My first two births were vaginal, my last was a c-section. Give me a vaginal birth any day. If I got pregnant with a fourth child, I would be afraid if I had to have a second C-section.
Oh, I am too old now. But I just wanted to affirm your point that caesareans are not conducive to wanting another child. It was a scary, painful experience. Horrible to deal with a newborn post scary surgery on top of everything else. I also think good midwife care during the pregnancy and labor makes childbirth a much better experience, even when the birth ends up a caesarian. And working with a team that looks at birth as a natural experience, not a medicalized one. My first birth was vaginal but I had no midwife and it was also not a great experience. Having the midwife with my second and third really helped, even though I ended up with complications that ultimately resulted in a Caesarian for my last birth- I felt it was a last resort rather than pushed on me and that made a difference.
Ann, I so appreciate the equitable tone with which you write. It is so difficult to write about these kinds of topics, and your tone is clear and peaceful. There is humility here. There is a full accounting of your background and how you come to your conclusions. It is so refreshing!
🥰 I am so interested in the certificate program that you mentioned you had completed, but when I looked it up, it appears that Harvard no longer offers it. Does this seem right to you?
I would love to see data on whether induction, particularly with first labor (with first child), more often leads to c-section than does either non-induced first labors or induced second, third, and later labors. In my anecdotal experience, this is the case.
That’s a great question—and one that’s been studied quite a bit. Large studies like the ARRIVE trial (and follow-ups) found that induction at 39 weeks didn’t increase the risk of C-section. But ARRIVE was a tightly controlled randomized trial where doctors (there were no midwife providers in the study) followed a strict protocol, including waiting at least 12 hours after full dilation before diagnosing “failure to progress.”
In the real world, many providers don’t use evidence-based protocols. I often hear from people who were recommended a C-section really early in their induction process. So while the research doesn’t show higher C-section rates with induction in theory, in practice it really depends on how it’s managed.
Anecdotally, I agree with you. CNMs tend to wait longer for spontaneous labor (in my group we still wait until 41 wk) and also have lower C-section rates than OBs for similar patients.
Just anecdotally, my care team started whispering about a C section when I had only been in labor for about 11 hours (not full dilation. As in, from 1 cm). There was no indication anything was wrong. It was nearing lunchtime though. I was a first time mom. I later learned that it’s quite average for first time moms to take 13 hours. Thankfully my baby came not long after that, or I’m not sure I’d have the presence of mind to say no.
Unfortunately, in addition to this well-researched issue, the loss of Medicaid is going to result in fewer births for this low income population as well. Tragic.
Also the discrimination against immigrants, who generally have higher birth rates...it doesn't help. God help us if they remove birth right citizenship.
I wanted my VBA2C specifically to increase my chances of having a fourth child later on. Having another C Section was my number one fear and hesitation about having more children. Thankfully I had an amazing hospital and have successfully given birth via VBA2C 2X now
Oh, that's great! My hospital attends a lot of those too and it’s wonderful to give people that option. Glad you were able to have the kids you wanted safely!
This is fascinating. I had an experience of extremes. My mother had nine births by C-section (including me), so that’s all I knew growing up. I thought vaginal births were weird and gross since I had only heard of them from a distance.
When I grew up, I realized that we were very much in the minority and did my own research and decided I didn't want my wife to give birth via C-section, and not even in a hospital if I could avoid it.
Funny enough, the woman I married was the daughter of a lay midwife and was born at home herself with the help of a midwife. Then, all five of our kids were born naturally, although our first was born in a hospital, and they definitely pressured us to choose a C-section. We refused, and were so turned off by the experience that we had the remaining four at home with a midwife.
I've heard that my mom was pressured to stop having children by doctors who refused to give her any more C-sections in the future, and also pressured her to get a tubal ligation while she was already cut open.
Your mom sounds very similar to my mom. And you sound like an excellent husband. I had my husband, an attorney, attend key appointments with the OB when I was planning a VBAC. His job was to wear a suit and glare litigiously. He rocked it :)
Thank you! …and well done. Sounds like he was the perfect advocate for you! I didn't have a suit on, but I also glared at them and said things like “put that pitocin away!”
