Today’s review is about INVISIBLE LABOR by Rachel Somerstein. After the author had a traumatic and unplanned cesarean section, she embarked on a journey to understand more about the procedure’s history. It is part memoir, but also dives deep into the long-ranging effects the c-section has on women’s lives.
Author: Rachel Somerstein
Series: None
Age Category: Adult
Publisher: Ecco Press
Publish Date: June 4, 2024
Print Length: 336
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Invisible Labor Synopsis
Synopsis
An incisive yet personal look at the science and history of the most common surgery performed in America–the cesarean section–and an exposé on the disturbing state of maternal medical care
When Rachel Somerstein had an unplanned C-section with her first child, the experience was anything but “routine.” A series of errors by her clinicians led to a real-life nightmare: surgery without anesthesia. The ensuing mental and physical complications left her traumatized and searching for answers about how things could have gone so wrong.
In the United States, one in three babies is born via C-section, a rate that has grown exponentially over the past fifty years. And while in most cases the procedure is safe, it is not without significant, sometimes life-changing consequences, many of which affect people of color disproportionately. With C-sections all but invisible in popular culture and pregnancy guides, new mothers are often left to navigate these obstacles on their own.
Somerstein weaves personal narrative and investigative journalism with medical, social, and cultural history to reveal the operation’s surprising evolution, from its early practice on enslaved women to its excessive promotion by modern medical practitioners. She uncovers the current-day failures of the medical system, showing how pregnant women’s agency is regularly disregarded by providers who, motivated by fear of litigation or a hospital’s commitment to efficiency, make far-reaching and deeply personal decisions on behalf of their patients. She also examines what prevailing maternal and medical attitudes toward C-sections tell us about American culture.
Invisible Labor lifts the veil on C-sections so that people can make choices about pregnancy and surgical birth with greater knowledge of the risks, benefits, and alternatives, with information on topics including:
With deep feeling and authority, Somerstein offers support to others who have had difficult or traumatic birth experiences, as well as hope for new forms of reproductive justice.
Invisible Labor Review
I received a free, digital, advanced reading copy of this book from the publisher via NetGalley. My review is my own and reflects my honest opinion about this book.
INVISIBLE LABOR by Rachel Somerstein peels back the centuries-old layers of misogyny and racism behind the business of childbirth and, specifically, cesarean sections (C-sections). After enduring her own traumatic and emergency C-section, Somerstein, as a way to cope and understand, decided to investigate the history of C-sections. This effort inevitably grew in scope to include intersectionality of gender and race and how that affects the likelihood of birthing via C-section.
I want to start off by saying my review of this book cannot do it justice. Somerstein did a wonderful job researching and distilling all the information into ~330 pages, including references. So I direct any reader to this book for a fuller discourse on any topics I mention herein. That said, this book is, I feel, so important to read by anyone in the U.S. considering childbirth.
First, let’s start with birth trauma as a whole. It comes as no surprise that many people who give birth don’t have their pain or emotional welfare taken seriously. There is “the cultural expectation that a mother’s pain should be negated by that triumphant moment of union with her baby” (Loc 1186). From the time the pregnant person begins to report to the doctor for monitoring their care is overwhelmingly about the fetus rather than the birthing parent. (And, in general, physicians often dismiss women’s pain.) I shockingly learned that hundreds of years ago this was not the case. In fact, the health of the mother often came first. If the fetus threatened the mother’s health, the physicians prioritized the mother’s life. The methods weren’t pretty and because of that the Catholic Church essentially put a moratorium on those procedures. This encouraged physicians to come up with other methods, such as postmortem or forced C-sections, to “save the souls of the fetuses and not the lives of the mothers” (Loc 1221).
INVISIBLE LABOR also covers the topic of having a C-section essentially changes the trajectory of one’s options for subsequent births. Again, this was news to me. The medical community advises any future births after a C-section also occur via the same method. This is because apparently the incision area is a weak point in the uterus. So doctors want to prevent the very small chance of uterine rupture during labor, which is an emergency situation. Because of that, today doctors often aren’t trained on vaginal birth after cesarean (VBAC). Thus, it is incredibly difficult for a pregnant person to find a facility that allows VBACs. This essentially forces them to deliver via C-section even if they want to birth vaginally. The same goes for twin births or the lack of training these days on how to turn a baby in utero to facilitate vaginal births. It seems the default is C-section to spare the hospital a fetal death.
