“Irresponsible” Pope Francis? (Woman Who Had Seven C-Sections)

“Irresponsible” Pope Francis? (Woman Who Had Seven C-Sections) January 23, 2015
Pope Francis in St. Peter’s Square, 27 November 2013 (photo by Gabriel Sozzi) [Wikimedia Commons Creative Commons Attribution-Share Alike 3.0 Unported license]




This is the latest complaint of Pope Francis’ endless, relentless (and, I’ve found, usually wrongheaded) critics. It’s the second aspect of the infamous “rabbits” controversy that I wrote about two days ago.

* * * * *

Here are the pope’s related remarks, as recorded in America magazine:

This does not mean that the Christian must make children in series. I rebuked a woman some months ago in a parish who was pregnant eight times, with seven C-sections (cesareans). “But do you want to leave seven orphans? That is to tempt God! (Paul VI) speaks of responsible parenthood.

[. . . ]

. . . the key word is the one the Church always uses all the time and even I use it: it is responsible parenthood. how do we do this? With dialogue. Each person with his pastor seeks how to do that responsible parenthood.

That example I mentioned shortly before about that woman who was expecting her eighth (child) and already had seven who were born with caesareans. That is an irresponsibility (That woman might say) ‘no but I trust in God’ But God gives you methods to be responsible. Some think that, excuse me if I use that word, that in order to be good Catholics we have to be like rabbits. No. Responsible parenthood!

A woman who is a semi-regular visitor to my Facebook page, wrote in a public post there:

I don’t trust the liberal media and I do try to check original sources. And I love Pope Francis — I really do. But I think the choice of wording was poor and I also think he threw the pregnant lady waiting for her 8th surgical delivery under the bus. I’m sorry Dave but every time I read that I wince. And what is this “tempting God” theology as it relates to being open to new life? I don’t recall ever seeing that in the Theology of the Body, and I’m pretty sure this lady wasn’t trying to test God’s goodness or absolute power! I think Pope Francis needs to find a way to be pastoral in his evangelizing attempts — a way that won’t hurt and sadden the rest of the flock!

I replied:

It’s being an irresponsible parent, is what. The pope was exactly right. Now people are going after him for attacking this woman, while ignoring his point: that she ignored grave reasons for not conceiving another child, and put her children at risk of losing their mother (as he stated).

Grave reasons for not having further children, or spacing them, is every bit a part of Humanae Vitae as being open to life is. The two are not contradictory.

She counter-replied:

Where is the evidence that the pregnant woman and her husband ” ignored” grave reasons. Perhaps they factored them in. I’m really surprised at you David — and not in a good way.

This led me to make a lengthy and detailed response:

* * * * *

I don’t see that it is even arguable. First of all, the pope was himself familiar with the woman’s case (having rebuked her in person); therefore he would have known (most likely) more factors than the ones he mentioned in his interview. As usual, he is not being given the benefit of the doubt by his critics. In an article in Vatican Insider it’s stated:

It is clear that he scolded this woman not because she had fallen pregnant with her eighth child but because she was going to have her eighth child having given birth by cesarian seven times before that meaning that she was putting herself seriously at risk.

So now the argument (if kept up) would be over whether C-sections entail a greater risk. Yes, they do. Here is what the Wikipedia article on the topic states:

Risks to the mother

In those who are low risk the risk of death for Caesarian sections is 13 per 100,000 and for vaginal birth 3.5 per 100,000 in the developed world.[4] The UK National Health Service gives the risk of death for the mother as three times that of a vaginal birth.[11]

In Canada the difference in bad outcome in the mother (e.g. cardiac arrest, wound hematoma, or hysterectomy) was 1.8 additional cases per 100 or three times the risk.[12]

. . . As with all types of abdominal surgeries, a Caesarean section is associated with risks of postoperative adhesions, incisional hernias (which may require surgical correction) and wound infections.[13] If a Caesarean is performed under emergency situations, the risk of the surgery may be increased due to a number of factors. The patient’s stomach may not be empty, increasing the anaesthesia risk.[14] Other risks include severe blood loss (which may require a blood transfusion) and postdural-puncture spinal headaches.[13]

