It would be more convenient if all births happened on a specific date and during a specific time. Some OB/GYN’s and, less commonly, some midwives prefer it this way. There are myriads of excuses or false reasons why an OB/GYN or midwife would want to schedule a cesarean section or order an emergency cesarean section. Why would they do that, you ask? It is more convenient, and they (the OB/GYN’s) get paid more for a cesarean delivery than a vaginal delivery. The hospital gets paid more, too. Also, I think it is no coincidence that the most likely time an emergency cesarean section takes place in the U.S. is between four and seven pm, Monday through Friday. The OB/GYN or midwife wants to get home to their family in time for dinner.
The most common (and often false) reasons for a scheduled or emergency cesarean section:
1. Failure to progress:
The average first time mother’s labor lasts between six and twenty four hours. It is certainly very common for a labor to last even longer, (or be shorter). Six and twenty four are based on an average, not an individual. In a perfect world, a woman’s cervix dilates one centimeter per hour. One of the most common reasons for an emergency cesarean section is “failure to progress”. Just because a woman’s cervix is dilating one centimeter every two hours does not mean that woman is “failing to progress”. This is a situation where you need to look at a clock. Getting towards the end of the day? Yep, you got it, your doctor might be lying.
2. Big baby:
Also known as fetal macrosomia, the “big baby syndrome” is extraordinarily rare. I have read countless stories of women achieving VBAC’s (vaginal birth after cesarean) with eight, or nine, or ten pound babies effortlessly after having a cesarean section with their first born because their doctor said their baby was too big. And I have read many stories of women who were sectioned for the big baby reason, only to give birth to six or seven pound babies. Also, when the measurements of the baby are taken via ultrasound, those measurements are meant to be taken as plus or minus two pounds. If the ultrasound technician says there is an eight and a half pound baby, so says a cesarean section must be scheduled, the baby very well could be six and a half pounds. In addition, if a woman is told she has a narrow pelvis or birth canal, it is important to consider that the birth canal stretches considerably during birth. And during pregnancy, a woman’s ligaments become more elastic due to a release of the hormone relaxin from the placenta, and the pelvis will widen during birth. A woman’s pelvic opening is the smallest while laying down on her back, (OB/GYN’s damn well know this), too. If the doctor took pelvic measurements while the woman is lying down, and tells the woman she is too small, he’s full of shit!
3. Twenty four hour deadline for broken bag of waters:
It is true, there is a risk of infection once the amniotic sac breaks. However, that risk becomes almost nonexistent if there are no vaginal exams, no plunges into a bathtub, and generally nothing is allowed to enter the vagina. And even if there were intrusions into the vagina, the risk of infection increases as follows: “…the incidence [of infection] r[ose] from 2% for labor 3 hours to less than 6 hours to 8% for labor 12 hours or longer,” . It is also probable that genetic factors can predispose a woman to intrauterine infection, despite the amount of time her amniotic sac has been ruptured. It is, nevertheless, common hospital or doctor policy to perform a cesarean section after twenty four hours of ruptured membranes.
4. The baby’s heart rate is decelerating:
Under most circumstances, a woman’s birth is highly medicated – epidural, Pitocin, the works. All these medical interventions are largely unnecessary. All these medical interventions also impact the baby’s and mother’s health negatively. Pitocin is used to augment or induce labor in 81 percent of women, according to a survey conducted by Robbie Davis-Floyd, a cultural anthropologist at the University of Texas. Too high a dose of Pitocin can cause heart rate decelerations in unborn babies during labor. Once heart rate decelerations occur, it is likely the OB/GYN will immediately perform an emergency cesarean section on the laboring woman under the guise of “saving the baby”. However, research shows that worrisome heart rate pattern rarely predicts injury. Ladies, look at the clock.
5. You have a breech presenting baby:
It is extraordinarily rare to find a doctor willing to attend a vaginal breech (butt or feet down, as opposed to head down) birth. In this day and age, lawsuits abound. Many doctors and hospitals have banned vaginal breech birth because of the malpractice insurance rates. But, guess what? The outcomes for vaginal breech birth are statistically better than a cesarean breech birth! One in twenty pregnant women have breech babies at term. That is a lot of cesarean sections! Delivering breech babies vaginally is, unfortunately, no longer a skill taught to OB/GYN’s or midwives, so it also may just be that the doctor caring for the mother-to-be with a breech presenting baby cannot attend her vaginal birth because of lack of training and experience. The doctor caring for the woman often says it is more dangerous, rather than telling her about the risk of lawsuit or lack of training. Tsk, tsk.
This post could be miles long, but I will stop here, at the “top five reasons” a doctor or midwife says a woman needs a cesarean section. The medical community caring for pregnant and birthing women is in a sad state. It is imperative that people take a good, hard look at what doctors or some midwives put pregnant women and their babies through – it is unnecessary, untruthful, and unpalatable, to put it lightly.
The next time an OB/GYN or midwife schedules or performs a cesarean section, look at the clock, or ask when their next vacation is scheduled. Don’t be surprised about what you find out.
1. National Collaborating Centre for Women’s and Children’s Health (UK). Intrapartum Care: Care of Healthy Women and Their Babies During Childbirth. London: RCOG Press; 2007 Sep. (NICE Clinical Guidelines, No. 55.) 11, Prelabour rupture of membranes at term. Available from: http://www.ncbi.nlm.nih.gov/books/NBK49375/