Why You Should Wait Until At Least 39 Weeks Before a Planned Induction or Cesarean

***I'm going to post a little disclaimer here and now before continuing: This post does not include medically indicated/necessary early inductions or cesareans. I am only covering elective inductions and cesareans (and RCS) in this post. Please keep that in mind as you read. Thank you.***

The end of pregnancy is a trial. You're exhausted, you feel horrible (no matter how easy a pregnancy you've had), and you want nothing more than to meet your baby and get it over with. That's normal, understandable, and totally okay. But if you're considering inducing or having a c-section (repeat or primary), there are a lot of good reasons to wait until you are at least 39 weeks.

Did you know that some experts estimate that at least 50% of deliveries between 36-39 weeks are scheduled? Is this evidence based? Does this include medically necessary inductions and c-sections? No, not really.

Did you know that at least 1 in 3 first-time moms is induced? Did you know that inducing increases your chances of having a cesarean birth? Do you know by how much? Do you know what crucial developments happen for your baby in the last few weeks of pregnancy? Here are some statistics:

• At least one-third of these inductions have no medical indication. First-time mothers who are induced at term for no medical reason have a C-section rate of approximately 24%, with the largest percentage of these Cesareans being performed in early labor—before the woman reaches 6 cm. 
• The average gestation of a first-time pregnancy worldwide is 41 weeks, 1 day.
• First-time mothers who undergo elective induction of labor are twice as likely to have a C-section as those who go into labor on their own.
• A significant percentage increase in both C-section deliveries (67% increased risk—that’s big), and NICU care (64% increased risk), for women and their babies who undergo non-medically necessitated inductions.

So, if induction itself, even at term, presents such risks, why are women so quick to request an early induction? And what are the risks associated with inducing prior to 39-40 weeks' gestation, and why is this happening?

• Your baby’s brain grows 35 percent between 34-41 weeks.
• A full-term pregnancy lasts 40 weeks, but elective deliveries are often planned for two or three weeks earlier. And even though 37 weeks is also still considered full term, studies show that babies born even a few weeks too early are at greater risk for health problems than those who are born later. That has some doctors campaigning to curb the trend of scheduled labor and delivery.
• More than 25 percent of infants born electively between 37 and 39 weeks required admission to the neonatal intensive care unit (NICU) for an average of 4.5 days, compared with fewer than 5 percent of infants who were delivered at 39 weeks or later, according to a recent study published in the American Journal of Obstetrics & Gynecology.
•  Labor inductions can set in motion a chain of events that ultimately make a C-section more likely. First-time mothers who have had their labor induced double their risk of requiring an emergency C-section, which typically results in a longer recovery period for mom, according to a recent study in Obstetrics & Gynecology.
•  A recent study by the March of Dimes, National Institutes of Health and the Food and Drug Administration found the risk of death -- however small -- more than doubles for infants born at 37 weeks compared to those carried to a full 40-week term.
•  Most women give birth between 38 and 42 weeks of pregnancy. But very few babies are born on their due dates. It is normal to give birth as much as 3 weeks before or 2 weeks after your due date 
• 10 to 15 percent of all births in the U.S. are "early elective" deliveries (meaning prior to 39 weeks' gestation, via cesarean section or induction, without a clear medical reason), two new studies find -- and some hospitals report that number is as high as 44 percent. But, the American College of Obstetricians and Gynecologists (ACOG) staunchly advises against elective deliveries before 39 weeks.
•  Most recently, a study published in the journal Pediatrics in early July, involving more than 100,000 New York schoolchildren, found that children born at 37 or 38 weeks did worse on third grade math and reading tests than kids born just a week or so later. The study showed that 2.3 percent of the children born at 37 weeks had severely poor reading skills, compared with just 1.8 percent of children born at 41 weeks; that's a 33 percent increased chance of severe reading difficulty. They also had a 19 percent greater chance of having moderate problems in math.
•  The last few weeks of pregnancy are critical to both lung and brain development. Complications of elective deliveries between 37 and 39 weeks include:
  
• Increased NICU admissions
• Increased respiratory distress and TTN
• Increased need for ventilator support
• Increased rate of sepsis
• Increased feeding problems 

• Babies born too early may have more health problems at birth and later in life than babies born later. Being pregnant 39 weeks gives your baby's body all the time it needs to grow.
  Here's why your baby needs 39 weeks:
• Important organs, like his brain, lungs and liver, get the time they need to develop.
• He is less likely to have vision and hearing problems after birth.
• He has time to gain more weight in the womb. Babies born at a healthy weight have an easier time staying warm than babies born too small.
• He can suck and swallow and stay awake long enough to eat after he's born. Babies born early sometimes can't do these things.

