Tuesday, October 5, 2010

How To Avoid a C-section

The Cesarean section is something that many women list as one of their number one fears of birth. Many women dread the possibility of a c-section and want to avoid them at all costs. Of course we all acknowledge that in a true obstetrical emergency the c-section can be a lifesaver, but most women would rather not be part of the growing number of iatrogenic, arguably unnecessary, cesarean sections.

Many, many months ago the Midwife that writes Birth Sense wrote a post on things you can do to avoid your first cesarean section. Shortly after that, the childbirth educator at Banned From Baby Showers wrote a follow-up post listing a few things she would add to the list of things you can do to avoid a c-section. Both posts are included below.

I've also included a link at the bottom to a list of questions you should ask your care provider before choosing one for your prenatal care and birth!

Avoiding the first c-section: Five simple precautions to take

by the Midwife Nextdoor

  • It’s major abdominal surgery, and carries increased risks for mother and baby
  • It often puts the mother in the position of having repeat c-sections, because she cannot find support for vaginal delivery after a cesarean
  • It increases the risk of abnormal implantation of the placenta, which can lead to hemorrhaging or need for hysterectomy
  • It increases the risk of unexplained stillbirth in a subsequent child.

No one will argue that c-sections can be lifesaving under certain circumstances.  Placental separation, placenta previa, cord prolapse, and certain abnormal presentations of the baby might cause injury or death to mother and child if it were not for the ability to deliver a baby by cesarean.  I am thankful we have the ability to perform this surgery in a very safe manner.  However, the majority of c-sections are not done for emergent, life-saving reasons.  It’s those c-sections I want to focus on preventing.
Since most women having a primary (first-time) c-section are also having their first baby, I have five simple precautions that have been invaluable in my practice in helping women to avoid a c-section.  I am writing from the perspective of hospital birth, knowing that the majority of women will not choose home birth, although I believe this is the number one way to avoid a c-section:
1.  Stay at home in labor as long as possible, and consider giving birth at home.     Why? 
  • Consider an animal in labor.  If you’ve ever observed a cat or dog preparing to give birth, you may have noticed that they seek solitude.  If they are disturbed during labor, they ahve a natural “fight or flight” reflex that slows or halts labor, allowing them to move to a safer location.  While we as human women can intellectually understand the reasons for moving to another location (the hospital) to give birth, our bodies may still respond with a slowing of the labor process.     
  • It is understood that pain relieving medications can have a slowing effect on the process of labor.  Epidurals are associated with a higher rate of vacuum, forceps and cesarean births in some studies.  Yet it is difficult for a woman in hard labor to resist the offering of total relief of her pain.  When you are at home, you know the pain medication is not available, and so the mind does not focus on it.  It is easier to work with the contractions when you aren’t constantly thinking of the epidural available to you in only minutes.
  • Staying home in the earlier stages of labor helps you to avoid the urge that hospital staff will feel to “speed things along” if your first part of labor takes many hours.  It is common for dilation from zero to four or five centimeters to take many hours, and sometimes more than one day.  If you are in the hospital and you are not yet dilated to four centimeters and having contractions three or four minutes apart, you are not in active labor.  This part of labor is best spent at home.
2.  Hire a doula if you can possibly afford it.  If not, seek out an older woman who has had several children naturally herself, or has been present at several natural births, to be with you at home until you decide to go to the hospital
  • A woman who is familiar with the process of a normal birth will be invaluable to you in helping you know when it is time to got to the hospital.  She can reassure you that what you are feeling is normal, that you can do it, and that you are stronger than you think.
  • Many women are afraid to stay home in labor.  A doula or experienced woman will be aware of the normal process of labor and be able to help you feel calm about laboring at home.
3.  Find a practitioner who does not put arbitrary time limits on how long you can be in labor.  If you are feeling strong, the baby is doing well, and you want to keep going, there should be nor reason to rush to a c-section simply because the labor is taking longer than average.  
4.  Carry on your usual activities as long as possible.  Far too many first-timers make the mistake of doing everything they can to speed labor along.  All too often, their efforts succeed at nothing but making them miserable and exhausted.  Allow labor to unfold in its own time.  Ignore the contractions until you are physically incapable of doing anything else during a contraction as well as in between  contractions.  This is where many women take their labor too seriously.  They think because they have to breathe with a contraction, they are in hard labor.  The actions of the mother between contractions are more indicative of the stage of labor.  During the latter stages of dilation, the woman is usually quiet, tired, and may even fall asleep between contractions.  She does not feel like talking much, or doing anything but resting before the next contraction.   If your labor starts in the day, do what you normally would have been doing if you’d not started labor.  If your labor starts at night, stay in bed and try to sleep, at least between contractions.  If you cannot sleep, at least rest until your normal getting-up time.
5.  Stay off the fetal monitor!  The American Congress of Obstetricians and Gynecologists has published guidelines for intermittent auscultation of the baby, stating that it is just as safe for low-risk pregnancies as continual monitoring.  It has the added benefit of having a lower c-section rate.  This suggests that many c-sections are done for “fetal distress” seen on the monitor tracing, when the baby is actually fine.  Once you allow someone to connect you to the continual monitor, you most likely won’t be off of it for the rest of your labor.  What is intermittent auscultation?  It is not being connected tot he monitor for 20 minutes out of every hour, as many hospitals’ protocols require.  Rather, it is listening to the baby’s heart rate with a hand-held doppler before, during, and after a couple of contractions every 15-30 minutes during the first stage of labor.  A skilled practitioner can determine if the criteria indicating fetal well-being are present, even with a hand-held doppler.

