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Tips for Reducing your Chance of Cesarean

17 Tips for Reducing Your Chance of Cesarean

17 Tips for Reducing Your Chance of Cesarean

- Teri Nava-Anderson, 4/7/17

It's Cesarean Awareness Month. In honor that, here are some tips that we have noticed help improve a low risk birthing person's chances at having a vaginal delivery.

  1. Visualize the birth you want.
    • It's difficult to know or achieve the kind of birth you want if you don't spend some time thinking about your preferences.
    • Statistically, women who are unable to visualize a vaginal birth have a higher incidence of cesarean.
    • Listen to a guided visualization of a vaginal birth if you have trouble imagining it.
  2. Choose the kind of birth location that matches the kind of birth you want.
    • Does your birth location specialize in the kind of birth you want? 
    • If you want an unmedicated or low intervention birth, for example, inquire as to how often birthing persons have unmedicated or low-intervention births at that facility during your walk-through.  If that number is low, your care facility does not specialize in your preferred type of birth.  Be aware that you may be choosing an scenario with which your facility might not have extensive experience and that this may understandibly push them outside their comfort zone. You may have to advocate strongly for your preferences in such an environment.
    • Check the cesarean rates of your care facility.  Studies show that the chance of having a cesarean depends more heavily on where you deliver than on the provider and you. In California, you can look here.
  3. Choose a care provider who specializes in the kind of birth you want. 
    • Midwives are natural birth specialists, trained in physiologic, vaginal birth who will screen patients and pass high risk patients onto surgical specialists.
    • OBs are surgical specialists, some of whom are very open in saying they prefer cesarean to vaginal delivery and encourage everyone to have surgery.  It's ok to ask what their favorite kind of delivery is. If 30-50% of your OB's patients have a surgical delivery, and only 5% of their patients have non-induced, non-augmented, non-medicated vaginal deliveries, then they don't see natural birth often and may not be very experienced or comfortable with physiological birth. This dynamic of decreasing experience significantly contributed to the loss of breech vaginal delivery options and the rising cesarean rate nationwide.
    • It's ok to ask a lot of questions about your care provider's practice, so there are not unexpected surprises when you are in labor.  If you are trying for a vaginal birth after a cesarean, for example, you can ask about their success rate with VBACs or even vaginal births in general.  Ask how often they induce non-VBACs and if they induce VBACs at all. 

      If your care provider says they only do cesareans when necessary, ask them how often they typically see a cesarean as necessary.  Do they primarily do them when there may be a potential (but not presently) urgent need in 12-24-48 hours, when the need is currently urgent, or when the need is emergent? Do they do often do cesareans without a trial of labor, and if so, for what reasons? Does their comfort level with the risks match yours?

