Confessions of an Obstetrician

Top Ten Signs Your Doctor Is Planning To Perform An Unnecessary Cesarean Section On You

Posted on November 14, 2012 by Jonathan Weinstein

Jonathan Weinstein, ObGyn

I have been a practicing OB/GYN
for fourteen years. I live in Frisco, Texas, one of the fastest growing
cities in the United States, and I truly enjoy living and working here.
It is a great place for my family and, for the first time, my office is
attached to the actual hospital I practice in. This is the third and
final place I will practice medicine. I trained with some of the most
respected academic OB/GYN’s in the country. These physicians have
contributed to books on Obstetrics, created practice guidelines for the
American Congress of Obstetricians and Gynecologists (ACOG), and taught me to practice medicine based on scientific evidence.

I follow a few simple rules: do no harm, give your patients options,
and provide information so they can make
informed decisions. So, last night I was sitting in my office looking
at the fourth Cesarean Section (C/S) operative report
of the day for yet another patient who wants to have a vaginal delivery
following a previous C/S. I am frustrated and feel like I am fighting a
losing battle.

When did Cesarean Sections (C/S) and elective inductions at 39 weeks
become the standard of care? That is not what I was taught,
and that is not in any textbook or ACOG
practice bulletins. So why in Dallas, Texas do people have to drive
more than an hour to find a doctor who actually has no desire to do an
unnecessary C/S? It has become obvious that I cannot attend every
vaginal birth a patient wants to have after their traumatizing C/S
experience. If close to 50% of the patients are getting a C/S each day
and there are hundreds of practicing OB/GYN’s in the Dallas Metroplex,
the math is not difficult. I know at least one physician who only does
C/S’s, and vaginal delivery is not even an option. If one of his
patients delivers vaginally it is only because the baby came faster than he could get to the hospital.
This is the only place I have lived where C/S and elective inductions are king. So, women of the world, I am giving you the knowledge to stand up for yourself before you get that first C/S!

Top Ten Signs Your Doctor Is Planning To Perform an Unnecessary Cesarean Section on You

1. Arrives to Labour & Delivery immediately after office hours and says,“I just don’t think this baby is going to fit.”

2. Third Trimester, Routine Office Visit, “I think this is going to be a big baby. You should just have a C/S” – Did you know? ACOG has very specific guidelines for when it is
appropriate to offer a patient an elective C/S for MACROSOMIA (fancy
word for large baby). ‘Prophylactic (elective) cesarean delivery
may be considered for suspected fetal macrosomia with estimated fetal
weights greater than 5,000 gms (11 pounds) in women without diabetes and greater than 4,500 gms (9.9 pounds) in women with diabetes.

3. “We should induce at 39 weeks because your baby is getting too big” – Did you know that, according to ACOG:
‘Induction of labor at least doubles the risk of cesarean delivery without reducing shoulder dystocia (rare situation where baby’s shoulder can get stuck at delivery) or newborn
morbidity(complications). Suspected fetal macrosomia is not an
indication for induction of labor, because induction does not improve
maternal or fetal outcomes.’

4.Performs routine ultrasounds at end of pregnancy to see how big your baby is. Did you know that ultrasounds at the end of the pregnancy can be 1-2
pounds off? Ask some VBAC patients who were talked into a C/S for this, then had a vaginal delivery of a bigger baby the next time.

5. “You have a positive herpes titer (or history of herpes); the baby will get it if you deliver vaginally.” Try some Valtrex for the last month of the pregnancy that is pretty
much standard of care now. It prevents outbreaks and allows for a
normal vaginal delivery.

6.“Your baby is breech. You need to have a C/S” Ever heard of or performed an External Cephalic Version (process by which a breech baby is turned to the proper position)? It really does

7.“You have pushed for 2 hours” (with an epidural that prevents you from feeling anything so you are
probably not pushing effectively; this is evident on exam because the
baby’s head is still perfectly round, but you do not need to know that)“It’s just not going to come out”

8. “I scheduled you for an induction at 39 weeks. It is just soooo… much more convenient for you!” (and so much higher risk of ending in a C/S, especially if you are not
dilated when you start the induction). At least 80% of my VBAC patients were induced the previous pregnancy. For whose convenience was the induction?

9. First Visit (7 weeks),“Congratulations you are having twins. I will go ahead and schedule
your C/S at 38 weeks, but don’t worry if you go in to labor early I will cut you right away!” Translation, “I am scared out of my mind for you to deliver your babies vaginally because I am not trained on
what to do when the second baby is coming, plus it pays more to cut you
open. Oh yeah, I don’t have that great a rapport with you because I
only spend 2 minutes (fundal height, heart beat and ‘I’ll see you next
time’) with you each visit, so I am afraid I will be sued for trying to
do the right thing.”

