman Who Dies In Childbirth In The U.S., 70 More Come Close.” NPR, May 10, 2018,
2 “Trends in Out-of-Hospital Births in the United States, 1990–2012.”  Centers for Disease Control and Prevention, March 4, 2014,
3 “Induced Labor after 39 Weeks in Healthy Women May Reduce Need for C Section.” National Institutes of Health, February 1, 2018,
4 Margulies, Megan. “Should Pregnant Women Be Induced at 39 Weeks?” The Washington Post, June 27, 2016,
5 Sun, Lena H. “What Time of Day Are Most U.S. Babies Born?” The Washington Post, WP Company, 8 May 2015,
6 Young, Allison. “Hospitals Know How to Protect Mothers. They Just Aren’t Doing It.” USA Today, July 27, 2018,

Kathleen McNamara teaches writing at Arizona State University, where she serves as an Associate Fiction Editor at Hayden’s Ferry Review. Her recent work has appeared in The Pinch; Sierra Nevada Review; The Carolina Quarterly, where it won the 2018 short fiction contest; and elsewhere, and is forthcoming in Nimrod, where she was selected as a finalist for the Katherine Anne Porter Prize in Fiction. She lives near Sedona with her husband and their son, and is at work on a novel that explores the lingering effects of nuclear weapons testing at the Nevada Proving Grounds.