7. Cesarean Series: Part 1 - Is Your OB’s Reason for a Cesarean Bogus?

Humans have been using Cesarean section surgery, or c-section, since ancient times in ancient cultures, so it is impossible to determine when the first one was done. Doctors performed the surgery, which involves cutting through the abdominal wall into the uterus in order to retrieve an infant, and in ancient times it was most often done on a dead or dying woman in emergency situations, but there is some evidence that women could survive the surgery. These days, obstetricians don’t just use it for times of life or death, they use it to increase revenue, help plan for staffing and avoid working holidays. Its overuse is finally getting the attention it deserves due to the dramatic increase in maternal death rates in the United States. 

In my next blog posts, we’re going to be exploring some of the bogus reasons doctors will tell you to have a c-section along with some valid reasons, how the procedure is performed, the risks of c-sections, and the impact the surgery has on us and our babies. We’ll also dig into how c-sections tie into the astronomically high maternal death rates in America today and why so many of these surgeries are being performed on American women.

Today, the United States of America has an average c-section rate of 33%. That means one out of every three babies is cut out of their mother’s wombs. And yet, we aren’t up in arms about this. How is that possible? Well, that’s because this major abdominal surgery has become normalized in our society. Some women will even schedule a c-section because they just don’t want to go through the whole labor and birth process because we have been conditioned to fear birth and view it as an event that we must be saved from by our “hero” obstetricians. *eye roll* If a woman chooses an elective cesarean and is well informed on all of the risks, then that is her choice, but women have also had these procedures FORCIBLY performed on them by court order because the government thought it knew better than a mother how she should birth her baby because that baby is seen as the state’s property. This is hideous stuff and it’s happening in this day and age.

Many obstetricians (OBs) are much sneakier in their attempts to coerce women into c-section surgeries to birth their babies. Rather than court orders, they lean on using scare tactics as their favorite go-to in their tool belt to get a woman to consent to a surgery that she doesn’t want to have done.

It’s obvious that there are too many c-sections being performed in the United States, so what are all these reasons that women are being told that surgery is the only safe way to birth her baby? One of the top reasons that women consent to a c-section is because the doctor used continuous fetal monitoring via a cardiotocography machine and observed “nonreassuring fetal heart tones.” The first recording of fetal heart tones goes back to 1906, and ever since then, doctors have been pathologizing this part of labor, pretending to understand anything about the subject and using it to coerce women into interventions and c-sections. Cardiotogographs or fetal heart rate monitors were introduced in the year 1968 without any evidence that they improve fetal outcomes. All the information behind fetal heart tones is theory and unproven. Research has shown us repeatedly that these machines do not save babies' lives and yet this piece of technology is something that the medical birth complex is so attached to and refuses to give up, probably because of their ability to use it to convince women that surgery is the fix. The truth about these situations is that the doctor is saving your baby from a situation that they single-handedly caused because if the monitor is not just reading wrong, that fetal distress was most likely caused by your doctor putting you on Pitocin to induce or augment your labor because he wants you out of that bed as soon as possible. In his rush to get your birth completed on his timeline, he has put your baby in danger, because, as discussed in my previous blog post, Pitocin causes your contractions to be much stronger and much longer than normal and because of this, your placenta cannot sufficiently refill fast enough with oxygenated blood which leaves your baby compromised, so in this situation, your doctor would be saving you from a situation that he is responsible for in the first place when the Pitocin could just as easily be turned off instead of resorting to major abdominal surgery, but that wouldn’t line his pocketbook or move you along to your postpartum room any faster.

Failure to progress in labor is another fave go-to for an OB when labor isn’t keeping up with THEIR schedule. How would you like to be in the hospital where you’re in an unfamiliar environment with strangers shoving their hands into your vagina, bright lights accosting your eyeballs, and annoying beeps going off every five seconds, to then have your doctor tell you that your body is FAILING you because you aren’t progressing as fast as they’d like you to, and because of this you need to have your baby cut out of you, because time is money, baby! That sounds pretty barbaric to me. So, because they’ve put your progress on a timeline with no allowance for variation, you have to stick to their policy? How about no? If you’ve been following me for any length of time, you already know that that’s not true and you can say “NO” loud and proud to a c-section. One of the likely reasons that your labor isn’t progressing is because your body is in fight or flight mode caused by the hospital and the adrenaline that your body is releasing acts against the labor process, slowing it down because as mammals, if we aren’t calm and have our natural oxytocin flowing through us, our body evolved to assume that you are in danger and need to be able to make it to a safe place away from whatever is making you feel uneasy to birth your baby. The restriction on movement in the hospital will also lead to a failure to progress. If a woman isn’t allowed to labor in a position that feels intuitive to her and if she can’t tune into her body and her baby because she’s cut off from the feeling and forced to lay in bed only to be rolled from side to side by her nurses every half hour, that can also lead to a failure to progress. Basically, everything that happens in the hospital is a hindrance to the natural birth process and slows it down, so don’t be surprised if this happens to you, and be aware that birth doesn’t need to be on a timeline.

Just like other mammals, we require a safe place to birth our babies.

