What You Need To Know {Now} About C-Sections. But don’t. -with Dr. Marjorie Greenfield


What you need to know about Cesarean Sections (C-Sections) with Dr. Marjorie Greenfield

(With Dr. Marjorie Greenfield, Ob/Gyn & mama)  You’re shooting for a vaginal birth & have learned what to expect {step-by-step}.  You’re anxious about the possibility of  a c-section, you’ve tried to completely block it out of your head…you haven’t learned anything about ‘em but you know enough to know you don’t want it to go down that way.

But sometimes C-sections are the best option for your baby. And knowing if it truly is by asking the best questions, will give you the confidence and peace during your baby’s birth. 

“Is this c-section medically required? Why? What other options do I have? What else can we do?”

There are options you have & decisions you make {or don’t make}, early on in labor, that increase the chances of getting a c-section. And we cover that in this class. 

Bottom line…Learning a little about c-sections can help you avoid a c-section. If that’s what you want. 

what do I need to know about c-sectionsDr. Greenfield gets real. We’re so grateful for her! She shoots you straight. She gives candid answers to questions like “what can I expect with a c-section?” & also delves into the most common reasons women hear their provider say ”I recommend a c-section”. And what you can do to try & avoid it. 

Did you know baby’s cord being wrapped around their neck is very common & is not itself a reason for c-section?  Dr. Greenfield explains the reasons why & how it’s normal to see this. 

You’ll Also Learn:

  1. How you might avoid the “failure to progress” scenario too many moms hear (“many providers don’t think “The 4 Ps” & how they play a role in the “failure to progress” scenario you might hear.
  2. The questions you should be asking your provider about c-sections.
  3. Why you should think about how many babies {total} you want to have when weighing the risks/benefits of a c-section.
  4. The TOP way to reduce your chance of getting a c-section. (Don’t miss this one mamas).

Who is Dr. Marjorie Greenfield?

Dr. Marjorie Greenfield is just awesome. She’s a mom, has been a  board certified OB/GYN for the past 25 years & is a fellow of the American College of Obstetrics & Gynecology (ACOG). She’s a Professor at Case Western Reserve University School of Medicine  & she’s a talented writer/author (most recent book is “The Working Woman’s Pregnancy Book) & check out Dr. Greenfield’s website.

Watch the Interview [private Premium Membership|Gift-Premium Membership|Coaching|Vault] (download MP3s-  Part 1, Part 2)

 Part 2



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Dr. Greenfield- Cesarean Sections (c-sections) : things you need to know NOW but don’t.


Sarah Blight:                           Hi, this is Sarah Blight with your Baby Booty Interviews. And today we’re chatting about C-sections, and, um, I just wanted—kind of make a disclaimer that we  are all in favor of C- sections because they are medical life- saving—can be medical, life saving surgeries, and I just want to kind of promote this interview and start this interview by saying that asking questions does not mean that we’re against them, it just means that we want to help you understand them before, um, you might need this information, um, because we’ve heard from moms that they really wish they would have learned some of these facts and some of this information before they had their birth experience.

So we are here to be educated so we can all make better decisions faster. Well today we are chatting with Dr. Marjorie Greenfield. She’s an OB/GYN and she’s been a doctor for 25 years. She’s a professor at Case Western Reserve University School of Medicine. She’s also an author of The Working Woman’s Pregnancy Guide—or Pregnancy Book, and she has taught and practiced OB/GYN for the last 25 years and she’s a mama herself, so thank you so much Dr. Greenfield for joining us today.

Dr. Marjorie Greenfield:        Well thanks for having me.

Sarah Blight:                           So, C- sections can be an invaluable and life- saving procedure, and I was reading that in the 1970, about one out of every 20 births was a C- Section, and that number now is about 1 in 3. Can you tell us why?

Dr. Marjorie Greenfield:        I—well there’s many factors that have played into this. You know, and some of them are going to sound a little weak, but I’m just going to give you a whole set of them, so you can kind of get a feel for it.

Sarah Blight:                           Okay.

Dr. Marjorie Greenfield:        I think from the way that the medical community sees it, there’s several things. One is that, the relative risk of the caesarean has gone down, that it used to be that we didn’t have as good surgical methods, we didn’t have as good antibiotics; we didn’t have ways of preventing the complications of caesarian. So caesarean itself has gotten safer over the last 30 or 40 years. So, the risk benefit ratio, if you want to look at it that way between a caesarean and a vaginal birth, shifts when a caesarean isn’t such a medically—such a medically dangerous thing. It doesn’t mean that it doesn’t have risk, but that it would—it’s not as dangerous now as it was 40 or 50 years ago, let’s go with that.

Sarah Blight:                           Okay.

Dr. Marjorie Greenfield:        So that’s one thing, because all medical decisions are made in thinking about risks and benefits on each side of the equation, and so I think the perception of the risk of caesarean has gone down, and that’s one thing that has changed that perception and that balance in terms of the way that we think about it. So that’s one thing. Um, a major thing has been the medical- legal climate, that you never get asked why did you do that Caesarean, you didn’t need to do that in court, you get asked, “Why didn’t you do it sooner?” or “Why did you not do it at all?” And so there’s a perception that Caesarean saves babies, and so in terms of a medical legal thing, if you ever have a complication, the question is always, “Well why didn’t you just do a caesarean?” So there’s a lot of legal pressure on the medical team to, anytime that there’s a concern, jump to caesarean, so I think that’s another big thing that has happened in terms of the likelihood of caesarean.

