Did you know that in 2020, 31.8% of all births in the United States were Cesarean births? Whether you choose to have a scheduled Cesarean or a Cesarean is recommended after you have been in labor for some time, it is worth learning about this procedure ahead of time, and how the support of a doula can help to make your birth and postpartum experience a positive one. Here, I will discuss 5 popular myths about Cesarean births.

Myth #1: Julius Caesar was the first baby born by Cesarean.

Surgical births have a long and interesting history, with ancient references appearing in Europe, Asia, and Africa. However, there is no evidence that Julius Caesar himself was born by this mode. The name “Cesarean” refers to a Roman imperial decree (from Caesar) that if a mother died or was dying in childbirth, an operation should be used to cut the baby out and thus potentially save the life of the child. The first recorded surgical birth that both mother and infant survived happened in Switzerland in 1500. Over the next few centuries, anatomical knowledge and medical education developed considerably; however, sterile technique and anesthesia were not introduced until the mid-1800s, making surgeries unbelievably painful and dangerous. In America, other obstetric and gynecological surgeries were developed in the 19th Century by performing them on enslaved women without anesthesia, the legacy of which may be seen in the higher rates of Cesarean births and maternal mortality among African American women even today. Today, even as the World Health Organization is concerned about the number of medically unnecessary Cesarean operations being performed, and that the rates for this procedure are highly unequal across the world, directors of the organization have pointed out that the procedure does play a vital role in saving lives in certain high-risk birth situations.

Myth #2: The most important thing about a Cesarean is avoiding it.

It is true that a Cesarean birth is a major abdominal surgery, and that does bring with it certain risks and a painful recovery period. We will talk below about how to manage your recovery after a Cesarean. But it is also true that in some situations, this can be a life-saving surgery for the mother, baby, or both. Some people may even have reasons to prefer to have a surgery, which can be scheduled ahead of time, to the unpredictability of labor, and previous experiences like a difficult labor or history of sexual trauma may play into this. It is important to seek out unbiased support for your birth experience. A doula should never want a particular birth outcome for you more than you want it yourself, and should never push you toward a decision that doesn’t feel right to you. If you end up having a Cesarean that you were not planning on, you may have a lot of questions and emotions to process afterward. It is important for your support team to allow you to express whatever you are feeling, help you get answers to your questions, and not add their own judgments or biases to your experience.

Myth #3: There’s nothing I can do to alter my chances of having a Cesarean, or to make the experience more pleasant if I do need one.

There are some circumstances in which it is true you may not have a lot of choice about this. Evidence-based standards of care do recommend Cesarean births in certain medical situations, and you probably do not have a lot of control over these situations. But the Cesarean rate in the United States is roughly double the rate that the World Health Organization suggests as necessary to save lives, indicating that many of the surgeries performed are not based on medical evidence, but on some other factor, such as provider’s preference or convenience. If avoiding an unnecessary Cesarean is important to you, you can substantially increase your chances of a vaginal delivery by carefully selecting your medical provider and asking questions about their practices when it comes time for you to have your baby. Providers vary a lot by how readily and in what circumstances they will suggest a Cesarean, and what measures they will take to support a vaginal birth. You can start by checking the statistics on Cesarean rates for the hospital where you are considering having your baby. These statistics should be available from the hospital, or from your state health department. This document has the published Cesarean rates for hospitals in my state of Alabama in 2019.

It is also a good idea to ask about the individual doctor, practice, or midwife you are considering. Here, you may need to get a little bit clever. I found information about the number of vaginal vs. surgical deliveries for some, but not all, of the OBs in my area by checking the “find a doctor” section of my insurance portal, but this did take some digging and exploring. Asking questions about what situations your (potential) provider feels would warrant a Cesarean and what procedures they recommend for managing different circumstances in labor can give you a good idea of whether this provider will offer you the best chances of having the kind of birth that you are hoping for. A doula with knowledge of the providers in your area can also offer suggestions about providers who are most aligned with your wishes and philosophy about birth. Of course, all of this depends on you living in an area that offers a choice of providers. If you are not fortunate enough to have a choice of providers available to you, you may want to consider whether traveling to another area for your birth is a possibility, and becoming an advocate for systems and policies that will enable more choices for safe childbirth in all geographical areas.

