Your baby’s due date is quickly approaching and you are probably now beginning to feel how real everything is. This is happening. YOU are going to have a baby! That means this baby has to come out. If you have started your research on birth and have maybe watched some Youtube videos on vaginal births and C-sections (which, be prepared if you do watch the videos), you may begin to realize that having a cesarean birth is major surgery. I do want to say, thank goodness for cesarean births because they have saved millions of women’s and babies’ lives. However, it isn’t something that I would recommend electing to schedule without medical reasons. If it is your first choice to have a C-section, be sure to fully educate yourself on the procedure and the recovery. I want all of our readers to be well prepared. If a C-section is something that you decide is best for you and your child, I support you. If a C-section is something that you want to avoid as much as possible, there are some things that you can do to lower your chances of having one. Here are my 11 ways to avoid a C-section.
1. Choose your doctor and hospital carefully.
I feel like many women think that their regular OB/GYN is automatically the person that should deliver their baby. This is not true. I know that you probably have a wonderful relationship with your doctor, otherwise you wouldn’t be going to him/her, but you need to ask some tough questions to see if he/she is going to support you with the birth experience that you want. You only get one time to give birth to this baby. And this experience can affect your future pregnancies and births. If your doctor isn’t giving you the answers you want or is stalling with their answers, I recommend that you consider looking for another doctor because whoever is your medical provider is a major way to avoid a C-section.
Be sure to ask your doctor what his/her C-section rate is so you know how often they perform them. This can give you an idea if a C-section is in your future. The national average of cesarean births is 31.9% (which is still a high number — that’s about one out of three women), but I know of doctors that have much higher and lower averages than that.
You also want to ask what his/her practice’s/call group’s C-section rate is. Your doctor might not be the person at your birth, which happens a lot of the time. Make sure that you have an understanding of how the on-call doctors practice, what their C-section rate is, and what their philosophy is on birth.
Another question to ask is which hospitals they have privileges at. If you start asking people in the community (which I highly recommend asking doulas in your area since they have been to probably 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 and I will say, having a positive atmosphere and support team of care providers helps tremendously with the outcome of your birth.
2. Or choose a midwife and birth center.
Some people think that having a midwife might be weird or even scary, which is unfortunate. A midwife is a safe and wonderful option. Midwives truly believe in your body and its ability to give birth. Midwives also have a much lower C-section rate than OBs — ranging around 3 to 4%. Unfortunately, some doctors are a lot quicker to recommend a C-section even when there might be more alternatives that you could try. Midwives don’t quickly resort to C-sections often as doctors but they will call for one if one is truly needed.
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 of 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.
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 what your wishes are. The more that 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 than what they led their patients to believe during their prenatal visits. I also recommend keeping a list of questions on your phone or a piece of paper so that you don’t forget those important questions. Otherwise, pregnancy brain can set in!
4. Hire a Doula.
Studies show that doulas lower the chances of C-sections by 40%. A doula is not a midwife. A doula is someone who is trained and experienced in childbirth who provides continuous physical, emotional, and informational support to the mother before, during, and just after childbirth. She’s there to help you achieve your desired birth preferences and help you avoid a C-section. She will make suggestions and advocate on your behalf in case you are too distracted or delirious to make these decisions yourself. She can help you determine when the right time is to get an epidural and when/how to change into different positions after you receive it. If you are wanting a natural birth, she can help you with position changes, massage, counter pressure, hydrotherapy, aromatherapy, coaching you and supporting you through each contraction, keeping your partner involved and comfortable, and so much more. A doula can also help you ask the right questions if your OB or midwife is suggesting a C-section. Hire a doula!
5. Don’t get induced, if possible. Let your labor start on its own.
While your doctor may say that an induction will not increase your chances of a C-section, I still would recommend avoiding being induced if possible. In my opinion, inductions should only happen if they are medically necessary for the mother and baby. Most inductions use Pitocin—a synthetic form of oxytocin, the hormone that causes labor contractions. However, Pitocin causes contractions that are abnormally strong and painful, which usually has women asking for pain relief. This can cause a vicious cycle because pain medications typically disrupt the forces of labor meaning more Pitocin is needed. But unfortunately, there is a limit that a doctor can give. If the uterus is pushed too hard, it will not relax enough between contractions to permit healthy circulation. This then can cause fetal distress, and a cesarean would then become necessary. This is known as the cascade of interventions. This is the chain of events that drives the cesarean epidemic. So again, if it is medically necessary, an induction is a good option instead of resorting straight to a C-section. But if an induction is not medically necessary, I would suggest holding off.
