In defense of unnecessary cesareans

I want to defend unnecessary cesareans.

I have a personal stake in this. I had a c-section. I didn’t want it. My baby’s head was turned sideways, facing my right hip (occiput transverse). I had been through 4 weeks of prodromal labor, with painful, productive contractions, followed by 24 hours of active labor. I had an epidural and artificial membrane rupture after about 15 hours labor, but no pitocin. I pushed for 5 hours, before the OB gently explained that I was doing everything right, but she didn’t think vaginal delivery was a possibility.

I held back tears until my husband left my side, and then I sobbed. I sobbed while the anesthesiologist reassured me and I sobbed while the medicine in my IV burned and stung me and I sobbed when my husband came back.

I had been told that I could avoid a c-section if I educated myself:

And if I believed in and trusted myself:

I was educated. I did trust myself. And somehow a c-section was still happening to me. I was terrified of what would happen to my relationship with my baby, and I was so scared of what I expected to be weeks or months of painful recovery:

You know why my c-section was traumatic? Because I felt like it was my fault. Because everything I read about c-sections treated them as something that happens to women who are uneducated and don’t advocate for themselves. Because I had bought into the idea that, if you don’t give birth vaginally, you did something wrong.

I don’t know if my c-section was necessary and I never will. Maybe if I had been somewhere without access to modern medicine, I would have been in labor for a few days, vomiting, in mind-warping pain, increasingly weaker and more exhausted, and eventually her head would have turned and I would have given birth vaginally.

Would that have been better?

Would that have been the way an educated person gives birth?

But I will never know if my c-section was necessary, and that gets to the crux of why I want to defend unnecessary cesareans: because of the gray area. C-sections are a great example of a signal detection problem.

There are some births where c-sections (and other interventions) are clearly unnecessary. There are other births where c-sections (and other interventions) are clearly necessary.
But an uncomfortable percentage of births fall in that gray area in between, where it is simply not possible to tell if the c-section is necessary or not. In that gray area, there are four possible outcomes:

1. True positive: A c-section is necessary and performed
2. True negative: A c-section is not necessary and not performed
3. False positive: A c-section is not necessary, but performed
4. False negative: A c-section is necessary, but not performed

Now, think about the consequences of 3 and 4:

So, obviously, we want to err on the side of more false positives than false negatives.
I worry a great deal that the natural childbirth movement will have the unintended consequence of shifting that signal detection criterion and increasing the false negatives — increasing preventable deaths and permanent injuries.
We need more research and better evidence so we can decrease the size of the gray area, not an arbitrary push to decrease c-sections.
And in the meantime, I wish we could cut c-sections a break. Stop treating c-sections like the worst case scenario and remember that there are a number of outcomes that are quite a bit worse. And until we have perfect signal detection, unnecessary cesareans are actually the better choice, compared to failing to perform a necessary one.
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7 thoughts on “In defense of unnecessary cesareans

  1. Vanessa Termini says:

    Thank you for expressing this. I am becoming more aware of the guilt that women are feeling regarding many issues in childbirth. Your story is sacred. It is important to hear everyone’s story.

  2. I am so glad that you shared this. The “Natural” Child Birth (NCB) Movement really needs a wakeup call; it is beyond irresponsible to propagate unfounded pseudoscientific claims. It is not only harmful to women whose birth experiences are ruined by nonsensical guilt but it’s dangerous and deadly as we’re seeing with home births (and vaccination).

  3. And the first link above and the comments to it are beyond obnoxious. Dripping with arrogance and sanctimony, women crediting themselves with their vaginal births with no science to back them whatsoever. Epidurals administered once you reach 4 cm do NOT increase your chance of a c-section; that’s indisputable. Neither does induction at 41 weeks or beyond (because waiting longer also increases your chance of a c-section since your baby gets bigger, and a macrocosmic baby doubles your chance of c-section – it turns out to be a wash at 41 weeks). The science on both of those is crystal clear. The U.S. has a high c-section rate for a variety of reasons including obesity/GD/macrosomia and our extremely low rate of forceps and vacuum-assisted deliveries (compared to Europe – because c-sections are safer overall since those deliveries are more dependent on the skill, both innate and learned, of the practitioner). I really wish that there were a way to hold non-scientific claimants accountable.

  4. I had a c-section under nearly the same circumstances with my first, head was turned, 24 hours of intense labor and no movement. The doctor also informed me of a small pelvic bone abnormality that usually would not be too difficult to work around but my boy was stubborn. So for my girl, I chose up front to have a C-section and because I did, and because the painkillers were incredible, I had her nursing within an hour and a half of her being born. I also had a simple recovery, just had to be careful and not lift anything (although i cheated when it came to my 2 year-old). I suppose what I am trying to say, I am only one case, but this case shows that it is perfectly possible to have a C-section and still bond with your baby just fine.

  5. Pingback: in defense of unnecessary c-sections | Ex Natural Childbirth Advocates

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