An incisive yet personal look at the science and history of the most common surgery performed in America—the cesarean section—and an exposé on the disturbing state of maternal medical care
When Rachel Somerstein had an unplanned C-section with her first child, the experience was anything but “routine.” A series of errors by her clinicians led to a real-life nightmare: surgery without anesthesia. The ensuing mental and physical complications left her traumatized and searching for answers about how things could have gone so wrong.
In the United States, one in three babies is born via C-section, a rate that has grown exponentially over the past fifty years. And while in most cases the procedure is safe, it is not without significant, sometimes life-changing consequences, many of which affect people of color disproportionately. With C-sections all but invisible in popular culture and pregnancy guides, new mothers are often left to navigate these obstacles on their own.
Somerstein weaves personal narrative and investigative journalism with medical, social, and cultural history to reveal the operation’s surprising evolution, from its early practice on enslaved women to its excessive promotion by modern medical practitioners. She uncovers the current-day failures of the medical system, showing how pregnant women's agency is regularly disregarded by providers who, motivated by fear of litigation or a hospital’s commitment to efficiency, make far-reaching and deeply personal decisions on behalf of their patients. She also examines what prevailing maternal and medical attitudes toward C-sections tell us about American culture.
Invisible Labor lifts the veil on C-sections so that people can make choices about pregnancy and surgical birth with greater knowledge of the risks, benefits, and alternatives, with information on topics including:
Rachel Somerstein is the author of Invisible Labor: The Untold Story of the Cesarean Section and an associate professor of journalism at SUNY New Paltz. She has written about maternal health and other topics for the Boston Globe, Washington Post, and WIRED, among other publications. She lives in the Hudson Valley with her family.
"This book is for mothers looking to see themselves reflected in the story of birth, and for those seeking to better understand the many reasons why their births may have unfolded the way they did."
For author Rachel Somerstein, the trauma of giving birth haunted her long after she held her daughter in her arms. The anesthesia she was given during her emergency C-section didn't take, and though Somerstein screamed in agony and kicked so much in response to the pain that nurses had to hold her down, the procedure continued. Afterward, she assumed her experience was unusual, but later she discovered that "breakthrough pain" during C-sections isn't that rare. The problem is, people aren't talking about it and researchers have only begun to investigate it.
Somerstein's birth trauma compelled her to explore the history of C-sections. In this illuminating book, she deep dives the history of C-sections and reveals how enslaved women bore the brunt of early experimentation. In addition to outlining the increasing rate of C-sections performed in the US, she also explains why the number of C-sections performed each year keeps going up, how health care companies profit from C-sections, and which people are most negatively affected by these trends.
Too few pregnant people are aware of what comes after a C-section, and Somerstein ensures that readers have a full picture of recovery, from the possible need to wait two years before conceiving again (to allow the body time to heal) to the probability that all future births will be C-sections (as a VBAC [vaginal birth after C-section] poses a great risk of injury). While discussing recovery, she also explores the mental aspects of life after giving birth and breaks down birthing myths, such as the idea that once a woman holds her new baby, all the trauma of giving birth disappears.
Invisible Labor makes shocking revelations about how hospitals prioritize a fetus over the body housing it and asserts that at some point during pregnancy, the pregnant person loses their civil rights. In light of recent abortion laws in the US, this subject couldn't be more topical.
Woven throughout the book are glimpses of other women's traumatic pregnancy or birth experiences. And Somerstein uses the terms "pregnant women" and "pregnant people" interchangeable, making for an inclusive read.
Invisible Labor is a revelatory book on pregnancy, a rallying cry to legislate for adequate paid prental leave in the US, and an invitation to openly discuss birth trauma. Highly recommend!
My heartfelt thanks goes out to Ecco books for sending me a copy of this enlightening book that I was dying to read.
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ORIGINAL POST 👇
Author Rachel Somerstein's unplanned c-section was complicated by her clinicians making a series of errors that resulted in her having SURGERY WITHOUT ANESTHESIA. 😱
This traumatic experience compelled her to research the history of cesarean sections. Invisible Labor is the result, a book that "weaves personal narrative and investigative journalism with medical, social, and cultural history to reveal the operation’s surprising evolution".