Women who had Caesarean sections were more likely to have problems with later pregnancies, and it is recommended that women who want larger families should not seek an elective Caesarean. The risk of placenta accreta, a potentially life-threatening condition, is 0.13% after two Caesarean sections, but increases to 2.13% after four and then to 6.74% after six or more. Along with this is a similar rise in the risk of emergency hysterectomies at delivery.[15] 

Mothers can experience increased incidence of postnatal depression, and can experience significant psychological birth trauma and ongoing birth-related post-traumatic stress disorder after obstetric intervention during the birthing process.[16] Factors like pain in first stage of labor, feelings of powerlessness, intrusive emergency obstetric intervention are important in the development of birth trauma.[16]

Subsequent pregnancies

Further information: Delivery after previous Caesarean section

Women who have had a Caesarean for any reason are somewhat less likely to become pregnant or give birth again as compared to women who have previously only delivered vaginally.[17]

Women who had just one previous Caesarean section are more likely to have problems with their second birth.[4] Delivery after previous Caesarean section is by either of two main options:

Vaginal birth after Caesarean section (VBAC)

Elective repeat Caesarean section (ERCS)

Both have higher risks than a vaginal birth with no previous Caesarean section. Criteria for making VBAC include that the previous Caesarean section should be a low transverse one. VBAC (compared to ERCS) confers a higher risk for mainly uterine rupture and perinatal death of the child.[18] Furthermore, opting for VBAC results in 20-40% of times in that Caesarean section is performed eventually anyway, with greater risks of complications in an emergent repeat Caesarean section than in an ERCS.[19][20] On the other hand, VBAC confers less maternal morbidity and a decreased risk of complications in future pregnancies than ERCS.[21]

There were also additional risks to the baby that were described in the article.

Wikipedia also has an entire article entitled: “Delivery after previous Caesarean section” which details a host of risks involved.

Fellow Catholic apologist Scott Eric Alt stated in his excellent paper on this topic: 

[N]oth­ing at all is “bad about a C-section,” . . . the pope was speak­ing of a woman who had already had seven of them and was going out of her way to get preg­nant again. A Face­book friend and fel­low Catholic blog­ger, JoAnna Wahlund, explains why the pope was right to be con­cerned. (This was in a Face­book thread on my own page.)

All preg­nan­cies have the poten­tial to be risky. But seven C-sections dras­ti­cally increases the risk of pla­centa acc­reta, which can cause the uterus to rup­ture (killing both mom and baby). If a woman has had seven C-sections, her uterus is paper thin, and doc­tors tell her, “Another preg­nancy could very well kill you and your child,” then yes, it is risky and irre­spon­si­ble to delib­er­ately seek to achieve preg­nancy in that sit­u­a­tion.

Now, what the pope says, in effect . . ., is not, Don’t have a C-section but, If you’ve had seven of them, maybe going out of your way to get preg­nant again isn’t the best thing. Don’t tempt God. There are licit ways for you to avoid preg­nancy, which you should use. If you do oth­er­wise, you risk that you will die, your baby will die, and your other chil­dren will be left with­out a mother. Respon­si­ble par­ent­hood.

Therefore, the pope’s reasoning is perfectly in accord with medical knowledge (as well as Catholic ethical teaching and thinking on reproduction and childbirth). C-sections entail not insignificant risk; multiple ones entail that much more risk. It is (generally speaking) irresponsible to deliberately have eight c-sections.

For further information about the risks of multiple c-sections, see:

Multiple C-Section Complications (Sandi Busch, Livestrong, 10-24-13)

Multiple C-Sections: How Many Is Too Many? (Elizabeth McGee, C-Section Birth & Recovery, March 2009)

Placenta Accreta: Multiple C-Sections Can Kill Mother (Susan Donaldson James, ABC News, 4-18-11, with accompanying video)

How many C-sections can a woman safely have? (Roger W. Harms, M.D., Mayo Clinic, 6-12-12) 

Maternal Morbidity Associated With Multiple Repeat Cesarean Deliveries (Robert Silver, MD et al, Obstetrics & Gynecology: June 2006 – Volume 107 – Issue 6 – pp 1226-1232; with a host of further related articles listed)

Multiple C-Sections Linked to Raised Complication Risks: Study Women who had 5 or more cesarean-section deliveries had more bleeding, preterm births (US News and World Report: Health, 11-1-12)

Intra-operative complications increase with successive number of cesarean sections: Myth or fact? (Shumaila Zia and Muhammad Rafique, Obstetrics and Gynecology Science, May 2014; 57(3): 187–192)

Once again, his rebuke was a loving and wise one, and he deserves no scolding or withering criticism for making it.