Those are some pretty good, science-based, reasons to wait (at the very least) 39 weeks before scheduling your child's birth. If you're considering inducing or scheduling a cesarean, these are definitely some points to consider when it comes to timing.

Other Myths Surrounding Pregnancy, Labor, and Birth:Fact or Fiction?

Time for miscellaneous myths surrounding pregnancy and birth!

• Your pregnancies and births will be just like your mom's: FALSE? TRUE? PLAUSIBLE.
• There is no way to know. If you are built exactly like your mom, your pregnancies take the same course as your mom's did, and you choose to labor the same way and your babies are in the same position as your mom's were, then yes, you have a good chance of your pregnancies and births being just (or at least a lot) like your mom's. But like everything concerning birth, there is no guarantee. I've known some moms who had all (necessary) cesareans, but their daughter(s) went on to have all-natural, uncomplicated vaginal births, and vice versa. Genetics may play a part, but they don't ensure that anything will go the way you "expect," just because it happened that way with your mom.

• Pregnancy and birth are inherently dangerous: FALSE, but also kind of TRUE
• This is difficult. I like to answer this with the phrase I heard somewhere once that says, "Birth is as safe as anything gets in life." There are always risks with anything, and birth is no different. Yes, birth is a natural, biological process that all mammals are made to go through, but that's not to say that nothing can or will go wrong. What you have to look at are the things that can go wrong, how likely they are to happen, and how they apply to you and your situation. If you are of average weight, normal blood sugar, blood pressure, active and somewhat fit, no previous abdominal surgeries or medical conditions, you have an extremely low chance of dangerous complications in pregnancy and birth. If you have maybe one or two things wrong (like gestational diabetes, or high blood pressure, or a scar from a surgery, etc), you still aren't very likely to experience serious complications. 
• Think of it this way: just because there is a risk, however slight, involved, that does not make the thing itself (birth) dangerous, and there are things that can be done (good prenatal care, taking good care of yourself during pregnancy and before conceiving, etc.) to improve your chances.
• Viewing birth as inherently dangerous and a thing to be to be feared does nothing but perpetuate myths and, well, fear. Fear doesn't help. If you view birth as normal, and only to be seen as dangerous if legitimate warning signs show up, you increase your chances of nothing going wrong. It's surprising what fear can do to sabotage your efforts and create problems where there aren't any. Our induction, c-section, and maternal/fetal morbidity rates can vouch for that.

• Home birth is inherently dangerous, and hospitals are the safest place to give birth, with no downsides or risks: BOTH TRUE AND FALSE ON ALL COUNTS


• "Home birth compared to hospital birth.
  One systematic review from the Cochrane Collaboration (Olsen and Jewell 2004) found just one randomized controlled trial comparing home to hospital birth. That study showed that women could be randomized to home birth, but included too few women to interpret the results.
  
  Another review pools the experiences of over 24,000 women from six controlled observational studies comparing planned home birth with modern hospital back-up to planned hospital birth (Olsen 1997). Observational study designs are less definitive than controlled trials. Two of the six included studies were done in the U.S. The pooled home and hospital groups had a similar rate of death for babies after 20 weeks of pregnancy or in the first four weeks after birth. No maternal deaths occurred in either group. The following outcomes favored the home birth group:
  • fewer low Apgar scores (rating newborn well-being)
  • fewer severe tears in the mother's perineum (tissue around the opening of the vagina).
  
