6 Tips to Avoid a Cesarean

I’m often asked how to avoid a cesarean. While none of these tips is a sure fire way to avoid a cesarean, they can definitely help you, especially as you add them together.

baby in c section, avoid cesarean, cesarean birth, what happens in cesarean birth, baby held high, holding baby up, baby in lights, April is Cesarean Awareness Month and I am devoting my posts this week to issues surrounding cesarean births. Last week, I wrote about cesareans in general and the U.S. c-sections rate as well as some of the myths as to why the c-section rate is as high as it is.

6 Tips to Help You Avoid a Cesarean

1. Choose a Provider You Completely Trust

Your provider will be making the clinical judgment calls throughout your pregnancy, labor and birth; you need to be totally comfortable that your provider hears you, understands your hopes and visions for your birth and demonstrates respect for your questions and birth wishes.

If you leave appointments feeling unheard, brushed off or uneasy, trust your gut. Perhaps that indicates you should shop around. Ask your provider what his/her individual cesarean rate is. How decisively did they answer? Did you get a solid response or a vague explanation of their high risk patient load? How does their cesarean rate line up with the hospital, state and national rates? I’m not suggesting an elaborate analysis, but know this number and listen as you ask.

Remember, too, that while you may love one doctor in a group, you may never see that doc during your labor and birth. Obstetricians are surgeons, consider that as you decide who to hire are your provider. Low risk Moms do very well with midwives whose care is generally collaborative, low intervention, and individualized.

The midwifery model of care is based on pregnancy as a state of wellness, the medical model is focused on complications and problems. Childbirth Connection is a fantastic resource and in this article, explains the differences between the care models of midwives and doctors.

2. Choose the Birthplace Where You Feel Most Comfortable

Labor progresses best when Mom feels at ease, safe and protected. We are mammals, and like mammals, if uninterrupted we often birth in the dark and peace of the night. Also, like mammals, if we feel afraid or threatened, labor can stall or even halt until we feel safe again. For some, this is a choice between hospital, birth center or home, for others it will mean choosing between which hospital makes them feel most comfortable.

Don’t just consider the flashiness, the appearance and the “look” of the facility, but the community reputation, the size, how the staff makes you feel and whether you need to go through triage. Evaluate your prospective birth place on it’s cesarean rate. In discussing how to avoid a cesarean, make sure you know if the hospital where you are planning to give birth is on the high or low end of the national average. What is their primary c-section rate and how does it rank up against the WHO recommendations, and the national average?

Your birth place may be guided by where your provider practices, but these two decisions go hand in hand and are the first critical decisions you make in owning your birth.

3. Own Your Birth

“If you don’t know your options, you don’t have any,” is a truth noted by Diana Korte and Roberta Scaer, authors of A Good Birth, A Safe Birth. You cannot make truly informed decisions if you do not have balanced and thorough information. Evaluating an intervention takes knowing the hoped for benefits, the possible side effects, what other procedures or interventions may be needed because of it, and what would happen if you did nothing. If you do not know your options, you won’t know what to ask or how to best weigh a suggested intervention.

Remember that this is YOUR birth, you are the customer, speak up, ask questions, read the research, read evidence-based books. [Suggested authors: Henci Goer/Amy Romano, Ina May Gaskin, Debra Pascali-Bonaro, Penny Simkin]. Go into your birth feeling confident that you understand where the science comes down on common or routine procedures.

You cannot subcontract this out. You can hire or invite in support, but you must do your homework, grab on, own your birth and advocate for yourself.

Here are a couple of examples to get you started digging (hint: both of these can increase your chance of a c-section). Continuous electronic fetal monitoring shows no improvement in outcome and may increase inductions, cesarean babies, suctioning a baby, blue bulb syringe, blue bulb suction, hospital suctioning, OR, picture in a cesarean, what happens in a c section,cesarean rates, read to learn what it is and the alternatives. Induction – it’s best to let labor start on it’s own. A failed induction = a c-section.

4. Hire a Doula

Admittedly, I’m biased, but the research supports my bias! This systemic review showed that women who received continuous labor support were less likely to have any anesthesia medications, less likely to have assisted births (vacuum or forceps), less likely to rate their birth negatively and they were more likely to avoid a cesarean.

Freedom of movement, changing positions, and using gravity are all beneficial in labor and in working to avoid a cesarean, and a doula will have a Mom moving!

5. Optimal Fetal Positioning

I’m always saying, “Stack the deck in your favor.” The tips included here will help you do that and they have a cumulative effect. I love Gail Tully’s Spinning Babies website which is based in the concept of optimal fetal positioning. By being conscious of Mom’s own position in pregnancy, especially in the last trimester, plus doing some of these exercises, seeing a chiropractor, doing yoga, all can help get your baby into the best possible position before labor even begins helping to avoid a cesarean.

