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Introduction From Risk to Remedy During the 1960 US presidential campaign, the wife of the Demo­ cratic candidate was pregnant. Shortly ­ after John F. Kennedy won the election, Jackie Kennedy gave birth to their first son by emergency cesarean section. While the emergency was unexpected, the surgery had long been planned. At the time, the dictum “once a cesarean, always a cesarean” prevailed in American medicine. As someone who had given birth by cesarean previously—to a stillborn ­ daughter in 1956, followed a year ­ later by the now-3-­ year-­ old Caroline—­ Kennedy was subject to that guideline. Thus, from the moment he learned of her latest pregnancy, her obstetrician, John Walsh, had anticipated a third surgery. Originally, Walsh scheduled the surgery for mid-­December. When Kennedy began to hemorrhage on November 25, he moved up his plans.1 Birth by cesarean section was rare in the United States in 1960, representing fewer than 4 ­ percent of births overall. Doctors performed cesareans so infrequently that a significant number of Americans did not even know the meaning of the term. In the aftermath of John Jr.’s birth, however, few escaped the torrent of information about the surgery. Newspapers and magazines provided explanations of how and why physicians performed cesareans. The birth of John-­John, as the president’s toddler son quickly came to be known by a smitten citizenry, was one of the first public signs of the normalization of cesarean birth.2 Two years ­ after John Jr.’s birth, Jackie Kennedy was pregnant again, and her obstetrician planned another cesarean. For a second time, the press used one of 2  Cesarean Section her pregnancies to demystify and destigmatize the surgery. Time magazine likened the operation to a ­wholesome athletic event, assuring Americans that having multiple cesarean sections was “hardly more dangerous” than the president’s well-­ publicized 50-­mile hikes. Another article informed ­women that the drugs doctors routinely administered during ­ labor to ease pain posed a greater threat to maternal and infant health than cesarean surgery. Cesarean section was to be neither dreaded nor feared. If the first lady of the United States needed one, anyone might.3 The newfound ac­ cep­ tance of the surgery was short-­ lived, however. On August 7, 1963, the Kennedys’ second son, Patrick, was born via emergency cesarean almost six weeks before his due date. Weighing only 4 pounds 10½ ounces, and suffering from hyaline membrane disease, Patrick lived less than two days.­ Every detail of her baby’s brief life and death was so widely reported that Jackie Kennedy complained that the press had turned her ­family’s personal tragedy into “a theatrical production.”4 While the birth of John F. Kennedy, Jr., sparked greater public and medical ac­ cep­ tance of cesarean surgery, the death of his younger ­ brother seemed to highlight its dangers. Newsweek noted that while Patrick Kennedy’s death had been traumatic for the entire nation, “it ­will have a special trepidation for the 200,000 American ­ women who each year are delivered of babies by Caesarean section.” Indeed, the Kennedy baby’s death had such a profound effect on such a vast audience that it spurred scientists to discover the cause of, and develop a cure for, hyaline membrane disease. Patrick Kennedy has since been credited for saving more lives than any other child in history, a claim that perhaps mitigated Jackie Kennedy’s understandably distraught reaction to the relentless publicity surrounding his death.5 The starkly opposing views of cesarean surgery engendered by the very dif­fer­ ent outcomes of the Kennedy sons’ births reflected the two traditional, contradictory perceptions of cesareans in US history. Throughout the nineteenth ­ century, and into the early de­ cades of the twentieth, the vast majority of American doctors termed cesarean surgery death-­ dealing; only a slim minority viewed it as potentially life-­ saving. Patrick’s birth harkened back to the old fear and discomfort, while John’s birth represented the relaxed attitude ­toward the surgery that would prevail 20 years ­ after his birth. The two births thus became a fault line between the trepidation, even horror, that was common before World War II if physicians faced the possibility of cesarean surgery and the surgery’s post-1980 normalization, when doctors ­ were often relieved to be able to perform a cesarean section and Introduction  3 avoid what they, and increasingly their patients, perceived as the discomfiting vagaries of vaginal birth. While before the 1970s doctors and their patients almost always...


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