It’s also one of those things where the more you do them, the more they don’t seem like a big deal to some people, and, you know, some moms are now coming in and saying “I would actually prefer one”. And so I think the moms’ perceptions of risks and benefits has also shifted, as so many of their friends have had caesareans. So I think that’s another thing that’s played a role. And then, there are actually some things that may have played a role in terms of actual risk of a vaginal birth compared with a caesarean under certain circumstances. Older moms are more likely to end up with a caesarean for several different reasons, and our mom’s giving birth have shifted to older ages. Also, heavier moms are way more likely to end up with a caesarean, and we all know that there’s been kind of an obesity epidemic, and so, the moms that are overweight are more likely to end up with a caesarean and a higher percentage of people are overweight.

Sarah Blight:                           Can you tell us why—why are more obese or overweight people?

Dr. Marjorie Greenfield:        Um, there’s actually several reasons. Um, one is that overweight women make bigger babies, which have a harder time fitting. And another is that because there’s more soft tissue, you know, the tissues that are muscles and fat and all of that, in the—instead of blocking the birth canal, it can actually make it harder for the baby to come down. We call it soft tissue dystocia. So that it’s not that the bones of the pelvis are any different, but that there’s just more tissue around it that prevents the baby from coming down, so I think that’s another factor.

And then gestational diabetes is much more common in overweight women, and gestational diabetes is also associated with a higher likelihood of caesarean because of extra big babies and also because there’s a feeling that it—you can’t let pregnancies go on well past the due date with gestational diabetes, so there’s more inductions in diabetics. And abductions is actually another reason, I think, why caesareans have gone up, because when you induce labor, you increase the chance of caesarean.

Sarah Blight:                           Yes, and I would love to talk to you about inductions, maybe in a different interview. Um, what can women expect with the c- section? You know, how much does it—how much time does it take, what happens, kind of from start to finish typically. I know you’re—we’re making a generalization and every hospital probably does things a little bit different, but in your experience, how do you c- sections normally happen? What can people expect?


Dr. Marjorie Greenfield:        The typical c-section—if it’s a first c- section, usually goes really well. It’s actually subsequent c- sections that have—that take more time and have more risks, but um, assuming that I’m talking to people who haven’t had one before, so we’ll be talking about first caesareans. So, first c- sections—typically, if the mom already has an epidural in, then they usually use that epidural for the anesthetic for the caesarean, they just does it more strongly that they does it for labor. If the mom doesn’t have an epidural in, then she will need some sort of anesthesia obviously for the caesarean. Um, most commonly we use regional anesthesia like epidural and spinal, because it’s much safer in pregnancy than compared to going to sleep. Um, so just—if you’re only looking at safety issues, epidural and spinal are safer. If you’re also looking at the mom’s experience, um, a good epidural or spinal is nice in that the mom  is aware and she gets to hear her baby’s first cry and remember her birth experience, and we can try to make it as personalized as possible. Um, the caesarean itself is usually done with an—a bikini incision, so in a crosswise incision on the abdomen, so—if you just kind of walk through the scenario, the mom is in the operating room on the operating table, um, once her anesthetic is in, her regional anesthetic is in—usually if she doesn’t have a bladder catheter already, you put a catheter in, because the bladder needs to get out of the way to make room for the surgery so you don’t endure it.

Um, then the—we usually wash the mom’s tummy with an antiseptic and cover her with sterile drapes. And then at that point, usually, if she has somebody who’s going to be with her for the birth, they come in at that point typically, at least at our hospital. Um, after she’s kind of covered up. Um, once she—and we always test to make sure she’s numb before we start, I think sometimes people are worried about that. How are you going to know that I’m really numb, but we just basically pinch the skin really hard and make sure that she doesn’t feel it at all before we start. Um, we make an incision that’s like a bikini incision and that allows us to get into the abdomen, we don’t normally cut muscles, we just separate them. So, in terms of abdominal strength, it doesn’t usually have a big impact on abdominal strength in the long term.

Uh, we get down to the uterus, we basically separate out the layers so we can safely get to the lower part of the uterus, and we make it—on a crosswise incision on the uterus as well, um, under most circumstances, and that’s the type of incision that you could safely labor on afterwards and have a V-back if you wanted to. Um, we then reach in and deliver the baby’s head, and then just like a regular vaginal birth, first the head and then the shoulders, um, and then basically clamp and cut the cord—if it’s not an emergency kind of situation and we’re not expecting a problem, we don’t usually have pediatricians there, the nurse usually just dries the baby off, makes sure everything’s okay, um, and the baby is normally with the parents by the end of the case. But, after we had done getting the baby out, we close up the uterine incision, um, make sure that there is no excess bleeding or anything like that, um, close the abdomen in layers, um, the skin can be closed sometimes with—it’s basically three different common ways that the skin might be closed. It might be closed with staples, which sound horrible but actually they—when they’re taken out fairly quickly they leave the least scar and they’re really good with repeat surgeries, as opposed to – you know, with first surgeries, it’s not as important. Or we close with a running suture under the skin, which can either be an absorbable suture, which doesn’t need to be taken out, or a non- absorbable suture, which is usually taken out about three days after the surgery, and that’s not usually a big deal, coming out it doesn’t usually feel really better, anything.

Um, once the surgery is over, um, then the mom and the baby go back to the recover area, um, and then everything is, you know, pretty much the same, they just have to wait for the epidural to wear off, because she won’t be able to put the weight on her legs until the epidural has worn off and she can kind of move and have her strength again.

