#312 | Avoiding the Unnecessary Cesarean: A Five-Step Evidence-Based Approach

Today we’re talking about one of the most important—and misunderstood—topics in maternity care: the unnecessary cesarean. In the U.S., about one in three babies is born by C-section, but in physiologic birth settings, that number can be as low as 2–4%. So what’s driving the difference?

In this episode, Cynthia and Trisha unpack the many layers behind the rising cesarean rate and offer a grounded, evidence-based approach for avoiding surgery when it isn’t truly needed. From provider practices to birth environments, timing to interventions, we explore what really makes a difference in protecting your ability to give birth naturally.

We also talk about the deeper side of birth: how your nervous system, your sense of safety, and your trust in your body all play a powerful role in how birth unfolds. If you’ve ever been told you might need a C-section because your baby is “too big,” or you’re wondering how to stack the odds in your favor for a physiological birth—this episode is for you.

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Transcript

I'm Cynthia Overgard, owner of HypnoBirthing of Connecticut, childbirth advocate and postpartum support specialist. And I'm Trisha Ludwig, certified nurse midwife and international board certified lactation consultant. And this is the Down To Birth Podcast. Childbirth is something we're made to do. But how do we have our safest and most satisfying experience in today's medical culture? Let's dispel the myths and get down to birth.

Well, today we're going to talk about the obvious. So what do you think Trisha? Well, I think one of the most important things that we can do is help mothers learn how to avoid the unnecessary cesarean section. We know that at least a third, if not more, probably more, at least a third of C sections are performed unnecessarily. They are performed, you know, because of all kinds of reasons that we're going to talk about in this episode, and that leaves women traumatized by their birth experiences and feeling black of peace with their birth outcome. So if we can help mothers understand there are very real, very significant, very effective and simple things that you can do to dramatically decrease your risk of having an unnecessary cesarean section. And I just want to make a couple of points off of what you just said. One is that I know they say probably at least if they unnecessary, right? The good old they I, I personally don't agree with that. I'm I have my own theories working all the time in my own mind, and I definitely don't agree that it is only a third that are unnecessary. And I think this is an I think this is an informed theory, because we know that as one example of several, Ina may Gaskin attended 1000s of births over many decades and never achieved over even a 2% cesarean rate, and her average was 1.4% that's only 14 women per 1000 women in the United States. Now, obviously that was a possibly a select population. She was very serious about talking with them about diet, etc. So it's not just a random sampling that went to her and had these good outcomes, but my argument is, if she and so many other midwives can achieve outcomes like this, then surely there's room for a much greater improvement over what we're seeing, if not down to the low single digits. So in the world, Health Organization says the tipping point is about 10% and after 10% we have higher maternal mortality. So I think somewhere in those low single digits to 10% is is where we really could and should be as a society. But who knows? We don't really know. Do the math for us, how many C sections would be unnecessary if we expected the necessary amount to be about 10% and we have a rate of 33%.

Well, it's triple what we expect it to be, yep, and that's but you know, if they're saying a third are unnecessary right off the bat, then they're saying it should be closer to 22% but anyway, the statistics are less important than a woman feeling at peace With her birth, and not every woman who has a cesarean section doesn't feel at peace with her birth. In other words, there are certainly women who have cesarean sections who feel at peace with their birth, because, in fact, many times they are necessary. And we also know women who have vaginal births who are not at peace with their births. But for this conversation and this episode, we are staying very strictly within the limits of logical ways to reduce your likelihood of experiencing an unnecessary C section. Now we came up with tons, and we've, we've taken what began as a list of 17 things and put them into like five, I think, five or six broad categories that we're going to tackle one by one. So shall we dive in? Yes, and just to point out, these are not just our theories or our ideas or our perceptions. These are all proven with, like a lot of good evidence to be true. And if you take one, you can have a dramatic difference in your chance of having a C section. If you combine them all together, we can potentially achieve that extremely low rate of necessary C sections.

So the first one is, give birth with Ina may Gaskin.