MY List of Things You Can Do to Avoid a C-section
By Donna at Banned from Baby Showers

I've seen a couple of lists lately about the top 5 things a woman can do to avoid a c-section. While I think these lists are good, they differ from my personal list. I thought I'd take the time to write out my list. I guess I'll keep it to a top 5 as well, so as to not overwhelm anyone.

Education for both husband and wife: Some women are able to advocate for themselves in labor, but most are not. Preparation on the front-end is huge. Dad needs to know what is going on and how he can help. He needs to know what's normal and what's not. He needs to know the questions to ask. Having a doula will help with a lot of this. The doula cannot speak for mom, but dad can. I love The Bradley Method for this reason. Both individuals take responsibility for their role in the birth.

Careful Choosing of a Care Provider: Also huge. All the education and preparation in the world won't matter a bit if you have chosen a care provider and/or hospital who is determined that you need to be rescued from your pregnancy, labor and/or birth. This is the step where, if you ignore the red flags popping up during the education/preparation phase, it will bite you in the end. If you are getting information and statistics about your doctor or hospital that make you second-guess their philosophies, don't ignore them. It's never too late to switch care providers. I've had people change in the middle of labor! Typically, care providers like to see you for the last month of your pregnancy. I changed care providers at 33 weeks with my third pregnancy. A bit nerve-racking, but worth it for a great outcome. You will only give birth to this baby one time. Don't take on the "maybe for the next baby" attitude. Do it this time! Do it for thisbaby! If you don't know where to start, ask your out-of-hospital educator or doula for referrals.

Keep Moving - Don't Lay Down and Take It: Remaining in a hospital bed is one of the worst things you can do. They can/will strap a monitor on you and "watch" you from the nurses station. Health care at its finest! Laying around for your labor leaves it all up to your baby to make its way out. Baby needs movement. He is moving around, changing position, trying to find the easiest, most comfortable way out. If mom is moving -- walking, sitting on birth ball, pelvic rocking, rotating hips, even standing -- she's using gravity and movement of the pelvis to help her baby descend and get into a good position. Mom will have less vaginal exams (which often lead to Failure to Progress diagnosis), less time on a monitor (which often leads to a false-positive signaling fetal distress), and usually a more comfortable and faster labor. What's good for mom is usually what's best for baby.

Drug-Free Birth: I'm not just talking epidurals here. I'm talking inductions as well. Pitocin is a drug. Prostaglandins (cervical ripeners) are drugs. Baby may react "fine" to induction drugs, and he may not. There's no way to know how your baby will react. So trust in your body to start labor on its own. Don't be induced. Stadol, Nubain, Demerol -- they are all drugs that go to the baby. There will be physical results to the baby when they are born if they received these drugs -- more sleepiness, "laziness" at the breast, depressed breathing. If mom had educated and prepared herself during the pregnancy, she probably skipped this step. It's a tough thing to hear a mom's birth story and realize that her c-section was a direct result of her own actions -- induction, pain-relieving drugs, trusting her doctor, and not educating themselves on the normal process and what to do and what not to do.A woman is 50% more likely to have a c-section if she is induced, and four times as likely to have a c-section if she has an epidural. These are numbers that we simply cannot ignore.