10. First Pelvic Exam in Office (7 weeks),“Hmm, your pelvis is pretty narrow”.

Bonus Tip:
11. 38-week visit, “Your blood pressure is a little high today. You are probably developing
preeclampsia or toxemia. That can cause you to have a SEIZURE! The
treatment is to deliver the baby. You need a Cesarean Section, as this
is the quickest way to resolve it. Let’s get you up to L&D NOW!” Translation – Preeclampsia or Pregnancy Induced High Blood Pressure is a pain in the butt. If I induce you, it could take 24 hours or more and then I would have to manage your blood pressure, and put you on
Magnesium. This is way too inconvenient. Do not worry you can try to
have the baby vaginally next time. Yeah right!

Well, I hope you future moms find
use for these tidbits of info. If anyone wants to add anything, please
feel free. Your experience may help other women in the future.
Remember, there are only a few emergent reasons for a C/S such as fetal
distress, unexplained heavy vaginal bleeding, etc. It is okay to ask
your doctor questions. We are not supposed to bite.

Jonathan Weinstein, MD, FACOG

Husband to a Labor and Delivery Nurse with 27-years’ experience
Father to two beautiful children, Zoe and Ashton

70 thoughts on “Confessions of an Obstetrician

  1. Pingback: Morning coffee round up | Janet Fraser

  2. I had two natural births at KEMH WA in 1984 & 1988 both delivered by midwives with student doctors assisting had no complications no stitches , the midwife at both births was excellent.

  3. Thank you!
    I have been seriously thinking about returning to Uni to become a midwife and have found so much information on this. It’s a bit frightening and it can’t help the mother at all, to be constantly in an anxious state about her pregnancy right up till the last second… any scared woman would be easily pressured into a C/S.

    My own birth involved an induced labor and Preeclampsia … my own mother had high blood pressure and I had to be induced four weeks early due to my cord disintegrating. So I am aware of times when these things are so important… but that isn’t every time.

  4. You’re making some pretty broad assertions here about Dallas doctors. I had a 9.5 lb baby last year at 41 weeks, vaginal delivery, and my doctor did not once mention a c-section in the 6 months he was my provider. This is a huge practice affiliated with Dallas Presbyterian (Walnut Hill OBGYN). Maybe you could refer some of your overflow to them.

    • I reread this article to see what you were referring to about doctors in Dallas, because I was glad to read that your doctor was persistent in helping you have a vaginal delivery. You don’t mention if yours was a VBAC delivery, or a vaginal delivery unrelated to a previous c-section. I’m just guessing that it would have been less likely for your doctor to stick with you to 41 weeks if you had previously had a c-section.

      I don’t believe Dr. Weinstein indicates that all doctors in Dallas are cesarean prone. He makes the following assertions:
      1. Over 50% of births in the area are c-section.
      2. Apparently it is difficult to find a doctor in the Dallas area who will perform a VBAC.

      He then describes behavior that will indicate if your doctor is prone to cesarean deliveries. He didn’t say every doctor had this practice, but there are a lot of cesareans occurring in the Dallas area. It is really wonderful that your doctor is not a part of this problem!

      In the interest of full disclosure: I am not biased toward vaginal deliveries, as I personally had 4 c-sections for LGA (large) babies delivered between 40-43 weeks. I wish I had been able to have vaginal deliveries, but after that first 10 lb 5 oz. baby at 43 weeks, none of the OB-Gyns in my area were interested in discussing VBAC…

      Also, this is a repost of Dr. Weinstein’s blog from November. His blogsite is mentioned at the bottom of the article. It is unlikely that he will see your comment on this site.

    • I am glad you had a good experience with that practice, and truly some of those OBs are better than others. I really like 2 of them in particular. But you lucked out. I don’t think Dr. W will be sending his overflow there at any point, they practice *very* differently.

  5. Wow THANK YOU!
    This is an amazing article, I only wish Iwould have found it sooner. Could h avesaved me allot of stress for sure! I will be passing this on to all my pregnant friends! Thank you again.

  6. I read your article with great interest and I also wondered why so many women were having these c/s today. I put it down to the mother wanting an easier birth, but by what you have written here, this might not be the truth of it !
    Why is this practice being so widely used!
    Is the real reason, it’s the money the Doctors will make by performing this procedure compared to natural childbirth!

  7. Thank you!!!!!
    I wish there were more OBs out there like you! After 2 beautiful home water births I fell pregnant with spontaneously conceived triplets. I found an amazing supportive OB here in Australia (Dr EdwardWeaver) who agreed to let me have my triplets vaginally. At 34+5 they were all born within 14 minutes of Baby A being born. A and C were cephalic, B was breech. We stayed in hospital for a week just to fatten up. They are 5 months now and still exclusively breast fed. It can be done!!!!

    • Wow. You are an amazing woman. 1) For having a natural birth with triplets, I rarely hear of twins being born vaginally, let alone triplets. 2) For exclusively breastfeeding them all, still at 5 months. It’s becoming less common for anyone to exclusively BF through the recommended 6 months, let alone twins and triplets. I’m so glad you can experience that with all 3 of them. We’re still BFing at 18 months and I hope you can keep gong with all of them until the 4 of you feel it is mutually agreeable to stop.

