The rate of Caesarian births in the U.S. is currently over 31% (Rita Ruben, “Answers Prove Elusive as C-section Rates Rise”, USA Today, 2006). This is not because one in three women cannot birth a baby naturally; rather it is the result of medical management of labor among other things. Many common birth interventions create what professionals call a “cascade of interventions” with the ultimate intervention being a C-section. If you want to give yourself the best chance of avoiding a surgical birth, here are a few things you can do.
Choosing a Doctor or Midwife
The single most important thing you can do to avoid a Caesarian section is to put yourself in the care of a professional who does not do them lightly. When interviewing care providers, ask what their Caesarian rates are. If they are over 10% for non-repeat C-sections, you may want to keep looking. If you are a Vaginal Birth After Caesarian (VBAC) candidate, ask about those rates.
On top of the rate itself, talk to the care provider about his or her philosophy of birth. Does she follow the model of active management of labor or does she sit back and let things progress on their own? Does he induce 3 days after your due date, or does he wait 2 weeks as long as both you and the baby are doing well?
Most midwives will have a more natural approach to birth than doctors, but this is not always the case so don’t make any assumptions. There are Certified Nurse Midwives who are very medical in their approach to childbirth and there are doctors who believe in letting nature take its course.
Induction Increases Risk of C-section
It stands to reason that if a woman’s body isn’t ready to give birth, attempting to force it to do so will sometimes fail. This is especially true of a first-time mother. Many women who go into labor naturally have cervixes that are already partially effaced and/or dilated. Their labors are shorter and their contractions more effective at pushing the baby down and out.
Some care providers like to induce shortly after a woman passes her due date or because the baby is suspected to be big. You can refuse inductions for these reasons and convince your care provider to monitor the baby’s well-being until you go into labor on your own. Late ultrasounds and belly measurements are not reliable ways to predict a baby’s size in late pregnancy.
Continuous Electronic Fetal Monitoring Increases C-section Risk
Some hospitals prefer to use continuous electronic fetal monitoring (EFM) on all of their patients. It is meant to monitor the baby’s well-being and improve outcomes, but it has statistically led to more C-sections and no improvement in babies’ health. ("Routine Electronic Monitoring Of Fetuses Is Challenged in Study," Warren E. Leary, New York Times, 1995)
EFM confines a woman to bed, which makes labor more painful (inviting pain interventions) and keeps the mother from finding the necessary positions to help her baby move into the correct position for birth. It is also distracting to the support team; they find it difficult not to focus on the numbers, jumping lines and beeps of the machine rather than on the birthing woman.
If your care provider insists on using EFM, tell her you will allow it intermittently (for example, 10 minutes once every hour). A better option is to use a stethoscope or Doppler at regular intervals to check the baby’s heart rate. It is just as safe and effective without raising the C-section risk.
Minimize Birth Interventions
Interventions during labor can create a cascade effect, one leading to another ultimately ending up in a Caesarian section. Minimizing how much you interfere with the natural process of your labor will give you the best chance of a vaginal delivery. This does not mean you cannot have pain relief if you really need it. If you do decide you need an epidural, make sure you are at least 5 cm dilated to minimize the risk of C-section.
Believe In Yourself
Birth can be just as much a mental event as a physical one. If you have faith in your body’s ability to birth your baby vaginally it can be a self-fulfilling prophecy. Surround yourself with people who believe in you, too. Politely stop anyone who tries to tell you a negative birth story or one that ended in a Caesarian section.
Read pregnancy books and birth stories about successful vaginal births. A great book for positive birth stories is Ina May's Guide to Childbirth by midwife Ina May Gaskin (Bantam Books, 2003). Also, prepare yourself to avoid pain interventions by researching natural comfort measures. You may also want to look into techniques such as acupressure or hypnobirthing. Having good labor support from a doula, friend or one of your midwives in addition to your partner is also helpful.
Caesarian sections exist to rescue a baby and/or mother from a dangerous birth situation. No one can guarantee that this won’t happen to you, but there are many things you can do to minimize the possibility. Go into labor naturally, move around during labor, and minimize interventions. Most importantly, find a care provider who is as dedicated to your vaginal delivery as you are.
