A Cesarean Is a Birth, Not a Failure
Written by Sarah Pearce, Certified Doula
Sarah Pearce is a nationally recognized full-spectrum doula, former pediatric nurse, placenta specialist, and midwifery student. With nearly a decade of experience, she supports families through fertility, birth, postpartum, and newborn care. She is the founder of Trinity Doula Services, one of the largest doula agencies in the St. Louis region.
Nearly one in three babies in the United States is now born by cesarean. Provisional Centers for Disease Control and Prevention (CDC) data show that the U.S. cesarean rate reached 32.5% in 2025, the highest since 2013. Even among low-risk first births involving a single, term, head-down baby, the rate reached 26.9%, the highest since 2012. Cesareans are one of the most important lifesaving interventions available in maternity care. They can also be overused. Both things can be true.
When cesareans save lives
There are situations where vaginal birth becomes dangerous or impossible. Placenta previa, cord prolapse, uterine rupture, certain abnormal fetal presentations, severe fetal intolerance of labor, placental abruption, and other complications can turn cesarean birth into an urgently needed intervention.
I know that personally.
At almost 19, I arrived at the hospital in labor expecting an unmedicated vaginal birth and learned my baby was footling breech. Within a short time, I was undergoing a stat cesarean.
I am grateful that surgery existed when I needed it.
But respecting what cesareans can do should not prevent us from examining how often we use them.
When major surgery becomes common
After attending more than 250 births, I have watched cesareans happen for many reasons. Some were unquestionably necessary. Others followed diagnoses such as “failure to progress” or “arrest of descent,” situations where the line between taking too long and being unable to give birth vaginally can become much less clear.
Our understanding of normal labor has changed.
The American College of Obstetricians and Gynecologists (ACOG) now considers six centimeters the beginning of active labor and recommends allowing adequate time before diagnosing active phase arrest when mother and baby remain stable.
Slow does not automatically mean impossible.
A baby may need time to rotate. Position changes may help. Contractions may need to become stronger or more coordinated. Sometimes labor simply takes longer than expected.
And sometimes, despite every reasonable effort, cesarean becomes the safest option.
The goal should never be eliminating cesareans.
The goal should be eliminating unnecessary cesareans.
Cesarean birth is not the “easy way out”
A cesarean is major abdominal surgery followed immediately by newborn care.
A mother may be recovering from abdominal and uterine incisions while simultaneously bleeding vaginally, experiencing uterine contractions, producing milk, undergoing enormous hormonal changes, waking throughout the night, and caring for a newborn.
Cesareans also matter beyond the immediate recovery. One surgery can affect options and risks in future pregnancies, which makes avoiding unnecessary first cesareans particularly important.
But none of this means a mother should feel ashamed when she needs, or chooses, a cesarean.
Reducing unnecessary cesareans and respecting cesarean birth are not opposing ideas.
We need a better conversation
We have created a strange divide in birth culture.
On one side, cesareans can be treated as routine, as though major abdominal surgery is simply another interchangeable way of giving birth. On the other, women sometimes leave cesarean births feeling as though they failed because they did not give birth vaginally. Neither serves families.
We should be able to say that cesareans save lives and carry real risks and recovery needs. Some cesareans are necessary, while some may be preventable. Families deserve informed consent and evidence-based recommendations. A cesarean birth is still a birth.
My own cesarean was followed years later by two vaginal births after cesarean (VBACs), including an unmedicated vaginal birth. Those births did not prove that my body finally “worked.” They did not redeem my cesarean. My cesarean never needed redemption.
The goal of maternity care shouldn't be vaginal birth at all costs, nor should it be surgery at the first sign that labor isn't following a predictable timeline. The goal should be the right intervention for the right person at the right time.
And when that intervention is a cesarean, the mother on the operating table has not failed. She gave birth.
Read more from Sarah Pearce
Sarah Pearce, Certified Doula
Sarah Pearce is a highly sought-after birth and postpartum expert, a former Licensed Practical Nurse (LPN) specialising pediatrics, a placenta encapsulation specialist, and the founder of Trinity Doula Services, a rapidly growing full-spectrum doula agency serving Missouri and Illinois. With over a decade of hands-on experience in fertility, labor support, physiologic birth, postpartum recovery, newborn care, and high-pressure pediatric nursing, she has become known for combining evidence-based education with deeply intuitive support. Sarah has supported families through all types of birth settings and is working towards becoming a Certified Professional Midwife. Her work empowers families during life's most transformative moments.
References:
American College of Obstetricians and Gynecologists (ACOG): Patient education on cesarean birth, risks and benefits, recovery, and vaginal birth after cesarean (VBAC) or trial of labor after cesarean (TOLAC).
Evidence Based Birth®: Research-based education on cesarean rates, labor practices, informed decision-making, and evidence surrounding common birth interventions.
Centers for Disease Control and Prevention (CDC), National Center for Health Statistics: Current U.S. birth data, including national cesarean and low-risk cesarean rates.
International Cesarean Awareness Network (ICAN): Education, peer support, cesarean recovery resources, and information for families considering vaginal birth after cesarean (VBAC).