 6. Decline or Delay an Epidural

Stay home and enjoy early labor, bake a birthday cake, play Monopoly and alternate activity and rest, don’t rush to the hospital. Nothing happens faster there, and in fact, getting there too early can slow things or open you to unnecessary interventions that could ultimately lead to a C-section.

Even if you’re planning an epidural, it’s will help you to avoid a cesarean if you’re able to delay it until you are at least 5 centimeters dilated. Epidural medications can cause Mom’s blood pressure to drop and can slow contractions. Stalled contractions can lead to the need for Pitocin which sometimes is not tolerated well by the baby which can lead to a cesarean. An epidural limits movement and can make it harder for a baby in a bad position to get into a better one for birth.

There are times where an epidural is just the thing to allow a Mom to rest and open but even then, delaying it is less likely to result in a C-section. Take a natural childbirth class to learn relaxation and comfort measure for labor until you get an epidural, or to avoid one entirely.

Later this week: Tips if you’re having a cesarean.

 

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17 Responses to 6 Tips to Avoid a Cesarean

  1. Joanna says:

    These are good tips but I’m very thankful for my c-section, which saved my Son’s live (and mine) when I had a placenta abruption.

    • Leah DeCesare says:

      Absolutely! That is a true emergency and there is a reason for c-sections! They can be life saving! You make a good point – these are tips to avoid an UNNECESSARY cesarean! (Unnecessarean) 🙂 To give yourself the best possible shot at vaginal birth.

    • Cass Michael says:

      But don’t forget- sometimes doctors TELL parents the C-section saves lives when really in the particular case it might not have.

  2. Michele C. says:

    Good tips. I actually would have needed a c-section if not for my epidural – it relaxed me enough to finally progress past 5cm where I had been stuck for hours without progress. So I’m glad I got it when the pitocin contractions were just too much (induced because of gestational diabetes). I delivered at a ‘high’ c-section rate hospital for the area but gave birth there twice with no c-section, with amazing doctors, and at a hospital with a level 3 nicu, which meant that when my daughter had to go to the nicu, we weren’t separated. That is what made me comfortable – to know that if (or in my case, when) something went wrong, we were both in the best place for help. I went into my births with plans that were thrown out the window for various reasons, and being flexible and open to whatever was safest for me and my baby was the best approach possible.

    • Leah DeCesare says:

      You’ve got the right mindset – no one knows how their labor will unfold and it’s important to be flexible and educated about different possibilities. I have seen an epidural work beautifully like it did for you, to relax and allow progress, perhaps that even helped you to avoid a cesarean!

      You note something important, too, just because a hospital has a high c-section rate (say 33%), there are still 67% of babies that are delivered vaginally there! It can simply speak to the culture at the hospital and is good data to know and factor into a decision about birth place. Thanks for sharing your story!

  3. I couldn’t agree more!! I think the difference in attitude toward our sections is if we believe they were necessary or not. When you believe it saved you or your baby then it’s easier to get over the disappointment. But when you believe it was unnecessary, then it’s really hard to look beyond the extra recovery time and impact on future pregnancies.

    • Leah DeCesare says:

      Great points! Mom’s own perception of the birth is what matters most and must be respected. It’s not helpful – and in fact is hurtful – when someone says, “What difference does it make? At least you have a healthy baby.” Mom knows that and is grateful for that – but she can grieve the loss of the birth she wanted simultaneously and that must be acknowledged and supported.

  4. These are great tips! Thanks for sharing. I think many moms go in to the whole L&D process completely unprepared and uneducated. But, like Stephanie said, it is all in your attitude and perception.

    • And c-section isn’t the only thing that can go “wrong” in your l&d…..I had my daughter vaginally, but it was still very traumatic, and not at all the labor I had hoped for.

      • Leah DeCesare says:

        True on both comments. The evidence shows that doula support actually improves a Mom’s view and satisfaction with her birth. Every woman deserves experienced support dedicated only to her and Dad’s/partner’s needs.

  5. Very interesting post! I had 3 vaginal births and then my 4th was a c-section because I had done such horrible damage to my body and they were afraid another vaginal birth would be too dangerous for me and my baby. My 5th is a c-section, too. I remember trying to avoid them with the first 3, but then I had to for the safety of my babies (and me) for the Henry and now for this one. I think this is an important post for women and look forward to reading the tips for a c-section, too!

    • Leah DeCesare says:

      Thanks for your comments, Audrey. Labor and birth take many paths and each woman’s experience is her own. I’d like to hear your tips for other Moms having a cesarean, too!

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  9. […] father was so nervous about the c-section that he woke up and came to the hospital with us, dark and early on that January morning to wait, […]

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