By April 1970 space travel was largely regarded as mundane. Two successful moon landings had taken place and the public had started to view space travel as an endeavor with as much risk as road tripping to see family in Ohio.

For the crew of Apollo 13 though, it was the culmination of years of training. They were all stand out pilots who were excited to have the chance to go to the moon- a genuine, once-in-a-lifetime opportunity. For Commander Jim Lovell, this was the top of pyramid. He had clocked more time in space than almost any other astronaut and had even seen the moon on flyby when he was part of the Apollo 8 crew’s Christmas mission. (You can still  see the video coverage where they filmed the Moon from space, reading from the first chapter of Genesis. Whatever your religious views, it will give you chills as you think about just how vast and ancient our universe is.) Lovell had had an incredible career. Apollo 13 was his last mission and visiting the moon was everything he could have wished for as a pilot and astronaut.

The third moon landing mission Apollo 13 launched with little fanfare or attention… until a malfunction left astronauts Jim Lovell, Fred Haise and Jack Swigert stranded in space while NASA engineers worked day and night for almost six days to solve an ever increasing list of problems and bring the astronauts back home safely.

The situation was far from ideal. A routine stir of the oxygen tanks had caused an explosion on the spacecraft leaving the astronauts with no other option than to leave the spacecraft Odyssey (which was meant to ferry the three men to and from the moon) into the lunar landing module or LM (which was designed to carry two of the crew to land on the moon from lunar orbit). With three occupants instead of two, the LM’s carbon dioxide filters quickly started becoming overwhelmed and the filters between the Odyssey and the LM were not interchangeable, so NASA engineers had to figure out how create an adaptor using only the materials the astronauts would have on board.

The LM was not designed for multi-day usage, so they had to turn the power down to an absolute minimum to subsist for the entire journey back to Earth. (For a point of comparison, there is a famous line in the movie where one engineer protests this idea shouting “You can’t run a vacuum cleaner on 12 amps!”) This meant that the onboard guidance computers had to be shut down. It meant turning off the heat so the astronauts were floating around in temperatures as low as 38 degree temperature with no warm clothing. Water had to be rationed to last the entire trip (Fred Haise developed a UTI and subsequent kidney infections during the whole ordeal.) And no waste dumps were allowed for fear it would mess up the already tenuous trajectory of the injured space craft. All human waste was confined to bags and kept in the craft.

The odds were not good. But as lead flight director Gene Kranz would later say, “Failure was not an option.” They refused to let three men die in space and simply kept working problem after problem. After a lot of hard work, courage, and a few lucky breaks (like the onboard computer not shorting out when it was powered for reentry and missing a hurricane at splashdown), the crew of Apollo 13 made it safely home to their families. The mission was considered a successful failure. They failed to reach the moon and none of the crew would ever have the chance to visit the moon again. But despite all the challenges, they made it safely home.

NASA and other space agencies don’t make a habit of pushing spacecraft to work in ways that defy design and specification. It would sure save a lot of power, but turning onboard computers and heating off are not routine because of the risks involved to the astronauts. Nobody wants to make those types of sacrifices unless it’s absolutely necessary. On the other hand, if you ask anyone at NASA who had to live through Apollo 1 (fatal fire during training), Challenger (explosion on the launchpad) or Columbia (disintegration upon reentry), which they would choose, they would take Apollo 13 in a heartbeat. No one wants dead astronauts.

A c-section should be the same way. It’s not ideal. You are surgically cutting open the womb. There is a 12 percent chance of damage to the mother’s internal organs. There is an increased chance of hysterectomy, blood transfusion, uterine infection and future placental abnormalities for the mother. There is a 1.1% chance of some kind of injury to the baby, ranging from minor to serious. The baby is very likely to experience respiratory problems which will require a NICU stay. Breastfeeding is frequently more difficult because of the problems associated with nursing after major surgery. We’re talking about additional risks over a normal, uncomplicated vaginal birth, but when faced with a life and death situation, we all want safe mothers and babies. And if that means the obstetrical equivalent of pulling out a lifeboat in space, turning off the power, and fashioning a carbon dioxide filter adaptor from duct tape, we’re going to do it because it has a good chance of saving lives.

When we talk about c-sections, we’re not talking about a choice between risk and no-risk. C-sections carry additional risks over normal, uncomplicated vaginal birth. The engineers and astronauts realized that every decision they were making about the Apollo 13 mission carried an additional risk of death over an uncomplicated mission, but those risks were worth the chance of bringing the astronauts safely home because they were not dealing with a normal, uncomplicated mission. C-sections should not be seen as a routine procedure. Health professionals, parents and birth workers need to keep in mind that c-sections are the obstetrical equivalent of Apollo 13. If we start confusing “normal” with “emergency” we are creating a situation that exposes mothers and babies to additional risks.

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