People want to criticize him, moreover, because he mentioned a real person. He didn’t mention her name. In the Bible, St. Paul mentions actual names of people whom he was rebuking:

2 Timothy 2:16-18 (RSV) Avoid such godless chatter, for it will lead people into more and more ungodliness, [17] and their talk will eat its way like gangrene. Among them are Hymenae’us and Phile’tus, [18] who have swerved from the truth by holding that the resurrection is past already. They are upsetting the faith of some.

2 Timothy 4:14-15 Alexander the coppersmith did me great harm; the Lord will requite him for his deeds. [15] Beware of him yourself, for he strongly opposed our message.

Others, like Simon the Sorcerer (Acts 8:9-24), had their names mentioned in Scripture, to be known for posterity as a bad example. St. Paul wrote at length about a person in the Corinthian church (though not by name this time; just like the pope’s statement) whom he recommended as a recipient of social stigmatization until he repented:

1 Corinthians 5:1-5  It is actually reported that there is immorality among you, and of a kind that is not found even among pagans; for a man is living with his father’s wife. [2] And you are arrogant! Ought you not rather to mourn? Let him who has done this be removed from among you. [3] For though absent in body I am present in spirit, and as if present, I have already pronounced judgment [4] in the name of the Lord Jesus on the man who has done such a thing. When you are assembled, and my spirit is present, with the power of our Lord Jesus, [5] you are to deliver this man to Satan for the destruction of the flesh, that his spirit may be saved in the day of the Lord Jesus.

Later, Paul told them to receive the man back into the fold after he repented (2 Cor 2:6-11). It was intended to help this person and to provide an example of how we should not act (in terms of sin), and how the community should react to the sinner, for the purpose of his repentance and restoration.

Likewise, the pope in rebuking this woman (the first time, in person), was trying to help her to better follow Catholic teaching. And by bringing it up again, he was trying to illustrate by bad example, how women should apply the responsibilities of parenthood, according to the Church. This helps people, too.

The problem is that all this is lost in today’s society. Rebukes are widely regarded as terrible, “judgmental” or “intolerant” things and “personal insults” and we mustn’t ever do that (unless, of course, the pope is the target). The notion of the loving rebuke for pastoral purposes is almost totally lost, even within the Church. This is what happens when people think more like the surrounding culture than according to a Catholic or otherwise Christian worldview. St. Paul also warned us:

Romans 12:2 Do not be conformed to this world but be transformed by the renewal of your mind, that you may prove what is the will of God, what is good and acceptable and perfect.

I don’t see that the pope has done anything wrong here, according to either the Bible or Catholic teaching. On the contrary, he issued a loving (though admittedly very stern) rebuke (in essence, an act of love): the example of which will help other women to avoid the same mistaken perspective. But because of our current cultural mindset, many cannot or will not receive it as such , and realize that it is entirely within a biblical worldview to do such a thing. He acted very much as St. Paul would (judging by the above examples), and Paul urged us to imitate him (1 Cor 4:16; Phil 3:17; 2 Thess 3:7, 9) as he in turn imitated Christ (1 Cor 11:1; 1 Thess 1:6). The Vicar of Christ should certainly imitate Christ and also the great Apostle Paul, who imitated our Lord.

[see also the vigorous discussion on my Facebook page]

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  • Great work Dave!

    I found this part of the lady's dialogue rather telling: "I don't trust the liberal media and I do try to check original sources."

    Makes me wonder what one considers "original" sources.

    God Bless you for defending Our Pope and Our Faith!

  • I appear to be one of those "irresponsible parents". My wife has had 7 c-sections.
    I agree with your facebook visitor.

    Multiple C-sections are grave matters and should be considered carefully — but in many cases the "danger" statistics are overhyped.

