Here's a blog entry from a midwife who is currently in med school to become an OB-GYN, and the attitude towards Vaginal Birth After Cesarean (VBAC) and planned cesareans she has encountered.
Here is a little excerpt:
Women are absolutely bullied into repeat cesareans. When I was training as a midwife at a freestanding birth center, we had women transfer to our care late in pregnancy all the time because their doctors were forcing them into a repeat (or primary!) cesarean without medical indication. In fact, we had one mother who said the doctor told her she had to go see a psychiatrist because she was literally crazy for requesting a trial of labor....
One of the ob/gyns at our school (and our main women’s health professor) told our ob/gyn interest club that he thought that his offering of elective cesarean to his patients was completely ethical...But, in reality, his practice does not simply involve maternal request for cesarean. The two women in my class who were his pregnant patients said that he offered them a non medically indicated cesarean at every single visit.
He even went on to explain at that meeting that he tried to convince his patients by extolling benefits of cesarean section, including “your mom can arrange to be there”. He told us that he preferred it because “twenty minutes, the baby is at the mom’s breast, and I get to go home, instead of waiting for twenty hours of labor.” He disparagingly said, “I am not a labor sitter. I am not a glorified midwife"....
Magnify That For Fat Women
Now take this attitude about "doctor-persuaded cesareans" and multiply it times TEN (at least) and you get the kind of pressure many fat women encounter from their doctors during pregnancy.
Sometimes it's really that egregious and obvious, but often it's more subtle and plays upon the fears they have carefully built up for us about how our weight and size might harm our babies.
"Well, dear, obese women have a higher risk of 'xxxx', so better do an early induction now (before the baby gets too big!...or before your blood pressure goes up!....or before your placenta degrades!). But you know, if we just schedule a cesarean, you don't have to go through all that messy labor pain, you can pick your baby's birthday, your mom can be there for the birth, and you'll have your baby in your arms in half an hour."
Or, "Chances are really high that you'll end with a cesarean anyhow; better and safer to do it in a planned and controlled fashion than as an emergency procedure. If there was a real emergency, it would take too long to get through all that extra adipose tissue and your baby might die. You don't want your baby to die, do you?"
(The last argument is used all the time.....and very successfully I might add.....to convince women of size out of trying for a VBAC and into scheduling a repeat cesarean. I've seen it work many many times.)
This is not to say that 'all doctors are bad.' Of course not. There are many wonderful doctors out there, and of course there are bad midwives out there too. It's not one's title or credential that makes you size-friendly or birth-friendly. BUT there is a set of cultural attitudes and beliefs about interventions that tends to cause more cesareans and complications with doctors than with midwives in general.
Some birth attendants truly mean well when they schedule fat women for early inductions and cesareans, thinking that they are providing the best possible chance at a "safe" birth for them, despite little evidence actually supporting that idea.
The problem is that they rarely question that belief, in research or in practice. It just becomes "standard of care" for obese women, without any careful examing of whether it actually does improve outcome or not.
There is just simply a culturally-warped attitude in favor of birth interventions and "the machine that goes PING!" in medical training these days. Add in the additional bias about the 'dangers of obesity' and it means that fat women are being pushed into inductions and cesareans at RECORD rates today.
Fat women can birth vaginally. But often, they are simply not given a real opportunity to do so.