9 ways to avoid unnecessary Cesarean birth

4 Apr

In observation of April’s Cesarean Awareness Month, I would like to make a few comments and direct readers to several resources on cesarean section/surgical birth.

First, it’s important to acknowledge a few things on this topic:

  • Cesarean birth is major abdominal surgery, so it is not something to be taken lightly. There are more risks for both mother and baby in this mode of birth, and healing usually takes significantly longer and is more complicated for the postpartum parent.
  • It’s a good thing that cesarean birth is possible when it’s the best birth for a baby, but the vast majority of the time this is not the case.
  • Obstetricians’ primary training is in surgery. We tend to trust and lean towards our expertise. Also, many doctors never see a natural vaginal birth during their time in medical school/residency.
  • In 2014, the American College of Obstetricians & Gynecologists (ACOG) issued a major report on how to safely reduce the dangerously high cesarean rate in the U.S. They are 18 important and evidence-based recommendations. However, studies show that hospitals take an astounding ~17 years to incorporate new recommendations, so we are a long way from making visible progress in this area.
  • In a cesarean birth, the baby misses critical seeding of the microbiome, which is a major contributing factor in the overall health of the immune system of the baby. There is research being done on helping seed baby with mom’s vaginal microflora in cesarean birth, but U.S. hospitals are far from making it standard procedure.
  • In light of these things, expectant parents need to be their own advocates to reduce their chances of an unnecessary surgical birth.
  • For women who have had a cesarean in a previous birth: assuming healing goes well, it’s thought to be very safe (even optimal) to give birth vaginally in a subsequent pregnancy if she would like. This is called a VBAC. It’s important here, too, to find a supportive care provider for this specific scenario.

Lamaze_CesaraenInfographic

Reduce your chances of an unnecessary cesarean:

  • Choose a care provider who 1) has a low C-section rate and 2) is supportive of your goals. For low-risk, healthy women, it’s best to avoid working with an OB who specializes in high-risk since those patients more often require cesarean.
  • Consider hiring a midwife as your care provider, because this takes you one step farther away from a cesarean. Midwives work both in hospitals and home. They are experts in natural, uncomplicated birth and always work in conjunction with an OB in the unlikely event a cesarean is necessary.
  • Secure continuous labor support (doula or family in addition to partner).
  • Stay home as long as possible.
  • Use gravity-friendly positions in labor, balancing activity to help progress with rest for stamina.
  • Drink and eat; you need fuel for this marathon of indeterminate length! (Check out this late 2015 press release from anesthesiologists telling hospitals they should stop withholding food from the laboring woman.)
  • Use all your labor coping tools — these are learned most optimally in a birth class environment.
  • Request intermittent fetal monitoring if that is not your care provider’s default.
  • Wait for your labor to gain momentum (cervical dilation of 5cm+) before considering epidural or any medications, if possible.

In preparing for the unlikely but possible scenario of a necessary cesarean, discuss incorporating gentle cesarean techniques (aka “woman-centered” or “family-centered”) with your care provider in order to help it feel like the positive birth that is truly is. Information on this topic here and here.

Read more:

International Cesarean Awareness Network (ICAN)
What You Need to Know about Cesarean (Childbirth Connection)
Video: What’s the Deal with Cesareans? (Lamaze)
Statement on Cesarean Section (Coalition for Improving Maternity Services/CIMS) 
Video: Women-Centred Cesarean Technique (YouTube)

ACOG’s Report on the Safe Reduction of First Cesareans
How to Have a Natural & Gentle Cesarean (Wellness Mama)
“Using a Mother’s Microbes to Protect Cesarean Babies” (NY Times)
Microbirth (documentary)
Lamaze International: VBAC — Yes, It’s an Option!
VBAC Facts

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