The prologue to Invisible Labor tells the story of author Rachel Somerstein’s cesarean section. After her labor stalled, Somerstein was asked to consent to a surgical birth after more than a whole day in labor. She agreed and the procedure began. From there, the situation deteriorated. Somerstein had a faulty epidural and she could feel the entire surgery. When she told the medical team what was happening, no one stopped operating.
Fortunately, her baby was born healthy and Somerstein (mostly) recovered from her ordeal. Yet, the consequences of her surgery and how it was performed lasted years. This is one example of what Somerstein calls “the cascade of consequences.” Distinct from the “cascade of interventions” that refers to the creep of medical procedures during birth often maligned by the so-called natural-birth movement, Somerstein’s argument focuses on the relationship between the cesarean procedure and one’s post-birth future. The book’s chapters trace how experiencing a cesarean section can influence future birthing choices, even limiting how many children one has. Some obstetricians refuse a trial of labor for a vaginal birth after a C-Section and will not perform more than a certain number of them, thereby constraining how many children an individual can have. Placenta problems, some life threatening, become more likely after surgical birth. Many birthing people experience postpartum mood disorders. Others never recover from abuse experienced during the procedure. Some doubt whether a cesarean was necessary or realize later they were pressured to consent.
For many, including Somerstein, one central consequence pervades the others: self-blame, a common outcome of births gone unexpected or wrong. This impulse to hold oneself responsible for any divergence from the ever-elusive ideal birth corresponds with the central thesis of Invisible Labor: that individuals are forced to bear responsibility for hard births, including cesarean births, due to a corporate medical system that punishes people rather than generates collective care, safety, and accountability. The shame comes from many sides and can land irrespective of one’s role in the birth process: providers often blame birthing people for their poor health outcomes but are themselves sometimes unfairly blamed for medical emergencies; self-congratulating peers whose insistence they “did pregnancy right” harms others and keeps their own doubts at bay; and one’s own self-blame that gives them a false sense of control over a very unpredictable process.
While the book is billed as a history of the C-section, readers will learn a thorough history of obstetric violence told through the vehicle of the procedure. Somerstein tells that story using a personal lens, which makes sense. So many people experience rough births by cesarean, but remain feeling alone in their trauma and shame. History highlights the cesarean’s social, religious, and economic history of violence. Physicians practiced the early versions of the modern cesarean procedure on enslaved women and disabled women during the nineteenth and twentieth centuries. Legends of Julius Caesar notwithstanding, the C-Section was not a regular part of obstetric care until the early twentieth century. Before that time, they were not designed with the health of the birthing person in mind. In the sixteenth and seventeenth centuries, the Catholic and Protestant churches said surgeries were to be performed after the death of a birthing woman in an attempt to save the life of the baby. For many years, it was performed alongside a hysterectomy, a procedure that saved many lives (before that, many people had hemorrhaged and died because surgeons did not yet close the uterine incision), but precluded the possibility of future biological children.
In Somerstein’s story of violence, the villain is capitalism. More and more hospitals do not offer obstetric care because of the lack of profit; Black women continue to die of pregnancy related illness under racialized profit models in which they receive less prenatal care and experience higher rates of neglect and abuse; postpartum depression and anxiety is little-understood and under-treated because such research and care take time and money that is hard to find.
The solutions Somerstein proposes do not fit easily within late capitalist insurance, and for-profit hospital models. Midwifery care, which reports better outcomes overall, takes time and hospitals prefer the perceived objectivity of machines over the bodily knowledge of the patient or responsive care from a (live) birth attendant. Labor (often) takes a long time. Relationships between patients and providers take time to build.
The book and its bibliography will be useful for academics across many fields. Strong chapters on pain, postpartum mood disorders, and vaginal births after cesarean, the business of healthcare, and the history and future of birth technologies. Somerstein situates the book in neoliberal post-feminism, engages the work of reproductive justice activists and scholars, and interviews many medical doctors and public health researchers studying the problems of obstetric violence. Somerstein’s candor about the built-in pain of birth (some would call it an inherently violent process) evokes the radical feminist movement’s objection to natural birth due to fundamental inequities. Only certain bodies can give birth; beyond the physical risks, those bodies are forced to go through one of the few gauntlets of care available.
Birth hurts. That has remained true throughout the ancient period, slavery, and into Late Capitalism, even with much better pain management. Certain people suffer more. Pregnancy and birth usually turn out OK; too often, they do not. Somerstein acknowledges that these facts defy easy narratives and instead asks us to sit with these realities. Perhaps by sitting with them, we can find more creative answers.
Reference: Somerstein, Rachel. Invisible Labor: The Untold Story of the Cesarean Section (New York: HarperCollins, 2024).
Image credits: The Metropolitan Museum of Art. “Sheet.” (1800-1900) Sage Fund, 1928.