Sarah Blight:                           So will she be able to hold her baby, um, right away. Are her arms at, like, mobile while you’re finishing this, the procedure or…

Dr. Marjorie Greenfield:        That’s a great question. You know, usually, it’s actually really hard to have mom hold the baby, because the sterile drapes are kind of covering her chest, and there really isn’t any place to put the baby, so usually, the dad or the visitor holds the baby, and the visitor or whoever’s with the mom can usually bring the baby right up and put them kind of cheek to cheek and let the mom bond with her baby and kiss and talk and everything, but the mom isn’t usually the one holding the baby at that point, and you really kind of can’t put the baby to breast at that point, just because of the way the mom is really lying flat- flat, and that sterile drapes are kind of coming over her chest before they pick up in front of her face.

Sarah Blight:                           Okay. So, in recovery is when the mom then could try breastfeeding and things like that?


Dr. Marjorie Greenfield:        Yeah, right, exactly.

Sarah Blight:                           Okay. Um, how long does this procedure normally take? Barring, you know—no complications.

Dr. Marjorie Greenfield:        Um, the quickest one I’ve ever been involved with from the incision, starting until we totally finished it was a little under 20 minutes. But typically, I would say 45 minutes is probably more typical.

Sarah Blight:                           Okay, great. Alright, so let’s go through some of the common reasons why women are told that they might need a C- section. Um, so, the first one, baby’s too big to fit through the pelvis. What is that all about? Can you really tell if the baby’s too big?

Dr. Marjorie Greenfield:        Okay, yeah. So there’s basically two parts to that answer.

Sarah Blight:                           Okay.

Dr. Marjorie Greenfield:        One is that, if ultrasound estimates the weight and the baby is bigger than 11 pounds, or in a diabetic if the baby is bigger than, I think it’s 10 pounds, then there’s a significant risk of the baby’s head fitting through vaginally but the shoulders getting stuck, and so the recommendation is to offer primary caesarean. So if the baby seems like it’s really, inordinately big, then there are—there is a school of thought that the baby may be better off being born by caesarean than having to try for vaginal birth. That’s a pretty unusual circumstance, and, you know, ultrasound is not that all accurate, unfortunately, at estimating weight. One of the things I think that’s surprising about that is they come out with an exact weight, you know.

Sarah Blight:                           Yeah.

Dr. Marjorie Greenfield:        You know, 7 pounds, 13.2 ounces, and it sounds like they really know something, but then the small princess, plus or minus 15%, which is actually quite a bit, it’s over a pound on a 7- pounder…

Sarah Blight:                           Right.

Dr. Marjorie Greenfield:        So, to say, I mean—but that said, the sort of national recommendation from the American College of OB/GYN is to consider—at least to offer a caesarean when the baby is expected to be over 11 pounds because of that risk. Now a lot of moms say, “No, you know, I’ve had a vaginal birth before. My baby was pretty big, you know, I’m still—I’m not interested” but it’s something that we do usually offer if we think the baby’s super big. But, that’s not most of the caesareans that we’re seeing for the baby not fitting. That’s much more commonly, when labor progresses up to a point and then just does not progress anymore, or the mom gets all the way dilated and is pushing and the baby just never comes down and enters the pelvis, and that’s when we say that everything’s been optimized, we don’t have any explanation other than the baby is just not fitting trough. Now, it’s a little bit complicated, this baby not fitting thing, because it’s really such a non- absolute. It’s a relative thing. So you can have a mom that delivered a 9- pound baby, no problem, and then has a baby that, quote- unquote, doesn’t fit that’s 8 pounds, because it also depends on sort of the way the baby is positioned coming down the pelvis, and the baby that’s occiput posterior, in other words, the baby is face up, um, instead of face—so baby’s back of the head is against the mom’s spine, and the back of the baby is against the mom’s spine, the baby’s facing up.

That’s an unfavorable way to try to deliver, and babies were much more commonly not fit when they’re occiput posterior. If the baby’s occiput interior, facing down towards the mom’s spine, that’s a much more favorable position, so you can get two babies that are the same size and the same mom, mom would fit and the other wouldn’t.

Sarah Blight:                           Why is it that sunny side up, as I’ve heard it referred to, is not as favorable of a position?

Dr. Marjorie Greenfield:        It just has to do with the diameter of the head that’s presenting to the pelvis, and it just is—it’s a bigger diameter of the head that’s presenting to the pelvis is basically my best way of explaining it. You know, one of the things though, in terms of preventing the need for caesarean, is that there’s actually  things you can do to prevent your baby from being occiput posterior, and the worst thing is lying kind of on your back, and a lot of moms labor on their backs now, because we’re so focused on the fetal monitoring, and the best monitoring, with the two belts and everything, is when she’s lying absolutely still on her back, and that’s actually a position that encourages the baby to go into occiput posterior.

So for moms that are wanting to prevent the need for a caesarean, the best thing that they can do would be to try to never be in a position where you’re kind of lying back. You’re better off way in one side, way on the other side, sitting straight up, walking around, um all—of all positions that you should be able to monitor the baby if it’s necessary, um, but just for people to be aware of that—sort of that, path of least resistance of lying back, is actually the worst position in terms of getting the baby in a position that’s not going to fit.


Sarah Blight:                           And I’ve also heard, is this true Dr. Greenfield, that when you’re laying on your back, your pelvis is like 30% smaller than if you’re squatting or laying in a different position, maybe standing up or on all fours?

