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How To Avoid An Unnecessary C-Section

By ceridwen |

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

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About ceridwen

ceridwen

ceridwen

Ceridwen Morris is a writer, mother, and certified childbirth educator. She is the author of several books and screenplays, including (Three Rivers; 2007). She serves on the board of The Childbirth Education Association of Metropolitan New York and teaches at Tribeca Parenting in New York City. Read bio and latest posts → Read Ceridwen's latest posts →

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9 thoughts on “How To Avoid An Unnecessary C-Section

  1. Andrea says:

    Great article, but a quick comment about the numbers. If the rate should be around 15% and it’s around 30% (just for the sake of simplicity), that makes half of all c sections unnecessary, and means that 15% of all births (not just surgical births) end in an unnecessary c section.

    1. ceridwen says:

      Andrea– Thank you. Of course! You’re absolutely right. Making the edit.

  2. mary says:

    Working as a pediatric therapist in a
    childrens hospital I can tell you that is better to be safe than sorry. Believe me when I tell you that I treat many children with developmental delays due to complications of a vaginal delivery. Have not treated a single child with complications from a cesarian delivery. Why would you put your child at any risk!!??. while I do agree that some c-section deliveries are probably unnnecessary why would you even place your child at risk for possible delays.

  3. Danielle625 says:

    @Mary, I would rather go for a VBAC than a c-section just because of the lower risks for mothers and babies, especially in future pregnancies. I have seen birth injuries just from over handled vaginal births, where the OB or Midwife should have just been more hands off. Emergencies can happen in any deliveries but moreso c-sections.

  4. Melgirl says:

    Sorry Mary, but your “better safe than sorry, just have a cesarean” approach doesn’t hold up under the science. Pretending that cesareans don’t carry risks for mothers and babies is dangerous. Babies face increased risk of breathing diffuculties, time in the NICU, increased risks of asthma/allergies (asthma a leading cause of illness and death in kids), prematurity and death. For moms, cesareans pose significant short and long-term health risks (infection, bleeding, dangerous placental abnormalities, death), and the sharp rise in cesareans coincides with the maternal death rate rising for the first time in decades in the U.S. Yes, vaginal births pose risks, as you see in your profession. But research shows that, all things being equal, vaginal birth is safer for moms and babies. An abundance of research shows cesarean poses significant risks, is major surgery, and should never be done without a darn good medical reason.

  5. MELISSA says:

    As a mother who just received a very medically needed Cesarean, I have to say that it does have a lot of risks and does cause problems for the babies. I was never able to go into labor, and the baby never went through the birth canal. This causes breathing problems because certain hormones are never released to tell the baby to push the fluid out of their lungs. Also going through the canal helps the baby clear their lungs to allow them to breath. I don’t know the medical terminology but my baby would of been healthier if I could have had her vaginally. (I was in full HELLP syndrom so that wasn’t possible)

  6. Tiffany says:

    I was lucky and was able to birth my now 8 year old daughter vaginally. Although I have heard of cases where the mother had to have an emergency c-section. My step-mother had to have my half-sister c-section. The embilical cord was wrapped twice around her neck preventing my sister from being born vaginally. Thankfully to this day she lives a very happy and healthy life being 11 years old and LOTS of friends.

  7. C Section Recovery says:

    What is clear is that a broad, clear, evidence based education program for both those working in the medical system and mothers to be is absolutely necessary.

    The evidence from numerous studies is available, if there is to be a halt and reduction on the ever increasing c-section rates, the results from these studies need to be collated and used as the basis for a clarification of cesarean reducing procedures to be adopted across the country.

  8. Trisha lawrie says:

    Number 11: consider homebirth!!!

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