She's I don't think she's doing that anymore. I wouldn't be surprised if she is alright. So the first one is, hire the right team. And what I want everyone to envision when they're pregnant and planning their birth is, who are the, I will say, women holding you up in this who are the women educating you? Who are the women who you can call when you're stressed, when you have an unnerving appointment or something comes up, you should feel like there's a team of people holding you up, and that should start with your provider, your doula, or your birth support, your childbirth educator, and we're only going to stick to those big ones, but I want you to also think in terms of maybe your chiropractor, your acupuncturist, your pelvic floor specialist. These are all your naturopath. There's so many phenomenal providers who are here to support you through your pregnancy, but let's just talk about the primary three.

So the options are basically, generally midwife or OB. And with midwifery care, you may have a midwife at home, you may have a midwife in the hospital, or you may have a midwife in a birth center. Midwifery led care has in general, even Hospital has significantly. Lower C section rates. Evidence suggests a 30% decrease in the relative risk of a C section for first time moms with midwife led hospital births compared to OB managed hospital births in choosing the right provider for you, we're going to talk about birth space next, but just talking about the actual person, you must ask the question, what is their C section rate? Why do they perform C sections? What is the most common reason? If you want to be really put them on the spot, ask them, How many C sections of the last how many C sections have you had in the last 10 births you've attended? They should know that, and hopefully they'll tell the truth. And that's why my favorite question is the other one. It's, what are some of the reasons that you need to perform C sections? And even if you phrase it like that, it really gets them into their comfort zone of of why they do them. And if you start to hear things where you know better, where's where research doesn't support it, like failure to progress is the most common one. If they say that women requesting it don't buy it something like 9% of women actually request these sections, and over 90% don't. But a lot of them will name that as a top reason. Big Baby. All the things you know from listening to all of our other episodes or working with us on Patreon, these are the things that you're already acquainted with, but get them talking about why they perform them. Because we're not ever sure they're going to tell the truth about their C section rate. We don't know if they're even tracking them. We don't know what their colleagues and partners are doing as far as their statistics. You really have to talk to them and get to know them and listen to their language. Are they using language that does not empower you. Are they using language like let I won't let you go past this number of weeks tells you everything you need to know, and what
you're really trying to get to is what their perception of a C section means. If they have a very positive view of a C section, your chance of having a C section is dramatically higher. And there's evidence to support this. There's a scale that where they've rated OBS on their their positive association with C sections, and for every point positively that they view a cesarean birth, the higher your risk is of a cesarean birth. So their perception of it matters. This is why you have to interview them and interview them substantially.

That reminds me of when my own provider who I left, of course, but who said to me, Cynthia, a bikini covers the scar --

Exactly. That's a perfect example.

Okay, so hiring a doula or your birth support, if you are not hiring professional labor support, for some reason, you really do want to give a lot of thought to the labor support you're going to have. For example, in my HypnoBirthing class, I have a document that I will share with anyone who doesn't have a formal hired labor support person, like a doula, to help their support person, if it's a sister or on rare occasion, than a friend, to give them information, to support them in their birth, just to help them out, if they're not professionally trained, but if you do hire a doula, really, everything shakes out better with a doula, lower rates of postpartum depression, higher satisfaction with birth, lower C section rates, lower induction rates, better breastfeeding rates. Many doula is need to do a few free or nearly free births in order to earn their certification. Experience is very important with a doula, but my usual position is, if you really feel trust with the person, and you really feel like you just kind of love her and want to see her when you're in labor, and you're just going to relax when she gives you that first hug, then she's probably the right person for you. So you really do have more options than you may think, because I know doulas can be 1000s of dollars depending on where women live, but you really want to think through those options, no matter what your resources are,
there's some really interesting statistics on doula. Shockingly, this is 2013 data, so it's probably changed a bit since then, or maybe a lot since then, but only 6% of women in the United States were hiring doula in 2013 that is a very, very small number considering how effective doulas are at decreasing the chance of intervention in birth. Most significantly, C section. Having a doula at your birth reduces the chance of a C section by 39% and still so few women are having them, although some insurances are starting to cover doula services, which is fantastic.

