After a decade of an increasing rate of infants born via Cesarean section, the numbers are now leveling off according to National Center for Health Statistics (NCHS) of the Centers for Disease Control and Prevention (1). This is exciting information for expectant parents who aim to have a vaginal births. This decrease is partly due to the American College of Obstetricians and Gynecologists (ACOG) setting new guidelines for non-medically necessary C-Sections as well as care practitioners holding off on “early” (before week 39) inductions.
With this trend finally shifting to prevent unnecessary Cesarean births, there are ways expectant parents can increase their chances of a vaginal birth.
Learn How to Prevent the Preventable C-Section
1. Avoid Common Interventions, Including Induction Unless MEDICALLY Necessary
Unless it is medically necessary, it is best to avoid common interventions that may hinder your mobility, give possible false results or setting you on the “cascade of intervention.” Specifically with labor induction, pitocin increases stress on the baby and uterus and makes contractions more difficult to manage. Pitocin also necessitates an IV and continuous external fetal monitoring (EFM), restricts your mobility and raising the risk of epidural and Cesarean (2).
Another common intervention to be aware of is the usage of continuous EFM. The ACOG recommends that for a healthy low risk woman, the fetal heart rate be monitored with a fetoscope or Doppler every 30 minutes while in active labor and every 15 minutes during pushing (3). Once hooked up to the EFM, the laboring mother has about 6 feet of cord to negotiate while trying to stay active and mobile.
In a Cochrane review (Alfirevic, Devane et al. 2006), there were no differences between women who received intermittent auscultation and those who received continuous EFM in perinatal mortality, cerebral palsy, Apgar scores, cord blood gasses, admission to the neonatal intensive care unit, or low-oxygen brain damage. Women in the continuous EFM group were 1.7 times more likely to have a Cesarean and were slightly more likely to have a forceps/vacuum delivery when compared to women in the intermittent auscultation group. Women in the continuous EFM group were also more likely to require pain medication (4).
Other routine interventions you may want to think about and discuss with your care provider are routine IV fluids and artificial rupture of the membranes (AROM).
2. Know the Statistics of Who and Where You Are Birthing With
Knowing how often and why a care provider uses medical interventions will give you useful information about what you may expect for your birth. This can be helpful in deciding if your birth philosophies align and if you believe your care provider can help you have the birth you are aiming for. If you are finding out this information later in your pregnancy and the statistics are not what you expected, then this gives you time to plan for other tactics when working with your care provider. (For more information about this, read Not Sure About Your Doctor? What To Do? )
3. Get a Doula
Studies have shown having a doula, a professional labor support assistant, present at birth reduces the need for pitocin (a labor-inducing drug), forceps or vacuum extraction and Cesareans (2). The doula is also well versed in understanding the signposts of labor and can help determine when it is appropriate to head to the hospital or birth center. The longer you are able to stay at home, the greater chance you have to avoid common interventions.
4. Avoid Pain Medication For As Long As Possible
One thing I clearly remember from my Lamaze training was to not demonize pain medication and one’s choice to use it. However, my insightful teacher imparted the importance of, “only use it when you really need it.” Once an epidural is administered, movement becomes very limited. If a woman receives an epidural very early on in labor her ability to stay mobile is greatly compromised and that can effect the position the baby is in. If the baby is in an unfavorable position, being stationary is only going to hinder the baby’s ability to maneuver itself into an optimal birthing position. A baby’s less than optimal positioning can greatly affect the mother’s progress in labor.
Staying mobile and upright can help the uterus function at its most efficient level, creating space by moving the bones of your pelvis and assisting your baby in traveling deeper into your pelvis and wiggling itself into an optimal birthing position (3).
5. Educate Yourself About Birth and Labor Options!
I remember very clearly speaking with a second time mother who was going for a VBAC about pushing positions. She had explained that she got to full dilated rather quickly but had a hard time with the pushing stage. After three hours, it was declared, the baby was “too big” for her pelvis. Her baby (about 7 1/2 pounds) was born via Cesarean. The student passionately told me she did not want to go through another surgical birth and asked if I had any advice for her. I asked her if she was allowed to try multiple pushing positions. She said there were a few variations of the angle she pushed in, but they were all on her back. She said she didn’t realize she had a choice, other then what she was instructed by the doctor and nurse to do, and was very interested to know what other options she can try this time around.
We went on to schedule a time to go over some of her birth options, including the most beneficial and spacious pushing positions. We also talked at great length about understanding the risks versus the benefits of different birth options so when she was faced with making a decision or advocating for herself, she was educated about the subject. This particular mom, I am happy to report, did go on to have her second baby through a VBAC!