by Janelle Durham, MSW, ICCE, LCCE. Program Coordinator for Great Starts
Birth & Family Education
It is clear that for many women and babies, cesarean is a vital tool for preserving health and
well-being. But, it should only be used when the benefits clearly outweigh the
risks of the surgery.
In 2006, 31.1% of the babies born in
the United States were delivered by cesarean
surgery. Maternity care advocates worry that this rate is too high, and that
this valuable tool is being over-used. Healthy People 2010,[i]
the World Health Organization[ii],
and Coalition for Improving Maternity Services[iii] recommend a primary cesarean rate of 15%
or less for maximum benefit.
Here are some things you can do to
decrease your chance of cesarean.
Choice of Caregiver
Interview multiple care providers.
Discuss you birth plan with each one. If you are not in agreement, or if you do
not feel comfortable with them for any reason, interview others. Pick one you
trust, who shares your goals, who has a low rate of interventions, doesn’t
place arbitrary time limits on labor, and encourages you to use a variety of
self-help techniques to aid labor progress.
Consider using a midwife as your
primary care provider. Midwifery clients typically have fewer medical
interventions overall, and typically have a lower
cesarean rate. If a cesarean does become necessary, your midwife will refer
your care to an obstetrician.
Choice of Birthplace
Learn what cesarean rates are at
local birthplaces. Cesarean rates are part of the public record: they may be
available on-line or by calling the health department, or you can contact the
facility directly. Cesarean rates range widely. For example, at hospitals in
the Seattle metro area, in 2006, rates ranged from 23% - 36%.
Tour birthplaces, and ask them
whether they routinely use interventions such as IV, continuous electronic
fetal monitoring, or prohibiting moms from eating and drinking in labor.
Consider an out-of-hospital birth. A
major study of home births for low-risk North American women showed that they
achieved a 4% cesarean rate with overall good birth outcomes.[iv]
Hire a Doula
A review of the evidence indicated
that continuous labor support is associated with 26% less likelihood of
cesarean and 41% less likelihood of assisted delivery.[v]
Educate Yourself and Prepare a Birth
Plan
Be aware of your rights – look
online for “The Rights of Childbearing Women.”[vi]
Take childbirth education classes
that emphasize informed choice and self-help methods to relieve pain and aid
progress.
Review your birth plan with your
caregiver to make sure you are both working together to decrease your chance of
cesarean
Take Care of Yourself in Pregnancy
Eat a healthy diet, do moderate
exercise.
If you are overweight, it is best to
lose the extra pounds before pregnancy. Aim for moderate weight gain during
pregnancy.
Options for a Breech Baby
If you are told at 35 weeks that
your baby is breech, attempt to turn baby. Options include: acupuncture or moxibustion, a chiropractic technique called the Webster
technique, positions which encourage baby to turn head down, visualizations,
and having your partner talk to baby way down in your belly.
Ask your doctor to perform an
external version at 36 weeks or 37 weeks: they place their hands on your belly,
and press and push baby to turn him head-down. (Version will not be an option
if you have a scarred uterus, or any vaginal bleeding)
Most American care providers do not
offer vaginal breech delivery. You may be able to find someone in your
community who does if you do a lot of phone calling. However, you should NOT
attempt vaginal breech delivery with a care provider who is not well-trained
and experienced.
Avoid induction
Do not induce labor for non-medical
reasons, such as convenience, or because you’re tired of being pregnant. If
your care provider suggests induction for debatable medical issues, such as
being a few days past your due date or having a big baby, ask what other
alternatives you have.
Research consistently shows that
induction increases the risk of cesarean.
During labor
Stay at home as long as possible.
Learn to tell the difference between early labor and active labor so you can
delay hospital admission till active labor.
Be active and mobile, changing
position often.
Eat and drink
Use medical interventions only when
clearly indicated, not just because they’re routine. For example, avoid
augmentation with Pitocin or breaking your bag of waters, avoid routine IV, and
avoid continuous EFM.
Avoid or delay epidural – use all
the self-help skills for coping with labor pain and aiding labor progress
before you turn to pain medications.
During pushing, use upright or
side-lying position, spontaneous pushing,
If cesarean is recommended for
failure to progress
Ask your care provider about
timelines: can you labor for another hour before c-section?
If you’re still in latent labor
(before 5 cm), ask for sedatives to help you sleep, see
if you progress.
If in active labor, ask what other
options you can try before cesarean. Change positions? Pitocin?
Pain medications?
If pushing, ask about vacuum
extractor or forceps.
If you are not comfortable with your
caregiver’s response, you can ask for a referral to another caregiver for a
second opinion.
If cesarean is recommended for fetal
heart rate variations
Ask: how serious is it? How much
time do we have to make a decision? Would any care provider looking at this
heart rate recommend a cesarean, or would some think it was OK? Are there other
things we could try before cesarean: changing position? Giving oxygen or IV
fluids? Give me Pitocin or take me off Pitocin?
Sometimes, despite doing all you
could to prevent it, you reach a point when cesarean is a better option for you
and your baby than a vaginal birth. If this is the case, see our article on
having “The Best Possible Cesarean.”
Go to: Our
article on Cesareans
Our article on The
Best Possible Cesarean
[i] www.healthypeople.gov/Document/pdf/Volume2/16MICH.pdf Healthy People 2010
[ii] World Health Organization [WHO]. (1985). Appropriate technology for birth. Lancet, 2(8452), 436-437.
[iii] Goer, H., Sagady, M., and Romano, A. (2007) Evidence Basis for the Ten Steps of Mother-Friendly Care: Step 6 – Does not routinely employ practices, procedures unsupported by scientific evidence. Journal of Perinatal Education, 16: 1S, p 32-64. tinyurl.com/2erpvh
[iv]
Johnson, K., Daviss, B. (2005) Outcomes of planned
home births with certified professional midwives:
large prospective study in North America. BMJ 330:1416
[v] Hodnett ED, Gates S, Hofmeyr G J, Sakala C. (2003) Continuous support for women during childbirth. The Cochrane Database of Systematic Reviews 2003, Issue 3.