And finally, your childbirth educator? Who are you hiring to be the person who informs you of your rights, of your physiology, of your breathing techniques, who prepares your partner as a childbirth educator myself, I view my role as very important meaning. It's not just a class to me, it is a relationship to me. And for me, I provide support to women from the moment they sign up through their births, and that's what I want you to envision for whoever is supporting you. It should be a relationship rather than just a course. I had a private. Yesterday with two couples, and the man was great. One of the husbands attended, and he was really shocked at the childbirth class they took at the hospital. He said they didn't even mention the phrase breathing techniques, and everything that they said was to discourage any kind of empowerment. He said, like they were laughing. Two nurses were teaching the class. And I know some nurses are wonderful, and it pains me to even share a negative story about nurses, because the nurses that I know, and you know I they there's they've said they're so supportive and wonderful, but in this case, the two teaching the class, they were laughing at the couples who even try to have a birth plan. You know that you've heard that Trisha, that rhetoric and that like to that just tells you everything you need to know that's just not the right people for you. You have to find your people, whatever it is you're looking for your birth. So childbirth educator is part of that team, and as I said earlier, there's so many other important people to hire as well to support you, physically, mentally, emotionally through your pregnancy and birth and postpartum. Ibclc postpartum for breastfeeding, pelvic floor support, again, chiropractic, acupuncture, massage therapy. This is your team ready to move on the second one, let's go. Okay, go ahead. Okay. Number two is about the place of birth arriving at the right time to the right place. So first choosing the right birth setting. Birth settings. Basically, there are usually three home birth center or hospital. What about car and all the other ones we've heard about. Those usually are not planned or intended, but they are birth spaces, for sure.

Those are not planned, at least they are, yeah, generally not planned. Okay, we know that home birth and birth center births, just by choosing those two locations, you already significantly reduce your chance of having a C section. The C section rate for free standing birth centers nationally is about six to 12% and the C section rate for planned home birth is about 5% right? A little pretty similar to Item A there. However, only one to 2% of people give birth at home, 90% 95% I think it's 95% of people give birth in the hospital.

Please, please don't say people giving birth. Say women. Oh, I'm a stickler. Okay, you said it once, then you said it twice. So now I'm getting, you know, yeah, okay, I'm 95% of women are giving birth in the hospital. So in choosing the right place, if you are choosing a hospital birth, which, again, most women are you need to think about the hospital cesarean rate. You have to inquire about the hospital cesarean rate. One study out of California said that 77% of people believe that hospital choice does not impact cesarean rate. So basically, they don't care. They're just going to walk into a hospital with a 60% C section rate and believe that their birth is going to be different.

I mean, what the reason people believe that it's it's not even about caring or not caring. They truly believe the birth outcome is 100% out of a woman's hands. This is the first thing we have to change, and when women believe that, why bother doing anything? Why just why bother doing anything? They're just like, Oh, God, help me through this. I don't want to freak out. Help me through my birth. Really. It's, it's about thinking, what kind of birth do I want to have, and how do I prepare to have that kind of birth? Because it increases the likelihood of it. Not everything in birth is in your hands when you go into labor isn't, for example, how long your labor lasts isn't, for example, it can be influenced by position and hydration and things like that. But if only more women and their partners were empowered to understand we have such an influence over how the birth goes, they'll start to recognize, they'll ponder the question better when they're asked, does a hospital increase cesarean rates or not? But they're thinking, of course not, because if you need a cesarean, you need a cesarean.

Well, I think, I think that people are choosing their hospitals based on the quality of the hospital. So if this hospital gets good ratings, then that's a good hospital, but that does not make a good birth space. There's a very, very big difference. I mean, you don't need a top tier hospital with the top of the line modern medicine for emergencies and illness, to have a good birth, you need a hospital and a birth space that believes in physiologic birth, that trusts birth, and that's the question that what I mean when I say that people don't care is that they're not they're not thinking beyond the quality of the hospital. It's a good hospital. It's a good hospital. My friend went there. They had a great birth. It's the best hospital in our area. That doesn't matter if the C section rate is 55%

Well, you know what they offer at Greenwich Hospital, right here near us, lobster, lobster dinner after. You give birth a lobster dinner and champagne, as if you're going to want to sit and have a romantic dinner. Where is the baby supposed to be in that scene? I'm just wondering. It's just so ridiculous. But before you give birth, and you've only seen it in the movies, you don't realize there's any recovery to be had. You think you give birth and you're basically done. You get up and walk away. People don't understand. Men and women both don't understand so they get seduced by things like a lobster dinner after their birth. Filet Mignon is the other option. Truly. That definitely sounds better.

