14 Tips to Avoid a Cesarean

I had the pleasure of speaking at our local International Cesarean Awareness Network yesterday on this topic, and now I'm posting my list here. Before reading please know that you can do everything on this list and still need a cesarean. This list is to help you either avoid an unnecessary cesarean or a cesarean caused by interventions used inappropriately. There will always be some women who truly end up needing a cesarean for the health of her and her baby.

No one thinks they will have an unnecessary c-section, but many c-sections are preventable. The personal beliefs and philosophy of your doctor, the policies of your hospital, and the decisions that you make before and during labor can all make a c-section necessary that could have been avoided. Right now 1 in 3 American women are giving birth surgically. If a vaginal birth is important to you, then you need to take your birth seriously.

{One} Choose a Natural Birth
Some people see a natural birth as an attempt to gain bragging rights, or a selfish mother’s desire for a specific birth experience. However, the interventions that are necessary for a medicated birth come with very serious risks, many of which increase your chances of a c-section. This is referred to as a “cascade of interventions” and poses a real danger to mothers and babies. Preparing for a natural birth will help a couple avoid many of these risks and a surgical birth.

{Two} Maybe Don’t Hire a Surgeon to Attend Your Normal Birth

“It is no longer feasible for individual physicians who have invested 12 years in training at the cost of hundreds of thousands of dollars to dedicate extended periods to observing one normal woman in labor." (Macer 1992)

Many women don’t realize that much of an obstetrician’s training is in surgery. Some MD’s went into obstetrics not because of a love for natural childbirth, but because of their love for surgery. This is of course not the case for every doctor, but it’s something to consider when deciding on your provider. Highly trained surgeons are exactly what you want in an emergency, but in a normal birth, they may see complications that aren’t there and act prematurely. Some obstetricians hold the personal philosophy that surgical births are a simpler, easier way to birth, so they might be more likely to try to "save you" from your vaginal birth. Ask lots of questions and pay attention to how encouraging your provider is when you express your desires. Their reaction does matter.

Worldwide most expecting mothers hire midwives to attend low risk pregnancies. If a midwife finds mom to need specialized care, mom transfers to an obstetrician. This model shows better outcomes for mothers and babies. A midwife is a medical professional who has received extensive training in both facilitating normal birth and recognizing possible complications. Prenatally she does everything an OB does in a typical appointment, though is often more thorough.

{Three} Skip Providers Who Ban VBACs
A VBAC ban says a lot about your provider’s philosophy and knowledge when it comes to birth, as well as the hospital’s preparedness in the case of an emergency. If your provider does not attend VBACs despite the American College of Obstetricians and Gynecologists and The National Institutes of Health‘s 2010 recommendations to do so, what other recommendations are they not following? Where else are they not providing the safest, most evidence based care?

A hospital that does not allow VBACs often gives the excuse that they can't because they do not have an obstetrician or an anesthesiologist on the floor in the case of an emergency. This may seem reasonable, but wouldn't every couple choosing a hospital birth want a labor and delivery unit that is fully prepared for a sudden emergency? In reality this risk is very low, but many couples choose hospital births to have immediate access to emergency care, it's important to know which hospitals do not provide this.

{Four} Know C-section Rates
Find out the c-section rate for both your hospital and your provider. Hospital rates are easy to get, you can simply go to cesareanrates.com. You can get your provider’s rate by simply asking them, “how often do your mothers need a c-section?” That’s a little less confrontational than “What’s your c-section rate?” If your provider is defensive or doesn’t want to answer, that’s a red flag. The World Health Organization recommends 10-15%. Locally hospital rates vary from 23% at Sutter to 33% at CHOMP.

{Five} Take a Natural Childbirth Class
A natural childbirth class will teach you the risks of a c-section and skills to avoid one.  Be aware the difference between a birth class that simply informs you of options, and a natural birth class that gives you skills to achieve your goal of a vaginal birth with a past record of helping other couples achieve their goals. A good natural birth class can cut your chances of a c-section in half. Couples who chose the curriculum I teach, Birth Boot Camp, only had a 14% c-section rate in 2013, and I can say personally none of my students delivered by cesarean last year despite a few long (40+ hr) labors. The decisions these couples made prenatally likely prevented a cesarean in labor.

{Six} Let Baby Choose His or Her Birthday
In other words… don’t get induced unless absolutely medically necessary. Many women trust that their doctor will only suggest an induction if it is medically necessary but that just isn’t true, couples must be informed. An induction DOUBLES your risk of a c-section!