    Examine your wikipedia statistics:
    13 per 100k c-sections result in death — That means that 99,987 did not die. Yes it is mathematically 3x worse chances, but it still a small chance.

    On our first born, my wife experienced a partial accreta. Thank God we had a very expert OB/GYN who was able to effectively dig it out. We were warned every time that the odds were increasingly worse to have this occur with each subsequent pregnancy — the likely fix would be a hysterectomy. 6 additional c-sections later… no accretas.
    Your Wikipedia statistics say we were up to a "6.74% [chance of accreta] after six or more. " That's still 93% chance of no problems.
    The chance of a car accident on the way to the hospital is probably higher. (Maybe not higher than the chance of a deadly accident, but you'd have a pregnant lady in the car…)

    Our OB/GYN would portray these statistics in such a manner that would scare my wife all the time — If I followed the verbal math she gave us, by the 3rd c-section we had a 175% chance of accreta and certain death. Of course we were offered sterilization options with every c-section.

    If I told you that I had a financial investment that promised a slow growing return of 20 years that would cause you to lose all of your investment only 3% of the time would that scare you away? What about 7% of the time? If you still invest it at at 7% risk are you financially irresponsible? Of course not, there is still a 93% chance of good return. Those are significantly good odds of everything going well.

    I disagree with the appeal to medical knowledge & statistics here. The culture I witnessed going though this scenario for real was that the medical facility wanted to sterilize us so that we couldn't have children after the very first c-section.

    Where I agree with you is that the Pope did not use a name in his example — he was trying to illustrate his point. I don't think he is "rebuking" her for children — he is trying to answer the trope of "Catholics have too many children".

    I disagree with having multiple c-sections being characterized as a "mistaken perspective". Your facebook friend is correct — the pregnant woman & her husband's reasoning is very much required to determine "irresponsibility".

  • Thanks, Dave, this is great!

    I have a dear friend — godmother to one of my children — who has had 7 C-sections. Her doctors have told her after every surgery that her uterus looks fine, and they don't see any reason why she shouldn't get pregnant again, should she so choose. They say that based on her individual case, and the knowledge they have of how her uterus looked after surgery.

    That's why individual couples, especially those for whom the mother has had multiple C-sections, need to individually assess and discern the risk of a subsequent pregnancy. There's no "one-size-fits-all" approach. It is largely dependent on individual criteria.

    I'm baffled at the people who think Pope Francis was speaking to ALL women who have had seven C-sections (or more). He clearly was not. He was talking about the specific case of ONE WOMAN, and using it to make a broader point.

  • wfee,

    I have made it very clear in Facebook comments under the cross-posting of this paper, that individual cases can differ widely.

    There are medical statistics about risk, which are general, and the doctor and his specific patient, which is a particular and may vary from the overall "recommendations."

  • I've also added to my paper seven articles from major medical and news sites and medical journals, about the risks of multiple c-sections.

    This is not about nothing. It's a very legitimate concern, backed up by much data.

  • My late mother had to have an operation shortly before she died, where the risk of death was put at 20%. Of course we agreed to it because if she hadn't had it, there was a stated "1%" chance of surviving long.

    That was a clear choice. But if a person was otherwise healthy and wanted to undergo a non-necessary operation with a 20% risk of death, the rational choice would be (in most cases) to decline it.

    We don't go through life on an 80-20 basis. So, e.g., in a hypothetical where someone had a one in five chance of being killed by crossing a battlefield during a battle, they wouldn't usually decide to cross it (if it weren't necessary). The risk would be too great. Yet 80% of the time they would have lived.

    We don't take risks like that. I exaggerate to make a point, but it's a valid general point.

  • My husband's mom was still bearing children at the age I am now. So, his assumption is that I must supply the burden of proof that I'm not making a selfish decision. I am grateful for the Church's teaching on openness to life; I'm also grateful that the Church is also very sensible about, and sensitive to, each situation.

  • Clarification: I'm 42, and am reluctant to open my womb again.

  • I'm the semi-regular facebook woman.

    Mark T- Original sources would be things like actual transcripts. What would you consider an original source?

    Right on wfee!

