Maybe You Need A Caesarean, Maybe You Don’t

Do you need a caesarean or is it safe to watch and wait? Only you can decide what you're most comfortable with, but you need some solid information to make that decision.

Maybe You Need A Caesarean, Maybe You Don’t

World wide, the caesarean is the most common surgery performed. Given that only 50% of the world’s population is eligible for one, that’s pretty telling isn’t it! In some places as many as one in three women are having their babies surgically removed, in others it is much higher. When confronted by these figures, medical lobby groups claim that women are requesting caesareans, but this is not backed by any birth choices survey ever conducted.

The reasons for caesarean births reported on government reports don’t include “The mother asked for it”. And although many caesareans are classes as elective, the word elective is misleading. Elective purely means booked, not that the woman asked for it.

The main reason for caesarean births are commonly reasons that can be avoided. So what are those reasons and how do you know if you really need surgery or if you can go ahead with a vaginal birth?

Previous Caesarean: Often a doctor will tell a woman that she needs to have a caesarean to avoid the chance that her uterus will rupture in any labour after a caesarean, but the risk of rupture after 1 caesarean is either 0.5% or below depending on what study you look at. Rupture can definitely be a serious complication however the potential complications from caesarean surgery can be equally serious and the more caesareans you have, the greater the risks. [LINK Midwife Thinking] states

”So, out of the small number of women who experience uterine rupture, an even smaller proportion will lose their baby or uterus because of it. When the uterus ruptures 94% of babies survive.”

Small Pelvis: Small women have small pelvises, large women have large pelvises. It is extremely rare for a woman to grow a baby that is too large for her pelvis. Surely if being large was a requisite to successful birth, then the average woman would be larger than the average man? But this is not what we see in even one single racial group. This is not to say that a woman never ever grows a baby too large, but there is no way to actually know how your pelvis will work until you give it a try. If you stay upright, avoid induction, avoid epidurals, and move instinctively, you give your pelvis the best shot at birth. In her famous article Pelvises I Have Known and Loved, Gloria Lemay states

“Pelvises open at three stretch points—the symphisis pubis and the two sacroiliac joints. These points are full of relaxin hormones—the pelvis literally begins falling apart at about thirty-four weeks of pregnancy. In addition to this mobile, loose, stretchy pelvis, nature has given human beings the added bonus of having a moldable, pliable, shrinkable baby head. Like a steamer tray for a cooking pot has folding plates that adjust it to any size pot, so do these four overlapping plates that form the infant’s skull adjust to fit the mother’s body.”

Big Baby: The thought that your baby is big is a daunting one because no one wants to tear during birth however a tear isn’t major surgery like a caesarean. We need to remember that size estimates can be inaccurate, and that there is no way to tell how a woman’s pelvis will perform during birth, nor how a baby’s head will shape to fit. There are plenty of ways to reduce the risk of tearing, including avoiding an episiotomy, staying upright, pushing only when your body pushes, and giving birth in water. According to  Evidence Based Birth:

In fact, research has consistently shown that the care provider’s perception that a baby is big is more harmful than an actual big baby by itself….Women who were suspected of having a big baby (and actually ended up having one) had a triple in the induction rate; more than triple the C-section rate, and a quadrupling of the maternal complication rate, compared to women who were not suspected of having a big baby but who had one anyways.

Overweight Mothers: When someone overweight requires elective surgery they are often told to lose weight before they are scheduled. Undergoing surgery as a larger person exposes you to greater risks during the surgery and during recovery, and yet surgeons frequently tell women that they require a caesarean because they are overweight.  Our Bodies, Our Selves states 

”If the cesarean rate was significantly lower in the past for obese women, it means that most fat women can give birth vaginally under the right conditions, and that a high cesarean rate is not an inevitable outcome of obesity.”

