The absolute best way to avoid a medically unnecessary cesarean surgery is by being an informed consumer. As a birthing mother, once you leave your home and walk through the doors of the hospital, you are subject to the rules, procedures and preferences of the hospital and its staff. Most hospital environments are not natural birth friendly. Oftentimes, hospital policy requires continuous monitoring and restricted movement. As well, birth plans are oftentimes ignored and the mother is at the whim of whatever nursing staff and doctors are on call at the time. Interesting tidbit, various studies have shown that cesarean surgery rates reflect a startling trend. Many surgeries are performed earlier in the day and almost never on the weekends or very late at night, thus leading many to the conclusion that they are being performed more so based on the doctor’s convenience.

The World Health Organization states that a cesarean surgery rate of more than 15% constitutes a misuse of the procedure. This number is based on the likelihood of complications arising that would make major surgery medically necessary. Obstetricians agree that the following are complications that would indicate need for a surgical delivery- placental abruption, cord prolapsed, placenta previa, shoulder presentation, maternal infection such as HIV or genital herpes and fetal distress (which is open to interpretation). These complications occur rather rarely and account for an unbelievably small number of cesarean surgeries performed in the United States.

The truth is 1 in 3 babies are delivered via surgical means. Some hospitals have a cesarean surgery rate as high as 60%. The number of surgical deliveries being performed reflects a clear misuse of the procedure. The reasons the surgery is being performed covers a wide continuum. The following are just some examples of what doctors tell birthing mothers is their reason for recommending major invasive surgery instead of vaginal birth. None of these reasons are deemed medically necessary.

“You’re not progressing fast enough, we should do a c-section”
An important response to this statement- Is this an emergency, or can we talk about it? This simple question will help you, your partner and/or birth assistant gauge the true nature of the situation. If the situation is not an emergency, then your doctor and/or birth assistant are responsible for working with you to address the situation in a non-surgical form. You have the right to ask questions and get answers that you fully understand. As well, you have every right to make alternate suggestions/choices in lieu of what your doctor recommends.

Most hospitals and doctors have what is sort of a time limit on how long a woman is “allowed” to remain in labor after she has been admitted and/or her bag of waters has broken. It is crucial to be aware of what this time limit is as it will give an idea of how long to wait before going to the hospital, and it will give a glimpse of just how natural-birth friendly the hospital/doctor really is.

“The baby is too big for you to push out vaginally” or “Your pelvis is too small for the size of the baby”
The “too big baby” has existed as far back as the 1800’s and it is more often than not a myth. In all nature, a mother’s body will grow and produce offspring that can successfully be expelled from the body in both size and number. The calculations used to guesstimate a baby’s birth weight while still in the womb are highly inaccurate. Moreover, if, for example, a man 6’8”, 250 pounds impregnates a woman who is 5’1”, 119 pounds, this most certainly is not a recipe for a baby that is destined to be “too big” and is in no way a reflection of the woman’s pelvis being “too small”. Unless there is a specific pre-existing condition then the “too big baby” is nothing but a scare tactic.

“You’ve gone past your due date”
A woman’s estimated date of delivery is simply that, an estimate. It is not a date etched in stone and it most certainly does not represent a deadline of sorts as to exactly when a baby must be born by. In and of itself, going past your due date on its own is no indication of medically necessary surgery. Many women have irregular menstrual cycles which can easily result in a miscalculation of the gestational age.

“Since you are having twins/triplets, we will schedule you for your cesarean now”
A growing number of obstetricians have a personal preference to deliver multiples via cesarean surgery. However, in and of itself, carrying more than one baby is not a medically necessary reason for major abdominal surgery. Many birth centers consider a woman pregnant with multiples to be ‘at risk’ so it is a good idea to shop around for a provider as soon as you know you are having more than one baby. There are midwives and doulas with experience in the birth of multiples that can provide support and expertise during the birth. Something to keep in mind- prior to hospital birth being the trend, twin and triplet births have occurred safely at home.

“Your baby is breech and cannot be delivered vaginally” or “Your baby is not in optimal position for a vaginal birth”
In almost every case, a baby who is not in optimal position is delivered via surgical means. Up until about 1959, breech babies have been delivered vaginally. Most obstetricians today are not skilled in the art of delivering a breech baby and thus do not believe they can be delivered vaginally. There are some midwives who still deliver breech babies, but their numbers are dwindling due to the risk of malpractice suits. At present, a large number of breech babies are being born at home without the presence of a midwife or other trained medical professional. This is called unassisted birth.

“Your first baby was delivered surgically and so will all your other children”
A vaginal birth after a cesarean surgery occurs in no more than 9% of all births to mothers with a history of surgical birth. Most doctors strongly encourage women to have subsequent surgeries based on the misguided belief that ‘once a cesarean, always a cesarean’ without taking into consideration the compounding risks that increase exponentially with each surgery. Most importantly, repeat cesarean surgery has serious risks of complications (as do all major surgeries) that can result in hysterectomy, hemorrhage or even death. Having a cesarean surgery limits the amount of children a woman can safely have. A woman wishing to have a large family is not encouraged to have a cesarean surgery as the increased risks of repeat surgery can put both mother and child’s life at risk.

“A c-section will be much quicker and easier” or “A c-section is safer”
A cesarean surgery without complications can be fully performed in about 90 minutes. The full recovery time without complications for the mother is approximately 3 months. Quicker and easier for whom? As well, the cost of a cesarean surgery is at least 3 times as much as a vaginal delivery. In terms of safety, delivery via cesarean surgery with no complications has a 69% higher risk of neonatal death. When delivered surgically, birth injuries were 30 times more likely to occur.

For more information, check out my references at:

Goer, Henci “Cesarean Section: What You Need to Know” http://parenting.ivillage.com/pregnancy/plabor/0,,8wvj,00.html

International Cesarean Awareness Network
ican-online.org/

American Pregnancy Association “What You Should Know About Cesarean Birth” 

Childbirth.org “Cesarean Section”
childbirth.org/section/section.html

VBAC.com

Fischer, Robert MD “Breech Presentation”
emedicine.com/med/topic3272.htm

Tags: cesarean, surgery, birth, section, medical, risks, procedure

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