Where women's bodies are concerned, science and medicine have a lot of catching up to do. I'm grateful for books like this that shine a light on the oversights, deficits, errors, and desperate need for change in science and medicine for the well-being of women everywhere .
Oof, this is such a heavy topic I've put this review off for almost a month despite absolutely loving this book.
I joke that my csection felt like a magic trick gone wrong. The magician got partway thru sawing my in half, changed their mind, stitched me back up & sent me on my way like a Build'a'Bear.
But in all seriousness, this is very intense stuff. PLEASE really consider whether or not right now is a good time for you to read this if you: - are pregnant - plan to be pregnant soon - are triggered by pretty much anything pregnancy related - someone you love & are close to is pregnant
I hate to say that, because it's vital we're better educated on cesareans, openly discuss them (without judgement), see cesareans as equal to vaginal birth (while understanding someone delivering via cesarean needs additional support postpartum), I could go on and on...
For the sake of your mental health, please take into account how scary & hush-hush the reality of obstetrics & healthcare is in itself & whether or not you're able to handle any more reason to be disheartened.... Sheesh, how do I even write this without making the whole thing terrifying enough to turn people off and avoid this book completely? Thats the thing though, it IS terrifying. That's inherent of the whole ordeal.
No matter how many times I had to pause the audio to take a breather, put it on hold completely for a couple days because PTSD was creeping in from my emergency csection, or wipe tears away while holding my son who I'm so thankful all of the pain & terror gave me - WOW did I need this book. I'm almost as thankful to have found Invisible Labor to help me process it all afterward.
My hope is that the information Rachel Somerstein has so accessibly presented us with becomes common knowledge (already should have been for years now, but Invisible Women: Data Bias in a World Designed for Men by Caroline Criado Perez and Eve: How the Female Body Drove 200 Million Years of Human Evolution by Cat Bohannon have that tangent covered for me) & changes are made in an effort for happier, healthier birthing experiences.
Side note: I'm an open book & happy to answer any & all questions about my experience. Plz feel free to reach out 💝
Updated 14/4/24 to add - I FINALLY GOT MY TROPHY COPY!
Oof. Having had two for two traumatic births -- one where the C-section anesthesia didn't work, forcing me to endure surgery while fully feeling everything, and one while after laboring for seemingly forever, I ended up needing an emergency C-section due to my baby's heart rate dropping and then finding out she was born not breathing and had been without oxygen for who knows how long (she's okay, thank God) -- this book was relatable on so many levels for me. Doctors dismissing women's pain or concerns, doctors not trusting that we know our own bodies, getting PTSD from traumatic births, being told baby turned out fine so you should get over it... This book definitely made me cry. So much good information on a subject that isn't often talked about.
Invisible Labor: The Untold Story of the Cesarean Section and the Disturbing State of Maternal Medical Care by Rachel Somerstein – Review
Invisible Labor by Rachel Somerstein is a deeply felt and thoroughly researched investigative nonfiction book that lifts the veil on the history, science, and social dynamics of cesarean sections, the most common surgical procedure in the United States today. Somerstein, a journalist and professor, begins with her own harrowing experience of an unplanned C‑section that was performed with inadequate anesthesia, leaving her traumatized and searching for answers about a medical system that often treats pregnant people’s pain and autonomy as secondary to efficiency and fear of litigation. Throughout the book she interweaves her personal narrative with medical history, cultural analysis, and interviews with experts to explore how C‑sections evolved from desperate interventions into a normalized and often overused procedure, disproportionately affecting women of color and revealing broader failures in maternal care. Invisible Labor also examines topics like VBAC (vaginal birth after cesarean), the role of doulas and midwives, and how reproductive rights intersect with healthcare practices.
