How to Avoid a Cesarean - Ten Steps to Take for a Healthy Delivery

As Amanda shared in her article "Cesarean Rates are Rising", there is indeed a dramatic increase in Cesarean rates the past five years. While she examines the rise in elective C-section rates I would like to also examine reasons to avoid a C-sections, and steps you can take to help decrease the likelihood of a surgical birth.

Some Common Myths About C-Sections

~ " An elective Cesarean is as safe for my baby as choosing a vaginal birth."
Sometimes when we begin to examine the many choices available to us during pregnancy, labor and delivery we forgot that not every choice is equal. Indeed, with so many Cesareans now becoming matters of "convenience" it was startling when researchers at the U. S. Center for Disease Control and Prevention published the results of a new study in August 2006 stating that the death rate among neonatal infants (younger than 28 days) delivered by Cesarean was more than twice that of infants delivered vaginally. The article states that "this held true even after the researchers adjusted for socio-demographic and medical factors". In other words, Cesarean births weren't higher risk for the infants because higher risk pregnancies are often delivered by Cesarean; they were higher risk births due to the procedure itself. A scary statistic in light of the increasing number of women who chose Cesarean with no medical necessity.

~ "A Cesarean is a common procedure with little risk to me."
With Cesarean births more and more common it is easy to forget that a Cesarean birth is considered major abdominal surgery. You have not only all the risks associated with pregnancy and delivery, but also the greater risks associated with surgery of any kind. In fact, the September issue of Obstetrics & Gynecology published an article detailing the results of a study done in France that examined postpartum maternal mortality rates. Over the five year study they found women who deliver via Cesarean section are three times as likely to die from complications as women who deliver vaginally. The primary causes of death after Cesarean were thrombosis (blood clot), infection, and anesthesia complications.

~ "I will suffer less if I have a Cesarean Birth."
There are many methods of pain management for a vaginal delivery, not all of which require drugs. Consideration needs to be given to the type of pain felt, as well as the cause of the pain in both methods of delivery.

With C-sections the pain during delivery is non-existent because of the anesthetics, however the pain during recovery is often constant and long-lasting. Women can feel deep abdominal pain for months after the surgery. Dealing with pain, recovery from a major surgery, and the complications that can arise from surgical birth also comes at the worst time....when the new mother is trying to deal with a brand new infant, sleep deprived and often fighting postpartum depression.

Studies show woman recover from vaginal births faster, and suffer less postpartum depression than with a surgical birth. During vaginal deliveries the pain is intermittant and effectively over once the baby has arrived. One of the ladies I spoke with who has had one C-section and one natural VBAC (vaginal birth after cesarean) put it this way, "With my Cesarean I still suffered pain, in fact more than with my second birth. All I did was delay the pain until the very time I wanted to be the most attentive and focused to spend time with my new baby."

How to Minimize my Risks

In this next section I want to discuss several ways you can help minimize the chances of your labor ending with a surgical delivery. Obviously, there are times when a baby should be delivered via C-section, however according to the American College of Obstetricians and Gynecologists (ACOG) only about 10% of all total pregnancies should end surgically. With C-section rates much higher than that we have to wonder where the discrepancy comes from. Unfortunately, it often comes from patients not taking responsibility for their own health and health care decisions as many doctors will sometimes "err on the side of caution", leading to unnecessary C-sections.

1-Use Good Nutrition During Pregnancy
When you and your baby are healthy your chances of high risk pregnancy go down. And when you have a "low risk" pregnancy you have more options in terms of interventions to avoid during labor, reducing your risk of Cesarean. Eat lots of healthy carbohydrates, especially the last couple weeks, so you'll have lots of energy to draw from during your labor. Also, check out the website Blue Ribbon Baby for some fantastic information on a diet that can help prevent pre-eclampsia and toxemia, conditions that will make your pregnancy a high-risk pregnancy.

2-Stay Out of Bed!
You are in labor; not ill. Women who stay active during labor have been proven to have shorter labors, more comfortable deliveries, fewer forceps deliveries, better coping skills (as measured by amount of pain medication given) and generally feel more in control than women who lay in bed throughout the entire labor. Make sure your hospital policies will not interfere with your ability to walk around, sit upright, or squat in an upright position. Many hospitals will try to get you to consent to constant Electronic Fetal Monitoring (EFM) which makes it more difficult for you to move freely. Routine use of IV is another intervention many hospitals use that can impede a woman's mobility. Discuss these things with your care provider ahead of time so you know what to expect, and can secure their cooperation.

3-Stay Home for as Long as Possible During Early Labor
Early labor is the longest stage of labor, especially in first time moms. You will be more comfortable, and less stressed in your home environment and your pain level will stay lower at home than once you arrive at the hospital. Staying home during early labor also helps you avoid unneeded interventions like enforced fasting, routine IV's, and constant EFM which can all increase your chances of Cesarean delivery.

