Science
What the rise of the caesarean section reveals about pregnancy and childbirth in the U.S.
Book Review
Invisible Labor: The Untold Story of the Cesarean Section
By Rachel Somerstein
Ecco: 336 pages, $32
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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.”
Rachel Somerstein
(Joe Lingeman)
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.”
Science
AI windfall helps California narrow projected $3-billion budget deficit
SACRAMENTO — California and its state-funded programs are heading into a period of volatile fiscal uncertainty, driven largely by events in Washington and on Wall Street.
Gov. Gavin Newsom’s budget chief warned Friday that surging revenues tied to the artificial intelligence boom are being offset by rising costs and federal funding cuts. The result: a projected $3-billion state deficit for the next fiscal year despite no major new spending initiatives.
The Newsom administration on Friday released its proposed $348.9-billion budget for the fiscal year that begins July 1, formally launching negotiations with the Legislature over spending priorities and policy goals.
“This budget reflects both confidence and caution,” Newsom said in a statement. “California’s economy is strong, revenues are outperforming expectations, and our fiscal position is stable because of years of prudent fiscal management — but we remain disciplined and focused on sustaining progress, not overextending it.”
Newsom’s proposed budget did not include funding to backfill the massive cuts to Medicaid and other public assistance programs by President Trump and the Republican-led Congress, changes expected to lead to millions of low-income Californians losing healthcare coverage and other benefits.
“If the state doesn’t step up, communities across California will crumble,” California State Assn. of Counties Chief Executive Graham Knaus said in a statement.
The governor is expected to revise the plan in May using updated revenue projections after the income tax filing deadline, with lawmakers required to approve a final budget by June 15.
Newsom did not attend the budget presentation Friday, which was out of the ordinary, instead opting to have California Director of Finance Joe Stephenshaw field questions about the governor’s spending plan.
“Without having significant increases of spending, there also are no significant reductions or cuts to programs in the budget,” Stephenshaw said, noting that the proposal is a work in progress.
California has an unusually volatile revenue system — one that relies heavily on personal income taxes from high-earning residents whose capital gains rise and fall sharply with the stock market.
Entering state budget negotiations, many expected to see significant belt tightening after the nonpartisan Legislative Analyst’s Office warned in November that California faces a nearly $18-billion budget shortfall. The governor’s office and Department of Finance do not always agree, or use the LAO’s estimates.
On Friday, the Newsom administration said it is projecting a much smaller deficit — about $3 billion — after assuming higher revenues over the next three fiscal years than were forecast last year. The gap between the governor’s estimate and the LAO’s projection largely reflects differing assumptions about risk: The LAO factored in the possibility of a major stock market downturn.
“We do not do that,” Stephenshaw said.
Among the key areas in the budget:
Science
California confirms first measles case for 2026 in San Mateo County as vaccination debates continue
Barely more than a week into the new year, the California Department of Public Health confirmed its first measles case of 2026.
The diagnosis came from San Mateo County, where an unvaccinated adult likely contracted the virus from recent international travel, according to Preston Merchant, a San Mateo County Health spokesperson.
Measles is one of the most infectious viruses in the world, and can remain in the air for two hours after an infected person leaves, according to the CDPH. Although the U.S. announced it had eliminated measles in 2000, meaning there had been no reported infections of the disease in 12 months, measles have since returned.
Last year, the U.S. reported about 2,000 cases, the highest reported count since 1992, according to CDC data.
“Right now, our best strategy to avoid spread is contact tracing, so reaching out to everybody that came in contact with this person,” Merchant said. “So far, they have no reported symptoms. We’re assuming that this is the first [California] measles case of the year.”
San Mateo County also reported an unvaccinated child’s death from influenza this week.
Across the country, measles outbreaks are spreading. Today, the South Carolina State Department of Public Health confirmed the state’s outbreak had reached 310 cases. The number has been steadily rising since an initial infection in July spread across the state and is now reported to be connected with infections in North Carolina and Washington.
Similarly to San Mateo’s case, the first reported infection in South Carolina came from an unvaccinated person who was exposed to measles while traveling internationally.
At the border of Utah and Arizona, a separate measles outbreak has reached 390 cases, stemming from schools and pediatric centers, according to the Utah Department of Health and Human Services.
Canada, another long-standing “measles-free” nation, lost ground in its battle with measles in November. The Public Health Agency of Canada announced that the nation is battling a “large, multi-jurisdictional” measles outbreak that began in October 2024.
If American measles cases follow last year’s pattern, the United States is facing losing its measles elimination status next.
For a country to lose measles-free status, reported outbreaks must be of the same locally spread strain, as was the case in Canada. As many cases in the United States were initially connected to international travel, the U.S. has been able to hold on to the status. However, as outbreaks with American-origin cases continue, this pattern could lead the Pan American Health Organization to change the country’s status.
In the first year of the Trump administration, officials led by Health Secretary Robert F. Kennedy Jr. have promoted lowering vaccine mandates and reducing funding for health research.
In December, Trump’s presidential memorandum led to this week’s reduced recommended childhood vaccines; in June, Kennedy fired an entire CDC vaccine advisory committee, replacing members with multiple vaccine skeptics.
Experts are concerned that recent debates over vaccine mandates in the White House will shake the public’s confidence in the effectiveness of vaccines.
“Viruses and bacteria that were under control are being set free on our most vulnerable,” Dr. James Alwine, a virologist and member of the nonprofit advocacy group Defend Public Health, said to The Times.
According to the CDPH, the measles vaccine provides 97% protection against measles in two doses.
Common symptoms of measles include cough, runny nose, pink eye and rash. The virus is spread through breathing, coughing or talking, according to the CDPH.
Measles often leads to hospitalization and, for some, can be fatal.
Science
Trump administration declares ‘war on sugar’ in overhaul of food guidelines
The Trump administration announced a major overhaul of American nutrition guidelines Wednesday, replacing the old, carbohydrate-heavy food pyramid with one that prioritizes protein, healthy fats and whole grains.
“Our government declares war on added sugar,” Health and Human Services Secretary Robert F. Kennedy Jr. said in a White House press conference announcing the changes. “We are ending the war on saturated fats.”
“If a foreign adversary sought to destroy the health of our children, to cripple our economy, to weaken our national security, there would be no better strategy than to addict us to ultra-processed foods,” Kennedy said.
Improving U.S. eating habits and the availability of nutritious foods is an issue with broad bipartisan support, and has been a long-standing goal of Kennedy’s Make America Healthy Again movement.
During the press conference, he acknowledged both the American Medical Association and the American Assn. of Pediatrics for partnering on the new guidelines — two organizations that earlier this week condemned the administration’s decision to slash the number of diseases that U.S. children are vaccinated against.
“The American Medical Association applauds the administration’s new Dietary Guidelines for spotlighting the highly processed foods, sugar-sweetened beverages, and excess sodium that fuel heart disease, diabetes, obesity, and other chronic illnesses,” AMA president Bobby Mukkamala said in a statement.
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