Neither one appeals to me.

Scrambled eggs and toast. That's the perfect post birth meal, coconut water. That's my recommendation. Start with coconut water. So I think the other thing that's important to point out that we always say is that you should give birth where you feel the safest. For some women, that's home, for some women, that's the hospital, for some women, that's the birth center, that's part of how you come to this decision. But I do think also that many women don't realize that they feel less safe in the hospital than they think they do. Yeah, and that needs to be looked at. And many women feel think they feel less safe at home, when, physiologically, they actually would feel a lot safer at home. It's just their mind feels less safe and it's the reverse for the hospital. Their mind feels safer in the hospital, but their body does not, and we do have to consider how our physiology responds to these environments, because that is a huge driver in what is happening in our labor.

Yeah, and not everyone has a lot of options, and we always want to remind everyone that some women listening to this podcast are in far corners of this country or deep in the country. And we once interviewed a woman in where was it? Northern Idaho, on the border with Canada. And they don't have many options. However, if you do have options, who, if you have the luxury of options, I say this on the first day of my own HypnoBirthing class, I always say, I don't know where is the right place for you to give birth. I know that you know somewhere in you. So how if you're not sure, next time you walk into a hospital, what's going on? Do you stiffen or do you relax? Do you mutter under your breath? I hate hospitals. Do you feel unsafe at home and you have to get out of your house? I mean, you, you know the answer to the question, so pay attention. We go beyond statistics with things like this. You don't the statistics cease to matter when your physiology has such a major role.

Next, okay, the second part of this is arriving to the birth location at the right time. This mainly pertains to hospital birth, although it could be flipped to say, you know, don't have your midwife come to your home too early, or don't have too many people come to your home too early. Or if you're having a home birth and you're out shopping at Target or Whole Foods or Trader Joe's and you go into labor, go to your birthplace right away and get home. Maybe I thought that was the whole point of this one.

No, the main point of this one is, don't go to the hospital too early. That's you don't want to have the baby in target. Yeah, you're probably not going to, but it, you know, if you need to be in your birth space, get to your birth space. But you know, remember, I was in New York City when I went into labor and didn't get home for eight hours later and didn't have a baby for another 20 hours, I don't know, long time. Yeah, there's the risk there was no right to rush.

Yeah, there's the risk that comes with getting to a hospital early. That is your point,
exactly. Yeah. So the risk in getting to a hospital early, and there is data to support this, is that your labor could be slowed or stalled if you are not in active labor, and there is actually data to support this. A study done in 2023 found that those admitted after regular contractions, meaning they were less than five minutes apart, had half the odds of having a cesarean birth. Another study showed that there was a C section rate of 4% for those admitted at four to five centimeters versus 18% for those admitted at one centimeter. That's a really low rate. I was just going to say even 18% is very low. Both of those are low. So wherever that was go, there were they recent studies. One was 2023, wow. Did you say 4% to 18% so it was four and a half times higher when they got there early. Is that right? Four to 18%. Yes, yep, yes, yeah. I mean, no one should be admitted at one centimeter. You should always be sent home, pretty much always be sent home at one centimeter. And even I would say four to five centimeters is pretty early. Now we know that active labor really isn't technically starting until six centimeters, although why are we checking anyway? But the point is going too soon can definitely alter the course of your labor. We have typically said when you know it's time to go, that's when you should. Go you should, you should labor at home for as long as possible, until you sort of reach that place of being like I need to be in the space where I'm having my baby, wherever point that is in labor. That's probably the right point for you. The standard advice out there is the 411 rule, meaning that once your contractions are four minutes or less apart for lasting one minute and longer than one hour. That's when you should go to the hospital. If you need numbers and you need data, you can use that guide. But we just recommend not worrying too much about time you hear contractions and listening to your body and when you get that urge to be in the space where you want to be to have your baby go not being able to talk through your surges is a pretty good indicator. That's one that doula is use a lot when they get those calls from women in labor. But yeah, use your instinct. Yeah.

