A Woman’s Perspective: How to Avoid a C-Section
If your pregnancy is healthy and you don’t have any medical reasons to have a C-section, it’s best to have your baby vaginally.
The cesarean birth rate, first measured in the 1960s, is now as high as 32 percent in some areas of the US. Debate and concern continue as to why the rate is so high in specific areas. Some factors include an increasing number of multiple births, higher rates of obesity with concomitant diabetes in some women, and advanced maternal age.
Research shows many C-sections are unnecessary, the outcome of not giving low-risk pregnancy women more time in labor, and not adequately championing a “keep calm and labor on” attitude in both the early phase of labor (allowing women to stay home longer in the safety and cocoon of their own home) and the active phase of labor.
New studies illustrate that old labor curves do not provide adequate time for cervical change.
Guidelines now allow for a new addition of active phase labor (cervical dilation of 6 centimeters instead of 4 centimeters), as well as for more time in dilation and descent (four hours instead of two hours). This will play a key role in lowering the number of unnecessary C-sections and reducing the U.S. cesarean birth delivery rate.
There will be cases where C-sections are medically necessary. C-section is major surgery resulting in increased infection rate, maternal blood loss, maternal mortality rate, and potential problems for the baby. Further, compared with vaginal birth, recovery after a C-section is typically longer. Moms may experience as much as six weeks of post-operation pain and bleeding versus some perineal pain for one to two weeks and some bleeding for about four weeks after vaginal birth. And women who have a C-section for their first babyface subsequent pregnancy risks, including a higher chance of the placenta implanting or growing abnormally, or uterine rupture along the site of the first cesarean scar.
Unfortunately for too many women in this country, once a C-section is done, their remaining pregnancies are often delivered by C-section despite the plethora of good evidence that this need not be the case. I encourage women who have had a C-section to learn all they can about vaginal birth after cesarean.
New labor and delivery guidelines from the American College of Obstetricians and Gynecologists have significantly contributed to reducing unnecessary cesarean births, along with the federal government’s stated Healthy People 2020 cesarean delivery rate goal of 23.9 percent (or lower) for the first pregnancy, full-term, head down, cesarean births. Although still high, a 23.9 percent cesarean birth rate nationwide is a strong and viable goal for providers and healthcare institutions to have over the next three years.
All women are encouraged to educate themselves to help reduce their chance of experiencing an unnecessary cesarean birth. In doing so they will learn to trust their bodies more in childbirth, surround themselves with knowledge and, if an unexpected medical complication is encountered that does require having a C-section, they will understand why.
Here are some tips to help prevent unnecessary cesarean births:
- Consider having a doula in the labor and delivery room with you. Studies show women who use a doula are less likely to have a cesarean birth. A trained labor support person, a doula is not a doctor and therefore is not trained or permitted to give medical advice. Research shows, however, that doulas, working in combination with ob-gyns, midwives, or nurses, provide gentle advocacy — and a unique combination of communicative, physical, emotional, and informational support.
- Interview the team of doctors, midwives, and other labor and delivery support people you are considering so you can ascertain what philosophy they have about labor and delivery. You want people who will listen to you when advocating for yourself. Be sure to ask when they would intervene with surgery, when would they consider surgery appropriate, what their vaginal birth after cesarean rates are, and the number of first-delivery cesareans.
- Plan to deliver your baby in a facility that provides an environment for low C-section rates, and has a low primary cesarean rate — ideally near 20 percent. All hospitals are required to provide these rates.
- Read books on labor and birth, and attend childbirth classes to increase your body confidence, build trust in the birth process and feel at ease talking with your providers. Both offer labor coping skills, and help you make decisions should interventions be needed. I recommend: “The Thinking Woman’s Guide to a Better Birth” by Henci Goer; “The Official Lamaze Guide: Giving Birth with Confidence” by Judith Lothian and Charlotte Devries; and “Ina May’s Guide to Childbirth” by Ina May Gaskin. I also recommend two booklets published by Childbirth Connection, “What Every Pregnant Woman Needs to Know About Cesarean Section” and “Pathway to a Healthy Birth.” Of note, “A Declaration of the Rights of Childbearing Women” by Leilah McCracken was written in 1999 for Midwifery Today. It’s still a timely information-sharing piece.
- Avoid inductions simply to bene t schedules — research shows induction of labor in first-time moms may lead to an increased cesarean rate. Learn about types of induction and alternatives. If induction is needed for medical reasons, talk to your practitioner about the type of induction that he/she feels will work best for your specific situation.
- Learn how to recognize active labor and don’t go to the hospital until you have strong, active contractions. Since you often will not know when to go, be prepared to be sent home. The intensity of contractions is a much better guide to active labor than the timing of contractions. The more hours you are at the hospital prior to your baby’s birth, the higher your risk of intervention.
- Try to avoid an epidural in early labor. There are times when getting an epidural can actually help a woman have a vaginal birth, but many studies show an epidural in early labor increases your time in labor and can lead to interventions. Your childbirth classes and the healthcare provider may be able to give you natural tools to not need an epidural.
- Be sure your partner — if you have one — attends your childbirth class with you, and reads some of the same childbirth material you are reading. Even with a doula, your partner is an important part of your birth journey and can play a significant role in keeping you calm, laboring on, and preventing an unnecessary cesarean delivery.
The Marin Independent Journal welcomed Dr. Lizellen La Follette as their health columnist from 2015-2018. Her A Woman’s Perspective column appeared every fourth week in the Journal during these 3 years.