      Good for you! You must be one proud mama!

  8. My midwife turned my breach daughter 4 days before she was born!! People said it couldn’t be done!! Sooo glad I had a MIDWIFE!! Thanks ALICE!!

  9. I truly agree with this article as I have been a “victim” of a c-section that I felt was not needed, but rather a convenience to my obgyn. So I quickly switched docs when I found out I was pregnant with my 2nd. My new obgyn encouraged me and coached me through a VBAC, and I couldn’t have asked for more. Since then in have been educating women about most of the above tips. Thank you for sharing!

  10. My only question is how do you know if you fall under category #2 when category #4 is not a reliable method of determining weight.

    I had an 11lb 13oz baby, no diabetes, but had no idea how big she would be. Love that for my 2nd baby my doctor wouldn’t even consider an U/S based on the +/- 2lbs factor. My doctor educated me and I made a choice based on the morbidity and mortality rates of a VBAC, not my convenience. 2nd baby was 9lbs 8oz. 3rd was 9lbs 3oz.

    C/S should be for medical necessity, not convenience. It is major surgery!

    • A well-trained OB or midwife will be skilled at giving a much closer estimate of size based on stomach palpations and feeling for babies’ head size when they are checking for engagement and breech, etc.

  11. I’ve given birth 10 times. 4 times in hospitals, 6 times at home with a midwife. I’ve had one 3 weeks early at 6 lb 1 oz, and one 3 weeks late at 9 lb 1 oz (the bigger one was easier to push out) My first was when I was “too young” at 18, my last was when I was “too old” at 40. And many of them were born “too close together”. I was underweight and anemic with all of them. All of them are healthy kids. The risks they say are risks really aren’t especially if you watch your health. I liked my midwives because they spent more than an hour at a time with me and since they don’t have a knife backing them up and no agenda to make money off me or rush me they took care to watch my health and actually put me first. Get educated.

  12. Doctors are shooting themselves in the foot with this kind of behavior. It’s no wonder why homebirth is becoming so ‘popular.’

  13. I am a doula and I do births with this OB and was just with him two nights ago for a birth. I am also chapter leader for the Dallas Birth Network and asked him to talk at our April meeting meeting on the subject of this blog post. He doesn’t want to speak because he is tired of being one of the few doing what he is doing, literally tired. He misses his wife and kids b/c by doing this kind of birth (and especially VBACs) he cannot find a compatable partner so he ends up away from his family too much as he is always on call and often sleeps in his office instead of at home. I wish he could find a partner so that women would have even more good options in our area.

      • I am a midwife. Unfortunately, guidelines recommend that in order to support VBACs, facilities should have resources immediately available to perform a C/S in the rare event that labor causes the uterus to rupture. I work in facilities that support VBACs, and have seen uterine ruptures a few times in 15 years. If we weren’t able to do a C/S immediately, mom and baby would have died. Having a midwife attend the birth does not fulfull this requirement – I cannot do a C/S.

        So while midwives would help his practice, and he might not have to be awake all night with the patient, he would still be away from his family to stay close to the patient. This is another reason that a lot of hospitals will not offer VBACs regardless of the willingness of the OB/GYN. They do not want to pay the anesthesia and OR staff to stay “in-house” 24 hours a day when they have a VBAC patient laboring.

        The answer to this epidemic is to prevent the first C/S in the first place.

        Oh, and another clue that your doc may be planning a C/S? “You are not dilating or progressing at least 1 CM per hour, there must be something wrong with your labor. We have to do a C/S for failure to dilate”. This one DRIVES ME CRAZY!

        • yes!! i’m surprised he didn’t include that one, as that was what happened to me. looking back, i would have done it so much differently. at the time i felt like i didn’t have a choice in what was happening.

          love your insight.

  14. The narrow pelvis one is exactly what happened to me! Also, he said that he was concerned because I had borderline gestational diabetes.

  15. As a mama of twins, every conversation with my OB concluded with ‘be prepared for a c/s’. When I started interjecting that I wanted my babies to be delivered vaginally, I saw this his demeanor change, and the conversation would change or just end. Finally, when I was absolutely sick of being told the worse case scenario… my favorite of which was “the first twin could come vaginally and you may still need a c/s for no.2’… wtf.
    On the day of delivery baby b went breech, which we found out on my last ultrasound… along with her guess of how big the twins were. The babies were delivered at 6lbs 2oz and 6lbs 5oz… not 8+lbs.
    I am certain that if we hadn’t left our first OB at 26wks,switched to a midwife, and hired a doula, I would have a very different birth story. My story ends with, a beautiful boy and girl coming into this world head first. The OB commented he’d never seen a twin flip so quickly.
    I knew I had to keep everyone on the same page, and thankfully, I found the right support.

  16. Hi,
    Thanks for a great article! can you please tell us the true legit reasons to preform an induction on a woman.thanks.