The classic line from the midwives is when the mother puts the husband on the phone to call the midwife, you better be on your way.

Right? That's right, because she can't make the call herself. All right. The next one is under you probably haven't heard this one too much before, but understanding the role of your nervous system, it's the elephant in the room in this whole conversation, when any mammal goes into labor, nature is giving her endorphins, and our job is to keep you there receiving endorphins, but your body is really primed and ready to shut off those endorphins and close your cervix and drive all the blood away from your uterus if you have any stress, self consciousness, humiliation, fear, that's what we don't want, and that is actually what's driving your labor more than anything else. It's what starts labor, and it's what carries you through the entire process, failure to progress. In quotes, we just did a whole episode on this a few weeks ago. This can be so remedied when we think about making the woman feel safer and safer and safer. And that is, in fact, the top job of her partner, of her provider, of her doula. Everyone's job should be, how do we remove stress from mom? Don't even think or say the word stress, but that's what they're thinking. How do we make her feel safe, relinquishing relaxed. This is what drives and propels the labor process,

because adrenaline and cortisol block oxytocin, and obviously, oxytocin is the main driver of birth and labor, and the more oxytocin you have, the more endorphins your body releases, and that reduces your pain, naturally, your discomfort naturally makes it easier to cope. And this is exactly why what we just said about staying home is so important, because you generally are more relaxed and comfortable at home, which increases your oxytocin. And that transition sometimes to the hospital can increase fear and increase stress. And it's very common for laborers to slow down during that time. It's very common for laborers to be, you know, chugging along. And then they get to the hospital and suddenly the contraction space apart, or they go away for a period of time.

Or when providers change hands, that happens a lot. When a woman says goodbye to the provider she didn't like and a nice one comes in, things start to progress. Or if she loves the nurse or the doctor there, but their shift ends and they leave, and then another one comes in, and she doesn't feel as safe, her cervix can tighten.

So this is why it's so important to keep your space feeling safe, calm, quiet and protected. So things like Dimming the lights, listening to calming music, having the sound of water in the room can be really helpful. Wearing a sleep mask, I love that one. Like reduce the external stimuli so that your nervous system can stay as calm and relaxed as possible, which is going to facilitate higher levels of oxytocin, stronger contractions, and, you know, faster, smoother, easier birth.

And the final point to make on this is that no mammal can secrete a catecholamine, which is a stress hormone and an endorphin concurrently. So every woman in labor is receiving either endorphins or stress hormones. It's such a sad thought, when you think about all the women right around us right now giving birth at this very moment, how many are really receiving a flood of endorphins rather than resisting having fear, having stress hormones, and her body is in this conflict of trying to get the baby out, but there's the absence of endorphins because she doesn't feel safe. So your brain is the most important birthing organ, and that's an area close to my heart. It's a lot a lot of what I teach in my class. But the first thing a provider should talk to you about is that at your first prenatal, in my opinion, they should say, look, nature has designed this to be inherently comfortable for you, and it's my job as the provider to make you feel safe.

Oh, just hold space. Really, that's what you're doing. You're just creating a safe space for them and watching for things that you need to be a. Alert to but otherwise not intervening. Next one, okay, the next one is about learning to understand the biomechanics of birth, or body position, fetal position. I don't think you need to go into a deep class on understanding the physiology of birth. You really don't need to know any of that to give birth, but what you do need to know is that how you use your body, how you move your body, how you position your body in pregnancy and in labor does impact how the baby can move through the body. So we know certainly that upright positions in labor decrease the risk of fetal male position or slower stalled labors, therefore decreasing the risk of C section. Upright positions in labor actually reduced the chance of a cesarean by 29% and again, in one California study, for some reason, these studies all seem to come out of California, only 39% of women reported walking during labor after they were admitted. That means the rest of them were in bed.

That's just abuse, really is. I mean, I wonder how many were encouraged to walk, versus how many were left alone to walk if they felt like it, versus how many were told they may not get out of the bed even to go to the bathroom, I would just wonder about that.