  • Dave, I didn't go out of my way to address: 1. The dangers of C-sections or 2. The correctness of the biblical arguments for admonishing the sinner because THOSE WERE YOUR STRONGMAN ARGUMENTS. I know that Cesareans have more risks. I was a member of ICAN for 10 years and I have blogged and written against unnecessary and coerced Cesareans. I also never ever argued that what the pope said didn't have biblical back up. What I said in a nutshell was that I think there was a better way to say all of that – and doing it on the fly on a plane in front of a lot of reporters wasn't it! But for the sake of argument, how the heck do you know whether this lady went our of her way to get pregnant or not? You're making a lot of assumptions. And maybe if it is the safety of Cesareans that's the issue, perhaps we need to star admonishing the medical community that will coerce a woman into having major abdominal surgery at the drop of a hat. IN America we don't even know how to deliver breech babies any more because we just automatically go to the faster, easier and more costly Cesarean. I blogged about this years ago.http://www.mydomesticchurch.com/…/how-way-we-give-birth…

  • If I'm following this reasoning, there is a significant risk of mortality with the woman's c-section, making in it wrong for her to bear another child. What happens when that logic is applied to prior centuries?

    In the 1850s, a British woman's chance of death in childbirth (forget limiting to c-section) was 5/1000. Should any woman in prior centuries have risked more than one child? Certainly there was a great risk of orphaning the first. Looks like a population problem to me.

  • It's not "wrong" per se, but irresponsible, which is why the pope kept mentioning "responsible parenthood."

    People undertake activities all the time that entail risk (war, driving a car, extreme sports, even regular old sports).

    Nor has this anything to do with population. That's a myth. It's about education and access to good health care, and about understanding in an intelligent and thoughtful way the risks involved in multiple c-sections, rather than doing the thing and simply putting "trust" in God. That takes it too far and was correctly described as "tempting God" by the pope.

  • People are getting lost in debate over the risk of c-section when that isn't the point. It's likely that the woman revealed to Pope Francis additional details of her particular condition…such as that her doctor may have advised her not to get pregnant again but she felt she had no choice if she were to be a good Catholic. The fact that Pope Francis felt it necessary to "rebuke" her is a matter between him and the woman. Only they know the content and tone of their discussion. What I find interesting but disheartening is that the very same Catholics who are so quick to defend their own harsh speech in criticizing clergy and the Holy Father, are now criticizing the Pope for being too harsh. When they criticize clergy and Pope, they claim that one shouldn't sugar coat the Truth and that telling the Truth harshly is what's needed in their "fraternal correction" of clergy. They have a double standard. Nothing Pope Francis has done has lead me to believe that he is a harsh or cruel man by nature…quite the opposite. On the other hand, we seem to have more than enough armchair Popes flitting about the internet typing scathing and disrespectful remarks about Pope Francis. They claim the Pope is harming Catholicism and leading people away from the Church without considering that their own relentless nitpicking and Pope bashing does nothing to attract people to the Church. They consider themselves to be the ultimate Catholics, superior to everyone, and spend significant time criticizing, mocking and ridiculing others. Prayer for our clergy and Pope is what is needed, not all this drama and fake indignation.

  • SUPERB and insightful comment! I agree 110%!

  • Dave, What is the difference between being irresponsible and doing something wrong? If I were an irresponsible parent, I think that would be wrong— sinful.

    By the way, I'm not interested in critiquing the Pope, I am just trying to respond to your blog post. You put a lot of effort into showing why c-sections are dangerous to make the case that a woman having so many repeat c-sections deserves to be rebuked.

    Drop my comment about population, and tell me why your reasoning wouldn't mean that women in prior ages should not have had more than one child. The risk of childbirth for them was greater than the risk for women today undergoing repeat c-sections.

  • Responsible parenting? If the couple uses a fertility app or device they might be able to avoid another pregnancy unless of course God wanted that miracle to occur. Unless the pope asked them if that was a method in their marriage, who is to know. The woman might not have a regular and predictable cycle. According to the Theology of the Body, they are supposed to be open to love and all the graces and responsibility God gives us with that gift. They accepted this with their marriage vows, a sacrament. Evidently God continues to bless her with children and continued love and health IN SPITE of what the medical evidence concludes as risky. God bless her and her husband and large family. God loves them all in spite of the mocking they have received from us worldly folk. I hope she feels blessed that God is using her as He needs, proof that He can and will defy medical studies and fear as He needs to.

