Most folks today agree that the cesarean birth rate in the United States is too high.  From perinatologists to midwives to the women who give birth surgically, few would argue that there’s nothing to worry about. 

On the other hand, nearly everyone agrees that some cesarean births are necessary, such as in cases of complete placenta previa, prolapsed umbilical cord, or a placental abruption (when the placenta separates from the uterus before or during labor, cutting off blood supply to the baby). 

Why, then, do some c-section moms have to endure friends, relatives, and even strangers questioning whether their c-section was truly necessary?  Consider what one reader had to say about this:

“I had an absolutely necessary c-section (baby in a transverse lie low in my abdomen while in active labor for 14 hours).  I was still judged by other anti-section moms even after I said it was an emergency c-section.  I was given the “you know emergency c-sections are usually not really needed”.  I’ve come back with “even the ACOG requires a c-section for a transverse lie” but that does NOT make me feel any better about my body failing me.  I have also heard, and been guilty of saying, that “a womans body is made to give birth vaginally, your body won’t do something that will make that impossible”… And that’s not always true. Yes, a body is made to deliver vaginally but not every birth is meant to happen vaginally and just because someone had a c-section doesn’t mean they took the easy way out all the time.”

Why do some women feel the need to pass judgment on how other women gave birth?  As one c-section mom said, “It’s hard enough to enter the hospital planning a natural birth and suddenly have your dream shattered, leave with a cut on your belly and trying to breastfeed when you are in pain; I don’t need people telling me that none of this was necessary.”

Certainly, the blogs and websites that currently offer support and information for women who have had c-sections provide a much-needed service for the many women who want to avoid a c-section with their next  birth.  But as individuals, can we offer better support to each other?  Can we avoid passing judgment by accepting  that most women want a good outcome for their babies, and do the best they can with the information they have at the time?

Here, then, is my list of what not to say to a woman who’s had a c-section:

• If you’d gone to my midwife, she could have gotten the baby out without a c-section.  While it is true that midwives are very good at helping babies come out vaginally, that’s not the only goal.  In the years before cesarean birth was available,  there were occasions when a baby truly could not be born vaginally.  Eventually, mother and baby would both die because of obstructed labor.  Even if you are convinced your midwife could have gotten the  baby out, respect the mother who has had a cesarean birth, and acknowledge that some babies cannot be born vaginally.
•  Most “emergency” c-sections are not really emergencies.  While I believe that many emergency c-sections are not really emergencies, I have also seen many c-sections that were emergencies.  In those instances, I was very grateful for the option of a cesarean birth.  Unless you were present and aware of the circumstances surrounding the decision to perform a c-section, this is a difficult judgment for anyone to make.
• Trust birth/your body won’t grow a baby too big to get out/your body was designed to give birth/birth is natural.  Any and all of these mantras carry an important truth, but not an absolute truth.  There are women whose bodies grow babies too big to be born vaginally.  Birth is natural, and so is death.  Should I tell the woman who arrived at the hospital 8 centimeters dilated, only to be told we could not find a fetal heartbeat, that she just didn’t trust birth enough?  I believe we should trust the process of birth, unless there is a clear indication that the process is not working normally.  In those cases, there are times when a cesarean birth is the best option.
• If your doctor had ______, you wouldn’t have needed a c-section.  (Insert phrase of your choice: delivered your baby breech, done an external version, used forceps, not given you an epidural, let you get out of bed, etc.)  Again, this is making a judgment on the c-section mother.  At the time a woman consents to a c-section, she is usually tired, possibly in pain, and almost certainly scared for her baby’s safety and even her own.  To judge her because she made the best decision she could under very stressful circumstances is simply heartless. 

Many women who have cesarean births already feel their bodies have failed them.  To imply that they could easily have avoided a cesarean if only they’d been as smart as I am, simply reinforces this feeling.

Let’s continue to make sound, evidence-based information on VBAC and ways to reduce the risk of cesarean birth available for women who are interested.  Let’s also wholeheartedly support women who have had cesarean births, rather than criticizing or second-guessing their decisions.