Tips to Avoid an Unnecessary Cesarean Birth
Your birth matters…no matter how, where, or with whom you birth. Natural or medicated. Vaginal or cesarean. Each baby matters. Each woman matters. For some, having a c-section is absolutely necessary (about 15%) but for others, c-sections are happening unnecessarily.
A question I am asked often is: “how do I avoid a c-section?”
With the national average being over 30% and with some hospitals in the Atlanta area (where I provide services) having over a 50% c-section rate, this is a very important question and a very real concern for expecting mamas. The rate for cesarean should be closer to 15%...meaning there are too many unnecessary cesareans occurring putting many women at greater risk. This is a big gap to shrink but all the research continues to support that having a natural, minimally interfered with, vaginal birth is best for both mother, baby, and society at large. While some c-sections are medically necessary (between 10-15%), many are not. Knowing your options, knowing how to choose a provider, and knowing the steps to take to reduce your risk for needing a c-section are key.
Below are the tips you can use to help avoid an unnecessary c-section:
1.) Ask your provider what their c-section rate is. Also find out what the c-section rate is for the hospital you plan to give birth at. Aim for a cesarean birth rate around 15% and no more than 30%. You can search your area hospitals to learn about their maternity care statistics: www.leapfroggroup.org
2.) Let labor start on its own (meaning avoid induction unless medically necessary...let baby choose it’s birth date). A key note here…even if you need to have a c-section due to medical indication, if it is safe for mama and baby, it is best to let labor start on its own and then go to the hospital for the c-section. A good example for this is a breech baby. Some providers will suggest going ahead and scheduling a c-section if baby is presenting in the breech position in the 37-38th week. This is not a medical indication for needing a c-section. Research supports waiting until labor starts to determine if baby is still breech. This has two benefits: 1.) it allows time for baby to turn into the optimal head down position (which occurs in 95% of births) and 2.) allowing labor to start on its own ensures the baby is ready to be born. FUN FACT: Did you know that when the baby’s lungs are fully developed and ready to function outside of the womb, that there is a chemical reaction between the baby and the walls of the mother’s uterus causing labor to start? This is incredible!
3.) Labor at home as long as possible: Studies show that delaying hospital admission until active labor can help reduce interventions, including cesarean birth. ACOG (American College of Nurse Midwives) recommends laboring at home until active labor begins. A good rule of thumb to determine when you are in active labor is when you are having contractions 5 min apart for at least 1 min long and lasting for an hour...this is called the 5-1-1. That is not to say that this stage of labor isn’t hard work. It can certainly be challenging and it is sometimes many hours before someone reaches that active labor mark (especially for women having their first baby).
4.) Avoid or delay an epidural: If possible, avoid or delay the start of the epidural until active labor has began (between 5-6 cm). Reasons to avoid would include wanting to stay upright and active during your birth, decreasing chance of c-section, not interfering with the hormonal dance that occurs between mama and baby, and avoiding other medical interventions that come along with an epidural. Reasons for needing/wanting an epidural include personal choice or needing rest from an extra long or painful labor. This is not saying it is wrong to have or want an epidural. This is about knowing the interventions that can occur or are required when you have an epidural.
I have to take a little side note here to share some extra info about the hormonal dance that occurs between mama and baby during labor because it is extraordinary and incredible.
First you have oxytocin the “love hormone” which builds up during pregnancy and then increases a lot during labor. It stimulates powerful contractions that help thin and dilate the cervix, move the baby down and out, push out the placenta, and limit bleeding at the site of the placenta. Ways to promote the production of this hormone include keeping your birthing environment calm, safe, and comfortable. Minimize noise and disruptions from visitors or nurses. Stay upright and let gravity help keep baby pressed against your cervix. Breastfeed as soon as possible after the birth and avoid an epidural as it interferes with the natural production of oxytocin.
Next are the endorphins which are the calming and pain-relieving hormones released when you face stress or pain. When you don’t use an epidural for pain, the level of endorphins continue to rise steadily and steeply through the birth to help you cope with the pain. High levels of endorphins during labor and birth can produce an altered state of consciousness that can help you deal with the intensity of giving birth. High endorphin levels can make you feel alert, attentive, and even euphoric after the birth. Endorphins are believed to play a role in strengthening the mother-infant relationship. Studies have found a sharp drop in endorphin levels with use of epidural or other pain medication.
Then we have adrenaline which is our fight or flight hormone. This is produced to ensure survival. Women who feel threatened (even from fear or severe pain) may produce high levels of adrenaline. Adrenaline can slow labor or stop it all together. Earlier in human evolution, this disruption helped birthing women move to a safe place before birthing their baby. Ways to keep adrenaline down during labor and birth include keeping a calm, safe, relaxed birthing space, being informed and prepared, having trust and confidence in yourself, your baby and your provider, having a positive birth team surrounding you giving you support and words of encouragement, and avoiding intrusive, painful or disruptive procedures.
Each one of these hormones play a specific role and are vital to a safe and healthy labor and birth. It is beautiful and awe-inspiring.
5.) Hire a doula: Evidence from research on this topic has shown that having a doula support you through pregnancy and labor decreases your chance for cesarean between 25-39%. The ways a doula can help you lower your risk of a cesarean include: 1.) Helping you think through your choice of provider and birth location 2.) Support you in considering the benefits and risks of induction 3.) Lower the need for pain medications during labor 4.) Help you find your voice to advocate for the best care 5.) Create an environment that supports and normalizes the hormonal balance (see above!) 6.) Provide early labor support 7.) Encourage baby to be well-positioned for birth. In summary, the hormones that help move labor forward and relieve pain thrive on calm, privacy, and feelings of safety, connection, and nurture. Those are doula specialities! By offering continuous physical and emotional support, creating a “birth cave” in a hospital bathroom, or simply setting a calm, relaxing mood in the room, doulas can actually help labor work better.
6.) Maintain movement during labor: Walk, bounce on a yoga ball, take a shower, dance with hubby...keeping in an upright position as much as possible unless there is medical indication for needing to be in the bed and lying down. If you are limited to the bed for a medical reason or because you have an epidural, there are many positions you can take that are safe and effective for creating less pain and reducing risk of manual delivery, forceps, episiotomies, and cesarean.
7.) Be your ownadvocate!!! “Knowledge is not power, applied knowledge is power” by John Maxwell is a fantastic quote to help us frame our intentions for gaining knowledge during pregnancy for our birth. It is not just about having the knowledge but using it to advocate for yourself and your baby.
These are not hard and fast rules but can be a solid launching pad for conversation with your provider. When you read this, does something stir inside of you? Do you want to ask more questions? Are you feeling more curious about this incredible process of birth? If so, GOOD! Listen and lean in to those feelings, follow your intuition, trust the process and most importantly trust yourself.