Dr. Marjorie Greenfield:        Yeah, it—that’s true, more for—actually, the second stage, when the mom’s actually pushing, I think that that’s really relevant. Maybe not so much for the course of labor, but I think that for the course of labor, the positioning has more to do with trying to get that baby not to land into the occiput posterior. If the baby is occiput posterior, there are things you can do with maternal positioning to help the baby to switch. Um, but a lot of people don’t think of that, so we’re thinking, “Oh, the baby’s not fitting, baby’s not fitting” and nobody’s thinking, well, is there anything we can do to optimize the position of the baby, and lying way over on one side or the other is—has actually been shown to help the baby to come down.

Sarah Blight:                           Okay, very good to know. What, um—we talked a little bit, the next thing on my list was failure to progress. We talked a little bit about that just now when your labor is kind of at a standstill and baby’s just not coming out. Um, and you mentioned…

Dr. Marjorie Greenfield:        [0:16:00][Inaudible] to add to that…

Sarah Blight:                           Yes, please.

Dr. Marjorie Greenfield:        But—okay. Um, so failure to progress has many different causes, one of which is the baby’s too big.

Sarah Blight:                           Okay.

Dr. Marjorie Greenfield:        So I think that’s the way to think about it. And what we talk about with progress and labor are the four P’s. So there’s the passage, which is the size of the pelvis, there’s the Passenger, which is the size and the position of the baby. There’s the Power, which is the strength of the contractions. And there’s the Psyche, which is the mom’s, sort of, in—preparation for being in this position, um, and you know, that probably manifests problems through power, because a lot of anxiety will sometimes cause dysfunctional contractions. Um, we often see a mom who’s booming away in labor, and then during the admission process to the hospital, her contractions kind of poop out, and it’s just partly all the anxiety of—and excitement of being admitted, just kind of shuts everything off for a little bit, and it’s a physiologic process. You can imagine if the tiger’s chasing you, it’s not the best time to have the baby.

Sarah Blight:                           Right.

Dr. Marjorie Greenfield:        Um, so it’s no surprise that anxiety can interfere with labor, but that’s, sometimes, [0:17:08][Phonetic] talked about that as the fourth P.

Sarah Blight:                           Interesting. That’s very good to know. So relaxation then would be important to really help get your labor continuing to progress as well.

Dr. Marjorie Greenfield:        It does make a big difference, yeah.


Sarah Blight:                           And what other things can—since we’re talking about,  you know, ways that you can potentially avoid a C- section, things that you can do, um, what are some other ways that moms can really try to keep labor going?

Dr. Marjorie Greenfield:        Um, well, this one has several different answers. You know, there’s some—some people believe that the mom moving around helps her labor to go, and she needs to kind of judge what’s working best for her.

Sarah Blight:                           Yeah.

Dr. Marjorie Greenfield:        So for some people, walking around is best, for other people maybe sitting on the birthing ball is best, for other people, maybe getting some rest is the thing that they need, so partly it’s kind of knowing what you need. Um, in terms—and, you know, one of the things to go back to, other things you can do, it—to not have an overly big baby is to watch your weight gain during pregnancy, and I know that’s kind of a basic thing, but excess weight gain in pregnancy is associated with bigger babies, and so for moms that would prefer not to have the caesarean, being cautious about weight gain—cause so many moms are gaining 40, 50 pounds, and it’s going to potentially make for a bigger baby. I think that’s just another thing to kind of throw in there.

Sarah Blight:                           Good thing to think about. Um, another comment, one that we hear a lot about from mamas is the baby’s heart rate is decelerating, is declining. What can you tell us about that?

Dr. Marjorie Greenfield:        There’s—this is a really though one. You know, there’s a lot of, um, beliefs about fetal monitoring and what to worry about, what not to worry about, and it’s really shifted over the years where, um, everybody—it’s sort of expected now that all moms get continuous, electronic fetal monitoring in the hospital—at least in our hospital, it’s just kind of the default mode, and I think in most hospitals, if that’s true, and most moms who are having babies in this country are having continuous monitoring if they’re in a hospital setting.

Um, that goes back to the legal things that I talked about, about the, those—you know, some babies are going to have problems, and if babies that have problems end up getting consultations with lawyers or their families get consultations with lawyers, the lawyer’s going to want to see the fetal heart rate tracing, and so it’s part of the defense for the hospital and the people that took care of the patient to be able to show that the heart rate tracing was, quote- unquote, reassuring. And when it’s not reassuring, then we feel like we need to take action in order to make sure it’s reassuring. Now a part of that is medico- legal, and part of that is that labor is a stress on the baby, and that, you know, like you were saying, there are times when a caesarean is really necessary, and there are times where the heart rate is just showing us this baby is not tolerating labor…

[0:20:01]                                  End of Audio

Part 2


Dr. Marjorie Greenfield:        And that is the kind of situation where a caesarean can be life- saving for the baby.

Sarah Blight:                           Okay. Um, another one that I—we’ve heard a lot about is the cord is wrapped around the neck. How common is this in labor?


Sarah Blight:                           You knew I was going to ask that one, didn’t you?

Dr. Marjorie Greenfield:        Oh yeah, and I talk about this all the time. In The Working Woman’s Pregnancy Book, we talked about this because I get asked this all the time, and I think part of the image is so awful, it’s like you’re baby’s getting strangled, you know? I mean, that image of the cord wrapped around the neck, I mean, what a terrible image, you know, like you’re baby’s going to be chocked. But you have to remember, the baby is not breathing through its neck. The baby is breathing through the cord, so the cord is where the baby’s getting the oxygen, not its neck, so it doesn’t get chocked.