Reading this book made me feel both illuminated and unsettled, because Somerstein’s candid voice pulls you into the real emotional and physical stakes of childbirth while challenging assumptions about what “routine” medical care really means. Her blend of personal vulnerability and rigorous reporting invites empathy and a deeper understanding of how pregnancy, birth, and women’s healthcare have been shaped by history, technology, and systemic priorities that often overlook individual experience. There were moments where the stark critique of the medical establishment pushed me to reflect uncomfortably on how much power healthcare systems hold over bodies and choices, yet that very confrontation made this book impactful and important.
Rating: 5 out of 5 because it is courageous, enlightening, and offers vital context for anyone thinking about childbirth, medical care, or justice in reproductive health.
I disagree with the author on a host of things. But the data, history, and stories given here are compelling and horrifying. Things every woman should know.
I didn't finish this book for two reasons: first, it was overdue from the library, but second, because it was really difficult for me to read. Twenty three years ago, I gave birth to my first child under traumatic circumstances - a long, painful labor that ended in an emergency c-section with inadequate anesthesia. I received virtually no post-partum care, no scar care or physical therapy and my spouse and I were totally unprepared to care for a baby while I was recovering from major surgery. But over time, I realize that the way my birth trauma was set aside (all that matters is that the baby is healthy!) and that the kind of medical neglect I experienced is standard and rooted in misogyny has made me so so angry.
I am so grateful to Rachel Somerstein for writing this book - she made me feel seen in ways that I have never been able to articulate, and I have to wonder how difficult it was for her to write such a thoroughly researched book in the wake of her own experience with c-section trauma.
This book is written in a very accessible way for anyone who wishes to learn more about birth and cesarean sections. Disregarding the typos and sentences in need of editing (I read an ARC), it's easy to understand. However, I found that some clearly truthful claims are made in the book with citations included (which is great), but many more unusual or even incorrect claims do not have any citations attached. Statistics are often improperly compared to each other. Some sections demonstrate, in my opinion, a clear misunderstanding of some medical terminology and procedures. Others show a strong bias, whether that is due to personal experiences or political opinions. While I believe that any story involving those who feel betrayed or overlooked by medical systems is a crucial one to tell, I was unfortunately not satisfied with the way this book was organized.
As a professor of nursing specializing in maternal child nursing I can say that much of the information regarding the state of health care is all too true. The health care industry states that patient care is its priority, but indeed making a profit is the priority. Fortunately for me, I was able to work much of my career (before entering academia) in the nonprofit sector. I think things were better. The most disturbing aspect in this book is the continued racism and sexism that exists in America's health care.
Very informative! Helped me to understand how a C-section can and will sometimes effect a person! My mom had 6 kids and some of us were C-Section! So reading this book helped me better understand what goes into the c section operation/birth! The book helps you understand the emotional and physical pains of a C-section and what comes with it. The after care and everything. Very informational and helpful. I myself don’t have kids but I feel that if that were to change I’d understand the pros and cons of a c section.
Autonomy when it comes to birthing options is the arena where modern feminists and traditional-minded (and often religious) women meet, and the author is either ignorant of that, or deliberately incurious. The result is that she seems bent on pushing one specific sociopolitical agenda that effectively alienates a massive group of women who have thrown themselves behind her same cause. Honestly, I was torn between one star and two, but I guess I'm in a generous mood.
I cried, I learned, I felt seen. I will be adding this book to the canon of birth trauma literature that I recommend to survivors. Well done, Rachel - you wrote a serious piece of journalism with a lot of heart and intention. You opened my eyes while at the same time making me feel so validated about the things I already knew and felt. I am so glad you persevered and put this work of art out into the world!
While I've never given birth, and don't plan to, this book was absolutely fascinating and totally changed my perspective on c-sections. While I already had strong opinions about womens healthcare, I learned a ton from this book. Highly recommend.
“The reality is that we have not yet begun to see reproductive rights as human rights or … to accept that pregnant people are human.”
I learned a lot from this book, including the history of medical experimentation during birth on enslaved people, and the health disparities when it comes to C-sections — including the history of involuntarily and unnecessarily sterilizing Black women during C-sections.
