Why Avoiding the First Cesarean Matters

When thinking about how and where to give birth, many families focus on the immediate experience such as pain relief options, who will be in the room, and how the baby will be cared for. But the decisions made in a first birth can have long-term consequences that stretch into future pregnancies. One of the most significant examples of this is cesarean section.

What many families don’t realize is that the first cesarean is rarely just a one-time event. Once a woman has had a cesarean delivery, she’s far more likely to have another in future pregnancies. Many hospitals and providers still follow outdated policies that discourage or even prohibit vaginal birth after cesarean (VBAC)—even though VBAC is often a safe and viable option.

With each additional cesarean, there is an exponential increase in risks, including excessive blood loss, damage to surrounding organs, placenta abnormalities, and uterine rupture. These complications can affect not just the next birth, but a woman’s overall health and future fertility. Many people are advised to limit the number of cesarean deliveries because having too many can make it harder or riskier for a woman to have more than two or three children.

What is a Cesarean?

A cesarean section (commonly called a C-section) is a surgical procedure used to deliver a baby through an incision in the mother’s lower abdomen to reach her uterus. It can be planned in advance or performed urgently if unexpected complications arise during labor. The surgery typically takes about 45 minutes to an hour, with the baby being delivered within the first 10–15 minutes. The remaining time is spent closing the incisions.

In some cases, a cesarean is scheduled due to a known medical condition or a previous cesarean. In other instances, it may become necessary during labor if certain conditions arise. While it’s sometimes the safest choice for mother or baby, cesarean birth is still considered major surgery and involves a different recovery process than vaginal birth. In recent years, cesarean delivery has become increasingly common. According to the CDC, in 2022, over 32% of births in the United States were by cesarean section.

Reasons for Cesareans

There are both medical and non-medical reasons a provider may recommend or perform a cesarean. Medically necessary reasons can include situations such as breech presentation, placenta previa, fetal distress, or labor that fails to progress. In these cases, a cesarean can be a life-saving intervention for the mother, the baby, or both.

However, many cesareans are performed for less clear-cut reasons. Some are scheduled out of caution, convenience, or institutional policy, rather than out of true medical need. Hospital protocols, fear of litigation, and limited support for vaginal birth after cesarean (VBAC) all contribute to the high rate of surgical birth in the U.S. Unfortunately, when cesareans are performed without clear medical necessity, they expose mothers, and their baby, to increased risk.

Why Would I Want to Avoid a Cesarean Birth?

Cesarean birth can be life-saving when necessary, but it’s still major abdominal surgery with real risks, both short-term and long-term. Many people are surprised to learn just how many consequences come with that first cesarean.

Major Surgery Comes with Major Risks

It’s easy to forget that a cesarean is major abdominal surgery. It involves cutting through several layers of tissue and muscle to reach the uterus. While this is sometimes necessary, it’s far from the easy or simple option it’s often made out to be.

One of the primary risks with surgical birth is infection, which can occur at the incision site, in the uterus, or within surrounding pelvic organs. Excessive blood loss is another significant risk, as C-sections typically involve more blood loss than vaginal deliveries and sometimes require a transfusion.

These risks are important considerations when weighing the benefits and potential complications of a cesarean birth.

Harder Recovery

Recovery from a C-section is usually longer and more painful than from a vaginal birth. It may require strong pain medications and limit a new mom’s ability to move, breastfeed comfortably, or care for her newborn. And beyond the short-term recovery, scar tissue from the surgery can lead to long-term issues like chronic pelvic pain or complications in future pregnancies.

Avoiding that first cesarean means avoiding those risks, not just now, but in the years and births to follow.

Effects on Future Pregnancies

Having a cesarean increases the risk of placental complications like placenta previa and placenta accreta in future pregnancies. These are conditions that can cause severe bleeding and decrease fertility. Each subsequent cesarean adds more scar tissue, which complicates future births and sometimes leads to recommendations to limit the number of pregnancies.

Emotional Issues for Moms and Babies

For many women, having a cesarean can come with some emotional distress. Feelings of disappointment or trauma are common, especially if the surgery was the result of interventions or a rushed labor process.