The problem is that the cord, if it gets kind of, too much tension on it, um, can actually decrease the blood flow to the baby, and so anytime you get cord compression, you can decrease the blood flow to the baby, and typically the cord is compressed during the contraction, and then  releases between contractions, and so you may see a slowing of the heartbeat during the contraction, and then a release and a recovery as soon as the contraction’s over, that’s not usually a serious problem. And we see a cord around the neck all the time, I mean it’s very, very common, it’s a very standard thing. When we—when the baby’s head delivers, the first thing we teach the medical students is check for the cord and see if there’s a cord there, because it’s such a common finding. But you have to remember that the baby doesn’t get chocked, and that this is a normal thing, you know, it’s very common and it doesn’t—it sounds so awful, but it’s really usually not a big deal.

Sarah Blight:                           that’s a really good point. I hadn’t even thought about that before, ‘cause you do kind of imagine them, you know, kind of being hung or something…

Dr. Marjorie Greenfield:        Right.

Sarah Blight:                           And that’s not exactly what the concerns is, which what you’re saying.

Dr. Marjorie Greenfield:        Right, it’s just—cord compression is the concern, because as soon as the baby’s head is delivered, you can unravel the cord or the baby delivers through the cord and it’s not really a big deal.

Sarah Blight:                           Okay. Um, let’s talk about, um—I have a couple more—breech babies, um, when the baby is coming out feet first.

Dr. Marjorie Greenfield:        Right, right. It’s not a high percentage of babies that are still at breech at full term. If you look at premature babies, it’s more common to find a breech baby, because babies get themselves into the headfirst position by their own movements, usually, towards the end of pregnancy, and once they get headfirst, especially in a mom that hasn’t had a baby before, it sort of fits into the pelvis so well, and the tone of the pelvis is kind of enough to hold the baby into the headfirst position, so most of the time, by full term, most babies are headfirst. If your baby is breech, and you’re more than about 36 weeks, then you have to start wondering, are you still going to—is baby still going to be breech at term? So—then there’s a couple of things to think about.

Sarah Blight:                           Okay.

Dr. Marjorie Greenfield:        Um, there’s a procedure called external cephalic version, which is a way of helping the baby to turn by pressing on the mom’s tummy to get the baby to turn around, and normally, when I do that, I do that, um, on the Labor and Delivery unit, so that in case you got some cord compression or problem or saw a heartbeat—heart rate abnormality afterwards, you could go to emergency caesarean. I have to say [Knocking sound] knock wood, I have never had to do an emergency caesarean in the context of version, but, you know, we have gotten to the point where we’ve had a little discussion about the possibility of it, because sometimes you see a transient change in the heartbeat that makes you wonder. Um, it doesn’t always work. It works best in moms that have had several babies before, because their tummy muscles are softer, and so it’s easier to turn the baby. It works less well in a mom that’s very heavy, because you can’t kind of get your hands around the baby so well, um, or in a mom that’s—is having her first baby, where you have to be able to get the baby out of the pelvis and then turn it.

Um, so there’s some tricks we do for that, we put the mom in trendeleberg, where her head is lower than her hips, try to get the baby up and see whether we can turn it. There’s also some exercises a mom can do to help her baby to turn. Um, but if the baby doesn’t turn around, then you have the decision of, are you going to try for a breech vaginal birth, or you’re going to do a caesarean, and there’s been a lot of debate whether breech vaginal birth is a safe thing to do. Um, there are peop—there are practitioners who are very comfortable doing breech vaginal births, and there are practitioners that just don’t do them, partly because many of us train during a time when everybody had a caesarean for it. And so if everyone was having a caesarean for breech, then who learns how to do breech vaginal births? So it kind of becomes one of those self- fulfilling things, even if it starts to look like maybe it’s a reasonable thing to try. There’s basically four criteria that we use for when it would be a consideration to try for a breech vaginal birth, and it’s basically that the baby has to be in a good position.

There are some breech positions that are not acceptable for a vaginal birth, but many are okay. Um, so you want a position where the baby’s butt’s going to come first, and not one foot, because if you have a skinny part of the baby coming first, like one feet hanging down, that’s like the skinny part and you don’t know that the biggest part, which is the head, is going to fit. Also, there’s a tendency for the umbilical cord to drop down if there’s too much room in there, so a position where the baby’s but and legs come at the same time is the position that would be acceptable. The baby’s head also has to be kind of tucked down. So the head’s like this, it could get stuck like this in the pelvis. So it’s very, sort of, technical things. Labor has to be progressing normally, the mom’s pelvis has to feel like it’s adequate to handle a good size, you know, whatever size baby this is, but the number four one is the one that’s the trick, which is you have to have a practitioner that’s experienced and comfortable with breech vaginal birth, and that’s the one we’re missing in a lot of situations.


Sarah Blight:                           Okay. You mentioned there’s a couple of things that moms can do, um—one of my friends had mentioned that she had this situation and she was crawling on hands and knees [Laughter] and it worked for her. Um, is that a good thing to do for moms at home? To try to flip baby?

Dr. Marjorie Greenfield:        It’s—it’s okay!

Sarah Blight:                           Yeah?

Dr. Marjorie Greenfield:        It’s okay, you know, and basically what you’re doing is trying to just get the baby out of the pelvis, so the baby can turn itself. I would not recommend pushing on your tummy or trying to [0:06:07][Inaudible] the baby around yourself, but if you just get the baby out of the pelvis, and then the baby turns itself, that’s totally okay. So, the ways that you can do that, um, I don’t know how much crawling works, because your hips really need to be higher than your shoulders in order to get the baby out of the pelvis.

