Five Ways to Lower Your Risk of a Cesarean

Imagine you’ve just had surgery. You came through it great, but you know that for the next few weeks you’re going to need to take it easy, relax, not lift anything, and avoid bumping that scar area near your lap. And then you’re handed a newborn baby and told to take care of it, too.

This is reality for about a third of mothers giving birth in the US today. And while cesareans are certainly appropriate and life-saving in some cases, the current cesarean rate is more reflective of current birth practices and beliefs than it is of true medical necessity. Keeping yourself in a low-risk category and supporting the natural birth process by choosing some of the following tips can help you not have to imagine what it would be like to take care of a newborn after having major abdominal surgery.

#1 Stay Active

While most women know the importance of eating healthfully during pregnancy, many are not equally focused on how staying active and fit can help reduce your risks of complications which could lead to a cesarean. Research has also shown it can lead to a shorter labor. Who wouldn’t want to sign up for that?

A multitude of studies reinforce that mothers who keep active through their entire pregnancy have lowered risks of many complications and interventions, including cesarean. Helen Varney, author of Varney’s Midwifery textbook, cites several studies on exercise during pregnancy that show a 75% reduction in the need for forceps delivery or cesarean, which each carry risk to both mother and baby. Exercise helps you metabolize your food better, it helps keep your blood pressure stable, and it can ward off gestational diabetes, which for some women can raise your risk of interventive birth.

#2 Hire a Doula

In 2011, the well-respected Cochrane Collective published a review of 21 studies that was designed to “assess the effects of continuous, one-to-one intrapartum support compared with usual care” which is precisely what doulas provide. Not only did this review find that the presence of such support lowered the cesarean rate, it also decreased other complications and interventions associated with hospital birth and showed an increase in breastfeeding rates.

Some couples worry that having a doula will interfere with the role of their partner in the birth, however nothing could be further from the truth. Doulas are trained to support the birthing couple (or in some cases, be primary support if the birthing mother doesn’t have a partner to be with her during the birth) and not to take charge. Hiring a doula is a great investment no matter what the cost, because of the lifelong health benefits to you and baby from avoiding unnecessary or preventable interventions.

#3 Make Sure Your Team Knows Your Birth Plan — Without Having a Birth Plan

Birth plans can be a controversial subject. Women love them for their ability to clarify what they really want from their birth experience. Care providers (and often hospital staff) can hate them because in their view, they are a red flag that a patient may be controlling or inflexible. There is a phrase widely known in the birth community, often said by hospital staff, “The longer the birth plan, the quicker the cesarean.” There may in fact be some truth to that, since the attitude with which a mother bringing in a long birth plan may be treated can lead to her being undermined and unsupported in her birth. But knowing what your goals are is still a very useful thing.

A compromise can be to make sure your birth team (including your doctor or midwife) is very clear on your wishes and preferences. If your doula or partner know your birth plan details by heart, it will be easy for them to remind you of things like waiting for baby’s first bath; or when pushing, that you don’t want to be directed but push with the urge. Having a solid team who all know the “game plan” is much more useful in the long run than a piece of paper. That said, a short, one page bulleted mention of some of your top requests, especially if they are non-standard in your choice of birthplace, can be valuable if your primary provider is not on call or you have a nursing shift change.

#4 Hire an Expert in Non-Surgical Birth

In our expert-driven culture, we tend to assume that the more money one makes, or the more letters one has behind one’s name, the more expertise one has in a subject. This assumption also drives maternity care, with most women choosing an OBGYN for their care provider. However an obstetrician is not just a medical professional interested in birth, they also have a specialization in surgery, and for most obstetricians, surgery is what they do about a third of the time with their clients. Make sure you know your care provider’s cesarean rate when interviewing, as this is a good indication of their beliefs about birth.

Midwives, however, have a sole focus on normal birth. Their cesarean rates are typically much lower than OBs, and not just because they don’t take on high-risk clients. Studies have repeatedly shown that the midwifery model of care (MMOC) lowers all forms of intervention, even with higher-risk categories of pregnant women.

#5 Consider a Change of Location

Although most women in the US now go to a hospital to have their baby, in other countries, birth centers and homebirth are more widely utilized for low-risk women. The homebirth rate has been rising in the US. Advocates believe this to be a response to women being more active in seeking out patient-driven care outside of a medical model that may be less flexible than they desire. And homebirth can be a safe choice for many women; a recent Canadian study showed that planned homebirth had similar mortality rates, but much lower rates of interventions and cesareans than the planned hospital birth group.

For those not quite ready for the leap to home, a birth center (frequently staffed by midwives) can be a good option. Birth centers can provide a non-hospital setting for those unable to or who prefer not to birth in their home, but who want a more patient-focused birth experience.

Starting off your mothering journey can sometimes be an emotional and physical challenge, and avoiding adding major abdominal surgery to that mix is a worthwhile goal. While these steps are not a guarantee, they can help you make proactive choices towards achieving the outcome that you desire.

|by Krista Cornish Scott, a writer and advocate for birthing women in the spare moments she steals from homeschooling three children and her vocation as a classical musician. For more information about ICAN, please visit www.ican-online.org