{Seven} Don’t Take Pregnancy Laying Down
Getting plenty of rest in pregnancy is important, but so is staying active! It has been reported that women who are sedentary though out their pregnancy have 4X higher chance of needing a c-section. Staying active can keep you healthy and low risk. Be sure to also eat a balanced, whole foods diet with plenty of protein to remain low risk.

{Eight} Hire a Doula
Most couples don’t think they need a doula, but doulas have a real measurable impact on how your birth plays out. Having a doula present has shown to lower the c-section rate for those couples by up to 50%!

{Nine} Shut Down Negativity
Do you have a sister who loved her c-section? Is your mom telling you that you are just too thin to birth a baby normally? Women make these kinds of negative comments to expecting women all the time, not really considering how it may affect her. These comments are more about themselves than the expecting woman, they are voicing their own fears, disappointments, or insecurities. You can choose to remind them that birth is normal and you are making informed decisions to have a safe birth, or simply let them vent their feelings, knowing they are about them and not you. Try to surround yourself with women who trust birth and read positive birth stories.

{Ten} Choose a Comfortable Birth Environment
A mother who is terrified of the hospital will likely be unable to open and birth vaginally there. A woman must feel comfortable and safe for oxytocin, the hormone that causes contractions, to work properly. Feeling anxious and scared causes a surge of adrenaline which will interfere with oxytocin, slowing or stopping labor. Does mom desire a home birth but dad is anxious? Dads, do your research and help your partner birth where SHE is most comfortable, otherwise you may be setting her up for a risky surgical birth. Whether you choose a hospital, birth center, or home birth, be sure it is an environment you are extremely comfortable in.

{Eleven} Hospital Birthers, Labor at Home
A common reason for a c-sections is “failure to progress,” which much of the time means mom and baby were not in any real danger, labor just took longer than the doctor or hospital staff were willing to wait. Some women labor the textbook 12-14 hours, but many don’t, that’s just the average. Long, slow labors happen more often than you think, though not normally in a hospital because those moms are given medications to speed labor or c-sections. Once at the hospital there is a good chance you will be on the clock so consider not going until you are very close to birthing your baby, which you can determine with the help of a natural childbirth class and a doula.

{Twelve} Use Movement 
Movement and gravity help baby move down, and movement can be an excellent way to cope with contractions. Lying in a bed makes labor longer, more painful, and some babies just cannot come down when mom is lying. Some hospitals require women lay in beds with monitors strapped to their belly. Studies have shown that this increases the rate of cesarean without improving outcomes for babies. Choose a provider and birth place that uses intermittent monitoring.

{Thirteen} Keep People & Things Out of Your Vagina
A common intervention is cervical checks which are done by inserting two fingers into the vagina and then into the cervix.  This can be mildly uncomfortable or painful. A cervical check can push bacteria into the body, causing infection, maternal fever, and ultimately a cesarean. Cervical checks can also lead to a “failure to progress” diagnosis. Some doctors order internal fetal monitors for women which can also lead to infection in addition to restricting movement. Even in labor your body is still your body, frequent cervical checks are not necessary for a normally laboring woman.

{Fourteen} Options for Butt Down Babies
For babies who are breech (butt or feet coming first) some doctors will only do c-sections and not even inform women of the other options. Women carrying a breech baby can seek chiropractic care, acupuncture, moxibustion, find a provider who will do an external version to turn baby, or choose a provider who will attend vaginal breech births. Yes, babies can be born breech safely! In Monterey County we have several obstetricians and midwives who will suggest all the above and are happy to assist vaginal breech births. Ask your provider early on what their protocol is for breech babies, if he or she says c-sections are the only option, consider switching to a provider that will be more honest while helping you explore your options.

If despite your preparations you still need a cesarean, it's ok to feel a sense of loss. It may seem like all of your efforts were for nothing. None of us are promised an uncomplicated birth, but by being informed, choosing a supportive provider, safe birth place, and being an active participant in your birth you may be able to find comfort in knowing you and your birth team did everything necessary for a safe birth. If you are hoping to prevent or are recovering from a cesarean, I encourage you to join a local International Cesarean Awareness Network (ICAN) chapter.

Some additional resources:
The Unnecesarean
 VBACFacts.com
ImprovingBirth.org