It seems like the media is talking about the ridiculously high csection rates again and the questions get asked. Why are the rates so high? What is it about mothers today that’s causing 1 in 3 births to end in major surgery?

You wanna know WHY we’re in this mess? I’ve been asking that question for 5 years now, ever since I was aware of the issue. And many birth advocates have been doing it a lot longer than I have.

Here’s how you get a recipe for an unnecessary cesarean. Please keep in mind that this isn’t referring to the 15% of cases when a csection is actually necessary, nor is it referring to the breech and twin births where a csection may or may not be needed. This is in reference to the countless cases of mothers who could have had a vaginal birth but were robbed of that because of factors they were not aware of that were deliberately undermining their confidence in their bodies and that contributed to their “needing” that cesarean.

 

Start with one first time mother who isn’t aware of her rights to informed consent and refusal.

GP refers her to an OB. Does not mention midwife as an option for low risk women.

OB starts off relationship with “patient” telling the mother all the things she’s “not allowed” to do.

OB refers “patient” for tests; makes certain to word things in a way that makes it seem mandatory instead of optional.

OB starts performing cervical checks in the last month to give the mother false hope that she’ll have her baby “soon” or NO hope because “nothing seems to be happening yet”.

not a crystal ball

Mother spends last week of pregnancy wondering if she’ll ever go into labor on her own.

OB convinces the “patient” that the due date is an expiration date for the pregnancy. Makes no mention of the fact that very few women actually go into labor on their due date OR that full term is anywhere from 37-42 weeks.

due date estimations

Mother exhausts herself trying to go into labor by her due date. Gets discouraged when all her efforts “fail”. OB does not ever explain that THE BABY is the one that triggers labor and that she could still have a few more weeks to go.

OB schedules an induction for 41 weeks or 10 days past the due date because of “policy”.

Mother further exhausts herself trying to go into labor on her own and avoid the dreaded induction. She turns to online communities for help, but sadly is just given MORE false hope, induction horror stories, and a few comments that a healthy baby is all that matters. If she is lucky she might get a comment from a birth advocate or doula informing her of her right to informed consent and refusal, but months of indoctrination and disempowering language has undermined her confidence to actually refuse.

Mother “fails” to go into labor by the induction date. Her body and baby aren’t ready because she might be one of those women who gestates to 42 weeks or just past 41 weeks. Nobody informs her that induction of a first time mother can triple the risk of cesarean.

Mother experiences a very horrifically painful labor because Pitocin creates intense contractions that are much stronger than what nature intended. Is convinced that this is how all labors are. Gets the epidural she hadn’t wanted because the pain is too much. Is not told that the epidural could lead to restricted movement making it harder for the baby to navigate the pelvis.

“Fails to progress”.

cascade of intervention

OB decides to do a csection for “failure to progress” or “fetal distress”. Never mentions that the induction is the reason for that.

Mother is led to believe her body couldn’t labor well on its own, that birth is horrifically painful, and that a csection is “easier”.

Mother gets pregnant again. Goes back to the same OB that cut her the first time.

OB uses a VBAC calculator on her. Fails to mention that VBAC calculators are inaccurate at predicting a VBAC and then puts conditions on VBAC. Tells “patient” that she must go into labor by her due date (because that worked SO well last time) or else it’s a repeat cesarean.

VBAC supportive vs tolerant

OB starts doing measurements in late pregnancy to “guess baby’s size” even though fetal size is not a true indication of whether vaginal birth is possible. Tells mother baby is “bigger than the last one”.

OB does cervical checks in the final month. Tells mother she’s either making progress or not. Discourages mother further that her body isn’t working the way it “should”.

Due date approaches. OB has already scheduled a csection in advance. Mother tires herself out trying to go into labor on her own. Gets more comments about healthy babies, csections being “safer” and very few or no mentions of her right to informed consent and refusal, current VBAC guidelines, or current evidence that is contradictory to what her OB is saying. Months of disempowering language and power imbalances has made her less likely to question her OB or say NO.

Mother does not go into labor by her due date (because BABY ISN’T READY) and has the repeat csection.

