Pregnancy Is Like Nature: Cultural Arts to Navigate the Unexpected Cesarean Delivery : Academic Medicine

Secondary Logo

Journal Logo

Teaching and Learning Moments

Pregnancy Is Like Nature: Cultural Arts to Navigate the Unexpected Cesarean Delivery

Darivemula, Shilpa MD, MS1; Shah, Virali MBA2; Amanjee, Kritika MBA3

Author Information
Academic Medicine 96(10):p 1407, October 2021. | DOI: 10.1097/ACM.0000000000004247
  • Free
  • AM Rounds Blog Post

We had just wheeled an 18-year-old primigravida into the operating room. I explained, in Spanish, that she was going in for an emergent cesarean section—after many hours of pushing in active labor, her infant was showing signs of distress. She nodded slowly, eyes wide with fear. Though few words were exchanged, I could feel her disappointment. My words remained a limited salve, lost in translation.

Each year, many women undergo an unplanned cesarean section, accepting the increased risks of blood loss, infection, and challenging postpartum recovery to ensure that their infants have a safe passage into the world. Sometimes this decision is made in mere seconds under extreme stress, with many women often carrying feelings of guilt, shame, or failure afterward as their bodies recover. For women of color, the ability to communicate this grief to medical providers is sometimes limited by language or cultural barriers, leaving them especially vulnerable to the quiet trauma of living with a choice they felt compelled to make.

Addressing the emotional aftermath resulting from the incongruence of a birthing experience with cultural and personal expectations is essential to processing the harrowing experience of an emergent cesarean delivery. After a rapid and safe delivery of the infant, we worked meticulously to close our patient’s incisions. My attending, sensing the disappointed mood in the room, said, “Pregnancy and delivery parallel nature. Sometimes it is a storm, sometimes it is a clear sky, and sometimes it is rain, ever unpredictable. I hope she understands that there was nothing she could have done differently.”

As we placed each suture and closed her physical iatrogenic wounds, I wondered about the psychosocial process she would undergo to make sense of the unexpected. We wheeled her back to her room as her mother gently stroked her hair and started to sing a Spanish nursery rhyme to her and her new granddaughter. The rhythm immediately reminded me of the songs we danced to in classical Indian dance classes.

I remember as a young child just beginning to explore the intricacies of Kuchipudi and Bharatanatyam dance. I took on roles ranging from sulking lovers with twists of my feet to raging, demon-destroying goddesses with complex rhythmic movements of my hands. The female body was a book—it expressed paragraphs in a single movement. Using my body to tell these cultural stories not only allowed for emotional mutability, but it also cultivated a sense of pride, identity, and autonomy—the very things lost when undergoing an unexpected, undesired, but necessary cesarean birth. In dance, I was reminded that the body was not a victim of medical circumstance but an instrument rewriting the story in her own language through dance and music.

Childbirth is a complex interplay between mother, child, and passage; at times, surgery may be the only way for mother and child to survive the transition safely. Cultural arts can serve as a medium for self-expression and processing of bodily trauma for women of color. In those dance movements, surgical choreography, and nursery songs, there was a reminder of the unpredictability of life—a reflection of nature at its worst and best—and the power of the body to navigate it all no matter the role taken on. The true “natural birth” parallels nature—fierce, powerful, inevitable, and transformative—characteristics extant in both vaginal and surgical deliveries.

When I gently pushed the door open to discuss why she had a cesarean section, I saw her surrounded by family, laughing as she moved her arms to the fast rhythms of the Colombian band Bomba Estéreo. Her mother held her granddaughter, whispering prayers over her hair. “Baila!” the patient commanded, smiling, before wincing in pain. I tried a few movements to the beat. Laughter erupted in the room and in that moment, all barriers of language, knowledge, and power evaporated. We were 2 moving stories—2 bodies—reaching an unspoken acknowledgment of what was taken and given to her and why. Pregnancy is nature and all births are natural. Sometimes it takes a song or 2 to remind ourselves of the only dependable cross-cultural truth in deliveries—the inevitability of change.


This essay is dedicated to the authors’ teachers of dance, Ms. Anuradha Nehru, Ms. Sasikala Penumarthi, Mr. Kishore Mosalikanti, the late Padmabhushan Guru Vempati Chinna Satyam, Ms. Katherine Kunhiraman, and Ms. Ritu Mukherjee. The authors also wish to thank Dr. Fouad Sattar for his infinite wisdom.

Copyright © 2021 by the Association of American Medical Colleges