It's most likely because they were put on a continuous fetal monitor and had an IV put in their arm and then walking just didn't seem like an option anymore. They were and it isn't. They're tethered exactly so in labor, positions, recumbent positions, or women being on their back in labor increases the Cesarean risk by 29% when a woman is upright in labor, which the statistics show that only 4% of women giving birth in the US are upright. Now I don't know if this is just during pushing or at any point in labor. I assume it's during pushing the baby out, and we know that the pelvis can increase by up to 30% at that time, and to think that only 4% of women are utilizing that 1% of women are giving birth on their hands and knees. Now, if you left women to choose many, more than 1% would give birth on their hands and knees. This is because they are in the bed with the phenol monitor and tethered to that bed IVs in the arm, whatever it is that's making it difficult for them to choose whatever position they feel most comfortable in. And it's important for everyone to understand the sacrum, which many people know, but not everyone knows, is that lower, flat part of your back, that's the part that opens. It's only the back of the pelvis that's designed to open and expand when the baby is coming out. So this works beautifully. As long as you're not flat on your sacrum, for example, lying in a hospital bed, then it can't open at all, and you are being robbed of space that nature thought all along you would have when your baby would be coming out, you're being robbed and deprived of that. Nature was depending on you to have that open pelvis in order to get your baby through. So whatever position your baby is in and whatever size your baby is, nature expected you to have that space. You go to a hospital, you're put on a bed, on your back. You're being robbed and deprived of that, and that's driving up C section rates. So this is not just about your comfort, which is of the utmost importance. It's also about, as Trisha said at the beginning, the biomechanics for birth. That's exactly what we're talking about here, understanding the biomechanics, not just of your baby's position, but also of yours.

And also, just to clarify, this is we are talking about physiologic birth. If you have a birth with an epidural, it may be different, and side lying or using a peanut ball can reduce the chance of a C section if you are unable to just freely move about and get the position that you want right. If you have an epidural for any reason, still aim to be off your sacrum, even if you're lying on your side, beautiful, or off the sacrum, okay. Number five, the final point, the big one, the big one avoiding unnecessary interventions, namely, and firstly, Pitocin, how you go into labor is a large determining factor in how the rest of your labor will go to every extent possible avoid induction, if it is truly a matter of you and your baby being safer, for example, preeclampsia, then, of course, we're grateful for it, and it's important to go get the Pitocin, but you should be a very hard sell on this, so you should be optimistic when you're going into labor on your own. Right there, the odds are safe. Significantly higher than if you're going with Pitocin, and if you do need Pitocin for even a good reason, you can still have a wonderful vaginal birth, make no mistake, but statistically, it's a very good thing to avoid and keeps your birth lower risk.

Yeah, when we're thinking about augmenting a labor with Pitocin, I've really been racking my brain lately trying to think of a scenario where I think Pitocin is necessary. Pitocin is a power solution. It's a it's like a force. You're forcing the uterus to contract harder when the uterus is tired or the baby is malposition. So why are we pushing more power when what we really need is rest and patience? And if a woman could get all the rest and time that she needs for her body to recover and recoup and her oxytocin to get back on track and get rehydrated, would there ever even be a need at any point in labor for Pitocin. Now, I'm not talking about induction, speeding it up, yeah. Why are we ever using it? Yeah?