Mother finally learns the truth. Mother decides she doesn’t want to repeat the same pattern anymore. Mother does research on VBAC and learns she was “bait and switched” during that second pregnancy. Mother decides enough is enough and finds out that few to no OBs will accept her desire for a VBA2C. Is told she “has to” have a repeat csection.

Mother appeals to the online community. Gets shamed by the mainstream community for “putting her birth experience above her baby”. Is told it’s “too dangerous”.

Mother is constantly told to just do a repeat csection by everyone she knows. Risks of uterine rupture are a constant topic of discussion as a way to discourage her/scare her.

risks vbac

Unless she can empower herself to ignore all the negative comments she probably will give in. So few women have a will strong enough to withstand the scare tactics and coercive language. If she has a few stronger voices standing up with her, she’s more likely to succeed in a trial of labor after cesarean or multiple cesarean.

This can go one of two ways: Mother hires a different care provider, possibly even a midwife. She might do a homebirth or choose to labor at home as long as possible before going to the hospital. If there’s a VBAC ban in that hospital then she would also need to arm herself with the laws of informed consent and refusal because coercive tactics may be employed to obtain her “consent” for a repeat csection. If she stays home, she likely has an empowering VBA2C unless there is a true complication that arises and the midwife advises that she transfer to the hospital (very unlikely).

If the mother has no access to midwifery care or a truly VBAC supportive OB, she will likely be “bait and switched” again unless she manages to beat the clock and have a spontaneous, precipitous labor where there’s no time to get to the OR to section her.

If she has NO supportive voices of friends or even strangers on the internet telling her that what she wants is even possible or how to achieve that goal, then she might feel like she can’t do it and agree to a repeat csection.

The more csections she has, the more likely these scenarios will repeat themselves. I personally have a friend who had a VBA3C and she indeed had to fight for it. When she achieved that VBAC it changed her. It made her into that strong advocate that would be a voice to encourage other mothers seeking VBAC. She learned the hard way, as so many women do, that the system is not designed to support vaginal births.

We have too many csections because we have too many inductions scheduled before 42 weeks without medical cause.

We have too many csections because we have too many repeat csections scheduled on the due dates or just before, without medical reason for it.

We have too many csections because too many women are being led to believe their bodies don’t work and that they “need” interventions that they actually don’t. We have too many csections because not enough people are out there informing mothers of their rights to informed consent and refusal, evidence based practices and guidelines, and the difference between a care provider who is truly supportive and one that is placating their patients but fully intends to call ALL the shots later when it’s much harder for them to refuse without real or imagined consequences.

We have too many csections because there are too many OBs out there who operate under a patriarchal viewpoint of knowing what’s “best” and who would rather do what’s easiest for them in terms of convenience, profit, and liability. And sadly, they overshadow the GOOD doctors and the midwives out there who ARE serving mothers and giving them the empowering births they deserve, EVEN when those births have unexpected outcomes. 

We DON’T have too many csections because mothers are older, heavier, or less healthy than in the past. That’s just a scapegoat that the OBs doing all the unnecessary csections like to point to in order to take the spotlight off their own practices. But for over 20 years they’ve known the truth. They’ve ALWAYS known what they were doing was causing more csections and they still take the credit of “saving lives” because that’s easier too and the mothers generally don’t know any better. And the ones who DO know better? Well they’re condescended to and called “difficult” and they’re treated like a problem client who is more concerned with her birth vision than her baby. And I’m sick of their bullshit games, so I call it out when I see it.

Cascade of intervention save life

Mainstream parenting forums are made up of all kinds of mothers. Many of them disempowered and scared to go against “doctor’s orders” even when it’s clear that the doctor is lying to them. And others will get pissed at me for telling those mothers that they can say NO. And still others will say the same thing I am and share their own heartbreaking stories; their warnings to not fall for the same tricks they had. Their pleas for another mother to avoid the treacherous path that those of us who do this work can all see coming from miles away. Doulas know. Maternity care nurses know. Midwives know. Birth advocates know. We ALL know. We hear the stories, we help the women who were burned in the past and are now struggling against the obstacles of their first birth as they seek a more positive experience. And we are often punished and scorned for it.

But we persevere. Why? Because we know that many won’t listen the first time or even the second, but eventually they will. And when they do, we will be there for them. We always knew their bodies weren’t broken.

Advertisements