C-sections are sometimes necessary. Of all the medical interventions that exist, the c-section is perhaps the most important. It’s a relatively simple and safe surgery. But it is major abdominal surgery. And it’s performed too often.
The World Health Organization has looked at the data and come up with a reasonable recommended cap for c-sections at 10-15%. But in America one in three babies is born via c-section. This means that around 15-20% of all births result in medically unnecessary c-sections.
That’s a hard number to deal with if you’re pregnant and hoping for a vaginal birth. What are you supposed to do with that info? You don’t have the time or resources to change the entire maternity care system in this country. You’re due in three months! So let’s do the sensible thing and table the issue of maternity care for now. Let’s focus on you and what you can do.
If you’re hoping for a vaginal birth, there are ways you can reduce the likelihood of unnecessary interventions, including a c-section:
1. Care-provider, care-provider, care-provider. Ask your midwife or doctor for his or her rates of c-section among low risk mothers. If it’s high, your chances are high. If it’s low, your chances are low.
2. Hire a doula or bring in a positive, experienced labor support person. Studies have shown good labor support significantly reduces the chances of a c-section and other medical interventions.
3. Avoid labor induction, which can double the odds of a c-section. The reasons for the induction might be related to the ultimate reasons for the c-section but still, there’s a bounty of evidence pointing to the over-use of the labor induction drug pitocin. Talk to your care provider about ways to avoid induction.
4. Change position in labor. Labor is a dynamic process. There is movement: the baby is turning and coming down and out. You are pushing down. Amazingly, labor works even when you a re lying on your back, but gravity-friendly positions, rocking back and forth and leaning forward can actually help move the baby down and out. Take a childbirth education class and learn about positions that help labor progress (good positioning also takes the edge off pain).
5. Avoid an early epidural. An epidural is neither “good” or “bad.” It is not a cop out, it is nothing other than a tool for coping with pain. But we do have some research on the risks and benefits: An early epidural brings more risks than a late one. A late epidural after a very long labor, when mom is utterly exhausted, can actually give mom the rest she needs and actually help her deliver vaginally. But if you get an epidural before 5 centimeters the chances of a c-section do go up for a number of interconnected reasons. If you want to avoid other medical interventions and a c-section, try to hold off on an epidural until you’re over 5 centimeters dilated.
6. Stay home in early labor. There’s no reason to race in at the first contraction. Wait until you’re really in active labor; when contractions are about 3-5 minutes apart and have been for an hour. Talk to your care-provider about this, but in the absence of any other concerns this is a great way to avoid medical interventions and let labor really get going on it’s own.
7. Ask for intermittent monitoring instead of continuous monitoring: ACOG discourages the use of routine continuous monitoring as it prevents women from moving around in labor (which helps labor progress).
8. Learn as many pain coping techniques as possible and use the least aggressive ones first. Some examples: positioning, massage, water, vocalizing, relaxation breathing, visualization. All of these should be taught in a good childbirth education class.
9. Surround yourself with positive support leading up to and during labor. I’m not talking about people who are heavily invested in your having a “natural birth,” but people who are not afraid of birth and who make you feel safe and not judged. They are people who will be kind and loving and who will support your decisions.
10. Look into the option of a VBAC. It’s not always the right way to go, but sometimes it is. There are a lot of myths out there about VBACs, so make sure you’re working with good evidence-based research when you consider the options.
There are lots of things we can’t control in pregnancy and birth and, ultimately, in the upbringing of our children. There are plenty of moments when we recognize something is out of our hands. All we can do to prepare for those moments is trust that we will rise to the occasion. Maybe that means rising to the occasion of a very hard labor. Or an unexpected c-section. Or a planned c-section.
We can’t plan whether the baby is breech, we can’t plan when to go into labor. We can’t control lots of things. But when we can make decisions, we should. Research has shown that women feel better about their births– no matter how the baby comes out– when they feel they are an active part of the process; when they are given good information, and options when they’re available. They are happiest when they feel they’ve been treated with kindness and respect at a very vulnerable time.
So talk to your doctor or midwife. Always ask questions when something is confusing to you. Medical authorities can seem all-knowing and powerful, which on the one hand can make us feel safe, but on the other, can lead to moments where we feel we feel out of control or out of the loop.
To this day I get a little dazzled by even the most perfunctory medical check up and forget to ask questions. But it makes such a big difference to your sense of what’s happening. And to your feeling of autonomy, which is so important in labor. You’re doing this after all. Your care-provider is not.
So ask questions. Ask twice if the answer goes over your head. Doctors and midwives actually like a an engaged patient. Not someone who shows no respect for their expertise; but rather someone who considers their job important and who is engaged in that process.
photo: salim fadhley/flickr