  Because of important differences in conditions of the studies, the reviewer did not pool data on rates of interventions. Individual included studies found that women in the hospital groups had higher rates of artificially induced labor, artificially stimulated labor, episiotomy, cesarean section, use of forceps or vacuum extractor, and other interventions.
  
  The author concludes that (1) no good evidence exists to support the view that planned home birth with an experienced caregiver and hospital back-up is less safe than planned hospital birth, and (2) planned home birth may have advantages." 
• Source for the above quote:  http://www.childbirthconnection.org/article.asp?ck=10142
•  That pretty much sums things up. For healthy, low-risk moms, a home birth is no more or less safe than a hospital birth according to the available statistics, and includes a far, far lower risk of interventions (which often lead to complications created by said unnecessary interventions). It is very, very difficult to conduct studies that definitively determine the safety of home birth vs. hospital birth, seeing as only 1% of births occur at home. 
• But if you think about it, 99% (approximately) of births occur in hospitals, and we have a 1 in 3 (and climbing) cesarean rate, 1 in 3 (and climbing) induction rate, at least 60% of women will have an epidural, upwards of 80-90% receive continuous monitoring, over 90% labor and push on their backs, are refused food and water during labor, have routine iv fluids, and so on and so forth. None of this is evidence-based practice, yet it happens every day, and no one thinks to question whether hospital births might carry risks, as well? 
• Another thing to think about is that hospitals are not the sterile, sanitary environments they are made out to be." About 1 of every 20 patients gets an infection while hospitalized and up to 98,000 Americans die from these each year." Is that really what we consider to be "the safest" environment in which to give birth? 
• The benefits of hospital birth absolutely outweigh the risks in moms with health concerns or red flags for potential issues in birth, and it's always a good idea to be in close proximity to a hospital if you are planning a home birth in the event a complication should arise and a transfer become necessary, but to say that there are no risks whatsoever to hospital birth is absurd. All you have to do is look at the most common maternity care practices (and statistics), the fact that they are overly practiced, non-evidence based, and don't improve outcomes, and how high the risk of you or baby being exposed to infection that has nothing to do with childbirth, and you'll see that neither choice (home or hospital) is without risks. What you have to do is assess your situation with your care provider, and make the best choice for you.
• Sources:  http://summaries.cochrane.org/CD000352/benefits-and-harms-of-planned-hospital-birth-compared-with-planned-home-birth-for-low-risk-pregnant-women , http://www.naturalnews.com/036279_hospital_births_risk_injury.html , http://articles.mercola.com/sites/articles/archive/2012/07/26/hospital-birth-vs-home-birth.aspx , http://www.ncbi.nlm.nih.gov/pubmed/20572620 , http://www.nbcnews.com/health/home-births-rise-pediatricians-group-sets-new-guidelines-6C9652075 , http://chriskresser.com/natural-childbirth-i-is-home-birth-more-dangerous-than-hospital-birth , http://mamabirth.blogspot.com/2011/10/obstetric-lie-87-home-birth-is.html , http://birthwithoutfearblog.com/2011/10/26/home-birth-is-3-times-more-dangerous-than-hospital-birth-or-is-it/ , http://vbacfacts.com/hbac/ , http://www.bmj.com/content/330/7505/1416.long

