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C-sections and Size

Should Large Women Have C-sections?

By Jenn Director Knudsen

Nationwide, doctors, nurses and midwives are trying to decrease the rate of Cesareans. It's believed that the current rate, which experts place at about 25 percent, is too high. But not every woman can give birth vaginally. Some studies, for instance, show that for women who have had one or more Cesarean sections, they'll most likely have to deliver their next baby by Cesarean, too. Especially if their baby is more than 8 pounds.

Dr. Michael J. McMahon, an assistant professor at the University of North Carolina at Chapel Hill, recently completed one study that looks at pregnant women who'd had at least one previous Cesarean to determine who could then give birth vaginally. Dr. McMahon's study, published in the New England Journal of Medicine, looked at 6,000 pregnant women. Among them, 3,249 underwent a trial of labor, and 1,962 of them delivered vaginally. That means about 25 percent, or 1,300, women who'd had a previous Cesarean were able to give birth vaginally.

Still, there's no predicting which women can deliver vaginally after they've had a Cesarean. McMahon emphasizes that women pregnant with large babies are most likely to need surgery to deliver subsequent babies. "Ideally, if you could predict with accuracy the baby's weight before its born, this would help in counseling women, as big babies are less likely to be delivered vaginally," says Dr. McMahon.

Dr. McMahon says it doesn't bother him at all if he does more Cesareans than other physicians. "I have no problem saying the Cesarean section rate in this group of women is high because we just want a healthy outcome for both the woman and her baby," he says. 

So if a women believes she might be a Cesarean candidate, how can she prepare herself for the best delivery possible? The most important thing a woman can do from the get-go is to carefully choose her care provider, says Melanie Jordan, a certified nurse midwife, who delivers babies in a Los Gatos, Calif.-based clinic. "Women should ask themselves, 'What do I want from my birth experience?'" says Jordan, an advocate for trial of labor. If a mom-to-be is concerned her doctor may jump too quickly to surgery, she should shop around for one she trusts more. Jordan encourages women to thoroughly interview their doctors, asking questions like, How many Cesareans have you done? or What would you do if my labor stalled?

Want to see more?

• A C-section Baby Boom: Why Cesarean Delivery
  Is on the Rise
• Obesity and C-sections: Is There a Link Between the Two?
• A Guide to C-section Births: What Dads Need to Know
• Talk about it!