After Rachel Somerstein was rushed into an operating room for an unplanned caesarean section, her doctor made the first cut. “I felt that,” she told him. “You’ll feel pressure,” the doctor responded.

But, horrifyingly, Somerstein “felt it all: the separation of my rectus muscles; the scissors used to move my bladder; the scalpel, with which he ‘incised’ my uterus.” When her daughter was born, Somerstein was so traumatized that she couldn’t hold her baby. She screamed for her to be taken from the room.

Friends encouraged Somerstein to file a lawsuit; others balked, doubting that she could have undergone major abdominal surgery without anesthesia. The overarching message to mothers who experience traumatic delivery in this country is to get over it. “How long did it really take,” one attorney asked the author, “five minutes?”

It’s a common refrain: Just be happy you have a healthy baby. The dangerous and potentially unnecessary interventions of medicalized childbirth are never called into question when the pain and trauma of the person giving birth are invalidated. Somerstein quotes two scholars of healthcare and science: “Something is visible [only] when somebody recognizes it as relevant.”

Propelled by Somerstein’s own experience, “Invisible Labor” is a thorough investigation of birthing practices grounded in misogyny, racism and other forces contrary to the well-being of mothers.

Somerstein illuminates the capitalistic drive to rush birth in American hospitals facing infrastructural and staffing deficiencies: “Compared with vaginal births, C-sections are more efficient. Particularly if they are scheduled, a hospital can do far more of them … in a day.”

The medicalization of childbirth, including the C-section, undoubtedly saves lives. But the dehumanization of those giving birth, and the erasure of their well-being and experience, hurts everyone. As “Invisible Labor” shows, the lack of attention and communication in the hospital setting can be fatal.

Somerstein delves into the history of the C-section, which was devised to help save both mother and child. It was quickly adapted by enslavers, however, in “a push to bring about more slaves. In the U.S., most early caesareans took place in the South, and they still do today; a disproportionate number of Black and enslaved women made up the subjects.”

The history of birthing in the U.S. becomes a means of grappling with the history of slavery, racism and eugenics. Once the C-section was in practice, doctors realized that they could also sterilize women of color and those deemed disabled without their consent. “ ‘Acabó la canción,’ said one woman sterilized at L.A. County Hospital in the 1970s. My song has ended.”

Relying on essential feminist texts such as Adrienne Rich’s “Of Woman Born: Motherhood as Experience and Institution,” Somerstein amplifies the role of the midwife — and her removal from the delivery room, taking away a library’s worth of knowledge about birth and birthing people and placing them in largely inexperienced, male hands.

“Just as land gets colonized, so does knowledge,” Barbara Katz Rothman, a sociologist, told Somerstein. “By laying claim to birth, medicine established boundaries over who has authority to attend it.”

Shockingly, Somerstein’s research shows that the electronic fetal monitoring technology used in hospitals, known as EFM, is “notoriously unreliable.” Often, it reports a falling fetal heart rate or stalled labor when the baby and mother are perfectly healthy. But it allows doctors and nurses to tend to many patients, running from room to room and leaving patients alone. Doctors and nurses are trained in the technology instead of the skills of midwives, who know what to look for from extensive experience.

“When used on mothers who have not previously had a caesarean,” Somerstein writes, “EFM, according to one study, makes a person up to 81 percent more likely to have a C-section than mothers monitored intermittently.”

The C-section rate has grown and grown — to about 1 in 3 U.S. births — and “a C-section mom is about 80 percent more likely to have a serious complication, like needing a blood transfusion or an emergency hysterectomy.” Women of color and particularly Black women are more likely to have caesareans.

Speaking to Rei Shimizu, a social work researcher, Somerstein relates: “There’s an assumption in the health system … that nonwhite female bodies cannot give birth safely without intervention.”

“Obstetric racism is about white doctors being racist, but it’s also about doctors, white, Black, whatever, that when you’re expressing your concerns, they just don’t listen,” said Nicole Carr, a professor who spoke to Somerstein about losing her baby after her concerns about her pregnancy were ignored. “It’s a system that makes it so that when you go in and talk about your concerns, it’s almost like you’re not an expert in your own body.”

“Invisible Labor” does not claim that doctors or even medicalized childbirth is the problem. Rather, it’s a system that decenters our humanity and relies on technology and statistics.