    • Good question, Shimrit. “True, legit reasons” should be rare. In more than 1000 births, I have endorsed 3 inductions. Two of those were women with long rupture of the membranes (longer than 4 days in both cases) who started to spike a fever. In those two cases, the concern was “What if it’s a uterine infection?”. In the end it turned out that both of the women simply had the flu but that was only clear after their babies were born vaginally. The other (third) induction was a special situation where the woman had had an organ transplant and was on anti rejection drugs.

  17. Pingback: Confessions of an Obstetrician | Jessica Myracle: Doula and Massage Therapist

  18. Pingback: Top 10 Signs Your Doctor is Planning an Unnecessary CSection « Smart Birth Texas

  19. I had midwives for both of my children. I was very committed to natural childbirth for both, but unfortunately had to have c-sections for both. I had my midwives telling me in both instances that it was essential and I was still skeptical and felt very guilty because of articles like this. With my attempted vbac when they actually got in there it became clear that my uterus had begun to rupture. I’m so glad they pushed me into doing it, as I fear if I had waited longer I wouldn’t be able to have any more kids. I couldn’t agree more that csections are over performed in this country but I also think its important to point out that sometimes they are necessary for the safety of the mom or baby. I think it’s important mom’s know the truth about c/s but its also a tough position to put them In when it makes them question the experts they are dealing with in a time of intense vulnerability.

    • I don’t think anyone questions the validity of medically necessary cesereans. I had a ceserean with my last baby because he was sideways… when he was born he was considered premature at 37 weeks (dates were obviously off) and he had no body fat, and probably would not have been able to withstand the trial of labor. I honestly feel that the right choices were made, and every effort was made to ensure that I was able to go natural, but sometimes things just don’t work out, and that’s okay. Cesereans really can save lives. Unfortunately, they can do much more harm than good in mothers that don’t truly need them, as evidenced by the fact that our maternal death rate is higher than any other industrialized country.

  20. Haven’t read all the comments, but it is probably important to note that not all doctors practice these guidelines. Find an OB, just like the dr that wrote this, and you will not have an unnecessary Cesarean . I had two different OBs for the birth of my two children. I loved both of them. I followed recommendations from friends and I shopped around. Most importantly, I was not afraid to end our relationship if the information they were providing to me was not as I understood it should be. After all the practice of medicine is also a business. If you don’t like the service you get then spend your dollar elsewhere.

    Also, there should not be a war between midwives/homebirths and OBs/hospital births. I think that the industry and the professions should encourage what is best for mom and baby in most instances – a vaginal delivery! You should rally together to spread more awareness about these practices to help educate moms who don’t otherwise have to resources to understand these things themselves.

    • I specifically chose one particular OB because his wife was a midwife, and he had done a lot of training in Denmark with the midwives. He has one of the best records of that hospital, and he was a doc that was specifically working with only high risk women. So what does it tell you that he had a better outcome record than the OB’s delivering only low risk women? I know great and absolutely amazing doctors are out there. Unfortunately, there are all too many stories about docs more concerned with the money, or the potential for lawsuit 🙁

  21. Sadly, to me – now 16 years in the “birth biz” as a doula, childbirth educator, midwifery assistant and IBCLC, I feel a lot of it comes down to the end game scenario – a judge & jury sitting in a courtroom wondering if “you did enough”. Seems so much safer to just cut someone open or put someone on antibiotics. Our culture perceives *more* as better — “doing” is safer, prescribing is healthier, cutting is cleaner. To wait, to be patient, to allow time and biology to slowly work their magic — that’s neglect! Such a shame.

  22. Thank you so much for writing this! This hits home for me….

    Baby #1…. blood pressure began to rise at 39 weeks, induced due to elevated BP at 40w3d. Pushed for 1 hour 45 minutes, doc said he was “too big and not going to come out” and away we went to C/S. He was delivered at 4:30 pm, rather convenient timing for my OB, huh?! Following the section I was told I had a small pelvis and would never deliver any baby over 5 pounds vaginally. My son was 8 lbs, 8 oz. It was a traumatic experience and I had a horrible recovery. At 5 days postpartum I had developed an infection internally, had a 104 temp and hurt terribly despite the pain meds. It hurt so badly I could barely hold my baby, much less nurse him. My milk dried up and I was unable to nurse.

    Baby #2….Went into labor on my own at 36w3d, a little girl. I begged my doctor to let me deliver naturally, but she insisted that a VBAC was dangerous and that no one in OKC would deliver vaginally, and besides that, my pelvis was small so it would be too risky to try a vaginal delivery with her. This was a different OB too, same story about the small pelvis. So, I had a repeat c/s with my 7 pound baby girl. No complications this time thankfully.