Sarah Blight:                           Yeah.

Dr. Marjorie Greenfield:        But you know [0:06:23][Inaudible] position that little babies sometimes sleep in, where their head and their shoulders are down, their butts up in the air?

Sarah Blight:                           Yeah.

Dr. Marjorie Greenfield:        That’s the position that people can try and then, one thing that I’ve seen people recommend, and I’m not particularly recommending it because it’s a little bit—it could be a little unstable, and I would worry about somebody falling, but if you go on a slant board so your head is below your hips on your back, um, if—you definitely have to have a spotter if you’re going to do that, that that also can just help get the baby out of the pelvis so the baby can turn. Other people have tried playing music between their legs to get the baby to turn to the music,

I don’t know whether that just increases baby’s activity and gets the baby to turn itself, or whether there’s anything actually to that. Um, and also there’s a Chinese herbal treatment called Moxibustion that’s actually been shown to successfully help babies to turn compared to no treatment, which is pretty interesting, so it’s actually been shown in like a randomized study that it works. So, you know, you’d have to have a Chinese herbal practitioner, but it’s not out of the question.

Sarah Blight:                           Yeah. Well it’s good to give mamas options.

Dr. Marjorie Greenfield:        Right.

Sarah Blight:                           Um, okay, one last question I wanted to ask  you about, you know, common reasons that people, you know, have C- sections suggested is, is that you’ve had a previous c- section.

Dr. Marjorie Greenfield:        Right.

Sarah Blight:                           Um, and you had mentioned, you know, there was a time I believed when it was just a given that, you know, if you’ve had one, you have it again. Um, describe for us what now, you know, research and practice is showing now.

Dr. Marjorie Greenfield:        Well, it’s actually interesting, the pendulum has swung, and then swung back a little bit. So, in the 195-s, 1960s, once a caesarean, always a caesarean. You get to the 1980s, and the pendulum really swung the other way, where it was really encouraged that everybody try for a vaginal birth when they’ve had a caesarean before. Um, and there were some insurance companies that were insisting that people try for a vaginal birth rather than pay for another caesarean. Uh, there were a lot of practices where it was just absolutely standard and expected that the patient would try for a caesarean—or try for a vaginal birth, rather, for V- back. Um, but the pendulum swung back a little bit because of a bunch of reports about uterine rupture, which is where during labor, you—typically during labor, the old incision in the uterus opens up and it’s very dangerous to the baby as well as to the mom if that happens. Now, it doesn’t happen commonly when you’ve had the right kind of original caesarean, but it can happen and it’s not totally predict– -it’s not predictable.

There are certain factors that increase the likelihood, but it’s not totally predictable. And when it happens, it’s an emergency, you need to be able to react to it very quickly, and the American College came out with a recommendation that you should not allow a mom to try for a V- back. This was maybe, I don’t know, 8, 10 years ago, that you shouldn’t allow a mom to try for a V-back unless you and the capability of immediate anesthesia and caesarean. And that means you had to have onsite surgeon and onsite anesthesia, which many, many small hospitals don’t have. So what became the situation where many, many, many hospitals do not offer V- back.

They’re afraid of it for legal reasons, they’re afraid they’re going to get sued if something happens during the labor, they’re afraid that they’re not going to be able to meet these strict criteria from the American College, but the American College now has swung back a little bit the other way, and is now saying, you know, “Well”, you know, they sort of responded to the question of, “Why is that emergency and labor so much more critical than all the other types of emergencies you can have in labor that you need to do an emergency caesarean for?” And, you know, if you can have labor at that hospital and have the team have to come from home, then why can’t you have V-back labor at that hospital? So, it—the pendulum is swinging back a little bit the other way now, but there’s been a lot of debate about this. And, you know, it’s one of those things where the chance of a disaster, of something happening where the baby dies or has brain damage or the mom needs a hysterectomy—things that are really, really, really serious, horrible complications of trying for a vaginal birth, are maybe one in a thousand people that have labor, so maybe 1 in a hundred or 1 in two hundred actually has a uterine rupture, but most of those end up okay. And then, it’s maybe—of the people that try to labor, something like 1 in a thousand that will have this disastrous kind of outcome. But from a mom’s perspective, making the decision, it’s like, “Okay, so 999 out of a thousand would be fine, and 1 out of a thousand would be a disaster.” How do you weigh that? How do you think about that? It’s a very hard decision to make.

Sarah Blight:                           Yeah.


Dr. Marjorie Greenfield:        And, you know, I think—sometimes people go into it just feeling positive and saying, “There’s no reason to think I’m going to be the one”, but other people go into it saying, “Why should I take that chance?” and so, you know, when I counsel my patients about whether they want to try for a V-back or whether they want to go directly to repeat caesarean, that’s kind of, you know, part of the decision. It’s not the only part of the decision, but it’s a lot how people weight out that kind of risk.

Sarah Blight:                           Uh-hum, that’s great. Um, what are some of the questions that—types of question, I guess, that moms can ask if a c- section is brought up by their health care provider. Um, what can they—you know, to make the best decision, hopefully they’re in a relationship with their doctor where they’re collaborating together to have the best, you know, outcome. Um, so what kinds of questions can they ask to really get more information?

