A reader of another blog recently left this comment, “If you have a good doctor he/she would not do a C-section unless necessary.”

What is the definition of a “good doctor”?  I once knew a physician whom everyone believed was a “good doctor”.  Let’s call him Dr. Wonderful.  He had a very high cesarean rate, a high episiotomy rate, a high forceps/vacuum rate, and yet his patients adored him.  Why? 

He made each woman who came to him feel special.  He was handsome and charming, and would treat each woman as if she were the only patient in the world that mattered to him.  This is not necessarily a bad thing–I believe each patient should feel special and important to her provider.  However, when this perception of being special clouds a woman’s judgment, it is time to have a reality check.

Dr. Wonderful would visit his patient after whatever unnecessary procedure he did, sit by the bedside, take her hand, and very regretfully tell her how sorry he was that she needed ___________ (insert the procedure of your choice), but if he had not done it, ___________ would have happened (insert catastrophe of your choice).  So he very reluctantly had heroically intervened to save her life, or the life of her baby.  The woman would be trembling with gratitude toward this marvelous physician by the time he left the room.  None of his patients could ever believe that any of these procedures were unnecessary.

We’d all like to believe we can place implicit trust in our physician.  The truth is, however sterling a physician’s character and however pure his motives, he is still human and can only offer human opinions about the best course of action in any particular case.  It is still your body, and you are the one who will live with the results of whatever action is taken.  This is why it is important to consider seriously the advice of those whom you have hired to care for you during your pregnancy, but never to place implicit trust in those providers.

Many ”good doctors” have performed unnecessary c-sections in the years that I’ve been a labor nurse and then a midwife:

1.  “Jack the Ripper”, the nurse’s pet name for a certain doctor who always did a c-section by 5 pm if the woman had not had her baby.  One woman was being induced and was 4 centimeters at 4 p.m.  Dr. Ripper ordered her to be prepped for a c-section.  As I was prepping her belly, she suddenly said, “I feel the baby coming!”  I checked her, and she was completely dilated!  When I told Dr. Ripper, he rechecked her and stated, “I don’t know what you think you’re feeling, but she’s only 4 centimeters still.  Get her to the OR!”  The patient was profoundly grateful that Dr. Ripper had saved her hours of pain at the level she was feeling, since she “wasn’t dilating”.

2.  The doctor who promised to be the OB backup for my VBAC client.  When she came in in active labor, at six centimeters dilation, he checked her and said the baby was too large for her pelvis, and she needed a c-section in order to avoid damage to the baby.

3.  The doctor who ordered a woman rushed to the operating room when she arrived at the hospital completely dilated but with her baby in the breech position.  The baby’s bottom was already crowning, and this woman had previously given birth to two other average size babies, so would have been an excellent candidate for a vaginal breech delivery.

4.  The doctor who told a woman she would never dilate because he had been trying to induce her without results.  The woman was only 38 weeks pregnant, and had no medical need for induction.  The doctor was going out of town the next week and wanted to deliver the patient himself.  Her cervix was not ready for labor, and thus would not dilate.  Rather than stop the induction and give her a chance to go into labor on her own closer to her due date, he told her that her cervix was unable to dilate and she would always need c-sections.

5.  The doctor who told a woman she was too small to give birth.  She was not allowed to even attempt to labor.  I later helped her VBAC a 10 lb. baby boy after a four hour unmedicated labor–no tears, either!

6.  The doctor who told a woman that she was progressing so slowly it would take hours, maybe even days, for her to have her baby.  He then asked her if she wanted to risk her baby’s life that way?  “Your baby is fine now, but do you want to wait until his heart stops and take the chance we can’t get him out in time?  Babies can only take the stress of labor for so long”.  This woman agreed to the c-section her “good doctor” recommended for her first baby.  With her second baby, she dilated slowly in the early stages, but once she began active labor, she had a rapid labor and birth (VBAC). 

7.  The physician who examined a woman in labor, told her she had a “short” perineum and recommended a c-section so she wouldn’t tear.  “After all,” he said, “All the stars are doing it.  You’ll still have a pretty vagina afterward, instead of looking like a crumpled old paper bag down there”. 

These physicians were all considered “good doctors”–friendly, personable, kind, and at least outwardly, caring.  The problem is, doctors are human and don’t want to spend hours on end in the hospital.  C-sections are quicker, and that is very appealing.  I have frequently heard a physician say, “She’s going to end up with a c-section anyway, so why not do it at 5 p.m. instead of 2 a.m.?”   Or when a woman comes into the hospital with requests written in a birth plan, a typical comment is, “Sharpen the knives. . .let’s get ready for the c-section”. 

Ladies, if your doctor is a “good doctor”–friendly, charming, kind–you can appreciate his/her winning personality without relinquishing your common sense to him or her.  Ask about his or her primary c-section rate.  This si important because it includes only those who are having a c-section for the first time.  If this rate is over 15%, it is too high.  My collaborating OB’s primary c-section rate is about 10%. 

Here’s another tip–if a c-section is truly necessary and urgent, there won’t be much time to talk about it.  You’ll be flying down the hall on a gurney, rushing to the operating room.  If a doctor has time to argue with you about the reasons you should have the surgery, there is probably time to safely consider other alternatives. 

Yes, good doctors do perform unnecessary c-sections.  But with a little common sense, trust in yourself and your own judgment, and the ability to separate a winning personality from excellent medical skills, you can avoid being the target of a good doctor’s recommendation for an unecessary c-section.