I had six babies from 1985 to 1999. I had lots of friends through that time also having babies. My daughters have had three babies within the last six years. Oh how trends have come and gone in the field of childbirth.
The rates of induction are suspiciously high. Not exaggerating, both my daughters and most of their friends were assigned induction—early induction, after being terrified by their OBs. All babies were perfect, though small, since they were induced early.
Both my daughters were straight up sabotaged in the hospital from their their intention to breastfeed. By the time they came home with their babies there was no way to catch up.
IN MY DAY, the trend was very much toward having as natural a birth as was possible, depending on your circumstances, and breastfeeding was definitely supported and encouraged.
What has happened?
C-section, I assume, is subject to trends as well.
This is very interesting. I’m not American so i don’t actually what states have the largest populations but I’m curious how the rates of Black Americans in each state (and the resulting increase in maternal mortality) interacts with the risk factors from c-sections. Are they encouraging Black women to have more c-sections and taking on more risk? Or are these just separate things?
Yes, Black women do have higher rates of C-section, and I don't think all of it is justified by medical factors. There have been studies showing Black women have a harder time finding a physician willing to attend VBAC and that they are more likely to be subjected to "emergency" C-sections at times when the OR is open and it's convenient for staff.
I am not well informed on the subject but I have noticed, talking to recent moms my age, that they seem to be getting C-sections pretty frequently.
If you asked me 10 years ago, I would've thought that C-sections only occurred in 5% of cases, only used in emergencies. To a lay-person, cutting a woman open and removing the baby seems quite extreme.
After speaking with friends and family who have gone through it, it seems like doctors are actively pushing them towards C-sections in situations where it is not fully necessary. Like it is more convenient for the doctor or something.
I wonder if it is because doctors prefer to be in control of the situation rather than cede control and face uncertainty. When confronted with a choice, I think people usually choose the option in which they have greater control over their situation. Is it possible that this might bias doctors towards C-sections?
C sections are just all upside for the doctor. I will only comment in my part of the world but here, doctors get paid way more for c sections. Also
- C sections allow them to schedule the birth, and takes under 30 minutes, as opposed to potentially clearing their schedule and canceling with their other patients
- if the baby or mother die, they can claim they’ve done something. But there is a neonatal death from a vaginal birth, they can be accused of being negligent and missing the chance for a C section. Often, whatever goes wrong is names on the doctor even if the doctor made every single choice right in the moment. And we patients should not pretend that we are too high minded to do it, if our babies die and our OB is right there to take the fall, EVEN IF it happened because we went against medical advice
It's very complicated! And I plan to write about it in my next post, so stay tuned! But yes, I do strongly agree there is pressure for non-evidence based cesarean. Basically, there are a lot of different pressures on OB/GYNs. They can see 25-35 pts per day. They can be working day and night call. I think that, yes, because of this there is pressure to do births at times that are convenient for them. And it's a lot easier to plan the timing of a C-section compared to a vaginal birth. There are also financial incentives (higher billing) with C-section. It's highly variable. I work with a lot of great OBs who don't do unnecessary C-sections. I've also been exposed to those who do...
The data presented could possibly be explained by so many things. better screening and later maternal age of first birth could be one reason increased rate. I can also imagine some religious people who might continue to want to go through repeated pregnancies despite real & valid medical reason for needing c-sections which could spike the overall mortality rate.
But someone should definately look into whether doctor’s stated reason for why c-section was done and if it’s rate matches up with the expected prevelance of those patient factors.
It’s one anecdote (from Australia which has an average c-section rate of 30%) but I was 28, healthy, as was baby with my first. OB pushed a c-section on me 10 hrs into an induction, because it was 6 pm on the Friday before Christmas and “the good staff were about to go off shift”. Actually said to me when I queried the rationale for her ‘recommendation’. I was surrounded by 20 people within 2 min as I was bawling my eyes out because I didn’t want one. This OB also tried to push implanon (the rod) on me and tell me that I should wait four years till I tried again for another baby.