• "Don't VBAC, your uterus will explode!" "Once a cesarean, always a cesarean." "Multiple c-sections are 'the safer option'": FALSE, FALSE, and FALSE (in most cases)
• We'll start with VBACs. This is one of the most talked about myths that is really, truly false. There is less than a 1% chance of uterine rupture associated with a TOL (trial of labor) after one or two (low transverse incision) cesareans. And that less than 1% includes the "window ruptures" (uterine dehiscence), which are not complete ruptures, but rather small openings that do not go all the way through the uterus, and are not associated with any real complications and do not require repair. "According to the National Institutes of Health, 992-993 women out of 1,000 give birth without the complication of a uterine rupture. In comparison, more women without a prior cesarean are at risk for unpredictable complications including placental abruption, umbilical cord prolapse, and shoulder dystocia."  You are more likely, in a first, vaginal birth, to have complications like placental abruption, cord prolapse, and shoulder dystocia, than you are to have your uterus rupture in a VBAC. 
• And as I stated before, within that approximately 1% of VBAC mothers who experience a rupture, only a very small percentage of those are complete ruptures with severe complications. "Limited evidence suggests that there is a 2.8 – 6.2% risk of infant mortality after a uterine rupture."  So in the event that you fall into that 1% (or less) of those who experience a rupture, there is still only a 2.8-6.2% risk of death to the baby. Do you realize how small that risk really is, especially when compared to the risks to both mother and baby that are associated with a repeat cesarean? When you compare the "risks" of a typical VBAC with the risks of a completely normal pregnancy and birth, or a scheduled cesarean (repeat or primary) it really puts things into perspective. 
• There aren't many studies done on VBACs after more than 2 or 3 previous cesareans, or VBACs with a vertical (classic) incision, but there are success stories out there. If you fall into that category, you should find a VBAC supportive care provider and discuss your case with them, because it's hard to make any judgement calls on the safety of attempting a VBAC when there is so little real research out there (due to how uncommon it is for a mom to attempt a VBAC under those circumstances these days). Basically, a VBAC is no higher risk than any other pregnancy preparing for a vaginal birth.
• Some sources: http://www.guideline.gov/syntheses/synthesis.aspx?id=25231 , http://health.usnews.com/health-news/family-health/sexual-and-reproductive-health/articles/2010/07/22/vaginal-birth-after-c-section-4-factors-to-consider , http://www.childbirthconnection.org/article.asp?ck=10210 , http://vbacfacts.com/2012/04/03/confusing-fact-only-6-of-uterine-ruptures-are-catastrophic/
• Now we get to the old adage, "once a cesarean, always a cesarean." It's simply not true in the majority of cases. A minimum of 60-80% of women will be successful if they attempt a VBAC, and at least 90% of women with one or two previous cesareans are good candidates for VBAC. If the old saying (that so many doctors cling to) were true, that would not be possible. Also, ACOG has come out recommending VBACs as the safer option for moms who are good candidates, and that it should be offered as a viable option.
• Source:  http://www.acog.org/About%20ACOG/News%20Room/News%20Releases/2010/Ob%20Gyns%20Issue%20Less%20Restrictive%20VBAC%20Guidelines.aspx
• And our last point, the myth that "multiple cesareans are safer than attempting VBACs." I've already discussed the risks associated with VBAC, and how small they really are, especially when you compare them to the risk of any complications in a normal pregnancy and birth (with no prior cesareans). Here's a little comparison from http://vbacfacts.com/2012/04/11/best-compilation-of-vbac-research-to-date/ :
  "While rare for both TOL [trial of labor after cesarean] and ERCD [elective repeat cesarean delivery], maternal mortality was significantly increased for ERCD at 13.4 per 100,000 versus 3.8 per 100,000 for TOL. The rates of maternal hysterectomy, hemorrhage, and transfusions did not differ significantly between TOL and ERCD. The rate of uterine rupture for all women with prior cesarean is 3 per 1,000 and the risk was significantly increased with TOL (4.7 1,000 versus 0.3 1,000 ERCD). Six percent of uterine ruptures were associated with perinatal death. Perinatal mortality was significantly increased for TOL at 1.3 per 1,000 versus 0.5 per 1,000 for ERCD… VBAC is a reasonable and safe choice for the majority of women with prior cesarean. Moreover, there is emerging evidence of serious harms relating to multiple cesareans… The occurrence of maternal and infant mortality for women with prior cesarean is not significantly elevated when compared with national rates overall of mortality in childbirth. The majority of women who have TOL will have a VBAC, and they and their infants will be healthy. However, there is a minority of women who will suffer serious adverse consequences of both TOL and ERCD. While TOL rates have decreased over the last decade, VBAC rates and adverse outcomes have not changed suggesting that the reduction is not reflecting improved patient selection." And to back that up, here's an infographic illustrating the different risks associated with multiple RCS and VBAC: 

 