Remain Low-Risk: If you do not take care of yourself and become high-risk, you give up a lot of power. You need to physically prepare your body to give birth by regularly doing pregnancy exercises. You need to eat the required nutrition to grow a healthy baby. A well-balanced diet with plenty of protein will benefit both mom and baby. The old saying "eating for two" does not mean eating for two adults! Be wise and mindful in your life choices. Practice relaxation every day. This will help with all aspects of your life, even after the baby comes. Keep stress out of your life as much as possible. Choose pre-natal tests wisely. There are so many that are done these days. Find out why it's being done and what they expect to do with the results. You can opt NOT to do them. Some may unnecessarily put you in the high-risk category if you test positive.

Of course, I must mention that every now and then I do have couples that do everything right and still have a c-section. I recently had one of these and it broke my heart. This mom worked so hard. I truly do not know what she could have done differently. You can't feel bad about a c-section that comes out of a situation like that. I feel sad for her. She really wanted a natural, unmedicated birth, and was so prepared. ICAN will be an important part of her healing. 

Please See "In Search of Doctor Right: 11 Questions to Ask"


  1. Its good one to read and think about. Thanks for the article. I hope it will create some awareness among the people. I hope people will be careful while doing surgery.

  2. This is really very useful information and helpful in our live i was looking for these kind of information and at last i got it here so really i am grateful to you.

  3. I really appreciate this article, because so many moms don't understand there are THINGS YOU CAN DO to decrease the chances of a C-Section. Put another way, why wouldn't you do a few simple things to decrease the chance of MAJOR surgery. It's not something to be scared of, but just a good question to ask yourself. I just found this site...really good site with very helpful info.

  4. sigh...I wish people could get their facts straight before spouting off about epidurals. There is NOT ONE well designed study that shows an increase in caesarean section associated with epidural anesthesia. NOT ONE !! Suggesting that avoidance of pain medication is a way to avoid c-sections is cruel and unjustified and as far as I am concerned is a form of misogyny. Learn how to critically appraise the literature and at the very least, consider the impact of your words.

  5. @Something from nothing - where are the well designed studies that prove there is no link between epidurals and c-sections?

  6. Please link to reputable studies about your "epidural link," because it ain't there. And people who "do everything right," really?? Way to bash a lot of people.

  7. I believed in natural birth and breastfeeding.
    - That was my birth plan.
    I laboured for 26 hours and had to have an emergency c.
    I laboured the first 12 hours walking almost constantly (apart from resting, toilet break and having some dinner)
    My contractions started 5 mins apart. 5 hours in were 3 mins apart and from 9 minutes they were 1 minute apart.
    12 hours in I got an epidural as I was exhausted.
    5 hours in and it started to ware off in spots with cramps and contraction pain happening in those spots.
    Every hour I was allowed up to go to the toilet.
    20 hours in my waters broke but the contractions slowed down, the baby got stuck, meconium in the womb & baby got distressed, blood pressure went up (first time all pregnancy and labour)
    Baby had to come out.
    I couldn't breastfeed either.
    The more I pumped the less milk I produced. I was on the milk producing tablets both natural and herbal and nothing worked.
    it took me 10 months to start exercising without being in pain for 3 days from the scar (like the worst period pain x's 3)
    Now I am healthy, worked off 15 kg, got my spine straightened at the chiropractors, exercise with pushing the pram where it puts a bit of pressure on the scar so it 'toughens up'. (in small
    built up doses of pushing my
    exercise levels)
    It feels like its all gone so quickly yet at the time it felt like forever. Now I'm 'game enough' to try it all again 19 months later. Still would prefer a natural birth any day.
    However my midwife said that you can have a great C-section and a real bad natural birth. A great natural birth and a real bad C-section. Its all pot luck at the end of the day.
    All I'm glad is that my baby needed help and I wasn't stubborn enough to put him in danger to continue with the natural birth to suit myself. It also annoys me when women tell you that you can breast feed your child, you must never give up. Ive seen women try for 6 months - I tried for 6 weeks & that was enough trauma for my baby.
    Seeing him loose so much weight and struggling to function was frightful - think of what damage it can do to their brain and immune system if they cant get food.
    Babies do struggle more with formula but sometimes that's what women have to do and there is no shame in that.
    It has been a definite culture shock. I got told that women stress when they cant breast feed - I did but only because I didn't realise that some people cant breast feed - I just thought it was normal and that everyone could.
    Thank you for listening to my
    reality. It has certainly opened
    my eyes from the fairy tale image
    I had in my mind before baby came into our world.


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