I mean, in the case of fetal distress, it would increase the odds of distress. So this, this is the counter that doesn't help, speeding it up, that doesn't help, right? And when you're giving Pitocin to a low risk woman whose labor is just lasting a long time, that's putting her uterus at risk, it's a highly controversial drug, and it should be, and that's why even the FDA will not go near making blanket recommendations for Pitocin. It's staying very far away from it, and it's been around for decades, 6070, years, still not something that anyone is any major authority is really too comfortable getting behind, but it is used with reckless abandon. It is FDA approved for induction, just not augmentation. It's only FDA approved for the medical induction of labor, and that's it. And most are elective inductions of labor. So it's actually a very, very small percent only medical induction. And how many women would say, Oh, I'm sick of being pregnant. Can you induce me? And how many doctors are saying, Oh, I don't want that baby getting any bigger. Those are all non medical inductions, and they're not FDA approved for that, so they won't really get behind it. And they're very careful about the language that they're using, because they don't really want to recommend it, because it's, it's, it's very, a very dangerous drug, and it has been named the most abused drug in all of medicine. In the 80s it was, I'm sure there are far more abused drugs now even in medicine, for sure, but in the 80s it was named the most abused and overused drug in all of medicine, of course, being applied to millions of women, almost definitely unnecessarily. Another one I want to talk about is amniotomy. Amniotomy is not recommended even by ACOG, and does drive up fetal distress and the likelihood of a C section as well. That one is really, really tough, because, like, for what purpose should anyone do an amniotomy Almost no purpose? I won't say no purpose. I'll never, I'll never say no purpose, but almost no purpose. So you should be a very hard sell on anyone taking that mechanical tool that looks like a crochet hook and breaking your waters with it. They'll say it might speed up labor. Be wary of anyone who says they're doing anything to speed up your labor. That's not a matter of safety, and it's not true. And even ACOG says there are more than 15 studies that show it isn't true, but it is very risky, and beware of the cervical exam, where they accidentally break your bag of water. So another good reason to not have cervical checks, which could also fall under this list of unnecessary interventions that we we didn't actually put on here, but cervical exams are definitely an intervention. They create stress, they create fear, they create discomfort. They may unintentionally break your bag of water. They may intentionally break your bag of water, or intentionally, absolutely I'm certain it's happened. I hate to think that, but it does, yes, um, but just the, you know, just the unnecessary psychological stress of thinking about what your cervical dilation is, is unnecessary and creates a lot of that fear that we were talking about with the nervous system. You know, keep your nervous system protected. So epidural is another one. Epidural is particularly given to early in labor. Can very much slow down labor. They can very much inhibit your baby's ability to navigate the pelvis move down, especially because you are typically in bed and you're not upright and mobile, and you're taking away the ability for your baby and your body to move together. Epidurals also disrupt the natural hormonal cascade that we want to have in labor to help facilitate birth. There are other comfort measures that you can use in early labor, like. Water movement, breath work, massage, birth, balls, epidurals for a long, prolonged, exhausted labor where you're getting the labor where you are getting the epidural for rest, especially if you are further along in labor, sometimes do seem to make a difference and and help support vaginal birth, but early epidurals are definitely something that can contribute to C sections significantly.

And don't believe anyone who tells you that it doesn't slow labor because it does. They did a study a few years ago, I don't know, maybe around five years ago, and it was just such nonsense. There was a doctrine on television who said, well, now we've done a study, and you know, they believed for years, epidural slow labor, but it absolutely does not significantly slow labor. So I said that that cannot be. And when I looked it up, beware those studies, because the conclusion may say something that the study doesn't show. In the study, they had two groups of women, and unbelievably, now you're all assuming one group had epidurals and one group didn't, aren't you? They all had epidurals their whole labors. And for half the women, they removed them just as they started pushing. And the others, they kept them in. And they had the nerve to then measure like, oh, whose labors were faster, and there wasn't a significant difference. For those who had the epidurals removed right before they started pushing. And they made a whole study around it, and got doctors out on the news to say, Oh, look at this. It really doesn't make a difference. Every woman in the study had an epidural during her entire dilating stage of labor. You just have to be so careful. How did that make it past a review board? How is that even possible? Oh, are you? You should see the things that make it past review boards. But anyway, that's sort of the argument here. How are things getting pure because people are paid and then their doctors are put on television, and they're all, you know, it's this is how it works here. All right, that's not surprising.

The next one is declining continuous fetal monitoring. So continuous fetal monitoring is an unnecessary intervention in low risk birth, and it is a harmful intervention in low risk birth, and it significantly increases your risk of a C section because of false positives, so there is not a good understanding of fetal heart rate patterns, and many C sections are performed unnecessarily for non reassuring fetal heart rate patterns that turn out to be absolutely fine. The baby is just fine. So not only does it keep you in bed, but it just straight up, increases your risk of getting a false report of your baby being in distress. And, you know, being told that you need to have a C section as soon as possible.

