Policies and Attitudes and how they can prevent or lead to cesareans.

I want to point out that as I compare these two births right now, I am not judging these moms choices.  They each made the best choices for them and their babies along the way.  I am just looking at how different hospitals policies and care providers attitudes can have a big affect on the choices a mom makes.

When to admit a mom to the hospital:

Some hospitals have policies that a mom has to be 3-4 cm dilated before admitting them to the hospital.  This helps prevent un-neccsareay interventions such as pitocin and cesareans.

Addison was sent home 2 times because she wasn’t 3-4cm.

Cara was admitted at 2.5 cm. Had she been sent home until she was really in her active birthing time, it wouldn’t have been a big deal when her birthing time slowed down.  She may have gotten some rest and then birthing time may have started in the morning again.

Maybe having her walk the halls for an hour and then checking her to see if she made progress would have helped confirm if she was in her active birthing time?

Offering Epidural:

Addison:  Nurse let her know if she wanted it, she could ask.  Addison asked when SHE wanted to.

Cara:  Nurse tempted her with “best anesthesiologist” This is a hard offer to refuse.  The nurse might know the next anesthesiologist sucks.  Cara took the offer.  If she had waited until SHE wanted an epidural she probably would have gone a few more hours using upright positions and that may have helped her progress more.

Maybe this nurse wasn’t comfortable with Cara being un-medicated?  Maybe the anesthesiologist was bored and wanted to do another epidural?   Who knows why she presented her choice like that?  But you can see how her offer of the “best anesthesiologist” is different then saying, “let me know if you need any pain relief.”

Time Line for interventions:

This may be more care provider specific then location but I am not sure.

Addison went 8.5 hours with no change before pitocin was offered.

Cara was on pitocin 4 hours after getting to the hospital. This could be because her pw slowed down, because she wasn’t really in her active birthing time when they admitted her.

Suggesting a cesarean:

(Remember, in both cases mom and baby were doing fine.)

Addision:  A cesarean was never suggested, even with 10.5 hours with no change!

Cara:  A cesarean was suggested quite a few times. Starting even before her birthing time even started.   This creates a mind game for the mom and I think is manipulative.

Cara was told she wasn’t progressing, but this isn’t quite true effacing more and having her baby moving down IS progress.

The nurse said,

“If you haven’t progressed in the next hour you are having a cesarean.”

What if the nurse had said instead,

“You are making progress, you are effacing and the baby is moving down slowly.   With more time you will dilate as well.  We’ll check again in a few hours as long as you and baby are ok.”

The first way Cara was getting set up for a cesarean.

I can only guess that her OB had somewhere he wanted to be that early evening. He didn’t even give her until 5 like I thought he would.  (You think I am cynical.  But I just talked to another mom whose OB pressured her into a cesarean and she didn’t know why, until she found out the OB had a concert that night.)

Cara’s OB said to her during the cesarean,

“I thought we would end up here.”

Even if a mom has a great attitude and positive expectations

and plans well for her birth, she can be affected by others attitudes and expectations. Birthing moms are very suggestible.  Care providers and birth partners should take great care in what they say to them!

I share these Two Moms Tales to encourage moms everywhere to Choose Carefully! Your care provider AND your birth location together can have a huge impact on your birth.  Choose Carefully!

It is never too late to change.

  • In the last 2 months, I have seen 3 moms change birth locations and birth providers at 40 weeks.
  • It is easier to change earlier, so talk NOW with your care provider, but it is possible, even at 40 weeks.
  • Talk to your local doulas and childbirth educators for recommendations of good care providers and birth locations!
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6 Comments on “Policies and Attitudes and how they can prevent or lead to cesareans.

  1. I think this is a very good analysis of how the personality of the caregiver effects the birth and the birth outcome.

    Having a birth plan helps too. If the birth plan says, “please don’t offer meds, I know they are available and will ask for them if I want them.” then the partner(s) can help keep the hospital staff on the same page.

    You’re right about the hospital too. If the hospital staff doesn’t have a lot of exposure to unmedicated births, then they might not really understand that dilation isn’t the only expression of “progress.” Nurses that see a lot of unmedicated births know that, usually, birth is really boring! Those that don’t will want to see “more progress by X o’clock.”

    Thanks for putting this comparison together!




    Both moms had birth plans with similar wording. I think that some nurses just don’t read birth plans.


  2. I am 38 weeks and 2 days. My hospital won’t admit me until 3-4 cm. While this rule might be great in terms of avoiding unnecessary intervention, I live more than one hour away from the hospital! Getting “sent home” will mean spending uncomfortable hours in the car, not to mention wasted gas, etc.

    During our birth class at the hospital I asked if the 1-5-1 rule is equal to being 3-4 cm dilated and our instructor wouldn’t say yes or no. So how am I supposed to know if I have reached 3-4 cm?? I am a first-timer, I have no idea what to expect. I am so paranoid of wasting a trip to the hospital that I will probably wait too long!



    This is a situation where you may want to find a hotel nearby, or if it is day time a nice park in the area or a mall where you could go walk.

    Or here is an idea for checking yourself:

    I’ve checked doula clients using the xiphoid process. This is from Anne Frye’s Holistic Midwifery Volume 2:

    During a contraction and with mom on her back, determine how many fingerbreadths of space are between the fundus [top of the uterus] and xiphoid process [the triangular tip of the breastbone] at the height of a contraction.
    5 fb = no dilation
    4 fb = 2 cm
    3 fb = 4 cm
    2 fb = 6 cm
    1 fb = 8 cm
    0 fm = complete

    It isn’t exact science but I’ve had a midwife double-check me using a vaginal exam and I’m usually within a cm. It can give you a good idea and it is entirely non-invasive. I find it works best when you are flat on your back (just don’t stay there!) :)

    I had my dh read a few midwifery texts to get a better understanding of dilation and then he has always checked me in labor.

    I think the best way to judge progress is to hire a stellar doula who is confident in reading all the signs your body is giving in labor.




  3. have you seen feminist breeders vbac story? they were pressuring her towards another c-section. then after her vbac the doctor said “well, i missed my daughter’s birthday.”


  4. This post is so timely. There are a few moms over here (in Korea) with doctors telling them straight out that they will not get what they want and the moms are still resistant to change.

    I have told them, don’t listen to me, listen to yourself, if the doctor won’t answer your questions in prenatals it will only get worse during your birthing time. Also, if they are telling you that they will not let you have the baby right away and that you need to go somewhere else if you want that, then listen to THEM, go somewhere else.

    At least explore your options.


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