This topic also ties in with the institutionalization of medical care in the U.S. It’s basically a business and the goal is to bring in money. C-sections cost more and therefore hospitals receive more money from insurance companies. Never mind that it’s major surgery and electronic fetal monitoring (EFM) is unreliable and can result in unnecessary C-sections. (There’s another eye-opening chapter on EFM.) The C-section rate in the U.S. is shockingly high–~25-33% of births–and is likely due to several factors. Commodification is one of them, as is race and reliance on technology.
Somerstein also covers how the men infiltrated the midwifery space and how this has far-reaching effects on the level of care pregnant people received. It reduced childbirth to a medical procedure rather than an intimate and supportive community and family event. Care became more about what an instrument could detect rather than what knowledge could impart. It reduced provider-patient connection, which is apparently so important for building trust and emotional support. Moreover, it robbed minorities of their primary way of giving birth, introducing racism into a routine life event. (Somerstein dives deeply into this intersectionality.)
There is so much more I could include in this book review-turned-report, but I’ll stop here. If any of the above shocks or interest you, definitely pick up INVISIBLE LABOR. My only quibble is that the delivery of information veers a little more toward a journalistic style. At the same time, it’s important to cover all sides of this topic. So, that kind of analysis and writing style is par for the course. That said, it’s more digestible read one or two chapters per day. Overall, I’m very glad I read this. I recommend it to anyone interested in women’s healthcare and the intersectionality of that with race and commodification of birth.
Rating: 4.25
Content warnings: misogyny, racism, medical trauma
Reading format: Kindle e-book
If you liked this book, you may also enjoy THE BIG FREEZE by Natalie Lampert or JANE AGAINST THE WORLD by Karen Blumenthal.
This sounds both fascinating and shocking. I’m grateful that I never had to have a C-section, but I have friends who have, and it’s apparently a traumatic experience with a long healing time. I’m already angry about it and I haven’t even read the book!
It *is* both fascinating and shocking. I learned a lot reading this book. If I didn’t have to much else to read I’d likely reread it. It’s infuriating that the fact that a c-section is a major surgery has been downplayed because they’re so common now, but just because something is common doesn’t mean it’s necessarily the best choice (given the circumstance/context of one’s birthing situation).
I was talking about the increase of C-section births the other day with a woman who was preparing to give birth. She was upset because her reading had led her to understand that doctors were opting to do a bunch of medically unnecessary C-sections because it’s easier for them. According to her, they like to schedule the births now instead of waiting for it to occur naturally. She was pretty upset about it because C-sections can have negative effects on the mother and baby and, if it’s not medically needed, she didn’t want one.
I guess if you don’t know enough about it, though, you don’t know to advocate for yourself and just trust them when they tell you they’re going to do one. And, of course, you’re probably in a heightened emotional state where you’re more likely to want to go along with the professionals if they tell you they want to do a certain procedure–because you’re assuming it’s the best thing for you and the baby.
I don’t think the woman you were talking to is too far off the mark. The book, if I’m recalling correctly, does touch on the fact that it’s much easier on the doctor to schedule a c-section rather than wait on a woman’s body to start labor on its own. C-sections can have a negative effect and, I’m learning recently, can also increase the chance of secondary infertility. It’s just…infuriating that some doctors push a procedure that’s a major surgery if it’s not needed. (Of course, if a woman wants a c-section, that’s her own prerogative).
And you’ve hit the nail on the head: if you don’t know, you don’t know to advocate for yourself.
That sounds so shocking. My own experience of childbirth here in the UK thankfully was very different. I hope the book gives women a better idea of how to claim their right to a natural birth
I wish I could remember if this book talked about any UK stats, but it’s been a while since I read it. I wonder what it’s like in the UK. But yes, I hope anyone who reads this book walks away more informed about advocating for a vaginal birth if they don’t need a c-section for medical reasons.
This sounds like a fascinating but also difficult read. The healthcare system in the US is such a mess, but I definitely wasn’t aware of how it was impacting childbirth.
It is! It’s really frustrating to see how c-sections have impacted childbirth in the US. And most women probably don’t know any better for many reasons, including that it’s such a personal and secretive experience now.