Slow Labour: One of the top reasons for caesareans, Failure To Progress is viewed as problematic because a lengthy labour might result in foetal distress and maternal exhaustion. Whilst that is true at face value, what it doesn’t tell us that when a mother and baby are healthy, there is no reason not to simply wait for birth. The length of time that lapses from the onset of labour to a caesarean for Failure to Progress varies greatly around the world, and even from postcode to postcode. This shows us that the recommendations must be based on something other than evidence based practice. Failure to progress is diagnosed following a completely outdated, statistically insignificant graph known as Friedman’s Curve.  Evidence Based Birth explains why the Friedman’s Curve is so obsolete for modern women

“… mothers did not rapidly dilate starting at 3 cm like Dr. Friedman saw back in 1955. Instead, women began to see active labor at 6 cm. This was true for both first-time mothers and experienced mothers, although experienced mothers tend to dilate faster once they hit active labor (6 cm). ”

Low Fluid: This one can definitely sound serious. Everyone knows babies need to spend pregnancy floating around in amniotic fluid. However it’s important for women to understand the difficulties in diagnosis, and the options that are available in the instance of a confirmed diagnosis. In a guest post on The Unnecessarean, Christine Fiscer writes

“If decreased amniotic fluid is suspected through palpation, an ultrasound can be done to measure the volume found. However, this is not an exact science, as the volume found can – and usually will – vary from ultrasound technician to ultrasound technician, and can also sometimes be dependent on baby’s position. If the levels are found to be on the low side, evidence based protocols suggest having mom orally re-hydrate and return within 24 hours for another AFI ( Amniotic Fluid Index ), preferably by a different technician. This has shown repeatedly to have improved outcomes, versus immediate induction {or caesarean} for low AFI levels.”

The Position The Baby Is In: Breech, transverse, posterior , or a baby which has not yet engaged in the pelvis. All are reasons that women have been given for requiring a caesarean however they aren’t as cut and dried as you might think. A high proportion of babies will turn and present in a more favourable position if we simply wait for the onset of labour. A baby presenting in the transverse position is obviously the greatest indication for a necessary position related caesarean. A woman in hard labour with a transverse baby may need a caesarean, but before labour begins, it’s possible to wait and see whether the baby will align properly. Babies in the other positions listed can get out with the support of a skilled, supportive, birth attendant. Mary Cronk MBE reports:

”It is my view that a breech presentation is a normal presentation, though not the usual presentation. A normal labour and a spontaneous birth are not to be excluded just because the presenting part is breech, but I emphasise that I am not saying that all breeches can or should be born vaginally. Having attended many breech births it is my experience that if labour progresses well and spontaneously, and by that I mean, spontaneous onset at or around term, contractions that come oftener, last longer, get stronger, a cervix that effaces, and dilates and a presenting part that descends through the pelvis, this baby will be born.”

You are not dilated before 40 weeks: The purpose of labour is to dilate the cervix so the baby can travel through the cervix and out the vagina. There is absolutely no reason for a woman to have a dilated cervix before she even goes into labour.

As shown in the well known article The Myth Of The Vaginal Exam, although it is normal for care providers to perform a routine vaginal exam to assess dilation at the end of pregnancy, knowing how dilated you are means nothing. It is either disheartening unnecessarily, or encouraging, for no reason.

“Labor is not simply about a cervix that has dilated, softened or anything else. A woman’s cervix can be very dilated and not have her baby before her due date or even near her due date. I’ve personally had women who had a cervix that was 6 centimeters dilated for weeks. Then there is the sad woman who calls me to say that the cervix is high and tight, she’s been told that this baby isn’t coming for awhile, only to be at her side as she gives birth within 24 hours. Vaginal exams are just not good predictors of when labor will start.”

These are just a few of the more common reasons given for a recommendation of surgery, however there are many more. Whole Woman recommends that each woman assess her own situation thoroughly and consult many sources, not just this one article. This article does not suggest that the above reasons are NEVER valid reasons for a caesareans, the point is that women need to be thoroughly informed before consenting to major abdominal surgery.

If your care provider is unwilling to discuss the risks of caesarean surgery and continually emphasises the risk of vaginal birth then it’s wise to seek a second opinion. Your care provider may well be telling the truth, but we haven’t reached a point in history where one in three babies is born via caesarean because of obstetric wisdom. It is reasonable for women to expect their care provider to earn trust, to not simply award is because the care provider has a certificate to say they qualified as a surgeon, because all that certificate shows is that they learnt the material, not that they always apply it in the most ethical manner.


surgeon holds baby after caesarean
Caesareans are major surgery
License: Creative Commons CC0.

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2 Responses to "Maybe You Need A Caesarean, Maybe You Don’t"

  1. Valerie  17 June, 2016 at 1:31 am

    Stop bashing moms on how they give birth!

    • Whole Woman
      Whole Woman  17 June, 2016 at 2:03 pm

      Thanks for stopping by and commenting. I’m not sure I understand what you mean, could you clarify please?


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