It is important to remember that most plus-size moms can have successful vaginal births. And any doctor that tells you otherwise (unless you have other complications) is misinformed. There is no reason to schedule a planned C-section for an overweight first-time mom, unless there are other conditions or problems involved. The more you can help it along, the better, but you don’t need to be able to run a marathon to be able to give birth vaginally.

Squatting or knee-chest positions help to open the pelvis, so these positions might be effective for you. Use gravity to help you and walk and move around during labor if possible. Try to avoid just laying in bed on your back throughout your labor.

A 2004 study showed that plus-size women tend to have longer active labors (the time it takes to go from 4 cm dilation to 10). Normal women took about 6.2 hours while overweight women took 7.5 to 7.9 hours on average, Plus-size women tended to stall between four and six centimeters while medically obese women stalled under 7 cm. You should keep this study in mind and discuss it with your health care provider before you agree to a C-section for failure to progress. Because your body naturally may have a longer labor, things might actually be progressing at a reasonable rate for you, whereas it might seem too long when compared with smaller women. If you can wait out the extra bit of time (which might not sound like a lot now but can feel like a lifetime when you’re going through it), your labor may get through the stalled period and then move along.

A recent Saint Louis University School of Medicine study showed that plus-size women who had their labors induced took longer to deliver than smaller women. The study did not take into consideration evidence that plus-size women have naturally longer active labors.

The study also showed that plus-size women need more medication to induce and it took longer for the induction drugs to start working. The physician who did the study suggests that plus-size women wait for spontaneous labor instead of having labor induced if they want to reduce their chances of a C-section (a longer labor increases your chances of a C-section).

Some physicians now believe that all plus-size women should routinely be given epidurals as soon as they are admitted to the hospital. Recent studies have shown that epidurals do not slow labor at all and may allow it to actually progress faster because the mom is relaxed. Unfortunately, your comfort is not the reason behind this recommendation. Many physicians believe that plus-size women are more likely to have C-sections and putting an epidural in place eliminates the need for emergency spinal anesthesia (which can be difficult to place in a larger woman). The problem is that once you have an epidural you won’t be switched to a spinal should you need surgery, and epidurals can provide incomplete pain management during C-sections. Ultimately, the choice whether to have an epidural is yours alone and it is something you should discuss with your health care provider.