    Baby #3….Started the pregnancy with yet another doctor who also told me it would be impossible to deliver vaginally, small pelvis and two previous c/s’s, no way, it was “too dangerous”. I decided to read up on VBAC’s and was floored when I read the medical data out there supporting VBAC’s. I showed my husband, and together we decided to do whatever we had to do to find a doctor to do a VBAC, it was the safest option for me and baby from what we learned. At 24 weeks I switched to a doctor 2.5 hours away who had a long history of VBAC deliveries and who supported my decision 100%. Ironically, I received a phone call from my previous OB asking why I switched, explained to him that I found a doc who would support my decision to have a vaginal delivery and his response was, “oh that is GREAT! I feel you are a great candidate for a VBAC, I just can’t offer them, I know you will do well and I wish you the best!”. Same doctor who while I was a patient kept telling me it was “dangerous”, and “your pelvis is too small anyway”. Funny how the truth about his position on VBAC’s came out once I was no longer under his care. So, I had my VBA2C and it went GREAT! I delivered an EIGHT pound SIX ounce healthy baby boy, who came right out after just under two hours of pushing. Pretty ironic considering 3 OB’s told me I would never deliver a baby over 5 pounds, and my VBAC baby was only TWO OUNCES smaller than my first baby who kicked off my road to two C/S. And I only pushed for TEN MORE MINUTES with him than with my first baby. Such a shame. A true case for FAILURE to WAIT rather than failure to fit.

  23. I agree that the rate of c/s all over the country it high. I think it’s closer to 30% here in Florida. But we can’t also overlook a couple of key components to the equation. A lot of women “demand” to be induced before their bodies are ready. They are done, it’s time to get that kid out of them. And the link between induction and c/s is well documented. Not only that, but the liability for doctors, especially OB/GYNs is ridiculous. Here, you have up to 18 years to sue your OB for something you decide you can pin on them. And then your case isn’t heard by a medical review board or qualified medical professionals, it’s heard by a bunch of average Joes who don’t know anything about medicine. So combine demanding patients with doctors who often get sued…you get higher c/s rates and all the best OBs leaving our state in favor of more doctor friendly ones.

    • What you’re saying is true, Celeste, AND the consumer has a right to know, in advance, that the doctors are not following the edict “First, do no harm.” If a doctor was following that oath, no amount of impatience on the part of pregnant women would convince them to induce. No fear of a court room would have a dr risk major abdominal surgery for a woman.

      • Your naievete is extrordinarily amusing. “No fear of a court room would have a dr risk major abdominal surgery for a woman.” My malpractice is about 150K a year. If I were to be sued more than my insurance carrier likes, they will drop my coverage. If that happens, the state where I live wouldn’t cover me. For 300K per year. I would *immediately* be forced out of practice. You figure it out. Even good doctors have to do things they don’t want to do because of the greed of sue-happy patients and lawyers. If they don’t they’ll end up without a career.

        • Robert, if you and the other medical doctors spent more time with your patients (instead of 10-15 minutes per visit) and actually took the time to educate them, like midwives do, I highly doubt that many of them would be asking to be induced or have a cesarean because they would have a much better understanding of the negative impact that that would have for the mother and child. I did the medical birth route the first time around and was completely disgusted by the lack of education, support and compassion given during doctor’s visits as well as the birth. I was also given an episiotymy without my consent and could barely walk or sit for at least a week. My second birth was at a birthing center with a midwife and at each one hour visit (yes, EACH visit) my midwive talked to me about my concerns and answered all of my questions. The brithing center also gives weekly workshops on various topics, including what to expect during labour and the actual birth. A patient’s mentality completely changes for the better when they are given knowledge and lose their fear about birth. The think more about what is best for the health of themselves and their baby, instead of what is the most convenient for themselves.

  24. I am a type 1 diabetic that began my prenatal care in the US and moved to Israel at 5 months pregnant because everything was going very well and because the rate of C/S was much lower. (our plans were to move after the baby anyway, but this factor pushed our move forward). In Israel doctors are not present at delivery’s unless they are hired privately, otherwise there are midwives and labour nurses that are in charge of the entire process with occasional drop ins from the doctor on call. This allows for a much more calm and patient driven process. Obviously there are nurses that are better than others, but for the most part the mothers are less likely to be pushed to do something they don’t want to do or need to do.
    With the prospect of moving back to the US, I am terrified as a type 1 diabetic to have to face a doctor viewing me as a high risk pregnancy when in reality nothing about my previous pregnancy was high risk and, please Gd, nothing will be high risk in the future.

  25. I had my son at home and I am so glad I did. I pushed for 5 hours, probably because I refused to eat or drink and had no energy left to push. But he was born healthy and naturally and I was fine too. If I was at the hospital I would have for sure been cut open. I plan to always have a midwife and, please G-d, deliver at home!

  26. Mommas need to research their options and DON’T BE AFRAID TO SPEAK UP!!!! It’s your baby and your body. Remember you are paying your physician for a service, they are working for you. Midwives are wonderful and extremely capable for deliveries. Both my babes were born at a birth center with a wonderful midwife. You can even look in your area for midwife care in a hospital. There are SO MANY OPTIONS for OB care. I have to say that hands down, you can’t beat the relationship you create when you use a midwife your comfortable with. Also, listen to your intuition, it’s there for a reason. If it doesn’t feel right to you, it probably isn’t. Don’t worry about offending your dr or midwife, they should want your to be comfortable with your delivery!