  4. Do not put yourself in the position of having to fight for the birth experience you want in a care facility or with a care provider you do not trust.  For oxytocin to flow, for the uterus to contract well, and for the cervix to open easily, you need to feel safe and supported. 
    • If you feel that your care provider is not supportive of your birth preferences (even if they seem very nice, very capable, were your best friend's provider, have been your care provider forever, or were your care provider for a previous delivery), it is 100% ok to find another care provider who is on board and excited about the kind of labor and delivery you're hoping for.
    • Most people do not have the energy to ask for pros and cons of recommendations or the ability to thoroughly choose among them in the thick of labor.  You need to trust that your care provider is making decisions based on you and your baby, not their own schedule.  Conflict with your care provider(s) increases adrenaline, which can then force the lower band of uterine muscle to constrict and keep the cervix closed. 
    • Travel if you have to.
    • Be aware that the most common time for cesareans to be performed is right before a shift change.
    • Failure to progress is the #1 reason that labors end in cesarean. In recogizing that care providers may be recommendating cesarean for a "Failure to Progress" prematurely, in 2014 the definition of active labor was changed from 4cm to 6cm. This may help prevent what some have snidely termed "failure to have patience".
  5. Make a plan for an unmedicated birth.  An unmedicated labor helps with dilation, effacement, descent.  An upright labor statistically will progress more quickly. 
    • You need concrete skills to achieve the goal of unmedicated birth.  Most people who say they will go with the flow and try to "go natural" without having a skill set to do so, will get an epidural. 
    • Why should you try to avoid an epidural?  First an epidural is a package deal. Required in the package:
      • IV fluids
      • Continuous fetal monitoring
      • Blood pressure cuff
      • Bladder catheter
      • Restricted positions in bed
      • No food or drinks,ice chips only
      • Decreased gravity pull on baby
      • Possible effects of the epidural package:
        • Pitocin for slowed labor
        • Less engagement and assistance from baby
        • Compressed pelvic outlet making less room for baby to travel through the boney structure
        • Cesarean for failure to progress
        • Vacuum assistance because fetal ejection reflex is inhibited
    • Delivering on hands and knees or upright position helps make more space in the pelvis for baby to come through.
  6. Take a natural birth childbirth preparation course. 
    • Note that many hospital classes are often patient preparedness classes and are not primarily focused on helping you develop strategies for an unmedicated birth. Some hospital class instructors aren't allowed to mention risks associated with interventions. 
    • Statistically, taking a stand-alone class can increase rates of unmedicated birth substantially (example from Birth Boot Camp: 70% have unmedicated births, 30% have medicated births).  Many of our local hospitals have a 90-95% epidural rate.
  7. Hire a doula. 
    • ACOG noted in 2014 that the single most important thing you can do to lower your risk of cesarean is to hire a doula. Studies show a 50% decrease in cesarean, as well as decreases in need for medications, assisted deliveries, and increases in maternal satisfaction with birth experience, maternal/baby bonding, and breastfeeding rates.
  8. Say no to non-medically necessary inductions and let the baby choose their birthday.  Inducing increases the risk of a primary cesarean.  It can also lead to low heart rate, infection, umbilical cord problems, uterine rupture, and hemorrhage postpartum.
    • If your care provider is encouraging induction, know your Bishop Score.  Scores under 5 are not favorable for induction without cervical ripening and very frequently lead to cesarean.  Scores over 10 are considered more favorable for induction.
    • Bishop Score
  9. Be active before labor. 
    • People who are sedentary in pregnancy are 4 times more likely to have a cesarean.
  10. If you are low risk, many care providers recommend that you stay home until you are in active labor if you're close to the hospital and are expected to have a typical length labor, if that helps you feel more relaxed.
    • Taking a class that focuses on the holistic view of what active labor looks like will help you better identify when you're in active labor without checking your cervix.
  11. Shut down negativity. 
    • Keep yourself inside a bubble of peace. Your friends, family, and/or complete strangers may view your pregnant belly as an opportunity to process their own birth experience. You are under no obligation to listen. Simply say, "no thank you."
    • Get involved in your local ICAN chapter, read Ina May Gaskin, and find positive stories of people who have had beautiful birth experiences.
    • If you're having trouble finding ways to think positive, seek support from a therapist, other care provider, or other healer who specializes in birth trauma. There is help out there. We are happy to offer some recommendations.
  12. Eat right.  Good nutrition helps your body work through labor more easily.
  13. Get your partner on board with your plan, so they aren't coming at this from a place of fear.  If they aren't comfortable, you'll be worried about them, not you.
  14. Be active in active labor.  Use movement.  Your body communicates with you throughout labor, sometimes using pain to tell you when baby isn't lined up right.  Move your body to move the baby.
    • Know your options for movement in labor at your chosen care facility.  For example, if you have to have continual fetal monitoring, ask for a wireless telemetry unit so you can move away from the bedside.
  15. Keep things out of your vagina to decrease infection risks. Medical intervention and augmentation have their place, but in the absence of medical need, discuss with your care provider to possibility of:
    • No or infrequent cervical checks
    • Not routinely sweeping membranes or stretching the cervix unless actively trying to start or augment labor
    • Not artificially rupturing membranes
  16. If baby is breech, check your options for breech vaginal delivery (locally, breech delivery is possible at UCSF and UC Davis) – mybreechbaby.org
    • Be active about getting baby to turn beforehand using the techniques at spinningbabies.com, acupuncture and moxibustion, Webster technique chiropractic care, etc.
  17. Lastly, remember that no one is promised an uncomplicated birth.  Prepare for any outcome. 
    • Know that it's ok to mourn the birth you didn't get. 
    • Reach out for support from friends, family, care providers, or organizations like ICAN or Postpartum Support International. We host support meetings for both at our office in Mtn. House. See our calendar for upcoming dates.

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