As your due date approaches, you may start thinking more seriously about the type of birth experience you hope to have. While cesarean births can be life-saving and medically necessary in some situations, many women hope to lower their chances of needing a C-section if it can be safely avoided.^8,9

Even with careful preparation, labor can be unpredictable, and birth plans sometimes need to change. However, some choices during pregnancy and labor may help support vaginal birth and reduce the likelihood of unnecessary medical interventions.

As a doula, I’ve supported many different types of births over the years. Here are some practical ways families may help lower their chances of a C-section while still prioritizing the health and safety of both mom and baby.

In some situations, a cesarean birth may still be the safest option for mom, baby, or both.

How to Lower Your Chances of a C-Section

Every labor and delivery experience is different, and there is no guaranteed way to avoid a C-section. However, these tips may help support vaginal birth and reduce your chances of unnecessary medical procedures.

1. Choose Your Doctor and Hospital Carefully

Many mothers think their regular OB-GYN is automatically the person who should deliver their baby. This is not always the case. I know you probably have an excellent relationship with your doctor; otherwise, you wouldn’t be going to them. However, you need to ask some tough questions to see if they will support you with the birth experience you want. Your birth experience can have a lasting impact on how you remember this stage of life. And this experience can affect your future pregnancies and births.^10,11

Suppose your doctor isn’t giving you the answers you want or is stalling with their answers. In that case, I recommend you consider looking for another doctor because whoever is your medical provider is a significant way to avoid or help support vaginal birth. Here are some ways to go about choosing your doctor/hospital:

Inquire About Your Doctor’s C-Section Rate

Be sure to ask your doctor about their C-section rate, so you know how often they perform them. This can give you an idea of whether a cesarean delivery may become more likely or whether you can avoid it. The national average cesarean birth rate in 2021 was 32.1% (about 1 in 3 women).¹ But some doctors have much higher and lower averages than that.

Look Into the Practice or Call Group’s Rate

You also want to ask what their practice’s/call group’s C-section rate is. Your doctor might not be the person at your birth, which happens a lot. Ensure you understand how the on-call doctors practice, their C-section rate, and their philosophy on birth. Another question to ask is which hospitals they have privileges at.

Ask Others for Recommendations

Start talking to people in the community as well. (I highly recommend asking doulas in your area since they have likely been to the majority, if not all, of the local hospitals.) You will quickly learn which hospitals you want to avoid. Some hospitals have better reputations than others. Having a positive atmosphere and support team of care providers can help tremendously with the outcome of your birth.

Related: Questions To Ask Your OBGYN at Your First Prenatal Visit

2. Or Choose a Midwife and Birth Center

Some people think having a midwife might be weird or even scary, which is unfortunate. A midwife is a safe and fantastic option. Midwives are often known for supporting physiologic birth and encouraging low-intervention labor whenever safely possible.¹² Midwives also have a much lower C-section rate than OBs — ranging around 30-40%.² Unfortunately, some providers may have different approaches to labor management and interventions, even when there might be more alternatives you could try. Midwives don’t quickly resort to C-sections as often as doctors, but they will call for one if you truly need it.

If you do not feel comfortable having a home birth, you can choose to give birth at a birth center. Your environment there will be calm and peaceful as well. No matter where you choose, you can feel safe that your midwife will have all the training, tools, and medications to keep you and your baby safe. Talk to your local midwives and visit your local birth centers to learn more about these options.

Related: Midwife vs. OBGYN: What’s the Difference & Who to Choose?

3. Communicate With Your Care Provider

Whether you decide to move forward with an OB or a midwife as your care provider, you must communicate and ask questions during your prenatal visits. Let them know your wishes. The more you communicate and talk about what you want, the sooner you will discover how they will assist you and how your birth may go by hearing their replies. I have seen several OBs and midwives practice very differently from what they led their patients to believe during prenatal visits. I also recommend keeping a list of questions on your phone or on a piece of paper so you won’t forget the important ones. Otherwise, pregnancy brain can set in!¹³

4. Hire a Doula

Studies show that doulas lower the chances of C-sections by 40%.³ A doula is not a midwife. A doula is trained and experienced in childbirth and provides continuous physical, emotional, and informational support to the mother before, during, and right after birth.¹⁴ They’re there to help you achieve your desired birth preferences and help you avoid or lower your chances of a cesarean birth.^3,15,16

A doula will make suggestions and advocate for you if you are too distracted or delirious to make these decisions. They can help you determine the right time to get an epidural and when and how to change into different positions after you receive it.¹⁷ If you want a natural birth, they can help you with position changes, massage, counter pressure, hydrotherapy, aromatherapy, coaching/supporting you through each contraction, and so much more. They will also help keep your partner involved and comfortable.¹⁴ And a doula can help you ask the right questions if your OB or midwife suggests a C-section. Hire a doula to help you avoid a C-section!

Related: 30 Best Interview Questions to Ask a Doula

5. Let Your Labor Start On Its Own

Don’t get induced, if possible. While your doctor may say that an induction will not increase your chances of a C-section, I still recommend avoiding being induced if possible.⁴ In my opinion, inductions should only happen if they are medically necessary for the mother and baby.¹⁸

Most inductions use Pitocin — a synthetic form of oxytocin, the hormone that causes labor contractions.^19,20 However, many women describe Pitocin contractions as feeling stronger and more intense than spontaneous labor contractions, which usually leads women to ask for pain relief.⁷

This can cause a vicious cycle because pain medications typically disrupt the forces of labor, meaning more Pitocin is needed. Unfortunately, there is a limit to what a doctor can prescribe. If the uterus is pushed too hard, it will not relax enough between contractions to permit healthy circulation. This can cause fetal distress, and a cesarean would become necessary. This is known as the cascade of interventions, the chain of events that drives the cesarean epidemic.⁷

So again, if it is medically necessary, an induction is a good option instead of moving directly to surgical delivery. But I would suggest not getting induced if it’s not medically necessary.