As Midwives, we often hear women share how they felt robbed of their previous birth experience. And while a healthy baby is always a top priority, a woman’s birth experience matters, too. It shapes how she sees herself, how she bonds with her baby, and how she approaches future pregnancies.

For babies, being born via cesarean can mean a different hormonal and physical transition into the world, which may influence early feeding, sleep, or adjustment. While many families recover well, these emotional aspects deserve acknowledgment.

Why Are First Cesareans So Common?

The answer lies in how our maternity care system is structured. Many hospitals follow rigid timelines for labor progression. If a woman doesn’t dilate quickly enough, pushes too long, or her baby’s heart rate shows minor fluctuations, a cesarean is often suggested—sometimes prematurely.

Other routine practices like inductions, epidurals, restricted movement, and continuous fetal monitoring can also interfere with the natural flow of labor. This leads to what’s often called the cascade of interventions, where one medical step leads to another—many times ending in surgery. Learn more about continuous fetal monitoring vs. Intermittent auscultation.

How Can I Avoid a Cesarean Birth?

Many first-time cesareans are preventable. The key is preparing your body, mind, and birth environment to support a safe, natural labor. That preparation starts long before contractions begin.

Here are some practical steps you can take to lower your risk of an unnecessary c-section.

1. Choose a Supportive Care Provider

Not all providers approach birth the same way. Midwifery care is based on the belief thatbirth is a normal, physiological process, not a medical emergency. We trust the body. We support it with patience and personalized care.

By minimizing unnecessary interventions and allowing labor to progress naturally, we can dramatically reduce the risk of cesarean birth, especially for first-time mothers.

Look for a Midwife or provider who supports physiologic birth, uses intermittent monitoring, allows time for labor to unfold naturally, and has a low cesarean rate.

2. Take a Comprehensive Childbirth Class

Knowledge is power. A quality childbirth education class helps you understand how labor works, what to expect, how to manage pain naturally, and how to make informed decisions when interventions are suggested.

3. Hire a Doula

Research shows that continuous support during labor can reduce the likelihood of cesarean birth. Doulas provide emotional reassurance, physical comfort, and guidance for you and your partner throughout labor.

4. Let Labor Start On Its Own

Unless there’s a clear medical reason, avoid elective inductions. Spontaneous labor tends to be more efficient, and avoiding induction lowers your chance of a “cascade of interventions” that can lead to a cesarean birth.

5. Stay Healthy During Pregnancy

Your health during pregnancy plays a major role in how your birth unfolds. To lower the risk of complications that often lead to cesarean (like gestational diabetes or high blood pressure), focus on:

Balanced nutrition with whole foods, healthy fats, and adequate protein
Regular, low-impact exercise like walking, swimming, or prenatal yoga
Managing weight gain within recommended guidelines to reduce the risk of macrosomia (a baby that’s very large for gestational age)
Attending all prenatal appointments to monitor and manage any early signs of complications

Talk with your healthcare provider about more ways you (and your baby) can stay healthy during pregnancy.

6. Promote Optimal Fetal Positioning

Practice optimal fetal positioning like sitting upright, doing pelvic tilts, or using tools like a birthing ball. These methods encourage the baby to settle in a head-down, forward-facing position, which can help labor progress more smoothly.

7. Stay Active in Labor

Movement during labor helps your baby move down, opens your pelvis, and works with gravity to speed things along. Walking, swaying, squatting, and upright positions are all helpful for progression and comfort.

8. Be Patient with the Process

Labor doesn’t always follow a neat timeline. Some births move slowly—and that’s okay. Avoid pressure to “speed things up” unless there’s a clear medical need. Your body knows what to do.

9. Make a Birth Plan (and Discuss It!)

A clear, well-communicated birth plan helps your team understand your preferences and makes you an active participant in your birth. Review it ahead of time with your provider so you’re aligned.

Cesarean birth has an important place in modern medicine, but it should not be as prevalent as it’s become for first-time moms. Avoiding that first surgery, when possible, means protecting your body, preserving future choices, and giving your baby the healthiest possible start.

Why Avoiding the First Cesarean Matters