“We believe this visual omniscience will fix the problem,” Somerstein writes. “And we discard or forget that events take place outside the frame, including what subjective, embodied knowledge can reveal.”

Women who experience traumatic childbirth are far more likely to suffer from postpartum depression, anxiety or both. Perhaps “attending to women’s pain could be rectified by the simple but radical decision to ask women how they feel and listen to the answer,” Somerstein writes. Instead of telling her “You’ll feel pressure” when he made the incision, her doctor could have asked, “Do you feel pressure?” or, even better, “Do you feel pain?”

Then again, what do we expect in a country whose Supreme Court struck down women’s bodily autonomy? As it stands now, an unborn fetus has more rights than a woman or girl in many states. To create a better system of childbirth for mothers, we have to believe that the rights and indeed the lives of pregnant people matter.

“Invisible Labor” clearly and compassionately blends scientific research and reportage with the personal stories of Somerstein and other women. Childbirth is painful, but with the right care, it can also ground us in our humanity.

Some of the most moving accounts of birth in “Invisible Labor” come from women who had the support of a doula or midwife. When Somerstein writes that “every woman deserves the touch of a midwife,” she is communicating that every person deserves someone who will listen to and validate their experience. This should be the first standard of care.

Jessica Ferri is the owner of Womb House Books and the author, most recently, of “Silent Cities San Francisco.”

Los Angeles could soon end its requirement for city employees to be vaccinated against COVID-19.

City officials are recommending that the Los Angeles City Council halt the requirement as soon as early June, according to a newly released report. The COVID vaccination rule was first approved by city leaders nearly three years ago as public health officials urged vaccination to protect people from the coronavirus.

In a report, City Administrative Officer Matt Szabo noted that other local government agencies — including the cities of Long Beach and San Diego and Los Angeles County — had stopped requiring COVID vaccination as a condition of employment. Szabo said L.A. employee groups had not opposed ending the requirement.

The L.A. ordinance defined “fully vaccinated” as workers having received either one dose of a single shot vaccine, such as the Johnson & Johnson shot, or both doses of a vaccine that required two shots, such as the Moderna or Pfizer vaccines, but said the definition “may be expanded” if health officials required boosters. Under the city ordinance, workers could seek an exemption if they had “a medical condition or restriction or sincerely held religious beliefs.”

If city leaders approve ending the requirements, employees who resigned or were terminated because of the vaccination rule may be eligible to be rehired in the same positions as before.

Eighty-six city workers were terminated under the rule, Szabo said; it is unclear how many employees resigned over the COVID vaccination requirement because they do not have to report their reasons.

Los Angeles has faced numerous lawsuits over its COVID vaccination rule. In one of the latest suits, filed last week in federal court, a woman formerly employed as a city accountant said she was denied a religious exemption from the vaccination requirement and ultimately discharged from her position. She accused the city of discrimination, saying it had ignored its policy of “accommodating sincerely held religious beliefs.”

The move to halt the vaccination requirements comes as the Los Angeles County Department of Public Health has seen a slight uptick in COVID cases, although they cautioned that it was too soon to say if it would become a sustained increase.

When researchers talk about their biggest bird flu fears, one that typically comes up involves an animal — like a pig — becoming simultaneously infected with an avian and a human flu. This creature, now a viral mixing vessel, provides the medium for a superbug to develop — one that takes the killer genes from the bird flu and combines it with the human variety’s knack for easy infection.

So far, domestic poultry and dairy cows have proved to be imperfect vessels. So too have the more than 48 other mammal species that have become infected by eating infected birds and then died.

But researchers say there is one population of animal floating under the radar: Pets. The risk may be low, but the opportunities for transmission are abundant.

“I think companion animals definitely need to be in the picture,” said Jane Sykes, professor of medicine and epidemiology at UC Davis School of Veterinary Medicine, describing the viewpoint that diseases such as H5N1 should be viewed from a human, animal and ecosystem lens. None operates in isolation.

She pointed to our furry friends’ penchant for eating dead things, other animals’ poop and — in the case of cats — wild birds. Add to that our primate compulsion to touch, kiss and caress these animals that live in our homes (and sleep on some of our beds), and you’ve got a situation in which germs could be swapped and mingled.

Now consider the sheer number of companion animals and people in the U.S.