  27. I enjoyed reading this list and feel fortunate that my inductions at 38 wks with my first two babies didn’t end in a c-section. We were close with my first. And my doctor with my 2nd baby was doing almost all of these things…mentioning a c-section this time, many ultra sounds to check weight of baby, which were off. He was my smallest baby! The “light” went on for me during my 2nd pregnancy, induction and L&D experience. I researched a lot afterwards and never went back! My last two babies were born at home with the help of midwives. I guess I am a slow learner!

  28. thank you so much for this article! I appreciate your honesty and attitude toward providing information for the patient that we should have! I didn’t have to deal with this but I know a TON of my friends that have. I hope other doctors are encouraged to let go of the fears they have or feeling “inconvenienced” and give patients what they want.
    THANK YOU! 🙂

  29. Thanks for this article! I had OB care up until 36 weeks because as a first time mom I was terrified that something would go wrong. After being forced to see a perinatologist necessarily (for white coat hypertension that resolved after my first trimester when I stopped worrying so much about miscarriage), forced to have repeated ultrasounds to check for “intrauterine growth restriction” due to the BP, forced to take the glucose test THREE times because then they told me he was too big (the tests were always negative, btw… And I’m 6’1″), and eventually told by the OB “what’s wrong with your baby that he’s so big?” and being told we needed to induce at 39 weeks or schedule a C/S because of the risk of shoulder dystocia (baby was due during the holidays…convenient, eh?), my husband and I decided to switch care to the nurse midwife practice in the same office. Never had any issues there, and every single midwife in the practice told me they had no concerns about me delivering naturally… Which I did, at 41 weeks, 1 day, with a doula and a midwife, in the hospital, no drugs. 20 hours of labor, and 5 hours of using later, my 10 lb, 4 oz, 22 inch long son was born healthy and beautiful, with no shoulder dystocia. We had taken Bradley classes, which I credit with helping us know what was right and what was pushing too far by the OB, and our doula was amazingly supportive. Now he’s four weeks, exclusively breastfed, and gaining over ten ounces a week. Ladies, educate yourselves, and don’t let anyone intimidate you!

  30. Thank you so much for this. I have had 7 babies and my body doesn’t know how to make a small baby. Additionally, I tend to go post dates. I knew the stats and because I knew that big babies/post dates issue putting me in a compromising situation (I also have blood clotting disorder which would complicate matters in the event of a c/s), I elected to find a homebirth midwife. During labor, I listened to my body, spontaneously got on my hands and knees because nothing else felt comfortable and pushed my posterior 13 (yes, thirteen) pound 3 oz baby out in only three pushes. (

    In VA, I had a fantastic OB who sounds a lot like you. He was my OB for babies #3 and 4 and had been dealing with a lot of grief from his colleagues and the hospitals which allowed him privileges, in addition to getting reasonable malpractice rates from insurance companies. After we moved from the area, I found out he ended up retiring because it wasn’t worth the fight. VA lost an amazing OB who believed womens’ bodies knew how to birth without a lot of help from medical professionals. What a shame. Keep doing what you are doing, Dr. Weinstein. You are so needed!

  31. Thank you for posting this. It is nice to see a doctor with actual letters behind their name say this. I’ve been saying some of this for a while on various public forums, but people always scoff at me because I don’t have an MD. As if I need letters behind my name to be well educated about a topic. I have had great doctors and midwives 🙂 Nice to see more great doctors are out there 🙂

    • In my opinion, that should depend on whether the membranes are ruptured artificially or spontaneously and, in the latter case, whether or not mom had any cervical checks.
      There’s almost no chance of infection if a woman has no cervical checks after spontaneous rupture of membranes. There’s no risk in waiting if mom keeps her fluids up, and no one touches her vagina.

      I’ve been in this situation twice, both babies were born almost 3 days after my membranes ruptured.

      But I’m just a freebirther. If you ask most medical professionals, they’ll say that baby has to be born within 24 hours of the membranes rupturing.

  32. You forgot to mention ‘failure to progress’ It is often told to women that have a stall in their labor, which is completely normal. Doctors tell their patients they need to dilate x centimeters per hour or within a certain amount of hours. Everyone labors differently and this is untrue. In my experience with people it is the #1 reason women in labor have unnecessary C-sections.

  33. Thank you for this information. I have never had a cessarian, but the birth in the hospital with an OB/GYN for my first child was so traumatic. The nurses didn’t give a crap about my concerns, the doctor actually gave me an episiotomy without asking and used forceps to pull my baby out because I guess to him pushing for 10-20 minutes was too much for him to wait around for. Due to the episiotomy, I could barely walk and couldn’t sit for a few weeks. Later on, when I had time to really ponder over my birth experience, I realized that the doctor did whatever he needed to do in order to make the birth as quick as possible so that he could get the heck out of there. To him, my baby and I were mere numbers which helped his paycheck and NOTHING else to him.