At times, this felt like the author rehashing her (awful) traumatic C-section over and over again and a bit like her therapy. Of course her experience informed this book but it got to be a lot at times.
My own C-sections were emergency and elective (sort of) repeat, and I had a lot of feelings about that first one for a while because until it happened I hadn't even really considered it as a strong possibility. And then I questioned if I'd actually needed a C-section (but, hello, it was an emergency!) when I learned that others with my diagnosis were induced. Sometimes I still feel weird about having never actually labored, so even the title of this book throws me off.
But, even though it did at times make me feel guilty for not even attempting a VBAC with my 2nd, it felt like a necessary read and it was largely good. Good historical context and examines C-sections from so many different angles. I don't think the epilogue was helpful or necessary and contributed to the "VBAC is best" message.
Well written. Weaves the history of obstetrics in the United States with her own personal narrative and quotes from a variety of experts in the field. As a CNM I’m always shocked to find how few other obgyn providers have never been given an honest education on the history of how “we” as CNMs and OBGYN physicians came to be.
I appreciated Rachel sharing her deeply personal experience, she is so brave to put this into print/listening-for all the pregnant people who experienced medical trauma-they are not alone and it’s our responsibility of people who care for laboring people to do better!
Highly recommend for anyone working in the pregnancy and birth space-doulas, birth assistants, midwives of all educations/certifications, students, obgyn & family medicine residents and of course obgyn and anesthesia attendings.
I personally found the tone of the book a bit too negative. The author shares her difficult experience with a c-section, which made the beginning of the book feel somewhat traumatic for me. Additionally, much of the book focuses on challenging stereotypes, such as the idea that “women who give birth via c-section are not real women.” While I understand the importance of addressing these misconceptions, I don’t hold these views myself and would have preferred not to encounter them on nearly every page.
That said, please take my review with a grain of salt, as I haven’t finished the entire book.
Where do I begin…? I had a very traumatic emergency c-section in 2023 and I am still processing it. However, not once during my recovery did I consider my birth any less than a vaginal one… and this book leans heavily into shame. I’m not shameful that I had a c-section. And I don’t find myself longing for vaginal delivery… don’t read this book if you don’t want to feel like a victim.
This is an excellent, comprehensive overview of maternal care in the United States, not solely C-sections, though the author weaves in her personal experience with an emergency C-section birth where the an anesthesia did not work and the associated trauma as a central narrative in the model.
However, Somerstein doesn't make her own experience the focus. Her book is full of interviews and stories from others, in addition to meticulous research, ranging from the historical development of c-sections (including the cruel experimentation on Black and indigent women), to sidelining of midwifery by OBGYN male-dominated practice, to the current dismal system for childbirth.
There were a few standout chapters--- getting into the detail of how racial bias is built into the health system; the challenges of running a midwifery centric practice (which I read only a few months before the closure of a well-respected birth center in our area). I loved the chapter Somerstein had on electronic fetal monitoring (and her associated commentary on the misplaced trust we have in technology). I remember feeling nervous when that wasn't offered at the midwifery practice where I delivered, but eventually accepted the tradeoffs (no differences in outcomes & the ability to move around more freely). This was an excellent precursor to this recent article from the NYTimes on the ineffectiveness of Electronic fetal monitoring and its inadvertent contribution towards unnecessary C-section (a product of our risk averse, intervention-forward, and litigation-susceptible medical system) https://www.nytimes.com/2025/11/06/he...
Somerstein ends the book with many concrete suggestions, including looking at other cultures and political systems, and even the United States for good examples (including a community-owned, nonprofit Alaska Native Medical Center).
A great read for anyone interested in the social, political and historical context around maternal care.
Note: This review was based on the audiobook version.