When I found myself pregnant again in early 2020, I managed to track down a private midwife and had a completely unmedicated power VBAC followed by 2 more. After 2 successful normal births, the additional risk created by that first c-section was effectively erased. Two children would not have been conceived without my midwife’s care and experience.
This is such a nerve-wracking topic. I had a c-section for my first then got pregnant 6 months postpartum. Now need to decide whether to try for vbac with this one in a few months. Rather dreading the decision.
Recent large study is very reassuring for you. If you have spontaneous labor, your risk of rupture is less than .5%. And the risk of anything bad happening to baby IF you rupture is about 6%. Overall, risks of VBAC to baby are about equivalent to risks of stillbirth in any term pregnancy, if you do the math.
That's a tough one...the change of uterine rupture is a little higher with a short interval pregnancy. Maybe depends a bit on how many kids you'd like to have? And what the reason for CS was, how likely a successful VBAC would be?
Yeah, the doctors said we’ll assess risk more closer to the date. First baby was growth restricted, had a sudden drop in amniotic fluid, and was breech. I’d like to have two more, but the safety of the baby I have now is my priority. Will be so relieved to have him in my arms. 💛
Interesting, I never thought of this! My immediate thoughts are: would this dissuade women from having children at all, or are we talking about keeping moms from having more children than they currently have? The latter seems to be more the focus of this post. I am not sure c-section rates play a major role when someone decides she’s never having kids. But both affect a country’s fertility rates.
My mom had 3 c-sections! No issues to speak of and so I guess I never considered it as a deterrent to having more children. I managed to avoid having one myself.
This is a tricky correlation to think about because it’s only been in the past century (less, even) that maternal mortality has been low and more importantly, unexpected. In the past, if there was an issue… you might just die in/after childbirth. If you were able to birth baby after baby, you did, given lack of birth control options. Some percentage of women today who have had c-sections and are alive would not have survived in the past. Not to mention other life-threatening issues that go along with pregnancy and childbirth, c-section or not. But their “lack of babies” to add to the population would probably be made up for by someone who can have many kids. It sounds crude but it’s population-level thinking.
Basically, we’ve never lived in a world where there wasn’t some terrible, life-threatening risk to having a baby. With overuse of c-sections we’ve maybe spread the risk of bodily harm around more to avoid something more catastrophic. I hope this makes some sense.
There is definitely a C-section rate that is "too low." If you click on that 19% study that I linked, certain countries with poor access to safe C-section do have worse maternal/neonatal mortality. But that's more when we're dropping below 10-15%. I think your point is valid, but if you pull up the data, maternal/neonatal mortality plummeted mid 20th century and C-section rates didn't really start climbing this high until the mid 90's...
This is a common narrative about cesareans and it's actually not at all based in evidence!
Cesarean increases all cause mortality and birthing people are about 5x more likely to die directly following a cesarean than a vaginal birth, controlling for other factors. The cesarean rate has grown 500% in 50 years with no aggregate impact on babies saved and an overall increase in maternal mortality.
We have careful records from the 18th and 19th century that show maternal death was typically due to problems like PPH that modern home birth midwife can easily address with pitocin, or issues from poor sanitation (sepsis, puerperal fever). About 5% of ALL births were recorded as anything other than routine. Cesareans were used as a last resort and mostly on enslaved women.
We have extensive records showing a precipitous drop in maternal and infant mortality in the 20th century under midwifery care due to aggregate advances in public health. Hospital birth led to scores of deaths from sepsis. It became about as safe as midwifery in the American mid-century, ironically when OBs still drugged women with scopalomine and yanked babies out with forceps.
Cesareans are typically justified as ways to save a baby's life. Most medical indications for cesarean focus on the *potential* of pathology (eg cesarean for large baby to avoid the risk of SD) not the presence of one. And in the case of e.g. an abruption or prolapse (more common with AROM, a common practice of OBs) this is the case! But there's no epidemiologically or historically literate defense that can be made of a 30% cesarean rate. Cesareans are demonstrably far more dangerous for birthing women. They are slightly safer for babies in some cases, but certainly not at the current rate.