    With my second child, I chose to have a midwife and give birth at a birthing house (which is strictly only used by midwives for child birth and pregnancy visits). I had no complications, no drugs, and my baby was perfectly healthy. What a 100 percent difference in my experience. My baby and I were not just numbers, but real people who needed support and compassion.

    Thank you for your article. At least I know that there are a few doctors like you still around who actually care about their patients’ best interests instead of their own.

  34. I am happy to see that their are still doctors that care more about their patients (mom and baby) than their paycheck and convenience. I have given birth to 12 children and four miscarriages over the past twenty years. I have delivered with doctors in hospitals and have had the care of midwives at homebirths. I have never been induced and have never had a c-section. I have avoided epidurals (proven to slow labor) in all but my first birth.

    It makes me very sad that some women can’t find a physician or midwife that cares about their health and their further ability to give birth safely. Yes, it is true that some women need to have a c-section for the health and safety of the mother and baby, but this is not nearly as often as what we are seeing in the numbers coming from most hospitals today.

    I am truly blessed to have a doctor that has a less than 5% c-section rate. He has delivered twins, triplets and breech babies vaginally. He is one of the most well respected and highly sought after doctors in Georgia.

  35. I worked at an OB/GYN office in PA for a number of years before I got my RN license. Once I received that, I moved up to NY. I was absolutely APPALLED at the way those OBs practiced! They gave no time for inductions (most would be at 38 weeks), basically bringing the pt in the night before, gave cervidil and then the next day giving Pitocin. If by 5pm, the woman was not complete and delivered, she would be sectioned for failure to progress! They would also induce/section for “macrosomia” and, then, the baby would only be 7-8 lbs. It KILLED me! In PA (where I am thankfully back to) they allow 3-4 days for an induction, they actually look at the situation to determine when a pt would need a section. The docs push for vaginal deliveries over sections and the great majority of patients’ labors are managed by midwives.

    My first baby was a section, she had a large head and after pushing for 2 hours she didn’t budge an inch and her head didn’t even mold. I was told that I pushed really hard, which I felt that I did, but she also had really small fontanels and I feel that had something to do with her not molding her head. The doc who did my section was a friend and I know that she would not have told me to do that if she didn’t feel that it was for the best. Being an RN I knew the situation and knew that it wasn’t going to happen. Once the doc was in there, she did say that my pelvis looked very narrow and she could see that there was no way that huge head would have fit at all, so for my 2nd I was just going to have a repeat section. My 2nd baby was born 6 weeks early though. Much to my surprise, my water broke at 34 weeks. Her head was much more reasonably sized and I was able to have a VBAC! The recovery was WONDERFUL! So much better than my first! My girls just wanted to keep me on my toes, they both gave me complete surprises for the types of deliveries I had! I was very thankful for that because she was in the NICU for a little over a week because of how early she was and it made it that much easier for me. If I were to have a 3rd I would totally push for another VBAC!

    • Not sure where you are in PA, but your account of L&D is NOTHING like my experiences in PA. Midwives have been all but shoved out of local hospitals in my area. For the most recent year that data is currently available, my closest hospital has a 38%+ C/S rate.

      My first, I was induced at 39 weeks b/c of “pregnancy induced hypertension.” In my mind, I am certain it was more a “white coat syndrome” situation because I was monitoring my BP daily at home, and it was always well within normal limits. However, despite my taking those records to each visit, the fact that it was elevated at the doctor’s office was all that mattered to them. My induction was scheduled for early morning, and pitocin was started at around 8. I dilated from 2 (at the start) to 4 in 3 hours, then my water broke… and I didn’t dilate any more. At 6:00, the doctor came in and said we needed to consider C/S. My son was born at 7:15.

      With my 2nd, everything was going great, but at my 36 week visit, my daughter was breech. A C/S was scheduled at 39 weeks. (The option of VBAC was never brought up by the doctor, and her position at that point cemented the situation.) She ended up turning on her own the night before surgery was scheduled. Not one person even felt to confirm her position before cutting me. In fact, my doctor’s first words upon reaching her were, “Oh, theres her head!” :/

      By the time I was pregnant with my 3rd, I suspected that both of my sections had been unnecessary, and that I should be a VBAC candidate. When I brought it up with the same doctor, at my 16 week visit, he said, “We don’t do VBAC’s; they are too dangerous.” I ended up switching to receive care from midwives, knowing that I’d have to labor and deliver in a hospital, but never hearing that another c-section would be required until the very end, when baby was stubbornly transverse. (We did do an external version, and he turned back the next day.) His position was confirmed prior to surgery this time – the midwife palpated, and an ultrasound was done to confirm his position. Anyway, in order to get that change in perspective, and even the option of having a midwife deliver in a hospital (and this would have been the case even if I hadn’t been a VBAC patient), I had to drive 1 1/2 hours away from home. Very few local doctors will support a VBAC, especially after 2+ sections, citing hospital policy, inaccurately quoting ACOG, and fearing lawsuits, etc.