Dr. Marjorie Greenfield:        That’s a great question, and I think it’s a really important question for all—many, many different kinds of decisions that you make with your medical care, and basically what informed consent is, is the combination of understanding the risks, understanding the benefits and understanding the alternatives. And I think sometimes, as we’re counseling patients we get more focused on risks and benefits, and we don’t really talk about alternatives. And so one of the questions to ask in—as you’re having the discussion is what are the other options and what would happen if I took a different option, you know, so if another—if they’re saying you need a caesarean because the baby’s not fitting and there’s no other problem, it’s like what was your—anything else we can do to try to help get this baby to fit.

You know, if I change position, would it make a difference? Or, you know, and—you know, is there anything you can do to kind of buy some time and see whether it will make a difference. Um, but if you didn’t want the caesarean, and, you know, is there any significant risk to just stalling a little bit but trying some other interventions to try to help the baby to fit. If they say they’re really worried about the baby’s heart beat, it’s a really hard time to have a big discussion.

Sarah Blight:                           Right, right.

Dr. Marjorie Greenfield:        And so, you know, this is one of those things where, I think there are people—you know, and a lot of what I see on the internet is a big, um, emphasis on birth plans and on communicating your birth plan and I find that birth plans are not that helpful. I think they’re helpful as a tool for discussion during the pregnancy about common policies at that hospital and kind of what the different possible things that might happen are and what the likelihood is for you as an individual, and for things that are totally just open to discussion, and that’s great.

You can say your preferences, you know, I want the baby up on my tummy right away, you know, immediately after birth or no, I’d really rather that you  get the baby not so slimy first, you know? Things like that, that are just personal preference but the more important thing is to have a team taking care of you that you feel like has the same values that you do, and that you feel like you can have an important discussion and that you trust their advice, because to think that the birth plan is kind of like a contract that’s going to actually influence the advice that you get, I think that that’s very unrealistic.

Sarah Blight:                           Uh-hum. I think for me, I had a birth plan, I think for me it was helpful for me and my husband to sit down like you’re saying, and kind of go through these questions to really figure out what we thought about all this stuff, and then to communicate that to our physician during our appointments, you know? It was kind of like a basis of talking points, you know? And we had it with us at the hospital, just in case there was something we forgot in the moment. Um, but I think you’re right. If you expect it to be a blueprint for how you want your birth to go, it mostly likely won’t go that way, but I think as far as being a tool to kind of help start the conversation, it could be very useful in that way maybe.

Dr. Marjorie Greenfield:        Alright, right, I totally agree with you. I mean [0:14:50][Inaudible] I like birth plans, I don’t—it’s not that I have anything against them, I just think when the family kind of sees it as a contract…

Sarah Blight:                           Yeah.

Dr. Marjorie Greenfield:        I—that it’s just unrealistic to think that if you’re—if you really have a very different philosophy than your care provider, that bringing in a birth plan is actually going to influ[0:15:07][Inaudible] their care—and there’s actually a very—uh, [0:15:12][Phonetic] research study looking at birth plans, and whether their course of their labor  or their care was any different, and it was like, had no impact at all. This—I mean, the only difference was that moms with birth plans had a lower use of epidurals. That was the only difference in the two studies. There was no difference in caesareans, no difference in vacuum or forceps, no difference in continuous monitoring, none of the things that sometimes show up in birth plans, there was no difference. So I think that hospital setting has such a inertia or momentum of the way that they do things, that it’s—it really doesn’t make them typically changed basic principles of how they, quote- unquote, manage labor.

Sarah Blight:                           That’s a really good point. So how does conversations with your doctor now.

Dr. Marjorie Greenfield:        Right.

Sarah Blight:                           Yeah, good point. Um, one last question I want to ask you, um, for a first time mom who is considering the c- section—and we talked a little bit, we haven’t really talked actually about the risks, which I’d like to address that really quickly. Um, but how does giving birth via c- section today kind of affect future births? We’ve talked a little bit about V-backs, but are there any other risks that a mom may need to think about?

Dr. Marjorie Greenfield:        Definitely, and this is, I think, where—what we don’t talk about enough, which is that if you look at someone who’s now coming to you with a second baby, the biggest risk factor for complications with her birth is whether she had a prior caesarian or not. It is a huge risk factor. So, the caesarean may be a relatively good choice for that pregnancy or that baby, but it definitely is bad for the next baby, and I think that’s a really key thing to kind of keep in mind as you’re weighing out risks and benefits, that a previous caesarian increases the chance in the next delivery if you try for vaginal birth, of uterine rupture—that uterine rupture is not going to happen if you had a vaginal birth for your first. So that may be kind of obvious, but it’s just something to pay attention to.

The other thing that has to go into the equation is how many babies does mom—is thinking about having? Because it’s one thing to do a first caesarean in terms of complications. It’s—another thing not so far different than that to do a second caesarean. You start, get into the fourth or fifth caesarean, you can start running into scar tissue issues, which can take—make it much—take much longer to get the baby out, can lead to more complications for the mom with injury to other internal organs. When you’ve had several caesareans, you increase the chance of placenta previa, which is a serious complication of pregnancy where the placenta covers the opening of the uterus and requires a caesarean for sure, but also, um, can complicate pregnancy with bleeding and things like that. Um, and then there’s—the worst of all is called placenta accreta, where the placenta actually grows into the wall of the uterus, and it’s quite a bit more likely in moms that have had prior caesareans, and that is a life threatening situation for the mother, as well as the baby.

Sarah Blight:                           Okay.

Dr. Marjorie Greenfield:        So—when you look backwards, if you could only know, did she really need that first caesarean, it can—it really can have kind of a cascading effect on her future babies and risk [0:18:14][Phonetic] future babies.