Just as with a vaginal birth, there are also a number of opportunities to express your preferences for what happens in a Cesarean birth, but you may need some help advocating for your preferences if this isn’t something your particular provider is used to. There is a growing preference for “family-friendly Cesareans,” meaning that you might ask for your preferred music to be playing in the operating room (or request a quiet operating room, if that is your preference), for you and/or your partner to be allowed to see as the baby is lifted out of your uterus, and to have the baby placed skin-to-skin on your chest immediately or as soon as possible. Unless your surgery is a true emergency that must be performed very quickly, you will probably be awake for the procedure and you will probably be able to have your partner, or sometimes your partner and your doula, present with you. If you don’t feel comfortable having your baby lie on you while you are still on the operating table, your partner may be able to hold the baby. I have even seen a father disrobe in the OR for skin-to-skin with his newborn, and the baby tried to latch onto the father’s nipple!

Myth #4: If I have a Cesarean birth this time, I’ll only be able to have Cesareans in the future.

Although OBs used to issue the advice, “once a Cesarean, always a Cesarean,” this is no longer automatically the case. The rate of vaginal birth after Cesarean (VBAC) is rising, and there is a lot of good news for those who prefer to give birth vaginally after a previous Cesarean. To learn more about choosing and preparing for a VBAC, two excellent sites are VBAC Facts and the International Cesarean Awareness Network (ICAN). Also, check out my posts on Considering a VBAC? I’ve got your (V)back! and Addressing some questions frequently asked about VBAC (and any) labor and birth.

Myth #5: Since I’m having a Cesarean, I don’t need a doula.

There are so many ways that a doula can really help before, during, and after a Cesarean birth. If you are planning a Cesarean, I strongly encourage you to talk to doulas in your area about the support that they offer for this mode of birth. If you are not planning a Cesarean but want to be prepared for the possibility of one, this is also a great topic to discuss with your doula.

Before birth, your doula can help you to discuss your emotions surrounding pregnancy, birth, and parenthood, provide any requested advice about how to have a healthy pregnancy, and help you to examine your options for provider, place of birth, and choices about the birth itself. Your doula can also help you to prepare for the birth and postpartum period by helping you know what to expect and to set up your home in a way that will help you through the early days of postpartum recovery (surgical or otherwise) and caring for a newborn.

When it is time for your Cesarean birth, your doula will typically accompany you at the hospital and sit with you while you are waiting for the procedure to start. It can be surprising how long you may have to wait for a scheduled Cesarean, since the operating room may be taken over for an emergency before you. It can be comforting to have someone present who knows what to expect and is able to listen and validate what you are feeling as you anticipate the birth of your little one. During the birth itself, your doula may be allowed to be present in the OR once you have been prepped for the procedure. The doula can then explain to you what is going on (if that is what you want) and remind the medical team about any preferences you have discussed beforehand. If the doula is not allowed to be present in the operating room, you can ask if there is another member of the team, such as the anesthesiologist, who can tell you what is happening step-by-step. In the event that your baby needs to go to the NICU, your doula can stay with you, allowing your partner to accompany the baby without leaving you unattended. If your doula does not come into the operating room with you, they can still play an important role by staying with any other friends and family members waiting for you to come out of surgery, and getting your recovery area ready for your return.

The postpartum period after a Cesarean is when having a doula may really seem like a necessity. The physical recovery from abdominal surgery requires a lot of support. The postpartum hormonal changes and emotions about your new role as a parent will hit equally after a Cesarean and a vaginal delivery, but their effects may be compounded by emotions about the birth and a challenging physical recovery. Then there is establishing an infant care routine, one that can be carried out without putting extra strain on your incision and that allows you to get as much sleep as possible. Hopefully, you will be able to lean on a supportive partner and other family members, but sometimes it can be overwhelming to deal with family members who want to help but have their own opinions about how you should be doing things! A postpartum doula will help you process the emotional and practical changes that you are going through, help you identify your priorities for this period (such as sleep, establishing breastfeeding, or helping an older sibling adjust to the new baby), and provide practical advice and support for you to meet those priorities. Postpartum doulas typically schedule blocks of four hours or longer to spend in your house, and may even offer overnight shifts to help ensure that you get the rest you need to speed your own recovery. If you are breastfeeding, an overnight doula can bring the baby to you for feeding, while allowing you to rest in between feeds. Check out my page on postpartum services if this is something that you think would be helpful for you. Postpartum doula care can be scheduled ahead of time, during pregnancy, or later if you realize you need this support after you bring your baby home.