Do I really need a c-section? Can I have a VBAC? Can I give birth to a big baby without a cesarean? Is my pelvis too small? What's a good reason for a c-section?

These are all common questions for pregnant mothers to ask before or after giving birth. With way-too-high c-section rates in the U.S. and around the world, mothers need to ask these questions about c-sections.

Hey Mama Bears! This week we are talking more about cesareans. Specifically, we’re going to talk about bogus reasons for c-sections aka unnecesareans.

Now, don’t get me wrong… cesareans are absolutely life saving sometimes and I’m grateful they’re an option when necessary. However the World Health Organization and CDC agree that cesareans are overused, and could be contributing to an increase in maternal and infant mortality and morbidity.

As a mother, this is important for you to understand so that you are not in a situation where you’re bullied into an “unnecesarean” with fear based tactics. It is my goal that you are always making informed decisions and that you are totally confident in those decisions. Unfortunately, too often parents are pressured into a cesarean by being told refusing the surgery is risking their baby’s life… when that’s not actually the case.

Let me be clear, this article is not intended to serve as health advice or replace your provider’s recommendations, this article is purely for educational purposes and to serve as a launchpad for your own research, communication and decision making.

As we stated before, there are times when c-sections are absolutely necessary. Some examples of necessary c-sections include but are not limited to cases of placenta previa (where the placenta covers the pelvis), previous uterine rupture (though there are few reports of vaginal birth following uterine rupture, this is not the standard), unrecoverable fetal distress, uterine cord prolapse.

Unfortunately, there are a litany of other “reasons” given for cesarean, with varying degrees of validity. The following reasons for automatic cesarean are absolutely bogus in and of themselves. Please remember we’re speaking on a general level. There are many unique situations and circumstances that may change the situation and I do not discount that.

Previous Cesarean

I’m sure you’ve heard “once a cesarean, always a cesarean”. But that’s a big fat lie. While the VBAC rates in the US are slowly increasing and support for VBAC is growing, there are still providers and hospitals that outright refuse to support VBAC. Then, there is much variation among the ones who do. We talk more about VBAC Supportive vs VBAC tolerant providers here. But the bottom line is, simply having had a previous cesarean is NOT a reason for another c-section. Join the Mama Bear Resource Library to learn more about VBACs

Small Pelvis

“Your pelvis is too small to birth a baby”. Probably not. While cephalopelvic disproportion does happen, it’s extremely rare. Extremely rare. In fact, I recently supported a VBAC where the mom’s first cesarean was “because your pelvis will never be big enough to allow a baby to pass through”.

The truth is, there are all kinds of unique pelvis shapes, some make for “easier” birthing than other, but with a little knowledge of working with the pelvis instead of against it (like standard hospital births do by default), most women can vaginally birth their baby despite their pelvis shape.

Failure to progress

Failure to progress would be a labor that has arrested or a cervix that is not dilating despite what should be effective contractions and plenty of medical intervention… But most cases of failure to progress are actually failure to wait. Some labors are long. Not everyone dilates at the same rate. The fear-cycle that often exists in the hospital setting can inhibit effective labor. This is where having a doula can be extremely helpful. Doulas aren’t just focused on the physical progression of labor, but can help you work through emotional blocks, adjust positions to encourage position changes, and holistically address other potential causes of “failure to progress” before “cesarean” is even mentioned.

Past Due Date

Just. No. Not even if you’re a VBAC.

Long pushing stage

It can be common for a first time mom to push up to 4 hours… I’ve even heard some stories of mom pushing for 6 hours and having a successful vaginal delivery. But too ; moms are rushed into a cesarean after hours of hard work without a baby being in distress, and without actually trying positional changes and holistic approaches to helping the baby descend.

In Birthing With Confidence, we will talk about how to approach the pushing stage in an effective way that preserves your energy while working with your body instead of against it.

Breech Baby

This one is controversial… but the truth is… Breech birth is a lost art form. Somewhere along the line, providers stoped getting trained in breech birth techniques, so now they blankety schedule cesareans for all breech.

However, some breech babies can absolutely be born vaginally!!! I will be doing a series on breech birth and babies soon where we can dive into this conversation more… just know, that if your baby is breech, you STILL HAVE OPTIONS.

Twins

Again. Just no. Being pregnant with twins is not a good reason for an automatic cesarean. In the case of mo-mo twins it is commonly believed that cesarean is the only option for delivery, while this is popular practice, there is budding research that claims vaginal delivery may still be a possibility in some situations. This will definitely be one of those "individual" situations that has many variables at play, but in general being pregnant with twins does not exclude you from a vaginal birth. We can do a more in depth series into twins later this spring!

Suspected big baby

Well y’all know I’ve been loud about this one… but again… just no. Check out this article on birthing big babies!

As you can see, birth simply isn’t one size fits all and it’s very rare to automatically NEED a cesarean. While there maybe times cesarean should be a serious consideration, it is vital that mothers have access to individualized care, not purely policy based care. This can only be achieved when mothers begin commanding individualized care by practicing self-advocacy before and during pregnancy.

Jaimie Zaki is an Air Force Wife, Mother, and Nurse turned Doula and Lactation Consultant (IBCLC). Jaimie is passionate about helping you channel your inner fierce Mama Bear to empower you to Birth With Confidence. Jaimie teaches online Childbirth Courses, online Breastfeeding classes, provides online prenatal consults, online lactation consults and more! To work with Jaimie, email jaimiezaki@littlebearlactation.com