Thirty-five years ago, I began my residency in obstetrics and gynecology at Maimonides Medical Center in Brooklyn. I worked with a mostly Orthodox Jewish population, where large families were common and cesarean sections were strongly discouraged. In the early 90s, hospitals started tracking individual physicians’ cesarean rates, and the trend was to avoid cesareans whenever possible. After my residency, I completed a fellowship in Maternal Fetal Medicine and later started a practice focused on high-risk pregnancies, particularly for women who wanted a normal delivery.
For the past 35 years, I’ve been deeply involved in labor and delivery, often working hard to prevent cesareans. I’ve delivered over 6,000 babies and labored more than 2,000 women who had previous cesareans. I have spent countless hours strategizing and contemplating the best ways to achieve normal delivery. I might have more experience than anyone else in the country when it comes to avoiding cesareans. I share this background so you can better understand why I’m confident in the novel approach I’m about to describe.
In the United States, the cesarean rate has skyrocketed from 5.5% in 1970 to more than 32% today. There are many reasons for this increase. Fetal monitoring, for example, often leads to cesareans when there are abnormal heart rate patterns. The fear of lawsuits has created a defensive approach to obstetrics, and many important skills, like using forceps or performing external cephalic versions, are less commonly practiced. There are also more women with health conditions like diabetes, obesity, and high blood pressure, which increase the risk of cesareans.
For women who desperately want to avoid a cesarean, this list of factors may feel discouraging, as many of them seem out of their control. But the truth is, many of these issues can be managed, especially by choosing the right healthcare provider. However, I believe the biggest factor contributing to the rise in cesareans is something that most women have more control over than they realize. What I’m about to tell you may surprise you—it is not discussed and won’t be found on the internet or books, but it’s clear to me after years of experience.
Babies are too big! The average baby is too big. Wait, is that an inherent contradiction? Shouldn’t the average-size baby be the perfect-size baby? I ask you: Is the average-size adult the right-size adult? Is the average-size child the right-size child? The answer to both questions is not even close. We live in a society where most of us have sedentary lifestyles and eat too much processed food, especially sugar. Developing babies are subject to these same external factors.
My research shows that babies today are, on average, almost a pound heavier than they were 80 to 90 years ago. While it’s true that adults are larger and healthier than they were a century ago, it’s not by 15 to 20 %. As a result, many babies are simply too large to fit through the birth canal. This is a leading cause of labor dystocia (failure to progress) and fetal distress, two of the most common reasons for cesarean deliveries.
The solution to this “fit” problem starts with what the mother eats and how active she is during pregnancy. Restricting sugar, particularly in the second half of pregnancy, and increasing physical activity can significantly help reduce the size of the baby. The more sugar a mother consumes, the more her baby stores that sugar as fat. When a pregnant woman eats ice cream she’s essentially feeding her baby ice cream.
Exercise, like taking a brisk 30-minute walk every day, helps regulate the mother’s blood sugar and prevents excessive weight gain in the baby. Along with a controlled diet, this approach should include regular ultrasounds to monitor the baby’s growth. If the baby is growing too large, especially considering the mother’s body size, it may be time to consider inducing labor before the due date. Babies don’t grow to a fixed size—they’ll continue to grow until labor begins. Delivering one week before the due date can shave off up to a pound from the ultimate size of an overdue baby.
I call this approach NatureBack. It’s based on the idea that modern society has moved far away from what nature intended for pregnancy. For women who are committed to a normal delivery, my book offers guidance to help them make informed decisions, giving them the best chance for a natural birth.
Dr. Yaakov Abdelhak is a board-certified OB/GYN who also completed an additional fellowship in perinatology (high-risk obstetrics) and has been a maternal-fetal medicine doctor since 2002. He is a firm supporter of natural and vaginal birth whenever safe for the mother and baby. He is the founder of Maternal Resources, a thriving boutique-style practice, with offices in Hackensack, Jersey City, Hoboken, Howell and NYC.