Sarah Blight:                           As far as—in all of your experience, what have you seen as far as emotional, physical, breastfeeding recovery, the effects of that on women with c-sections.

Dr. Marjorie Greenfield:        The, you know, there’s some data on breastfeed that actually looks reasonably good, that breastfeeding success is just as good after caesarean as after vaginal birth. So, I worry about it a little bit, but it doesn’t look like it’s a huge difference in terms of breastfeeding success. So, you know, maybe slight differences but not a lot of difference. Um, the other things, in terms of the mom’s satisfaction, that has a lot to do with, kind of her own values and beliefs. I’ve had moms who had really long, lousy labor, that they were so happy to be offered a caesarean and felt like they gave it a great shot and it just wasn’t working and they’re so happy they have a healthy baby, and, you know, they’re perfectly happy with the decision to have a caesarean. And I’ve seen moms that grieve over the fact that they lost the vaginal birth that they were really hoping for.

So—and then I’ve seen moms who—I mean, I haven’t seen anybody that had a vaginal birth, I don’t think, that said, “I wish I had a caesarean” that’s not common. Um, but, you know, I’ve certainly seen moms that come to me and say, “I want to plan for a caesarean for my first baby. I don’t like the idea of vaginal birth. I’m afraid of labor, you know, there’s a significant chance I’ll end up with a c-section anyway, I just want to go right to it.” Um, so you know—I think it really depends on the mom’s personal philosophy and I don’t think we can really generalize—I think sometimes people assume everyone wants a vaginal birth over a caesarean, but I don’t think it’s necessarily true.

Sarah Blight:                           Okay. One last thing, um, from all your experience, is there any other advice or tips you have for mamas who are watching this interview about what we’ve been talking about today.

Dr. Marjorie Greenfield:        You know what, I just lost you part-way through your question, you got—you froze.

Sarah Blight:                           I froze, I—are there any advice or tips you have for moms, um, from all your years of experience, um, as a mom yourself and as a physician about c- sections?

Dr. Marjorie Greenfield:        I think—one thing, I – well several things. I think one is, your chance of having a caesarean is very proportional to the caesarean rate at the institution where you’re going to have the baby. So, if you want to have a lower chance of caesarean, you need to pick where you’re going to give birth. I think that’s a key thing—and also, in general, midwives have lower rates, lower chances of caesarean than a doctor for the same risk level of patient. So, if it’s something that’s important to you,  then choosing a care provider that has a low rate of caesarean and choosing an institution that has a low rate of caesarean will make it less likely for you to end up with a caesarean, so I think that’s one thing.

Um, the other thing is, though, that, you know, given the society that we live in, it’s unrealistic to go into labor, assuming you’re going to have a vaginal birth. And on the one hand, you want to think positive. On the other hand, I think to acknowledge that there is a chance that something will come up, and that a caesarean will be recommended and will appear to be the best choice under the circumstances. It’s important to kind of come to terms with—and maybe before you go into labor, so that—because I’ve had people where it did not cross their mind that they could end up with a caesarean, who are just blown away when somebody says to them, You know, this isn’t going well and, you know, we need to consider caesarean and even if you know why it happened, it can be just so shocking, I think, that it can really throw people for a loop and people have trouble coming to terms, you know, just coming to terms with their birth experience, and there’s some PTSD, I think people experience from having had the caesarean that if you kind of can accept that you really don’t know exactly what’s going to happen in labor, that you need to surround yourself with people that you trust and try to set the scene for a good experience, and then you have to have some flexibility and accept that you don’t have total control over this.

Sarah Blight:                           Mm, really good advice. Thank so much, Dr. Greenfield, for you insight and experience and information. I think—this is  a great interview to watch, to—even if you’re not planning on having a c-section and especially I would say if you’re not, to go on with what you said. Um, that way you know what could happen and you’re not kind of caught off- guard in the moment. Um, to all the mamas who are watching, if you have any questions or comments about c- sections, please leave them in the comment section below. Um, we also have links to Dr. Greenfield’s website, as well as where you can buy her books. So check out the links below. Thanks so much for watching, we’ll see you guys soon.

[0:23:03]                                  End of Audio



  • Erica

    OMG I wish I watched this before my first. My c-section wasn’t medically required. I just went along with everything they told me, I assumed it all needed to happen. And looking back, why didn’t my birth class teach me ANY OF THIS?? Better late than never, now I know & will be ready for this baby! This was really helpful, thank you for doing this & thank you Dr. Greenfield! Can I have her as my doctor?

    • yourbabybooty

      haha. If you live in Ohio near Case Western, you might be in luck! :) It is frustrating to look back sometimes and wish we knew more:( I hope that you find peace despite that! Thanks for sharing:)

  • Lori Q.

    Great info here. I’ve talked with quite a few of my friends (some close and some not) who ended up with a c-section and none of them were prepared for it. None of us wanted a c-section & we certainly didn’t know what we could do to prevent one. This is really good info to have. More of us need to know this early on in pregnancy. I agree with your perspective that the more information you have, the more you can guide yourself into the birth you want. Of course there are always things that could happen outside our control, but we’re guaranteed not to influence the outcome if we don’t know how to do it. Well done. You guys have a lot of valuable info on this site. I love learning from all the different perspectives of experts and moms a lot more than hearing from one person. Love it!

    • yourbabybooty

      wow I really like what you said “we’re guaranteed not to influence the outcome if we don’t know how to do it” very very true! We are very happy that you’re finding our content relevant and helpful! Feel free to let us know if there’s anything you’re not finding that you’d like to!