  36. Dr. Jonathan,

    This is awesome! I am amazed (and pleased) that a member of the medical industry would choose to come forward and tell it like it is. 😀 I wish more people cared as much about their patients as you do. Bless you!

  37. not only in your country, in Indonesia increasingly difficult to find a doctor who actually serve with heart.
    especially in large cities and metropolitan
    a lot of doctors whose goal is to get as much money.
    so it’s really important that knowledge, because knowledge is power.
    pregnant women must be willing to empower themselves and improve their knowledge.
    and do not forget to interview and negotiate with a provider who will you trust to the process of labor. do not let the process should be something sacred turned into something traumatic just because of lack of knowledge

  38. I have 10 children all born naturally without medications, 9 in the hospital, the last at home with a midwife. I was blessed to have wonderful OBs for all of my deliveries, except 2. My last OB (because my previous wonderful OB retired from deliveries so he could spend time with his family) did NOT listen to me at the birth so she was never used again. My next and last delivery was with a midwife at home.

    With my 9th, I was rear-ended at 6 1/2 mos pregnant. The seatbelt held my pelvic in place while the 6 1/2 mo gestation baby was not held in place and was forced forward at 40 mph. This forcefully pulled my pelvic out of alignment and place which caused the baby to be transverse or breach the rest of the pregnancy.

    I was seeing a Chiropractor due to the car accident. I noticed that every time she would adjust me, the baby would head down for a day or two before he would revert back. I had a couple of previous pregnancies where my amniotic fluids disappeared near the end of the pregnancy and that turned out to be the case with this pregnancy. I had been to the doctor that morning before my OB checked for my fluid levels. I felt baby go head down between my Chiro appt and my OB appt. We induced that afternoon due to low fluid levels and he was born before he turned head up again.

    With my 10th pregnancy, he was always transverse, breech and sunny side up. Unless I went to the Chiropractor. Every time I was adjusted, he would go head down. We finally realized that it wasn’t comfortable for the babies to be head down since the car accident! This birth was my first and only homebirth and we lived an hour from the nearest hospital. I was concerned about him being breech and transverse most of the time. But, I saw the chiropractor the morning before I went into labor, felt him go head down, and he stayed there until he was born at home, head first.

    So, if any of you have a breech or transverse baby, please consider finding a chiropractor who knows how to adjust pregnant women with breech or transverse babies. Had I not seen the Chiro that morning before my 9th was born, he would have been an automatic C-Section.

  39. I can’t help but notice that there seem to be some stark difference between the American and Australian model of obstetrics with regard to our attitude towards birth.

    In Australian obstetric departments, and speaking as someone who works in one, whilst we are very evidence based, there is much less practice of defensive medicine going on. Also, the approach to birth is much less clinical – you won’t see doctors wearing gowns and masks for normal vaginal deliveries (that for some reason aren’t delivered by midwives!) that’s for sure.

    I can’t help but feel that the vilification of American obstetrics that seems to be gathering momentum is lumping all obstetric departments in the same basket – please don’t! Maybe Dr Weinstein needs to move down under. He’ll find plenty of support here for evidence based, not defensive medicine.

    • Hmmm. . .you paint a pretty picture of birth in Australia, Louise, but I’ve been there. I’ve talked to midwives and breastfeeding counsellors all over the continent and it’s pretty much as bad as N. America. Some of the cruelest persecutions of midwives have been executed in Australia.

    • Um iI’d be interested to know your profession Louise ? I’m from Australia too and I’ve found it pretty much similar to the American trend – from my own experience of c/s & the struggle to vbac as well as experience as a doula and my association with Home midwifery in Qld. And the AMA is even more relentless in their persecution of homebirthjng women & practioners than even many of the US states.

  40. My husband and I were blessed with twins in December of 2015, we spoke a lot about how I wanted to deliver and I wanted to have a vaginal delivery. However, my Gyno started coming up with high blood pressure and soon enough protein in my urine. Not once was treatment offered for Preeclamscia. She then added Gestational Diabetes, which I knew for a fact I DID NOT HAVE because I took my glucose test the 100 times a day like they asked and not once did my sugar come out high :-/
    At 35 weeks, on my visit, they freaked us out like if I was dying and our twins were in danger and she made me have an “Emergency” C-section.
    My husband had a panic attack . We heard both of our baby’s perfect heart beats and I didn’t even have high blood pressure that morning .

    His niece at 19 yrs old , first child and her doctor also MADE her have a C-section.

    Its TRUE about the cash cows around DFW and San Antonio and they don’t care to really put your life and your baby’s life in danger!!

    Thank you Doctor for the insight of the truth!

  41. Pingback: When “VBAC Tolerant” is Your ONLY Option – Empowering Moms Canada

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