In January of 2021, we did an entire episode on intermittent auscultation, which is listening periodically throughout labor rather than continuous monitoring with Amy Romano, author/midwife. Okay, so just to give you guys some key reminders and key takeaways from this episode, first of all, please remember that any time that you are faced with a question, an unknown, an intervention in labor, don't forget the brain. Acronym brain, B, R, A, I N stands for what are the benefits? What are the risks? What are my alternatives? What does my intuition say? And most, most importantly, never forget to ask, What happens if I do nothing? That is such an important question. What happens if I do nothing? Usually, your provider will say, I don't know. Let's give it some time and see time is your friend. If there is a true, true emergency in birth, they will not give you time. You will know, right? So always ask, Okay? Second key takeaway is learn that there's no clock on labor. There's no time limit. Failure to progress is not a thing. It's failure to be patient. Birth will happen if we give it enough time. And if it isn't going to happen and you choose to do something otherwise, to have a C section because you're done, that's your choice. That's okay.

It means nothing. It's arbitrary. It's serving the hospital or the facility and not you. And there's no data on any of it, a very long labor, while exhausting, is no riskier, with no worse outcomes than a very quick labor.

Remember that a big baby is not probably a big baby. Ultrasound is inaccurate in assessing that at least. Half of the time, and at least 1/3 of women are told that they should have a cesarean for a big baby.

Not only is it probably not a big baby, but it is not a concern in almost all likelihood, when there's shoulder dystocia, there was something like a 52% to 48% split as to whether those babies were quote, unquote, big or not, but big babies are born to 8% of women. It is not a big deal. This is hardly an anomaly. It's all in the realm of normal, because fat is squishy, and some babies are 17 inches long, and some babies are 21 and a half inches long, and some are and again, those babies could weigh the same the short, chunky ones and the long, skinny ones. So we have to stop having this fear of a big baby and start wishing and working toward good fetal positioning and don't worry so much about the baby's weight.

If we go back to the statistic of only 4% of women giving birth upright, then we are looking at almost every woman with a big baby giving birth on her back. And of course, if you're giving birth on your back, what we talked about with the sacrum and the pelvic opening. Yeah, that's harder, and their baby's more likely to get stuck. So if we give big babies the chance to come out the way that they can by getting women off their backs, we're not going to see a fear of big babies. Providers just don't see birth that way, so they fear them. Okay? This is, you know, the obvious, surrounding yourself with supportive people, creating a birth space that supports your oxytocin, keeping yourself feeling safe, supporting the nervous system and supportive friends and supportive family. That's it. That's a bigger part of this, too. For a lot of people, a lot of couples, are really stressed about whether they don't have support from their family and their friends. You don't need to explain your birth plan to anyone if they're not supportive. So I think of it, we can summarize that if you can feel informed and confident in choosing the right provider for you, the right birth space for you, the right community surrounding you, and the right people on your team. You avoid unnecessary interventions, and you keep yourself upright and mobile in labor, your chance of a C section, an unnecessary C section is dramatically different than the average person.

So that's it. That's what we have. It was a lot to a lot to absorb, but as Trisha said at the beginning, these are supported by evidence, but also your own good intuition already knows all of this. So whatever you do, remember the support is the really big takeaway, the sting and that state of endorphins and oxytocin, that's your ticket, and it's everything nature already gave you. So by default you have everything you need. Just remember that, by default you already have everything you need for your most beautiful and safest birth.

So yeah, we're not choosing the things that are going to make our birth safer. It's already safe the way it is. You're choosing your select interventions to best support you. It's already safe the way it is, and you are choosing to keep it that way. 

Thank you for joining us at the Down To Birth Show. You can reach us @downtobirthshow on Instagram or email us at Contact@DownToBirthShow.com. All of Cynthia’s classes and Trisha’s breastfeeding services are offered live online, serving women and couples everywhere. Please remember this information is made available to you for educational and informational purposes only. It is in no way a substitute for medical advice. For our full disclaimer visit downtobirthshow.com/disclaimer. Thanks for tuning in, and as always, hear everyone and listen to yourself.