• Think about it this way: a cesarean section is major surgery, with all the risks and potential complications that entails. The more c-sections you have, the higher your risks are going to become. But with each successful VBAC, those risks go down. So in general, a VBAC is the safer choice than a repeat cesarean, especially if you want a large family. There are exceptions, of course, where a cesarean really is the safer option and the benefits outweigh the risks, but that is not the norm.
•  Sources: http://www.webmd.com/baby/news/20060607/more-c-sections-more-complications , http://blog.ican-online.org/2010/06/01/peril-of-multiple-c-sections/ , http://vbacfacts.com/2009/08/03/risk-of-serious-complications-increase-with-each-cesarean-surgery/ , http://givingbirthwithconfidence.org/2-2/a-womans-guide-to-vbac/weighing-the-pros-and-cons/ , http://www.childbirthconnection.org/article.asp?ck=10166

• Your body will bounce right back after giving birth: FALSE
• Come on. It took you nine (approximately) months to grow this child and for your body to change this month. Do you really think it's going to immediately go back to the way it was before? If it does, you are one of a very tiny (no pun intended) minority. Most women should expect to take at least as long as their pregnancy lasted (usually closer to a year after birth) for their bodies to truly recover. It also depends on what your fitness level was pre-pregnancy, as well as your weight gain while pregnant, what kind of birth you had, your recovery, your postpartum activity level, and the like. There are too many factors involved for there to be any definitive "rules" regarding the length of time it will take a woman to "bounce back." And that's normal, and okay.

• Doctors know exactly what it is that triggers natural, spontaneous labor, and can replicate it exactly when inducing: FALSE
• Well, kind of false. There are some pretty good theories and studies, but they don't all agree. Some say that it has to do with fetal adrenal glands, others sat that it is a protein secreted by the lungs once they're mature (and lungs are the last things to mature in a growing fetus, so that makes sense, right?), some say that the key is that tiny micro-fragments of RNA (DNA’s single-stranded cousin) in the uterus become extra active at the end of pregnancy. As circulating progesterone levels fall, these miRNA pieces are expressed strongly. The miRNA affect two important genes (ZEB1 and ZEB2). These two genes keep labor at bay, because they keep levels of contraction-inducing hormones, like oxytocin, down. Rising miRNA block the two genes, letting oxytocin loose, and labor beings.  There are still other studies that say it is a combination of some or all of the above. So yes, doctors have some very, very good ideas about what triggers the onset of spontaneous labor, but none have pinned it down completely definitively, and they are all difficult to predict. So even if they know what will cause it, that doesn't necessarily mean that they can predict when it will start, and they can not replicate it exactly while inducing. 
• Sources:  http://www.news-medical.net/news/2009/04/01/47759.aspx , http://www.drmomma.org/2008/01/fetal-lungs-protein-release-triggers.html , http://mamasandbabies.blogspot.com/2010/07/what-triggers-spontaneous-labor.html

• Breastfeeding is easy: FALSE
• I can vouch for this. I have one inverted nipple and one flat nipple, and my firstborn had nothing to latch onto. I had to pump to even give her anything to latch onto, and since my body apparently doesn't "let down" for pumps, my supply was greatly compromised and I had to supplement her with formula, even after we achieved a good nursing relationship (when she was 13 weeks old). My supply never recovered. With my second, she has an undiagnosed upper lip tie that caused her to have what seemed (on the outside) to be a good latch, but inside she was compressing my nipple, and I ended up with severely cracked nipples and real injuries (she took a chunk out of one, essentially, and I now have a scar). So I started pumping, and again, my supply disappeared. I tried nursing her again once I had healed, but she refused to latch on. 
• You would think breastfeeding would be the easiest and most natural thing in the world, but just as some women require help to give birth (either induction, vacuum, forceps, or cesarean) because their bodies have trouble, so some women have problems breastfeeding. And even if it does come naturally for you, that does not make it "easy." You are the only one who can feed your baby, it is physically exhausting, and for the first few weeks (sometimes months), you feel like baby is nursing around the clock, because their stomachs are so small that they need regular nourishment, and this "cluster feeding" helps to build your supply and help your milk come in fully. Even in the best of breastfeeding situations, there is difficulty. 