I can see that it’s way overused. I personally know, off the top of my head, 3 people whose babies would absolutely or very likely be dead if not for c-section and maybe they would be too. I realize that’s anecdotal but it’s hard for me to ignore that if that is the case with some people I know, it has to exist on a population level. I understand that childbirth just incurs some level of risk and maybe for every baby saved by a c-section, you have many other negative c-section outcomes so it could still be a net negative. It seems like the majority of c-sections are questionable. Convenience, fear of being sued, baby is in the wrong position and we’ve lost the skills for handling that, etc.
I’m actually pregnant with my second child. I was induced for my first and grateful it was a successful induction. I was able to deliver vaginally after 22 hours. My biggest fear was a failed induction resulting in a C-section, even though I know it’s common. (My mom had two c-sections a million years ago). I’m an older mom so I’m nervous but hopeful I can have a similar experience this time around.
My first two births were vaginal, my last was a c-section. Give me a vaginal birth any day. If I got pregnant with a fourth child, I would be afraid if I had to have a second C-section.
If you do have another baby, you'd be a really good candidate to try for a VBAC. Odds are really high when you've already had vaginal births!
Oh, I am too old now. But I just wanted to affirm your point that caesareans are not conducive to wanting another child. It was a scary, painful experience. Horrible to deal with a newborn post scary surgery on top of everything else. I also think good midwife care during the pregnancy and labor makes childbirth a much better experience, even when the birth ends up a caesarian. And working with a team that looks at birth as a natural experience, not a medicalized one. My first birth was vaginal but I had no midwife and it was also not a great experience. Having the midwife with my second and third really helped, even though I ended up with complications that ultimately resulted in a Caesarian for my last birth- I felt it was a last resort rather than pushed on me and that made a difference.
Ann, I so appreciate the equitable tone with which you write. It is so difficult to write about these kinds of topics, and your tone is clear and peaceful. There is humility here. There is a full accounting of your background and how you come to your conclusions. It is so refreshing!
Thank you so much! That means a lot to me ❤️
🥰 I am so interested in the certificate program that you mentioned you had completed, but when I looked it up, it appears that Harvard no longer offers it. Does this seem right to you?
Ugh, maybe? I can't find it online anymore. I will ask around. That was a great program! Sad if they got rid of it.
If you hear anything, I’d love to know! Very glad to have come across your work. I’ve subscribed and I’ll be watching for it:)
I would love to see data on whether induction, particularly with first labor (with first child), more often leads to c-section than does either non-induced first labors or induced second, third, and later labors. In my anecdotal experience, this is the case.
That’s a great question—and one that’s been studied quite a bit. Large studies like the ARRIVE trial (and follow-ups) found that induction at 39 weeks didn’t increase the risk of C-section. But ARRIVE was a tightly controlled randomized trial where doctors (there were no midwife providers in the study) followed a strict protocol, including waiting at least 12 hours after full dilation before diagnosing “failure to progress.”
In the real world, many providers don’t use evidence-based protocols. I often hear from people who were recommended a C-section really early in their induction process. So while the research doesn’t show higher C-section rates with induction in theory, in practice it really depends on how it’s managed.
Anecdotally, I agree with you. CNMs tend to wait longer for spontaneous labor (in my group we still wait until 41 wk) and also have lower C-section rates than OBs for similar patients.
Just anecdotally, my care team started whispering about a C section when I had only been in labor for about 11 hours (not full dilation. As in, from 1 cm). There was no indication anything was wrong. It was nearing lunchtime though. I was a first time mom. I later learned that it’s quite average for first time moms to take 13 hours. Thankfully my baby came not long after that, or I’m not sure I’d have the presence of mind to say no.
Unfortunately, in addition to this well-researched issue, the loss of Medicaid is going to result in fewer births for this low income population as well. Tragic.