“Two-thirds of households have a dog or a cat,” said Jane Sykes, a professor of small animal medicine at the UC Davis veterinary school. “That’s a lot of companion animals. There’s actually more … in this country than there are people in Australia and the U.K. combined.”

She also pointed to new research showing H5N1 antibodies in a group of Washington state hunting dogs trained to retrieve waterfowl, a carrier of the disease.

Ian Redmond, a U.K.-based biologist and head of conservation for Ecoflix — a not-for-profit animal-oriented streaming network — agreed.

“It stands to reason that pathogen spillover [when a virus, bacterium or protozoon is transmitted from one species to another] is most likely when different species are in close contact,” he said.

“While traditional companion animals such as dogs, cats and horses have a long history of such close contact with humans, giving thousands of years for us to develop natural immunity to commonly shared pathogens, it is the new situations that carry most risk,” he said, including “raw pet food of uncertain origin.”

It’s an area that epidemiologists, food safety experts and veterinarians are warily watching — a situation akin to the dangers posed by drinking raw milk.

“There’s at least one animal a day that we see on our service that’s eaten some bizarre raw food diet,” Sykes said. “It did not use to be like that at all.”

Raw pet food typically consists of uncooked meat, bones, fruits and vegetables. The diets are often marketed as “natural” or similar to what animals would eat in the wild.

Calls and inquiries to several raw pet food companies including Jeffrey’s Natural Pet Foods in San Francisco, BJ’s Raw Pet Food in Lancaster, Pa., and Instinct Raw Pet Food in St. Louis went unanswered.

A query to Emma Kumbier, veterinary outreach coordinator at Primal Pet Foods in Fairfield, Calif., also went cold after The Times asked about the kinds of processes or procedures taking place to ensure that pets are not inadvertently exposed to bird flu via infected poultry or cattle.

Jay Van Rein, spokesman for the California Department of Food and Agriculture, said the state’s Meat, Poultry and Egg Safety Branch licenses and inspects businesses that produce raw meat — as well as those that import raw products for pet food manufacturing.

“Raw meat pet food legally sold in California comes from USDA- or CDFA-inspected facilities,” he said.

Inspections are focused on sanitation, proper product labeling, storage, control of inedible byproducts, pest control and record-keeping. He noted that “cooking meat has been shown to effectively kill bacteria of concern and also has now been shown to kill HPAI [bird flu], so if an owner wants to ensure their pet is not exposed to these pathogens, they should cook the meat.”

Janell Goodwin, a spokeswoman for the Food and Drug Administration, said “all animal food must be safe, wholesome and not misbranded.”

She cited the Preventive Controls for Animal Food requirements, which state that pet food manufacturers are responsible “for ensuring that raw materials and other ingredients” are received only from approved suppliers “whose raw materials are subject to verification activities.”

But with only limited testing of dairy cattle currently taking place, and uncertainty about the spread of the disease in the U.S. cattle industry, determining H5N1 status in cows destined for slaughter is murky at best, experts said.

Van Rein said that people can take measures to protect their pets — and themselves — by avoiding raw meat. But if they insist on purchasing it for their pets, state health officials said, these precautions can lessen the risk: Keep it frozen or refrigerated until ready to use; thaw under refrigeration or in a microwave just prior to use; keep raw meat and poultry products separate from other foods; wash working surfaces, utensils (including cutting boards and preparation and feeding bowls), hands and any other items that touch raw meat or poultry with hot, soapy water.

Finally, Van Rein said, refrigerate leftovers immediately or discard them.

Veterinarians “really don’t recommend feeding raw food diets to dogs and cats,” Sykes said. “It definitely increases the risk of certain infectious diseases like salmonella and listeriosis.”

She said people can reduce their pets’ exposure to avian flu and other pathogens by keeping cats indoors, keeping dogs on leashes, and possibly avoiding raw pet food.

She said veterinary societies and outreach organizations are urging vets to be on the lookout for signs of H5N1 infection, which could include listlessness, conjunctivitis, blindness, neurological symptoms and/or difficulty breathing.

She noted that during the SARS-CoV-2 pandemic, pets were also infected. In response, diagnostic labs added specific tests for COVID into their PCR panels, “and that was a good way to monitor for it in companion animals.”

She said similar diagnostic tests should be made for H5N1.

“I think the sooner we get those types of diagnostic tests, the better it will be in terms of preparedness,” she said.