Cesarean section is the most commonly performed major surgery in the United States. One-third of pregnant women now deliver this way. The procedure has become so widespread that it can be easy to forget that it is a major abdominal surgery that carries risk for both mom and baby, interferes with bonding and breastfeeding, is very painful, and requires significant recovery time. In the US, about 3% of C-sections are elective and approximately 5% are true emergencies. But that's only 8%. What about the other 25%? Those fall in a grey area - meaning it is hard to know how many are truly medically indicated. And the truth is, many of them are probably not medically necessary. Read below to learn about 9 ways you can avoid ending up with an "unnecessarean".
1. Double check your due date
If you go past your due date, you are likely to face A LOT of pressure to get induced starting at around 40-41 weeks. Induction for post-dates has a high failure rate and often ends in C-section. Why? Because your body and your baby aren’t ready to go into labor yet, or they would have done so on their own. Research has shown that getting induced before your "cervix is ripe" makes you 3.5x more likely to end up with a Cesarean section, usually due to "failure to progress". In fact, "failure to progress" in labor is the number one reason for unplanned Cesarean sections. Unfortunately, post-dates induction is very common because many OBs and midwives still use an antiquated system that was devised in 1830 to calculate your due date (I know, it's hard to believe!). Naegele’s rule, popularized by German obstetrician Franz Naegele, calculates pregnancy at exactly 40 weeks. It doesn’t take into account how long your menstrual cycles are or how many babies you’ve had - both of which are likely to affect how long you carry this baby. So what's the best way to calculate a due date? Comparing 1) a very careful medical history taking into account your menstrual & obstetric history (last normal menstrual period, regular vs. irregular, cycle length, how long you carried any other babies), 2) a first trimester ultrasound (second and third trimester ultrasounds have high error rates) and 3) your date of conception (if you know it), to come up with a date is your best bet.
2. Encourage optimal fetal position
Baby’s position in relation to your pelvis matters a lot when it comes to laboring that baby out. A baby that’s butt-first (called “breech”) will end you in an automatic C-section in many parts of the country. Similarly, a baby that has its back facing your back is called “posterior” and can cause a long and more painful labor due to baby’s head rubbing against your tailbone. A posterior baby can usually be birthed vaginally, but is often much harder to push out than a baby that is in the “anterior” position (baby’s back towards your front). To encourage your babe to get in the best position, avoid “lounging” positions for long periods of time in your third trimester. Leaning back in a recliner or lounging on the couch on your back encourage baby to rotate to posterior position because the baby’s back is heavier than its front. Instead, adopt forward leaning positions, stand up straight and keep yourself moving throughout pregnancy. Walking and swimming are excellent ways to move. Lunges and squats are also great for opening up your pelvis and giving baby room to maneuver. And don't forget chiropractic adjustments throughout pregnancy - they are an excellent way to ensure your pelvis and spine are correctly aligned so that your baby can find just the right spot to hunker down. Check out www.spinningbabies.com to learn all about how to help your baby get into the best position.
3. Have an out-of-hospital birth with a midwife
A study done by the Midwives Alliance of America of nearly 17,000 births showed that midwives attending low risk births in freestanding birth centers and homes had a C-section rate of 5.2%! If having your baby outside of a hospital seems like a crazy proposition to you, I encourage you to do some research to see what the numbers really show. Ricki Lake's documentary, The Business of Being Born (available on Netflix), and the website www.evidencebasedbirth.com are two great places to start.
4. Hire a doula
Doulas have been shown to lower the risk of C-section by 28%. They also do a million other amazing things. Read our post on doulas for more information on this fantastic resource.
5. Eat & drink in labor
Think of labor as a marathon. Would you want to run 26.2 miles without any water? Without anything to give your body fuel to continue the race? Probably not. Your body needs energy and hydration in order to function properly. When it doesn’t receive proper nourishment it begins to malfunction and shut down. Similarly, when you don’t give your body fuel and hydration during labor, your uterus doesn’t contract as efficiently (meaning your contractions don't produce the positive results, like opening your cervix and bringing baby down, that we want to see) and you lose the ability to cope as well with your labor. While it is true that many women don’t feel like they want to eat when they’re deep into labor, even small things like a spoonful of honey or an electrolyte drink can be a HUGE pick-me-up. Many hospitals still won’t “allow” women to eat or drink during labor because of the risk that you could inhale your stomach contents if you have to undergo emergency general anesthesia. There is no evidence to support withholding food and drink during labor. The risk of aspiration is literally so small, 7 events in 10 million births, you have a better chance of getting struck by lightning!
6. If you have already had at least one C-section, be doubly prepared
Having had a prior C-section drastically increases your chances of having another C-section. Choose your place of birth and your provider very carefully. Ask for numbers - what is the VBAC (Vaginal Birth After Cesarean) success rate of your provider and hospital (if you are having a hospital birth)? Pay attention to language. Does your provider say they will "allow you to try for a VBAC" or allow you a "trial of labor"? This can be a bad sign, as the terminology itself already implies failure and loss of decision-making power. Learn everything you can about VBACs and their risks and benefits. Have a strong support team (including a doula), and birth in a place and with a provider that has an excellent VBAC track record.
7. Don’t let people put things in your vagina if your water has broken
Hands (or anything) in the vagina introduce bacteria that can go straight into your uterus and cause infection if your bag of waters has broken. This is because the water bag is the protective barrier between your baby and the outside world. Once it is broken, you are at risk for infection. If you develop an infection in labor, you are headed straight for the OR. Believe it or not, there are a lot of other ways to tell if you are getting close to being fully dilated. There is no need for your care providers to check you every hour or even every several hours. If your bag is intact, don't break it, as it automatically puts you on a "clock" and can increase your chances of ending up with a Cesarean.
8. Be very skeptical of the “big baby” argument
It is extremely difficult to estimate a baby's size before birth. Ultrasounds are notoriously unreliable (they can be several pounds off the mark) and many midwives and obstetricians do not have the skills to effectively estimate a baby's weight. The fear of "big baby" revolves around the risk of having a shoulder dystocia during the birth. This is when the baby's head is born, but the shoulders do not immediately rotate into the optimal position for birth. While this is a stressful event, it is very rare for a baby to be permanently damaged from a shoulder dystocia. No study has ever shown that elective Cesareans for big babies improves their health or that of their mothers. If you are diabetic, a big baby can be a legitimate concern. However, if you aren't, and your care provider is telling you your baby is too big and you will need a C-section or an early induction, find a new care provider. This is not a good sign.
9. Do your research, know your rights, and read between the lines
This is by far the most important thing you can do to ensure you get the kind of care that you desire for your birth. Know that you can say "no" to procedures that are offered to you. Know also that many times a course of care will be presented to you as if there are no other options, and this is almost always false. You can say "no" to these too - but you will probably be met with a lot of opposition - even coercion - so be ready. If you haven't read it yet, read this doctor's blog post that went viral about how she was pressured to have an unnecessary C-section. If you have done some research you will be able to ascertain when it is safer to say "no" and when the course of care proposed is actually a good one. Many procedures done during labor in the US are not supported by scientific evidence. And often, a care provider will tell you what you want to hear rather than tell you how they actually practice. Ask for their statistics. What is their induction rate? What is their C-section rate? Ask questions, look for the evidence, and don't take anything you hear for granted. This is your baby and your body - it's important - so do your homework and speak up!