• Everything in your pregnancy and birth will go according to plan: FALSE
• Birth is unpredictable. There is just no way to know what will happen. It is not a controllable situation. There are things you can do to ensure things go as close to your plan as possible (supportive care provider, setting you feel comfortable in, a solid plan, lots of education, a doula, etc.), but there are no guarantees. So be prepared and armed with information about your preferences should you have to diverge from your ideal plan, and it can still be a positive experience. Don't let anyone dissuade you from forming a plan, though; just include your wishes should things go off-track within your plan.

• Vaginal exams pose no risks: FALSE
• I addressed this in a previous post about dilation before labor starts. Vaginal exams increase the risk of infection (before or after your water breaks), accidentally breaking your water, and starting labor (which can be a bad thing if you're only 36 weeks, which is when most care providers offer/perform routine vaginal exams). There is no information to be obtained about your body's ability to give birth, or when labor will start, from a vaginal exam. Even vaginal exams in labor may be unnecessary, as there are other, less invasive methods of assessing dilation. Also, vaginal exams are only about 48-56% accurate, so why rely solely on them, anyway?
•  Some more sources: http://birthwithoutfearblog.com/2013/06/06/alternative-methods-of-checking-dilation-the-purple-line-and-more/ , http://www.scienceandsensibility.org/?p=5547 , http://pregnancy.about.com/cs/interventions/a/vaginalexam.htm , http://www.scienceandsensibility.org/?p=5673 , http://midwiferyramblings.blogspot.com/2011/01/vaginal-exams-why-they-are-unnecessary.html , http://www.pregnancy.org/article/are-vaginal-exams-pregnancy-necessary 

• Midwives are not as competent as OB, and an OB is the best choice for your care provider. OR: all doctors are evil, and all doctors and midwives have the same birth philosophy: FALSE, and FALSE
• Let's just specify this here and get it out of the way: OB's are surgeons. Their training is to see, prevent, and (failing at prevention) deal with problems medically. Midwives don't do c-sections, but they can usually do most everything else. They are specifically trained in birth itself as a natural process, not a medical condition. They are just as competent as an OB; their training is simply different. And if you are being cared for by a midwife (whether at home or in a hospital or birth center), she will know when things have moved out of her abilities and will get an OB (or transfer you). So OB = surgeon and sees birth medically, and midwife = birth professional who sees birth as normal and cannot perform surgery.
•  As to whether an OB or a midwife is the best choice for you, that's your choice. Not all midwives are created equal, and neither are all OB's. What you have to do is decide what your ideal birth would be, what options and providers are available to you, and which of those fit into your insurance/preferences, and find the one whose philosophy best blends with yours. Your medical condition can sometimes make that decision for you. A lot of midwives do not take high-risk mothers due to the likelihood of medical interventions becoming necessary, and in that case it's best for you to be in the hands an OB.
• No, not all doctors are evil. And some midwives certainly are. As I said above, none are created equal. There are some OB's who are more naturally-minded than some midwives out there. You can go to a practice with multiple OB's or midwives, and no two of them will have the exact same philosophy, even though they all practice together. You have to give yourself the time to interview care providers and find the one that fits best for you. 

• Pitocin is risk-free: FALSE
• This could not be more false. Doctors would have you believe that pitocin is this miracle drug that starts your labor just like if it were spontaneous labor, and has zero negative side effects and won't have any effect whatsoever on your baby. In fact, it makes for longer, stronger, harder contractions, which put a lot of stress on baby (and can cause fetal distress and oxygen problems), and make the contractions more painful and harder to bear than natural contractions. That's the short list of side effects. It also isn't approved by the manufacturer or the FDA for use in elective inductions. What does that tell you? I'll leave the rest to my sources. Suffice it to say that it is not a miracle drug, there are risks, and if your doctor says otherwise, you need a new doctor. 
•  Some serious sources: http://www.jhppharma.com/products/brands/pitocin.php , http://www.acog.org/About%20ACOG/News%20Room/News%20Releases/2013/Study%20Finds%20Adverse%20Effects%20of%20Pitocin%20in%20Newborns.aspx , http://www.rxlist.com/pitocin-side-effects-drug-center.htm , http://www.naturalnews.com/033259_pitocin_ADHD.html , http://evidencebasedbirth.com/crank-up-the-pit-2/ , http://www.autismspeaks.org/blog/2012/06/01/autism-pitocin-connection , http://abcnews.go.com/Health/study-pitocin-harm-babies/story?id=19148043 , http://www.huffingtonpost.com/2013/05/07/pitocin-risks_n_3224811.html , http://www.sicklycat.com/2012/05/24/21-reasons-to-say-no-to-pitocin-according-to-manufacturer/