6. Labor at home as long as you can.
Some women start feeling their contractions and immediately get excited and get ready to head to the hospital. Depending on how frequent your contractions are and how long they are lasting, 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 contraction is lasting one minute long, and that this is a continuous pattern for one hour straight. (The 5-1-1 rule.) So stay at home until it is really time. Most women feel more comfortable at home. At home, you can eat, drink, move around anyway that you would like, get in the tub, your shower, whatever you want! Once you are in the hospital, you will not have all of these options available to you.
Also, the longer you are at the hospital, the more medical interventions could be pushed on you. 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 that you have, the more likely you will have a C-section. So if you stay at home for the majority of your labor, you will lower your chances of having a C-section.
7. Have your water break naturally.
I can’t tell you how many times I have seen doctors walk into the labor and delivery room to see their patients and after a few minutes of chatting and doing a cervical exam, they tell the laboring mother that they are going to break her water. This is when the mother should ask why her doctor feels it is necessary to break her water at this time. It might be a good option, but you might want more time. The doctor might say that it will help speed up your labor, BUT artificially rupturing our membranes has shown to not always be an effective way to speed labor. It only causes your contractions to be more painful, it can cause your baby’s heart rate to plummet since the water is no longer protecting them and surrounding them and their umbilical cord, and it increases your chances of infection. This is why it’s good to let baby break the water on his/her own unless it’s medically necessary.
And another note, 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. The reason for this is that they are trying to avoid infection, chorioamnionitis. So once your water is broken, you are on the clock!
8. Don’t get an epidural too soon.
If you decide to get an epidural too soon (before active labor), it has the potential to slow down and potentially stop your labor. Your medical providers will then have to counteract that epidural medication with another medication called Pitocin, which is a synthetic form of oxytocin (the hormone that causes your contractions), which is the drug that they use for inductions. If you get an epidural too soon, even Pitocin sometimes won’t help. I’ve seen it. You want to make sure that you have established a good labor pattern of effective contractions and are in active labor before you decide to get an epidural. The longer that you wait to get an epidural, the lower your chances are for needing a C-section. Here is when you should get an epidural.
9. Ask for intermittent monitoring.
If you are wanting a drug-free birth, you can request to have intermittent monitoring. If you are going to be induced or have an epidural, you will have to be continuously monitored since your medical team needs to see how your baby is reacting to the drugs being given to you. A lot of doctors still want their patients to be continuously monitored even when women are wanting a drug-free birth. However, continuous monitoring prevents women from moving as much during labor, which in my opinion is vital to having a successful unmedicated birth. You can move a few feet from the machine, but that’s about it. This means that women may be unable to change positions freely or use a bath or shower to help with comfort and control during labor or walk the halls. The medical staff can also at times become fixated on constantly getting a perfect reading from the monitor. Mind you, when you move, the baby moves 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 needs of the laboring woman, they sometimes shift to focusing on getting a constant reading of the baby’s heartbeat.
NOTE: Some hospitals have wireless and waterproof monitors. So if your doctor demands continuous monitoring, you can still have the option to walk around, move in different positions, and get in the tub with these monitors continuously on you.
As for intermittent monitoring, it is a wonderful option. Your care provider can still check to see how the baby is responding to labor, and it allows you to labor the way you want. If you want to move around, get in the water, you can! Also, monitors can be uncomfortable on your belly so to be able to take them off or have them use a Doppler instead is so much nicer!
10. Ask questions during your labor.
If your doctor is recommending a C-section, ask these questions first: 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 and in the end you’ll know that you did everything that you could.
11. If you have already 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). If you are wanting to have a VBAC, you want to have a doctor that has a high success rate of VBACs. They obviously will have privileges at a hospital that allows VBACs. So be sure to discuss this with your doctor if you decide to have another baby after a cesarean.
One last thing to keep in mind is that hospitals are in the business of babies. Hospitals want to get new patients in the beds and have a good turnover. This is a business for them. So if you’re there and not progressing fast enough for their standards, it’s very likely they’ll make suggestions to speed things up, sometimes to benefit their bottom line, not to the benefit of the patient or child. Know that you have options. This is your baby’s birth and your body. Listen to your gut and do what you think is best for you and your baby.