Before I start my review: no I'm not expecting ... but, how much do we know as women about our own bodies in general and our reproductive health particularly? (check these two if you're on a journey too: Womb: The Inside Story of Where We All Began and The Menopause Brain: New Science Empowers Women to Navigate the Pivotal Transition with Knowledge and Confidence ) This book other than helping me through understanding the mental toll - that I have never thought about of a C-section, made me think about how literally extractive are reproductive health policies in the US and I wouldn't be surprised if the rest of the world caught up with that madness ... and that's devastating ... The odds are in US numbers there is a 30% chance that you'll get a c-section, while you never learn anything about it.
“Other countries have social safety nets… the US has women”. This was an incredible glimpse into the medicalization of birth under our capitalist and deeply racist system. I appreciate how Somerstein looked at C-section from every possible angle, illuminating important issues and never losing sight of intersectional experiences. This was honest, raw, and filled to the brim with vital journalism. We must see the C-section from a wider lens. This procedure has roots in slavery, eugenics, and industrialization. The C-section can be lifesaving, as Somerstein outlines, but I didn’t realize just how many inequities exist and how exorbitant our maternal mortality rates are. It hit me on top of the head- in capitalism, of course the C-section would be prioritized for its ability to be “efficient”, uniform, and profitable. Consent, cultural competence, community, and above all, autonomy, must make its way to every corner of reproductive justice, including birth.
I took off one star because chapter titles didn’t always match with their content. I also wish trans birth stories were shared. It would have been a great way to round out this book- there’s more medical trauma to go around.
It feels weird to give this a star rating, so I won’t. I think this is an incredibly important book. That said, it was TOUGH. There is so much complexity and nuance in this topic, and it was hard to keep reading about all the ways the healthcare system can harm pregnant people. I can see how this would be so validating for someone who had a traumatic c-section, but it was tough for me to read, given my birth trauma (I had a uterine rupture and will have to have a c-section at 37 weeks if I decide to have any more kids). I definitely think the author did a great job managing the difficulty of the topic though, and I appreciated all the perspectives she included. It’s important to talk about these things, but it can also be really difficult to read about, so definitely skip this if you’re even remotely questioning if this is a good book for you to read.
So interesting, but also a little traumatic revisiting mine and others' difficult/life threatening deliveries. I don't know that I would recommend this to someone who would resonate with the stories shared, but it is valuable for others' to hear how common these experiences actually are.
This book is packed full of research, anecdotes, qualitative and quantitative evidence that are medical system ignores women, their pain, their requests, and their needs.
The author does an amazing job weaving evidence with personal narrative to create a book that never reads textbook-y and also never reads like a memoir. It is equal parts both while also telling the stories of other women that she follows throughout the book.
My wife is pregnant. I finished the book right as she turned the page into the third trimester - and I could not be more thankful that I read it. As a man who is told next to nothing about pregnancy and birth during his life and schooling, this book equipped me with a lot of knowledge and it led me to a lot more reading that I want to do.
This is one of several books I have read to help me reflect on a traumatic birth experience and I would recommend this book with caution to others in a similar situation.
I found the first part of this book about the history of c sections important and interesting. I did not know that the medical development of caesarian delivery is rooted in slavery.
The sections on the current state of maternal care, both during and after birth, were accurate and thought provoking (if USA-focused). The personal stories were very hard to read but necessary to bring the narrative together and bring some of the statistics to life. I would say that this book comes with a trigger warning to those who find reading about awful births hard.
What lets this book down is the vbac 'punchline' that ends the book with the impression that all birthing people should aim for a vaginal birth. This undermines the earlier points in the book about how c section parents can feel like they haven't 'given birth', and suggests that medical professionals who advise against vaginal delivery should not be trusted.
I've been meaning to get back to this when I had time, but time is a precious commodity. I <3 to read so much, I don't write many reviews but since I've had two c-sections in the 80s myself, I felt I just had to write something about this one.