Say it with me now: Breech is a variation of normal! If you go to the hospital at your 32 weeks appointment and your OB tells you that your baby is still head up and if she doesn’t turn head down, then you are going to have to sign up for surgery, it’s time to find another OB. That happened to me. If your obstetrician’s policy says that a breech baby means automatic c-section, your OB is unskilled and uneducated on breech presentation. Do you want an OB that only knows how to deliver a baby if they are head down? Babies are head up in about 1 out of every 25 births, so I’m pretty sure the human population would be dramatically less if vaginal breech birth was killing every mother and child that it happened to in the past, but it hasn’t. In fact, we’ve been having breech births since the dawn of time and we’re still having them successfully today, thanks to doctors and midwives who understand that this is not a position to fix, but that it is just different than vertex presentation, or head down babies. There was a study done that showed a very small difference between vaginal breech deliveries and Cesarean breech deliveries and OBs use this study to tell every mother that no matter what, their breech baby needs to be delivered via Cesarean. In fact, OBs have become so unskilled that people like Dr. Stu Fischbein are having to go around the United States and the world to in his ”Reteach Breech” seminars where he teaches those who are willing to learn or those that either forgot or were never taught this incredibly vital skill. Personally, I’d never want to go to an OB that didn’t know how to deliver a breech baby because there is always the possibility that you could have an undiagnosed breech that isn’t discovered until you are birthing your baby. So, I ask you, do you want an unskilled OB anywhere near you during your delivery? I mean, my God, these are the people that we are supposed to trust our babies with and they can’t handle a situation that occurs in 1 out of every 25 births? My brother was a breech baby and even back in 1970, my mother was convinced that breech was “dangerous” and she wad convinced that her birth was harder and more perilous than a vertex baby. I grew up with that story and yet when my fourth baby was still breech at 32 weeks and my OBs started discussing the possibility of “having” to have a c-section, I recoiled and my immediate reaction was “hell no, that is not happening.” My deep dive into vaginal breech deliveries is essentially what lead me down this path of being a doula, childbirth educator, and birth keeper for other women because I believe so strongly that we are built to birth and breech is normal.

Who had “big baby” on their c-section excuse bingo card because you nailed it. Doctors will often times order a late-term ultrasound and take certain measurements and tell you that your baby is “too big” to fit through the pelvis, but these ultrasound measurements can be off by pounds. My own sister in law was a planned c-section due to a “large baby” and he came out 5 pounds something. Does that sound large to you? No. They were wrong, so not only did he miss out on the benefits of a vaginal delivery, but he was also born earlier than he should have been and, due to several factors, he didn’t breastfeed successfully. This isn’t just an anecdotal story. The inaccuracy of ultrasound weights for babies is well documented. Some diabetes diagnoses will lead doctors to want to schedule a planned c-section immediately, but if your blood sugars and A1C are well managed and kept at normal levels, there is no reason to suspect that you will have a larger-than-normal baby. Those with uncontrolled diabetes will have more sugar circulating in their bloodstream which reaches the baby. These babies do tend to be on the larger side and are more likely to end in a shoulder dystocia situation, but even many shoulder dystocia situations can be avoided by allowing the mother to birth in instinctual positions that allow the pelvis to expand as it is meant to.

A doctor that doesn’t want you to VBAC, or have a vaginal birth after a cesarean, is a doctor that you need to run away from at full speed, or maybe just waddle, depending on how pregnant you are. Just because you had a previous cesarean does NOT mean that you cannot have a vaginal birth. The rule used to be if you had one c-section, the rest of your births had to be c-sections, but now we know better and you can successfully have a vaginal birth after cesarean or VBAC without too much of an increased risk of uterine rupture. The risk of rupture can occur if Pitocin is used to induce or augment labor because of these abnormally strong and long contractions that are caused by the use of this drug, so I’d suggest avoiding it altogether during labor in any situation. Your risk is less than 1% of uterine rupture if you VBAC and goes down with every successful vaginal birth after cesarean, so if you’ve had one VBAC, your chances are even greater for your next children.

“But, Katie! My baby’s cord was wrapped around his neck!” Ah, the old nuchal cord scare tactic. I bet you know someone who is under the false impression that their baby was “saved” by the doctor that delivered them due to the cord being wrapped around the baby's neck because they’ve been lied to. They’ve been told that nuchal cords are strangling their baby when that is 100% false. Nuchal cords have become a common scapegoat for doctors to blame in the event that there is a poor outcome with the baby, but the truth is that 30% of babies are born with their cord around their neck and there is no evidence to prove that nuchal cords lead to long term problems for the baby. The cord may be tightly pulled which may decrease blood flow until she is born, but once tension is released on the cord and if they are allowed to remain attached to their placenta, they recover quickly and there are no issues. The problems caused by nuchal cords are due to the intervention of the OBs after delivery. They will often, cut the cord to move the baby to the warmer, which essentially takes the baby away from the best recovery which is on the mother’s chest while still being able to receive all of their oxygen-rich blood from the placenta. Nuchal cords aren’t the problem, your OB is. 

Don’t get me wrong, there are situations in which I am grateful that we have lifesaving medical technologies that allow for cesareans, but we have to start looking at these “reasons” for cutting babies out of our wombs and start thinking critically about whether or not the doctors are wanting to perform this very lucrative surgery for their benefit or for ours. 

In my next post, I’m going to be going over some of the more nuanced situations where there can be pros to having a cesarean, so stay tuned for that, and don’t forget to sign up for my weekly blog newsletter where I’ll keep you up to date on when the newest posts are released. 

Until then, stay free!