For many expecting parents, the goal is to have as natural a birth as possible. But in the United States, cesarean sections are performed at an alarmingly high rate—far beyond what the World Health Organization (WHO) deems medically necessary. While C-sections are life-saving in certain circumstances, many are performed prematurely or out of convenience rather than genuine medical need. As a mom hoping for a vaginal birth, how can you navigate the pressures of medical interventions and advocate for yourself?
Why Are So Many C-Sections Performed?
The reasons behind high C-section rates are complex, but some common contributing factors include:
Hospital Policies & Time Constraints: Some hospitals have policies or expectations that prioritize efficiency over individualized care. The desire to manage labor within a specific timeframe can lead to unnecessary interventions that culminate in a C-section.
Liability & Fear of Lawsuits: Many providers practice defensive medicine, meaning they may recommend a cesarean to avoid any potential legal repercussions if complications arise during labor.
Convenience for Providers: Scheduled C-sections are more predictable and easier to plan than spontaneous labors, which can occur at any time, including nights, weekends, and holidays.
Failure to Wait for Labor to Progress: The modern medical approach often has little patience for longer labors. Yet, studies show that giving labor more time—especially for first-time moms—can significantly reduce the likelihood of a C-section.
Perception of Safety: Some expectant parents and healthcare providers perceive C-sections as a safer alternative to vaginal births, especially in cases of suspected large babies or advanced maternal age. However, this perception doesn’t always align with clinical evidence.
Overuse of Inductions & Interventions: Inductions that are not medically necessary can lead to a cascade of interventions, including stronger contractions, fetal distress, and ultimately, an “emergency” C-section that might have been avoidable.
Legitimate Reasons for a Cesarean
While unnecessary C-sections are a concern, there are situations where a surgical birth is the safest option for both mom and baby. Some valid reasons include:
Placenta Previa: This condition occurs when the placenta partially or completely covers the cervix, blocking the baby’s exit route and making a C-section necessary
Placental Abruption: Premature separation of the placenta from the uterine wall can deprive the baby of oxygen and nutrients, necessitating an immediate C-section.
Umbilical Cord Prolapse: When the umbilical cord slips into the birth canal ahead of the baby, it can compress the cord and reduce blood flow, requiring an emergency C-section.
Severe Fetal Distress: Abnormal heart rate patterns or other signs indicating the baby isn’t tolerating labor well may lead to a C-section to prevent further complications.
Uterine Rupture: A tear in the uterine wall, often at the site of a previous C-section scar, can pose significant risks, making an emergency C-section imperative.
Certain Medical Conditions: Maternal health issues, such as severe preeclampsia, active genital herpes infection during labor, or specific heart conditions, can make vaginal birth risky, leading to a recommendation for a C-section.
Multiple Pregnancies: Carrying twins, triplets, or more can increase the likelihood of complications during vaginal delivery, often resulting in a planned C-section.
One reason often cited for a C-section is baby positioning. While some positions, such as breech presentation, may make vaginal delivery more complex, it is still very possible in many cases. The real challenge is often finding a provider who is comfortable and skilled in assisting a breech birth. Many hospitals and doctors automatically recommend a C-section for breech babies, even though vaginal breech birth is a valid and safe option in the right circumstances. Other fetal positions that could lead to challenges during labor include:
Occiput Posterior (OP): When the baby is head-down but facing the birthing person’s abdomen instead of their spine, which can cause back labor and a longer, more difficult delivery. OP positioning may lead to a recommendation for a C-section if the baby does not rotate or if labor stalls due to ineffective contractions or prolonged pushing.
Transverse Lie: When the baby is positioned sideways across the uterus, making vaginal birth impossible unless the baby rotates. Because a baby in transverse lie cannot pass through the birth canal, a C-section is typically recommended if the baby does not turn before the 37th week.
Asynclitism: When the baby’s head is tilted to one side, making descent through the birth canal more difficult. If the baby remains misaligned, it can lead to a prolonged labor or ineffective pushing, increasing the likelihood of a C-section.
Breech (Frank, Complete, or Footling): – When the baby’s feet or bottom are positioned to be delivered first instead of the head. Many providers recommend a C-section because they may not have the training or experience to assist with vaginal breech birth. However, positions like Breech Tilt and Forward-Leaning Inversion can encourage a head-down position.
Questions to Ask Your Provider to Avoid an Unnecessary C-Section
Advocating for yourself starts with asking the right questions. Here are some you can discuss with your provider:
What is your C-section rate, and what factors contribute to it?
How long are you comfortable letting me labor before discussing interventions?
Under what circumstances would you recommend a C-section?
If complications arise, what alternatives do we have before resorting to surgery?
How do you determine fetal distress, and what steps can we take before jumping to a cesarean?
Can I have a say in laboring longer if my baby and I are stable?
Are there policies at this hospital that could increase my risk of a C-section (such as strict time limits on labor progress)?
Can I use movement, position changes, or other comfort measures to help labor progress?
What are the risks and benefits of waiting longer versus moving forward with a cesarean?
Empowering Yourself for the Birth You Want
Having a birth plan, hiring a doula, and ensuring your provider supports your goals are all crucial steps in reducing your chances of an unnecessary C-section. One key aspect of preparing for labor is understanding how movement and positioning throughout pregnancy can help your baby get into an optimal position for birth. Babies in a good position—head down and well-aligned with the pelvis—can reduce the likelihood of interventions, including C-sections.
My book, A Doula’s Guide to Labor Positions, is a great resource to help you navigate movement and positions before and during labor. It provides easy-to-follow guidance on how to encourage your baby into a favorable position, which can make labor smoother and reduce the chances of complications that could lead to a C-section. Learning about these techniques ahead of time can help you feel more in control of your birth experience.
While birth is unpredictable, being informed and asking the right questions can help you feel confident in your choices. No matter how your birth unfolds, knowing that you advocated for yourself will allow you to feel empowered rather than like a passive participant in your own labor.
If a C-section does become necessary, remember that it is not a failure—it is a birth. The most important thing is that you and your baby are safe, healthy, and supported in your journey into parenthood.
Have you experienced a provider pushing for a C-section before you felt it was necessary? Share your story in the comments—we learn best when we support one another!
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