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.
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 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.