By Dr. Leila El-Alti

“So, tell me,” she said, as she swiveled her chair away from her computer to face me, “how did you end up with a c-section?”

Her tone was warm and she was smiling. But something didn’t quite add up. I felt the question physically strangle me.

I was confused. There was a disconnect somewhere.

It wasn’t between her question and my reaction to it, but between my body’s unambiguous objection to the question and my mind’s inability to comprehend why.

I looked down and soothingly rubbed my pregnant belly, hoping I would figure out why I got upset with her question before I had to answer it.

I was in the second trimester of my second pregnancy. It was the first time I ever meet this obstetrician during my pregnancy, and I was absolutely petrified about the upcoming birth. But it wasn’t really anxiety or unfamiliarity that triggered my very physical response to what she asked.

I knew that she knew. The community midwife had already talked to her about me. She knew that my first birth was highly traumatic and that I’d been living with PTSD for many years because of that birth experience. She knew! Yet she didn’t ask me about my previous experience. She didn’t ask about medical events or complications. She didn’t ask about how I ended up with severe trauma. She chose to ask specifically about how I “ended up with a c-section”. She chose to use this exact wording.

But this wasn’t why the question felt wrong either. It’s not like I was expecting a particular question and was disappointed that she chose another.

She likely wants to inquire about the first birth in Sweden because the medical records are not available to her in Scotland, I thought to myself. But as reasonable as that explanation was, it didn’t comfort me. As the silence in the room grew heavy, my mind began racing. I had no choice but to ignore the tension in my body and answer the godforsaken question. I gulped, trying to hold back tears and failing.

“Umm…,” I started, and immediately choked. Tears flowed down unrestrained and I started sobbing.

It’s probably the anticipation of having to relive the trauma, I told myself. But that didn’t make sense. I knew it was relevant, so I was completely expecting the need to go over my story during the appointment, or at least some parts of it. I certainly didn’t appreciate being pressured to share details of traumatic events without further consideration for my possible lack of readiness to do so.

But over the years following that first birth, I’ve spoken to others about my trauma more times than I could possibly count. I was already trapped in an endless loop of reliving different aspects of the trauma through daily flashbacks and nightmares and triggers; so much so that discussing it again didn’t drastically worsen my distress. This didn’t by any means imply that I had become emotionally desensitized to intentional detailing of the traumatic events. Rather, when one’s default state of being was constant distress, feeling slightly more provoked or vulnerable no longer registers as a different experience in kind, merely in degree.

Perhaps it’s just anxiety about having to fight for a c-section, my mind offered. This was the trauma talking, of course. I had been ignored, neglected, disrespected, and denied care on my own terms so many times back in Sweden that I’d developed an immense fear of experiencing that again. So, I had already made it clear to my midwife that I wanted to give birth by elective c-section this time. I told her the very first time I met her. She spoke to this obstetrician. And the obstetrician had already agreed to my request before I even attended this meeting with her. There was no fight necessary. There was no uncertainty.

Ok then, what was the problem?

In between sobs, I began narrating how different midwives and obstetricians in Sweden violated me for days on end, how an obstetrician coerced me into an induction of labor I refused, how they shrugged off my suffering and romanticized my pain, how they sent me back home multiple times when I was begging for help, and how they denied every single request I made.

She was nodding, as if to let me know that she understood. I paused. I wanted her to stop.

Because she clearly didn’t understand.

“Let’s be clear about one thing,” I blurted out, holding my hand up, “I wanted a c-section”.  I felt the most intense wave of indignation sweep over me.

That made her stop nodding. She didn’t react.

“I always wanted an elective c-section, but it’s not a thing in Sweden. I asked and they refused. Multiple times. They told me I had no idea what I was saying. And they forced me to have an induction instead,” I said, my voice breaking.

What I experienced under Swedish maternity care cannot only be defined in terms of coercion and violence. It was much, much more than that. And it was somehow closely related to the disconnect I felt earlier. My body obviously recognized this truth, even when my mind was too slow to follow.

“I was 41 weeks pregnant. I was severely depressed and was always thinking about death. Always! They didn’t care.

“I said I didn’t want an induction. They didn’t care. All they cared about was vaginal birth. I never wanted a vaginal birth. They didn’t care.

“I kept going to the hospital and they kept sending me home. Until an obstetrician begrudgingly accepted that I was in danger. She simply said ‘no’ to a c-section with a wave of her hand. I said that I’d been in severe pain for months and that I won’t be able to handle more pain. She laughed, as if what I’d just told her was the most ridiculous thing she’d heard. I cried. She said that all women say that, then booked me for an induction anyway.

“Induction was the only thing they were willing to offer, she said. As if granting me access to care was a favor. So, either I accepted the offer or I’d have to go home. I couldn’t go home. I knew I’d die there. They knew that too. But I wasn’t able to fight for myself, so I nodded. I didn’t have a choice.

“The induction went on for days, and I was in so much pain all the time. They didn’t care. They said that pain was good. They just did things to me. No consent. They placed a cervical balloon catheter against my will. I said no so many times. They didn’t care. They did it anyway.

“But my cervix didn’t respond to anything they did. Of course, it wouldn’t. Not in the state I was in. That’s how I ended up with a c-section.”

The last words tasted bitter in my mouth. A taste of grief, resentment, and self-pity.

And…there it was, I finally caught up, it was an unconscious reaction to her choice of words and what she’d assumed about my first birth.

When one ends up with a certain outcome, it means that the outcome or events leading to it differ from what one had hoped for, planned for, or anticipated. It is an expression that underscores the passivity of a subject in effecting expected events or desired results.

So, when the obstetrician asked how I ended up with a c-section, the implicit assumption in her chosen words was that my c-section involved an alteration to an original plan of birth I had, or at least one that women generally tend to have. The assumption is that the c-section was an outcome I, or other women, do not plan for, desire, or expect. And given that she knew about my birth-related PTSD, explaining a traumatic birth experience in terms of an unwanted c-section becomes the path of least resistance.

It was to those unspoken presuppositions that I found myself reacting. It was to the nuance of my own reality compared to her naïve assumptions; to the intricacy and pain of my truth compared to the soothing familiarity of the narrative she chose to regurgitate. It was to her audacity to impose on me the same rhetoric that the Swedish maternity system excels at weaponizing. It was to her inability to grasp that trauma isn’t attached to a mode of birth but to the subjugation of women’s minds and bodies, and the prescription of their values and wills.

My second birth took place in Scotland on a cold and rainy Halloween morning. And it was indeed by elective c-section. So, I did get the satisfaction of avenging my past self at least by choosing and having the birth mode I always wanted.

Unfortunately, like the obstetrician, the staff were selective with their words and with their commitment to trauma-informed care provision. I was retraumatized so severely that large chunks of my memories have been erased. What I endured in the months following that second birth I wouldn’t wish on anyone, perhaps with the exception of healthcare providers who abuse women and those who help hide the evidence.

But that’s a story for another day.

---

Note: The featured image in this post is AI-generated.