The American College of Obstetricians and Gynecologists (ACOG) and the Society for Maternal-Fetal Medicine (SMFM) have released new recommendations to help new moms avoid cesarean births, during which a baby is delivered via a uterine incision.
Cesarean birth can be life-saving for the baby and/or the mother, but doctors are concerned cesarean deliveries are overused. Today, approximately 60% of all cesarean births are for a woman’s first delivery. If you have a medical issue that could complicate labor or delivery, such as maternal high blood pressure or the baby is in a breach position (buttocks or feet first), your doctor will opt for a C-section. In emergency situations when the baby or mother is in distress delivery will be via an “emergency” C-section. Let’s explore how to avoid a cesarean birth.
How Can I Reduce My Chances of a Cesarean Birth?
ACOG ‘s Safe Prevention of the Primary Cesarean Delivery recommends reducing cesarean deliveries by:
- Allowing prolonged latent (early) phase labor.
- Considering cervical dilation of 6 cm (instead of 4 cm) as the start of active phase labor.
- Allowing more time for labor to progress in the active phase.
- Allowing women to push for at least two hours if they have delivered before, three hours if it’s their first delivery, and even longer in some situations, for example, with an epidural.
- Using techniques to assist with vaginal delivery, which is the preferred method when possible. This may include the use of forceps, for example.
- Encouraging patients to avoid excessive weight gain during pregnancy.
Don’t panic if your delivery ends in a C-section anyway. Sometimes surgery really is the best method to protect you and your baby from complications.
- Find a health care provider and birth setting with low rates of intervention. Be sure to ask you health care provider about their philosophy on cesareans and their cesarean rate (rates vary between 10-50%1 nationally).
- Become more educated about birth by taking childbirth classes, reading books, and asking lots of questions.
- Create a Flexible Birth Plan
Key topics to discuss with your healthcare provide include:
- How long can you stay home before going to the hospital? For example, she might recommend heading in when contractions are four or five minutes apart, at least a minute long, for at least an hour. Often, the longer you’re in the hospital before the baby is born, the higher your risk of intervention.
- Explore options for coping with pain. If you can, avoid epidural analgesia, at least in early labor. An early epidural limits your movements and your baby’s movements which can lead to the need for an intervention (IV, continuous monitoring, bladder catheter, etc.).
- Avoid continuous electric fetal monitoring during labor. Studies show that EFM can increase the chance of cesarean by up to one-third.
- Ask for recommendations on turning a breech baby, and actively attempt these if necessary.
- Avoid induction if possible.
- Arrange for continuous labor support from a professional, like a midwife or doula. (Studies show that women with continuous labor support are 26% less likely to have a cesarean).
Want to Know More?
Complied using the following sources:
- ACOG: Nation’s Ob-Gyns Take Aim at Preventing Cesareans
- Maternity Center Association. What every pregnant woman needs to know about Cesarean section. New York: MCA, April 2004.
- Facker SB. Stroup DF. Peterson HB. Continuous electronic fetal heart monitoring during labor. In Neilson JP et al., eds.
- Pregnancy and Childbirth Module of the Cochrane Database of Systematic Reviews, updated June 1996.