My experiences are my own and do not necessarily reflect the others. Don't ask me how far along I was because I had a blood test in late January that indicated I was pregnant. My initial due date was 9/3. It was later changed to 10/3 and then 11/3 based on ultrasound results. I was diagnosed with Pregnancy Induced Hypertension in mid-July which sent me straight to the hospital. After 7 weeks in the hospital, my first c-section was labeled an emergency by the doctors and was preformed because blood tests indicated my body was shutting down and the organ that was most critical at that point was my liver. I was told that natural child birth and induction was not really a thing because my body had done nothing to prepare for such a birth. I was given a steroid to develop the baby's lungs. My baby was delivered on 8/27 weighing in at 2 lbs, 15 1/2 ozs. I was hospitalized for a week after birth and my baby was in until the end of the following month. Incidentally, she was on room air from the start and I later learned that PIH caused low-birth weights. This was 1983 and luckily I had 3+ years of saved PTO and disability pay, which allowed me to be paid in full and 1/2 time pay until the end of the following month. I was followed in my home by a visiting nurse for several weeks who indicated that she was shocked I was dealing with this so well. To this day, I feel like the medical professionals thought I should be crying over a healthy baby while others were suffering?
I will edit and write more when time permits.
Here's more.
My second pregnancy went off almost without a hitch until the end. I was a housewife, home with the first baby, so, had no income nor disability benefits. Because my husband had just started a new job at the end of my first pregnancy which had -0- health benefits. We applied for every kind of assistance. We already had WIC for our first baby, but I got it for me. (This is the best program ever!) We applied for food stamps (now SNAP) and were awarded a pittance, hardly worth the time and aggravation, especially when pregnant. We applied for medicare and were told we could pay the doctor more monthly than we were allowed in food stamps. Believe me, we could ill afford to pay him a dime, unless we stopped eating. Every time I visited the office it became a challenge to explain that yet again, I didn't have the money to pay what medicare said I could. At my 9th month, visit, the doctor would not see me and I was left looking for another doctor. I went to a local clinic and was treated with grace and respect. However, my due date came up and still no sign of a baby. I was told that inducing would not be beneficial because again, my body had done nothing to prepare. So, two weeks after my due date, you guessed it, another c-section.
I have had more than my share of surgeries, two tonsillectomies (10 years apart), two c-sections, a laparoscopy, a hysterectomy, and now a Septoplasty. One would think I should be done, but as I enter my senior years, I'll probably see at least hip and knee replacement and who knows what else.
But I have to wonder why the author seemingly did not qualify for disability?
Much of this book is well-researched, thoughtful, and informative. However, it is entirely colored by the author's unresolved trauma from her first (C-section) birth. While she acknowledges her trauma up-front - literally, her birth story is the prologue of the book - she does not take ownership of resolving the trauma and instead pours it out into the text.
My main response to this book, which I'm still chewing on, is that the author and several of the other birthing parents' whose stories are represented fail to take responsibility for the decisions they made leading up to and during birth. My initial reaction was, well, why didn't you educate yourself on the options? Maybe you shouldn't have skipped the C-section parts of What to Expect. Of course you should have reached out to your mom and your close friends to develop a support network before birth. You're the one who gave consent for your induction to be accelerated on the doctor's schedule. But this book did at least lead me around to the perspective that, often, that self-education and self-advocacy simply isn't available to expectant parents. I am reasonably confident in my ability to educate myself on most topics, at least to the point where I can advocate for myself and ask the "right" questions, and that my partner will be willing and able to advocate for me in the same way if I cannot or if I am being ignored. But we are both white, educated, white-collar. Given that much of this book is a criticism of the American hyper-individualized, technocractic standard of care in OB & birthing spaces, I wish Somestein had gone the direction of encouraging individual self-advocacy and self-education alongside promoting midwife and doula care. Fight fire with fire! Unfortunately, that path is not available to many parents, especially those who will likely be deemed "uncooperative" instead of "well-informed" (i.e., Black parents) - and Somerstein does a good job of highlighting these limitations and inequalities.
Although there was a lot of good info in the book, I can't in good faith recommend it at all, much less to an expecting parent, due to the overwhelming influence of the author's experience and unresolved anxiety and trauma. Write a memoir.