  • Hello Elena LaVictoire

    Thank you for responding and clarifying. I appreciate your response

    By "original sources" I do mean the actual transcripts. The problem however, that I very often encounter are individuals who claim they have read the "original transcripts" but the original transcripts were not made available until after the interview has gone viral across the ether-net and airwaves.

    Usually, when I have dealings with groups such as the sedevacantists and ultra-conservative "traditionalists" (radical traditionalists), I find that their claim regarding an "original" source are: 1)another website which misquotes the media source; 2)quotes the media but then decides to spin their own version of what Pope Francis "really said"; and 3) a website that claims they have reviewed the original transcripts but insert their own interpretation of the "original transcripts" without actually posting a link or source to those "original" transcripts.

    And because the transcripts themselves, are often in a foreign language that need translating, which takes time, naturally I become hesitant and suspicious when someone says they have read the "original" transcripts when the interview or commentary is but hours old.

    Thus, like you, I do not trust the "main stream" media (explains why I don't watch television) and I like to wait until the Vatican website or another trusted website, posts the actual transcript or full interview.

    So that is why I responded the way I did. Based on your initial dialogue with Mr. Armstrong, I could not discern whether you had actually read, or been able to reviewed the original transcripts. My Apologies if you have and I failed to understand that.

    I've worked in the medical field for over 21 years and during that time, I have performed tens of thousands of blood/Rh-typings and thousands of cross-matches on human blood products for purposes of transfusion, in the event something goes wrong during delivery, or c-section. In all my years I've witnessed only five women who have had c-sections go horribly wrong. Three of those women, sadly passed on to meet Our Creator, and all three of them left behind multiple children. The truly sad part is that only one of the five women, actually warranted a c-section do to her medical condition.

    While wfee points out that "Yes, it is mathematically 3x worse chances, but it is still a small chance.", small chances are all it takes to create a widower and a "motherless" child.

    I believe R. Walle has summed it up nicely.

  • I am surprised you cited wikipedia. Next time you need a credible source, my myspace page is available.

  • I've read all the comments thus far and have concluded, so much has been lost in translation.

  • Well, even though I am only on my second pregnancies, I found the Pope's commentary depressing, and this missive even more so. Mostly because, I had to have an emergency c-section with my first child, and so, I guess, to some extent, I'm being irresponsible as well by having my second child (I'd like 4). You're right that VBAC carries higher risk and may result in a repeat surgery anyway; but what a depressing thing to think about. Of course I do think about it, that's part of the reason I would not go past 4 (also given that I will be 34 probably by the time of having my last); but still, it would be nice to think that the church would espouse some kind of comforting message rather than just reminding us of the dismal statistics. I guess, from the perspective of a mother, I partially understand the wish of the mother with 7 children to have another; children are the most amazing presents ever – who would ever want to stop having amazing presents? It is, to some extent, selfless of her to destroy her body to bring forth new life, but, at the same time selfish for the risks she is indirectly subjecting her children too. So I guess I see both sides but, it feels unfair to judge her after she has been through SEVEN major surgeries. I would venture a guess that she did intentionally try for all of her kids (I'm basing this upon the fact that kids are wonderfully addictive); but it seems as though she wouldn't have come under this kind of fire if she had been lucky enough to have regular births. To some extent, it seems like she had a bout of bad luck with her genetics leading to 7 c-sections; I can imagine her looking over to other women who are highly respected for having so many children with envy. Anyway, I guess I personally am still hoping to be able to have four; I know as a mother I ALREADY have enough anxiety about medical complications even without someone overtly mentioning it, I would imagine that this poor woman probably felt even more anxious afterwards. Maybe you're right – maybe she should but, child birth is hard enough, why add to it? It's not as though she could reverse the decision at that point. But perhaps, you are right that, she should have limited herself – it seems (to me) a little bit selfish to keep venturing for more children (though understandable on some level). Most people have to be content with just two. I already feel I am overstepping things trying for four. I can't even imagine 7 but, I can imagine the motivation.