6. Labor at Home as Long as You Can

Some women start feeling their contractions and immediately get ready to head to the hospital. Depending on how frequent your contractions are and how long they last, the hospital may send you back home. They’ll ask you to come back when your water breaks and/or once your contractions are five minutes apart, each lasting one minute, and this is a continuous pattern for one hour straight (the 5-1-1 rule).²¹ So, stay at home until it is time. Many laboring mothers feel more comfortable at home, where they can eat, drink, move around however they’d like, get in the tub or shower, etc. Once in the hospital, you will not have all these options available.

Also, the longer you are at the hospital, the more additional medical procedures may be recommended. Labor interventions have the potential to slow down your labor and birth and pave the way for you to have a cesarean. It is shown that the more interventions you have, the more likely you are to need a cesarean delivery.⁷ So, if you stay at home for the majority of your labor, you will lower your chances of having a C-section.

Related: When To Go to the Hospital in Labor

7. Consider Allowing Your Water To Break Naturally

After a few minutes of chatting and doing a cervical exam, I have often seen doctors tell the laboring mother they are going to break her water. This is when the laboring mother can ask why her doctor feels it is necessary to break her water. It might be a good option, but you might want more time.

The doctor may say it will help speed up your labor. However, artificially rupturing our membranes is not always an effective way to speed up labor. It can cause your contractions to be more painful and your baby’s heart rate to plummet because the water no longer protects and surrounds your baby and their umbilical cord. It also increases your chances of infection.⁵ This is why it’s good to let the baby break the water on their own unless it’s medically necessary.

Something else to consider is that once your water is broken, the typical rule is you must have your baby within 24 hours (sometimes doctors will allow you to go past that) before you have to have a C-section.²² This is because they are trying to avoid infection, specifically chorioamnionitis.⁶ At that point, your medical team will typically monitor labor progression more closely to help reduce infection risk.

8. Consider Waiting Until Active Labor for an Epidural

If you decide to get an epidural too soon (before active labor), it has the potential to slow down and potentially stop your labor.²³ Your medical providers will then have to counteract the epidural medication with Pitocin, which is the drug they use for inductions. If you get an epidural too soon, even Pitocin sometimes won’t help. I’ve seen it. You want to ensure you have established a good labor pattern of effective contractions and are in active labor before you decide to get an epidural. The longer you wait to get an epidural, the lower your chances of needing a C-section.

Related: When To Get an Epidural During Labor

9. Ask For Intermittent Monitoring

If you want a drug-free birth, you can request intermittent monitoring. If you will be induced or have an epidural, you must be continuously monitored.^23,24 Your medical team needs to see how your baby reacts to the drugs given to you. Many doctors still want their patients continuously monitored, even when mothers wish to have a drug-free birth. However, continuous monitoring prevents laboring women from moving as much during labor, which, in my opinion, is vital to having a successful unmedicated birth.²⁵ You can move a few feet from the machine, but that’s about it. This means you may be unable to change positions freely, use a bath or shower to help with comfort and control during labor, or walk the halls.

The medical staff can also become fixated on constantly getting a perfect reading from the monitor. Mind you, the baby moves when you move, so monitors need to be moved to be on the baby to pick up its heartbeat. This can be quite often. So, unfortunately, rather than focusing on the laboring mother’s needs, they sometimes shift to concentrate on getting a constant reading of the baby’s heartbeat.

NOTE: Some hospitals use wireless, waterproof monitors. If your doctor demands continuous monitoring, you can still walk around, change positions, and get in the tub with these monitors on you at all times.

As for intermittent monitoring, it is a wonderful option. Your care provider can still check how the baby is responding to labor, and it allows you to labor the way you want. If you want to move around and get in the water, you can! Also, monitors can be uncomfortable on your belly, so being able to take them off or have them use a Doppler instead is much nicer!

Related: Water Birth: Benefits, Risks, and What You Need To Know

10. Ask Questions Before Agreeing to a C-Section

If your doctor is recommending a C-section, ask them these questions first to see if you can avoid it:

1. Is my baby okay? Is there any danger at this point?
2. Am I okay?
3. If we are both okay, can we please wait?

If an OB agrees to wait, it shows there is no urgency, just impatience.

Sometimes, a doctor may say, “Well, we can wait. But things will probably look the same in one to two hours. So why not do the C-section right now?” They might be right, but they might be wrong. You can continue trying; in the end, you’ll know you did everything you could.

11. If You Had a C-Section in the Past, Find a Medical Provider and Birth Location That Supports VBACs

Not all doctors or hospitals will take or allow someone to have a VBAC (vaginal birth after cesarean).²⁶ If you want a VBAC, you also want a doctor with a high VBAC success rate. They obviously will have privileges at a hospital that allows VBACs. Be sure to discuss this with your doctor if you decide to have another baby after a cesarean.

When trying to lower your chances of a C-section, it’s important to remember that every hospital and provider may approach labor differently. Asking questions, understanding your options, and communicating your birth preferences can help you feel more informed and supported throughout labor and delivery. Know that you have options. This is your baby’s birth and your body. Trust yourself, and do what you think is best for you and your baby.

Every birth is unique, and sometimes plans change—but being informed and supported can make all the difference. The ultimate goal is always a healthy mom and healthy baby, regardless of how birth unfolds. You’ve got this, mama.