Also the discrimination against immigrants, who generally have higher birth rates...it doesn't help. God help us if they remove birth right citizenship.
Agree. I’m trying to stay positive, but it’s a slog right now.
I'm with you 😔
Hey! I wrote about how c sections may reduce birth rates back in 2019: https://ifstudies.org/blog/are-elective-c-sections-artificially-reducing-birth-rates-around-the-world
Yes! You’re in my post!
Ann did mention your 2019 article in her post. Thank you for the link--will bookmark it!
I wanted my VBA2C specifically to increase my chances of having a fourth child later on. Having another C Section was my number one fear and hesitation about having more children. Thankfully I had an amazing hospital and have successfully given birth via VBA2C 2X now
Oh, that's great! My hospital attends a lot of those too and it’s wonderful to give people that option. Glad you were able to have the kids you wanted safely!
This is fascinating. I had an experience of extremes. My mother had nine births by C-section (including me), so that’s all I knew growing up. I thought vaginal births were weird and gross since I had only heard of them from a distance.
When I grew up, I realized that we were very much in the minority and did my own research and decided I didn't want my wife to give birth via C-section, and not even in a hospital if I could avoid it.
Funny enough, the woman I married was the daughter of a lay midwife and was born at home herself with the help of a midwife. Then, all five of our kids were born naturally, although our first was born in a hospital, and they definitely pressured us to choose a C-section. We refused, and were so turned off by the experience that we had the remaining four at home with a midwife.
I've heard that my mom was pressured to stop having children by doctors who refused to give her any more C-sections in the future, and also pressured her to get a tubal ligation while she was already cut open.
Wow, what a story! 9 c-sections is a lot. I'm glad she was ok. And that you found your way to some perhaps more peaceful births...
Your mom sounds very similar to my mom. And you sound like an excellent husband. I had my husband, an attorney, attend key appointments with the OB when I was planning a VBAC. His job was to wear a suit and glare litigiously. He rocked it :)
Thank you! …and well done. Sounds like he was the perfect advocate for you! I didn't have a suit on, but I also glared at them and said things like “put that pitocin away!”
I had six babies from 1985 to 1999. I had lots of friends through that time also having babies. My daughters have had three babies within the last six years. Oh how trends have come and gone in the field of childbirth.
The rates of induction are suspiciously high. Not exaggerating, both my daughters and most of their friends were assigned induction—early induction, after being terrified by their OBs. All babies were perfect, though small, since they were induced early.
Both my daughters were straight up sabotaged in the hospital from their their intention to breastfeed. By the time they came home with their babies there was no way to catch up.
IN MY DAY, the trend was very much toward having as natural a birth as was possible, depending on your circumstances, and breastfeeding was definitely supported and encouraged.
What has happened?
C-section, I assume, is subject to trends as well.
Great post, thx from an ancient 'recovering' CNM who, when getting on every plane, hopes someone will go into labor so I can assist just once again!
Haha as long as it’s a term baby! I have the same dream. Usually when they ask for medical help on flights, I’m worthless!
This is very interesting. I’m not American so i don’t actually what states have the largest populations but I’m curious how the rates of Black Americans in each state (and the resulting increase in maternal mortality) interacts with the risk factors from c-sections. Are they encouraging Black women to have more c-sections and taking on more risk? Or are these just separate things?
Yes, Black women do have higher rates of C-section, and I don't think all of it is justified by medical factors. There have been studies showing Black women have a harder time finding a physician willing to attend VBAC and that they are more likely to be subjected to "emergency" C-sections at times when the OR is open and it's convenient for staff.
Really great article, thank you for sharing.
I am not well informed on the subject but I have noticed, talking to recent moms my age, that they seem to be getting C-sections pretty frequently.
If you asked me 10 years ago, I would've thought that C-sections only occurred in 5% of cases, only used in emergencies. To a lay-person, cutting a woman open and removing the baby seems quite extreme.