• All of your pregnancies and labors will be the same (if you tore/had a c-section/had any complications/etc. once, it will definitely happen the next time): FALSE
• Again, I know from experience that this is not always true. My two pregnancies were very different (though they did have some similarities). I went into labor very clearly/obviously with my first and labored for 11 hours, and with my second I had prodromal labor for 3 weeks and a false labor scare, and my active labor was only 4 hours long. They differences were like night and day. Just from my own experience, I can tell you that no two pregnancies are guaranteed to be the same. 
• You may have had a completely natural, unmedicated labor and birth for your first, but you might develop pre-eclampsia with your next and have to be induced or have an emergency c-section. Or, you could have a c-section for "failure to progress" with your first, and go on to have a successful VBAC with your second. Anything can happen, and to expect all of your pregnancies and births to be exactly alike is absurd. That's not to say that they definitely won't be similar, though. Some moms do experience that. It's just not a guarantee. Sure, if you're healthy and take care of yourself, and your body "takes to" pregnancy and birth well, you're more likely to have all uncomplicated deliveries, but again, nothing is for sure.  

• Multiples pregnancy = automatic c-section: FALSE
• Many, many studies are coming out now that show that planned cesareans do not improve outcomes for twins, and vaginal births do not pose any more risks than a cesarean. If twin A is in a good position for delivery, even if twin B isn't, there is no reason not to attempt a vaginal delivery of twins.
• Sources needed to back this up:  http://www.ncbi.nlm.nih.gov/pubmed/7234227 , http://www.webmd.com/baby/cesarean-section-in-multiple-pregnancy , http://www.fitpregnancy.com/pregnancy/labor-delivery/ask-labor-nurse/how-safe-vaginal-birth-twins , http://www.futurity.org/c-sections-no-safer-for-twin-births/ , http://www.sciencedaily.com/releases/2013/02/130211102207.htm , http://www.ctvnews.ca/health/health-headlines/c-sections-not-better-for-twin-births-canadian-study-says-1.1160754
•  There isn't a whole lot of information out there about birthing more than 2 babies vaginally, but I did find a fun success story of a mom who delivered triplet girls vaginally in the hospital! It seems that the same rule applies here: If baby A is head down, and everything else looks good (no emergencies), why not give a vaginal birth a try?

• Bigger hips mean you will have an easy delivery, and narrow hips mean you'll need a c-section: FALSE
• "You can't judge a book by its cover." This applies to women's shape in regards to birth. There really is just no way to know if a baby will "fit" by looking at mom's hips. The female pelvis has a remarkable ability to open up to allow a baby to pass through. It's as simple as that.
• To back that up, some stories, as usual. I have decently proportionate hips (not too big, not too small), but most people would classify them as narrow. I quickly and easily gave birth (vaginally with no complications other than some tearing) to two Occiput Posterior babies, and that positioning is supposed to make for longer, harder births, and some doctors will do a c-section if they know baby's in that position, without even allowing a trial of labor. I'm proof that a labor that would be "difficult" for any woman can be easy, and I had narrow hips. If I had been judged based on that, I would never have been allowed to deliver vaginally. I know some women who are teeny-tiny and have no trouble giving birth, and some who have "birthing hips" and needed assistance (vacuum, forceps, cesarean) to give birth.
• A lot of these "baby won't fit stories" have less to do with the actual shape and size of mom's pelvis, and more to do with her positioning for labor and pushing. I've already talked about how the supine position over 90% of women are forced to labor/push in is counter-productive. It effectively closes the pelvis, or at least prevents it from forming as big an opening as it is capable of, which often leads to a diagnosis of "small pelvic opening" and a cesarean. Also, epidurals can make for less effective pushing (you can't feel what you're doing!), especially in first-time moms, which can also lead to the "inadequate pelvic opening" diagnosis and a cesarean.
• Sources:  http://thebirthteacher.blogspot.com/2008/12/shes-got-good-birthin-hips.html , http://www.bellybelly.com.au/birth/small-pelvis-big-baby-cpd#.UjDhFT_y1pA