4-Avoid Induced Labor if Possible
Studies have proven that the average first time mother actually has a gestational period of 41 weeks and 1 day. According to the research you aren't "overdue" until you hit 42 weeks. Be sure you discuss with your doctor or care provider whether an induction you may be discussing is absolutely necessary. Many inductions fail for the simple reason that the baby wasn't ready yet. In fact, medically induced labors are associated with an increase in Cesarean rates three times higher that of "God appointed" labors.

5-Eat and Drink as Desired During Labor
This is another area where many hospital "policies" fall short of what the research says is true. Recent studies have shown that women who are allowed to eat and drink as desired during labor (most women desired food during early labor and all desired fluids throughout) had shorter labors, needed less Pitocin augmentation (Pitocin augmentation significantly increases the risk of Cesarean), had babies with higher Apgar scores and less metabolic and blood sugar issues, felt more in control and required fewer pain medications (which all increase the risk of Cesareans as well). There was no difference in the number of mothers who were nauseated during labor.

6-Request Intermittent Fetal Monitoring
Avoid constant electronic fetal monitoring as it has been shown to drastically increase the rate of Cesarean, while doing nothing to improve the outcome of the infant whatsoever. Contrary to what they expected to find, when the American College of Obstetricians and Gynecologists finished their review of the use of electronic fetal monitoring during labors they found that not only does it NOT improve babies outcomes, but actually caused a much higher rate of operative deliveries, both vaginal (use of forceps and/or vacuum extractor) and Cesarean. In response to the new evidence they changed their recommendation to intermittent monitoring every 15 minutes during active labor and every 5 minutes during second stage (pushing stage). This means that rather than being constantly strapped to a machine, they recommend a nurse come in every 15 minutes to check the babies heart rate and your vital signs. This decreases the risk of surgical births dramatically.

7-Stimulate Labor Naturally if Necessary
There are several ways to stimulate labor naturally if your care provider feels your contractions are not strong enough. Many doctors will automatically use Pitocin, a synthetic form of the chemical oxytocin your body produces naturally, to stimulate stronger labor contractions. The risks associated with Pitocin are many, however. These include more painful, longer and stronger contractions leading to an increase of pain medication use, fetal distress and dystocia which all increase your risk of Cesarean deliveries. If you must stimulate your labor try using the restroom, walking, or nipple stimulation. Nipple stimulation will release oxytocin into the body naturally, not only triggering stronger contractions, but also providing natural pain relieving endorphins, a benefit synthetic Pitocin does not have.

8-Use Natural Forms of Pain Management
There is no drug used for pain relief during labor that does not carry with it risks of adversely affecting the baby. Many, including the epidural, also carry with it an increase of Cesarean birth rates. There are many forms of natural pain relief which can be utilized during labor. I will list them briefly here, and cover them in detail in later articles. Successfully coping with labor without using drugs can be achieved through the use of a doula or labor coach, massage, water, heat therapy, changing positions, music, soothing lighting, frequent urination, vocalization, visualization, hypnosis, and verbal encouragement from others in the room.

9-Carefully Choose Your Care Provider
Just like with every other occupation there are good, and there are bad. If you knew your friend took her car to an auto mechanic and he racked a huge bill, and then a co-worker took her car in and had the same thing happen, you might get a little leery; and with good reason! Ask questions. Discuss your options, concerns and desires with your care provider. Find out what their personal Cesarean section rate is as is can vary from person to person as drastically as 3% C-section rate from one midwife I know, to over 75% C-section rate from a doctor I know. Find out what interventions they consider "routine" and how flexible they are to listen to your desires. Remember, it is your body and your responsibility so don't be afraid to ask for what you want. Traditionally midwives tend to be more holistic in their approach than OB's although that isn't always the case. Ask around and don't be afraid to switch providers if you aren't comfortable at any point.

10-Consider VBAC if You Had a Previous Cesarean
Again, many hospitals will have a blanket policy against VBAC, however the World Health Organization recommends allowing VBAC's to prevent unnecessary secondary C-sections. Over 75% of VBAC attempts are successful (a higher rate of successful vaginal births than the local hospital in the town my son was born in!) so it can certainly be done. While discussing the pros and cons of VBAC are beyond this article, I highly recommend the book VBAC Companion by Diane Korte if this is something you are considering. It must be a well-educated and informed decision as there are some situations in which VBAC should not be attempted.

Information is Power

Cesarean births are a God-send for those precious infants who would have died without this lifesaving medical procedure. However, it isn't something to be chosen lightly or decided on a whim. Part of parenthood is responsibility and learning to make decisions that impact someone else's life. It begins in pregnancy and isn't finished until you stop being a parent (never!). The myriad of choices surrounding labor and delivery are just another part of that. Do your research, discuss any and all questions with your care provider, and in the end you have to make the decision that is best for you and your family given your specific situation. The more informed you are about that decision, the better you will feel once you've made it. Hopefully now you've had some Cesarean myths dispelled and can be more informed in your decision making process to avoid a surgical birth if desired.

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