After speaking with friends and family who have gone through it, it seems like doctors are actively pushing them towards C-sections in situations where it is not fully necessary. Like it is more convenient for the doctor or something.
I wonder if it is because doctors prefer to be in control of the situation rather than cede control and face uncertainty. When confronted with a choice, I think people usually choose the option in which they have greater control over their situation. Is it possible that this might bias doctors towards C-sections?
C sections are just all upside for the doctor. I will only comment in my part of the world but here, doctors get paid way more for c sections. Also
- C sections allow them to schedule the birth, and takes under 30 minutes, as opposed to potentially clearing their schedule and canceling with their other patients
- if the baby or mother die, they can claim they’ve done something. But there is a neonatal death from a vaginal birth, they can be accused of being negligent and missing the chance for a C section. Often, whatever goes wrong is names on the doctor even if the doctor made every single choice right in the moment. And we patients should not pretend that we are too high minded to do it, if our babies die and our OB is right there to take the fall, EVEN IF it happened because we went against medical advice
It's very complicated! And I plan to write about it in my next post, so stay tuned! But yes, I do strongly agree there is pressure for non-evidence based cesarean. Basically, there are a lot of different pressures on OB/GYNs. They can see 25-35 pts per day. They can be working day and night call. I think that, yes, because of this there is pressure to do births at times that are convenient for them. And it's a lot easier to plan the timing of a C-section compared to a vaginal birth. There are also financial incentives (higher billing) with C-section. It's highly variable. I work with a lot of great OBs who don't do unnecessary C-sections. I've also been exposed to those who do...
The data presented could possibly be explained by so many things. better screening and later maternal age of first birth could be one reason increased rate. I can also imagine some religious people who might continue to want to go through repeated pregnancies despite real & valid medical reason for needing c-sections which could spike the overall mortality rate.
But someone should definately look into whether doctor’s stated reason for why c-section was done and if it’s rate matches up with the expected prevelance of those patient factors.
It’s one anecdote (from Australia which has an average c-section rate of 30%) but I was 28, healthy, as was baby with my first. OB pushed a c-section on me 10 hrs into an induction, because it was 6 pm on the Friday before Christmas and “the good staff were about to go off shift”. Actually said to me when I queried the rationale for her ‘recommendation’. I was surrounded by 20 people within 2 min as I was bawling my eyes out because I didn’t want one. This OB also tried to push implanon (the rod) on me and tell me that I should wait four years till I tried again for another baby.
When I found myself pregnant again in early 2020, I managed to track down a private midwife and had a completely unmedicated power VBAC followed by 2 more. After 2 successful normal births, the additional risk created by that first c-section was effectively erased. Two children would not have been conceived without my midwife’s care and experience.
This is such a nerve-wracking topic. I had a c-section for my first then got pregnant 6 months postpartum. Now need to decide whether to try for vbac with this one in a few months. Rather dreading the decision.
https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(25)00003-3/fulltext
Recent large study is very reassuring for you. If you have spontaneous labor, your risk of rupture is less than .5%. And the risk of anything bad happening to baby IF you rupture is about 6%. Overall, risks of VBAC to baby are about equivalent to risks of stillbirth in any term pregnancy, if you do the math.
That is incredibly helpful; thank you!
That's a tough one...the change of uterine rupture is a little higher with a short interval pregnancy. Maybe depends a bit on how many kids you'd like to have? And what the reason for CS was, how likely a successful VBAC would be?
Yeah, the doctors said we’ll assess risk more closer to the date. First baby was growth restricted, had a sudden drop in amniotic fluid, and was breech. I’d like to have two more, but the safety of the baby I have now is my priority. Will be so relieved to have him in my arms. 💛
Best wishes! It sounds like you're in good hands and at least getting choices.
Interesting, I never thought of this! My immediate thoughts are: would this dissuade women from having children at all, or are we talking about keeping moms from having more children than they currently have? The latter seems to be more the focus of this post. I am not sure c-section rates play a major role when someone decides she’s never having kids. But both affect a country’s fertility rates.
