Talking about Cesarean Sections

11.03.09 From inside and outside the operating room


I’ve spent this week interviewing obstetricians and midwives for several upcoming articles. I also hosted a baby shower. While none of these events were intended to be “all about cesarean sections;” c-sections became the focus of our conversations and shined some light on the prevailing opinions people currently have about c-sections. While the most “informed” opinions presumably came from the obstetricians, the most enlightening conversations happened at the baby shower.

Doctor #1 in an east coast community hospital talked about the benefits of having obstetricians in the hospital 24-hours per day to supervise labors. He said it was the safest way to manage labors because a doctor’s presence and vigilance insures that if anything happens during labor, a doctor can do an immediate c-section. I asked what his hospital’s c-section rate was and Doctor #1 announced it was 40% and “won’t be going down.”

A midwife in a big-city, west coast, high-risk hospital talked about water births finding their way into hospitals. While the midwife was optimistic about her hospital’s willingness to nurture low-intervention practices like water births, she also voiced skepticism that they will really have much of an impact on their c-section rate. In her hospital’s view, high-risk means a high c-section rate – 35%. “I don’t see that number going down anytime soon.”

Doctor #2 talked about how doctors and hospitals are exploring ways to reduce the c-section rate. “It’s way too high but we’ll have to go to an entirely different medical model to make any significant change.” He felt the presence of in-hospital obstetricians to supervise labors would allow doctors to do fewer c-sections. When doctors are exhausted or feel rushed to make decisions because they need to get back to their busy offices; home to their kids or off to see a patient in the emergency room. They may do what they feel to be the quickest, safest solution to an impending problem – a c-section. If instead all that doctor had to do during his shift, was supervise labors and didn’t feel pulled in all directions, he’d likely sit on smaller problems longer and see if they resolve. The result, fewer c-sections.

Doctor #3 talked about changing the way we use fetal heart monitoring because they so often lead to unnecessary c-sections. He also felt we’d need to remodel the way we practice obstetrics in hospitals in order to affect.

A handful of women attending the baby shower had delivered within the past couple years. Two had home births because they felt that was their safest option to avoid “over the top” medical interventions. Another woman talked about her hospital birth where she felt “bullied” into a c-section. Yet another had a “lovely” vaginal birth in the hospital.

Yet another woman talked about her recent delivery, a second c-section. Her first labor was a “nightmare.” After three days in labor with an arsenal of “natural” childbirth skills, several shifts of midwives and a doula defending her wishes for a low-intervention hospital delivery, her cervix wouldn’t fully dilate. Exhausted, terrified of surgery and severely disappointed in her “failure “ to have “the perfect birth,” she eventually had a c-section. Afterward, she realized her baby’s head was far too big for her pelvis. Despite knowing the c-section was her only safe option, she struggled for years to reconcile her “perfect birth plan” with the birth she had.

When she became pregnant with #2, she scheduled a c-section. The loss of control she felt with her first delivery, the adamancy of her doula that the only “good” birth was a “natural vaginal birth” and the terror she felt when wheeled to the operating room still haunted her. She decided this time, she’d be in control. “The hardest part of that first c-section wasn’t the surgery, it was letting go. Now, I encourage women to allow themselves to imagine other types of births. There’s more than one way to have a good birth and sometimes that’s a c-section.”

This week’s conversations offer a peek into the many varying views we hold on c-sections: doctors, happy with high c-section rates, midwives who hope for lower numbers but remain skeptical we can achieve them in high-risk settings, doctors who want change and have great ideas about how to achieve them and finally, women, searching for ways to stay out of and make peace with the operating room. Let’s keep the conversation going.

Jeanne Faulkner, R.N., lives in Portland, Oregon with her husband and five children. Got a question for Jeanne? E-mail it to and it may be answered in a future blog post.

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