• The US has the best maternity care system in the developed world: FALSE
• I'm going back to my favorite infographic for this. It really says it all. 

 

• Also, does that fact that this blog (and sites like improvingbirth.org and evidencebasedbirth.com) exist not say enough about the state of our maternity care system to put that myth to rest?

• Gestational Diabetes and Pre-Eclampsia mean automatic inductions (or c-sections): TRUE (for Pre-Eclampsia), and FALSE (for Gestational Diabetes)
• First, Pre-E. It is a very dangerous condition that included high blood pressure and protein in the urine, which can be deadly to mom, and the only cure is delivery of the baby. If your condition isn't too severe and you're close to your due date, your doctor will probably induce. Yes, induction raises the chance of a c-section, but the benefits to saving mom and getting the baby out safely far outweigh the risks in this circumstance.
• Sources: http://umm.edu/health/medical/pregnancy/specialcare-pregnancies/preeclampsia-2 , http://www.marchofdimes.com/pregnancy/preeclampsia.aspx
•  On to GD.  The theory that induction of labor in moms with well-controlled GD improves outcomes for mother and baby is not supported by evidence. Yes, fetal macrosomia is more likely in women with GD, but a "big baby" alone is not enough of a reason to induce or perform a cesarean, as I have already talked about. There may be other complications, such as Pre-E, high blood pressure, birth defects, low blood sugar and jaundice in the infant, and stillbirth (worst case scenario) if GD is untreated or not controlled, so it is imperative for a mother with GD to receive adequate prenatal care to keep her GD under control and improve her odds of a spontaneous vaginal birth.
• Sources:  http://evidencebasedbirth.com/does-gestational-diabetes-always-mean-a-big-baby-and-induction/ , http://www.marchofdimes.com/pregnancy/gestational-diabetes.aspx

• Recovery from c-sections and vaginal births are "the same": FALSE
• I'm not even going to go into detail on this. There is no need. C-section births are major surgery, and vaginal births are not. Therefore, the recovery processes for each are different. And each mom who has a cesarean will react to and recover from it differently, as will moms who have vaginal births. There are too many factors that can influence recovery to count. But my point is this: cesarean births and vaginal births happen differently, and therefore recover differently.

• Inducing increases your chance of c-section: TRUE
• By 40-50%, to be exact. Here's a table that illustrates the factors that can increase your risks of a c-section, including induction and epidurals (which women are statistically more likely to get in an induction than in spontaneous labor):

• A suspected "big baby" is a legitimate reason for induction or planned c-section: FALSE
• I've already blogged about this one. It drives me crazy when I hear that someone is planning an induction or cesarean for suspected macrosomia (big baby), and no other reason. The evidence is definitively against this practice. Not even going to go into this in further detail, as I have already blogged about it, but I will cite some good sources.
• Sources: http://evidencebasedbirth.com/evidence-for-induction-or-c-section-for-big-baby/ ,  http://www.childbirthconnection.org/article.asp?ck=10456 , http://www.improvingbirth.org/2013/03/march-20-2013-news-from-acog-re-elective-procedures/ , http://www.peacefulbirthing.org/topics-of-interest/what-is-the-evidence-for-induction-or-c-section-for-a-big-baby-2/ , http://sarahockwell-smith.com/2012/11/04/big-babies-the-curse-of-mis-diagnosing-a-macrosomic-infant-part-1/ , http://summaries.cochrane.org/CD000938/induction-of-labour-for-suspected-fetal-macrosomia