Medical Interventions in Film and My Story

In the month or so before my due date, my family and I watched a whole slew of mediocre comedies about pregnancy, some of which I still plan on writing about in the next few months. And one of the last movies of this set that I watched was the 2012 comedy What to Expect When You're Expecting.

On one hand, the movie... wasn't great. 

On the other hand, I was actually somewhat impressed by the end of the movie at how well it covered so many different experiences of pregnancy and early parenthood. There were stories of planned and accidental pregnancies, IVF and adoption, first time pregnancies and even a miscarriage. The movie also centered women's experiences and pushed back against the pressure for a "perfect" pregnancy, having Elizabeth Bank's character Wendy give a (literally messy) speech near the climax of the movie declaring that the expectation to have the "pregnancy glow" is unrealistic and that "pregnancy sucks. Making a human being is really hard." 

So that's something! True, the humor in this film often fell for me somewhere between only lightly chuckle-worthy and fully cringe-inducing, but on the whole I found the stories actually pretty wide spread and balanced. 

That is... with one glaring exception: like in many works, the movie clearly showed a distinct bias toward unmedicated "natural" vaginal births. 

All the women who made it to the final birthing scenes near the movie's end soundly reject an epidural, with one character going as far as to yell at the doctor, "Do I look like somebody who wants to drug my baby?" and another loudly declaring "Hell no!" to the same question. The one character who (after she is second guessed by her husband and is reminded that asking for an epidural was something she had previously considered "crazy") finally does choose to get pain medication in the movie immediately has severe complications and has to be rushed into an emergency C-section where she is given morphine, causing her to not be fully conscious and miss her baby's birth. 

While there is realism in such complications arising despite a character's written desire for a more "natural," intervention-free birth plan, the fact that this is the only instance of either medication or surgery used in any of the movie's numerous birth stories is notable. 

And this movie isn't alone. Some movies, such as The Next Best Thing, use a laboring woman asking for medication as a comedic beat. However, usually any kind of medical intervention or non-vaginal birthing appears in media in the context of either terror or horror. 

Rosemary's Baby uses the drugging of Rosemary as part of the horror of the birth scene. Several gory horror and slasher films feature C-sections as torture, some even self-inflicted or done with horrifyingly improvised tools. Bella from Twilight has a bloody, improvised C-section because her vampire baby is literally trying to kill her, causing her vampire husband to literally bite the baby out of her (despite another vampire present being a medical doctor). Many films also link C-sections with death; Rachel in Blade Runner 2049 is noted to have died from her C-section (despite the story existing in a future where technology that can create literal human replicants and other fully artificial lifeforms) and the captured-bride Splendid has a C-section to try and save her child literally after she has already died in Mad Max: Fury Road.

Biting an incision... ick

Perhaps it is no wonder, then, that medical interventions in pregnancy can seem so scary: we have few if any cultural examples of such interventions being depicted as normal... or even preferable to the alternative. 

As Kiera Butler wrote in her article for Mother Jones on the often unexplored risks of vaginal birth:

 "Depending on the study, 50 to 80 percent of women who give birth experience tearing of the pelvic skin and muscles. For more than 1 in 10, the tearing is severe... In a 2015 Canadian study, a whopping half of all new mothers were still reporting [serious complications] a year after the birth...  For 1 in 10 women, the problem is severe enough to warrant surgery." 

And these are just the more "common" risks; a 2015 UK Supreme Court case "ruled in favor of a complainant who had not been informed of a childbirth risk they encountered, despite voicing concerns during pregnancy. The baby’s shoulder got stuck during delivery, resulting in brain injury due to a lack of oxygen, a problem which would have been avoided if a prelabour caesarean section had been performed."  

Truly, there are many reasons for a pregnant person to have medical interventions with their birth, from blood-pressure and inflammation concerns, to size and position of the fetus, to personal choice for either pain or life management. 

Which brings me to my story. I went into the hospital in the early stages of labor on a Monday afternoon. Contractions were hard, frequent, and long-lasting. Every single recommendation for when to go into the hospital was met... but, when we got there, we learned that I wasn't at the threshold for admittance because of my minimal dilation level. I was held in triage for about an hour and a half while some blood tests were done, and there I made some minimal progress in dilation and effacement. The nurses noted casually that I wasn't wrong though: the data being monitored showed that my contractions were incredibly strong and happening just moments apart. By the time I was admitted, just barely eeking over the finish line of minimal cervix dilation to stay at the hospital, my contractions were so hard that I literally threw up from the pain (my pain-tolerance measurement is now definitely in a whole new world because of this experience).

After that, I did get an epidural, which made me actually be able to process and think, but the complications weren't over. Over the next several hours, late into the night and early into the morning, I labored without much progress... except that especially hard contractions or movements caused my unborn baby's heartrate to suddenly drop. The night felt to me like the pattern of watching a yo-yo, up and down and up and down, as we'd get things stabilized only for the baby heartrate monitor to signal a drop again just as my contractions were starting to make a minute amount of dilation progress. We tried Pitocin. We stopped Pitocin because of heart issues with baby. Then we started again. Rinse and repeat. I was still not making a lot of progress. By five o'clock in the morning, we were discussing other options.  

I felt confident that calling it "early" and electing to get a C-section at this point rather than continue the yo-yo (and then potentially end up in a more immediate emergency situation) seemed like the best choice. My husband agreed but was terrified. After all, C-sections are when everything goes wrong in a movie. It's when the horror starts. There's blood and yelling and danger. 

In the end, it all turned out fine. My baby was born with 6:19 am on Tuesday, and I got to see him held up through the plastic surgery window; seeing him, I cried over how beautiful he was and how relieved I was at the outcome. I was awake and alert as my baby was held against my face, and then my husband held him skin-to-skin while my surgery was completed. 

It turns out, the baby had his umbilical chord wrapped around his throat twice, something called a double nuchal chord, and that plus the intensity of the contractions were making labor tricky. While nuchal chords are fairly common, affecting up to 30% of pregnancies, and "the American Journal of Obstetrics and Gynecology reports that, the majority of time, babies do just fine when one is present," the presence of 2 or more loops of cord around the neck is risker and rarer. A situation where 2 or more loops are present apparently "affects between 2.5% to 8.3% of all pregnancies" and if that chord is looped around the neck tightly, something that is more common with multiple loops, "blood flow through the entangled cord may be decreased during contractions. This can cause the baby’s heart rate to fall during contractions. Prior to delivery, if blood flow is completely cut off, a stillbirth can occur."

Between the nuchal chord and the baby's stress reactions in response, his airway had to be cleared a bit after birth, and doctors were concerned that I may have had the start of an infection. But ultimately what is important is that both baby and I are now happy and healthy. There was no death, no scary lighting or horror soundtrack. There was no one screaming about emergencies or anything resembling torture or tragedy. It was a birth outcome I rejoice in and a delivery I am ultimately happy about. 

I can say now that both my husband and I are happy we had the options we did. Perhaps it could have been less terrifying of a choice, though, if more works of media showed medical interventions in birth, both pain management and surgical options, without them being accompanied by the trappings of violence, panic, and horror. Showing images of a birthing person smiling with joy, their partner acting caring and relaxed, the medical staff acting with support and safety could go a long way. 

Source: Shutterstock

Then, maybe, people would really know the various options they can expect when expecting.