If fat were truly an intractable cause of cesareans, these low cesarean rates would not have been possible even back then.
In fact, many studies then showed that fat women had no higher cesarean rates than other women.
Big moms do have a higher cesarean rate, though many are probably unnecessary.
For some large women, a cesarean is no big deal, for others it is unwanted but endurable, and for still others it is a horror story, full of fat-phobic treatment or intense trauma.
Some research also suggests that larger women have a higher rate of being abused (especially sexually) which could also easily increase the c/s rate as well.
So although larger women tend to have higher rates of c-sections than average-sized women, it is unclear how much is due to problems from size and health concerns, how much is due to provider bias and patterns of expectations, and how much is due to deeply-placed body trust and empowerment issues.
It is so important for us to see that many of our fat sisters have traveled this journey before us.
Another example of this is the recent news release which trumpeted the high rate of c/s of fat women at a certain hospital and then suggested that large women should have an epidural put in place early in labor so that if a c/s is needed she is all ready.
Since a number of studies and meta-analyses have found that epidurals (especially in the beginning of labor) result in higher rates of c/s, and these doctors have already been told to expect fat women to 'need' a c/s, the number of fat women having a c/s at this hospital is likely to remain high.
Studies show that large women are induced at higher rates than average-sized women, and often are not given the same chances at Vaginal Birth After Cesarean that average-sized women may get, resulting in more repeat c-sections.
All of this increases the c/s rate, but is mostly due to patterns of provider bias rather than problems inherent to being heavy.