Right-I would expect this is more something that prevents women from deciding to have a third or fourth child (but maybe sometimes a second?)
My mom had 3 c-sections! No issues to speak of and so I guess I never considered it as a deterrent to having more children. I managed to avoid having one myself.
This is a tricky correlation to think about because it’s only been in the past century (less, even) that maternal mortality has been low and more importantly, unexpected. In the past, if there was an issue… you might just die in/after childbirth. If you were able to birth baby after baby, you did, given lack of birth control options. Some percentage of women today who have had c-sections and are alive would not have survived in the past. Not to mention other life-threatening issues that go along with pregnancy and childbirth, c-section or not. But their “lack of babies” to add to the population would probably be made up for by someone who can have many kids. It sounds crude but it’s population-level thinking.
Basically, we’ve never lived in a world where there wasn’t some terrible, life-threatening risk to having a baby. With overuse of c-sections we’ve maybe spread the risk of bodily harm around more to avoid something more catastrophic. I hope this makes some sense.
There is definitely a C-section rate that is "too low." If you click on that 19% study that I linked, certain countries with poor access to safe C-section do have worse maternal/neonatal mortality. But that's more when we're dropping below 10-15%. I think your point is valid, but if you pull up the data, maternal/neonatal mortality plummeted mid 20th century and C-section rates didn't really start climbing this high until the mid 90's...
That makes sense.
This is a common narrative about cesareans and it's actually not at all based in evidence!
Cesarean increases all cause mortality and birthing people are about 5x more likely to die directly following a cesarean than a vaginal birth, controlling for other factors. The cesarean rate has grown 500% in 50 years with no aggregate impact on babies saved and an overall increase in maternal mortality.
We have careful records from the 18th and 19th century that show maternal death was typically due to problems like PPH that modern home birth midwife can easily address with pitocin, or issues from poor sanitation (sepsis, puerperal fever). About 5% of ALL births were recorded as anything other than routine. Cesareans were used as a last resort and mostly on enslaved women.
We have extensive records showing a precipitous drop in maternal and infant mortality in the 20th century under midwifery care due to aggregate advances in public health. Hospital birth led to scores of deaths from sepsis. It became about as safe as midwifery in the American mid-century, ironically when OBs still drugged women with scopalomine and yanked babies out with forceps.
Cesareans are typically justified as ways to save a baby's life. Most medical indications for cesarean focus on the *potential* of pathology (eg cesarean for large baby to avoid the risk of SD) not the presence of one. And in the case of e.g. an abruption or prolapse (more common with AROM, a common practice of OBs) this is the case! But there's no epidemiologically or historically literate defense that can be made of a 30% cesarean rate. Cesareans are demonstrably far more dangerous for birthing women. They are slightly safer for babies in some cases, but certainly not at the current rate.
I can see that it’s way overused. I personally know, off the top of my head, 3 people whose babies would absolutely or very likely be dead if not for c-section and maybe they would be too. I realize that’s anecdotal but it’s hard for me to ignore that if that is the case with some people I know, it has to exist on a population level. I understand that childbirth just incurs some level of risk and maybe for every baby saved by a c-section, you have many other negative c-section outcomes so it could still be a net negative. It seems like the majority of c-sections are questionable. Convenience, fear of being sued, baby is in the wrong position and we’ve lost the skills for handling that, etc.
There are definitely both necessary, life-saving C-sections...and questionable ones. I wrote a follow up post about it here: https://open.substack.com/pub/annledbetter/p/the-c-section-rate-doesnt-have-to?r=8c5pl&utm_medium=ios
I’m actually pregnant with my second child. I was induced for my first and grateful it was a successful induction. I was able to deliver vaginally after 22 hours. My biggest fear was a failed induction resulting in a C-section, even though I know it’s common. (My mom had two c-sections a million years ago). I’m an older mom so I’m nervous but hopeful I can have a similar experience this time around.
Usually second births are easier than first births. Fingers crossed for you! 🤞
I was cheering for you throughout this. Vaginal birth is far safer and better. I had one of each.
thanks for reading!