Only a small percent of women plan an elective c section for the birth of their baby.
A survey in the United States revealed that only 1% of women who underwent a primary (first time) c-section reported to have planned the c section, with no medical reason.
Similar findings have been reported in other countries.
It just goes to show that the vast majority of women do want to have a normal childbirth.
In 1985, a c-section rate of 10-15% was declared to be an appropriate figure.
Anything beyond that was deemed to be without benefit to the mother and baby. Despite this, the c section rate in the United States increased by 53% from 1996 to 2007, with many other countries — including Australia — following suit.
In a response to the growing concerns of governments, clinicians and the wider international community, the World Health Organisation (WHO) have again reiterated their concerns about unacceptably high c section rates around the world.
In a recent statement, the WHO acknowledged that c sections are effective in saving mothers and babies lives (only when required for medically indicated reasons). However, they stated that based on their extensive studies, c section rates higher than 10% did not show any reductions in maternal and newborn mortality rates. This means that where c section rates are higher than 10%, they are not saving lives. Yet, the risks of major surgery still exist.
The WHO concluded that “Caesarean sections can cause significant and sometimes permanent complications, disability or death particularly in settings that lack the facilities and/or capacity to properly conduct safe surgery and treat surgical complications. Caesarean sections should ideally only be undertaken when medically necessary.”
It's time for us to sit up and pay serious attention.
With alarming statistics revealing that the rates of c sections average 30% in Australia and the United States — that's 1 in 3 babies being born surgically — what can we possibly do about it to help reverse the trend?
8 Helpful C-Section Prevention Tips
Here are 8 tips that can help to put the odds in your favour of having a normal birth.
#1: Choose A Primary Care Provider With A Low C-Section Rate
If you choose an obstetrician with a high or moderate c section rate, you're likely to follow in those footsteps. Always interview an ob gyn before you decide on one, and always ask about their c section rate. If it's higher than 15% (which is likely) then ask why he or she thinks the rate is so high. It'll give you some clues as to how they think and what their philosophies about birth are. Before interviewing an obstetrician, see BellyBelly's article about questions to ask an ob gyn.
Choosing a care provider with a low c section rate is a major step towards avoiding a surgical birth. However, the medical model of birth is heavily geared towards high levels of inductions and caesarean sections. True natural birth (no drugs, no managed third stage and so on) is next to extinct in a hospital setting.
For some women, the best option is a midwife. Studies have shown that for low risk women, primary midwife care reduces the likelihood of a c section. In addition, primary midwife care significantly increases the chance of a spontaneous vaginal birth.
Investigate your options, speak to a range of care providers, and decide on what feels right for you. But you wont know unless you compare both.
#2: Avoid An Induction Of Labour
There are some cases in which an induction of labour would be wise, for example, if a mother has been diagnosed with preeclampsia.
However, an induction of labour (with a pharmaceutical drug) increases the likelihood of an emergency c section — especially for first time mothers. In fact, 15 out of 16 studies have found that the c section rate for first time mothers undergoing an induction of labour is double that of a non-induced mother.
A recent study concluded the opposite findings. They found that induced women had a reduced likelihood of having a c section. However, the research was flawed. Women assigned to expectant management (as opposed to an induced birth) had a range of pre-existing complications, including low or excessive amniotic fluid, preeclampsia and others. Those in the expectant management group were able to choose to be induced or have a c section at any time.
Not only that, but first time mothers were included in groups with mothers who had given birth before. So it's impossible to come to a fair comparison. If you're interested in all the figures, Henci Goer has provided a fantastic analysis and interpretation here.
Synthetic oxytocin (pitocin in the US, syntocinon in AU) does not act in the same way as natural oxytocin. It does not cross the blood brain barrier. It can also bring on labour quite stong. Many women who have this drug quickly seek pain relief, especially epidurals.
Epidurals require you to be immobilised and catheterised (because you can't tell if you need to wee). You may or may not be able to push effectively, and as a result, require forceps or vacuum. But you may not even get that far, because for some women, inductions of labour fail to work, and the only option from there is a c section.
When you are induced, you become high risk. Why add risk to a birth that is completely normal?
#3: Hire A Doula
Time and time again, studies have confirmed that giving birth with the support of a doula can reduce the likelihood of a c section. A recent study published in the American Journal of Managed Care reported an almost 60% reduction in a woman's odds of having a c section, and an 80% reduction of having a non-medically indicated c section. Those figures alone are very telling. If doulas can have that much of an impact on the c section rate, are we doing 60-80% too many caesareans?
A doula is a trained birth companion who provides continuity of care and is known to you. She is a familiar face at birth who is on your team. She provides birth education, support, and many other pieces of the puzzle to help couples have a more empowering birth experience. She doesn't replace a medical carer or a partner, she simply joins the team and makes her contribution.
A systematic review of doula studies concluded that support from a doula is more effective than that from hospital staff or the woman's friends or family. She offers a trifecta of care that the others are unable to provide — and most importantly, she works for you. Not a hospital, insurance company or anything else with a vested interest.
Alternately, you may like to have a midwife as your doula. But just like anyone else supporting you at birth, make sure her philosophies are in line with yours.
#4: Get The Best Birth Education You Can
Would you get into a car and drive without a lesson from a driving instructor first?
Would you sit your driving test without reading all you can first?
Of course not. And the most important thing you need to know is that not all instructors or reading materials are created equal. Hospital classes can be useful for you to become familiar with where you'll be giving birth, finding out about the hospital and information about procedures. But many lack in-depth knowledge into the birth process, coping with pain, birth support techniques for your partner, options for third stage, the fourth trimester and so much more.
Independent birth education goes so much deeper than what you'll learn from a hospital class. Granted, some fantastic midwives do run classes in some places. However, the amount of mediocre classes that exist will not prepare you anywhere near enough. Find out more in BellyBelly's article, 9 reasons why you should choose independent birth education, here.
#5: Get Active Before The Birth
Being physically active before you give birth (ideally before you conceive) will help you for the endurance test that is labour!
Understandably, physical exercise can be difficult if you have terrible morning sickness or any painful health conditions. So if you are able, make it your goal to get out for a walk each day. It needn't be long or strenuous, but aim for a 30 minutes of comfortable walking each day.
If you're worried that will be too much, start out with just 10 minutes. That's 5 minutes walk before you get to turn around and come home again! Build up duration as you feel comfortable. Swimming and yoga are also offer fantastic physical benefits for pregnant women. Not to mention the emotional benefits of physicla exercise, which can help you prevent and manage anxiety and depression.
Any physical advantage you can arm yourself with will help you to have a better labour and birth. Unfortunately, our lives have become very sedentary from what they once were. Pushing ourselves physically can seem like more of an effort. But having a stronger body will be help you cope with the intensity.
#6: Get Active During Labour
Reclining or lying down on a bed during labour can result in a longer, more painful labour, while increasing your risks of cesarean section. A Cochrane review of 25 studies concluded:
“There is clear and important evidence that walking and upright positions in the ﬁrst stage of labour reduces the duration of labour, the risk of caesarean birth, the need for epidural, and does not seem to be associated with increased intervention or negative effects on mothers’ and babies’ well being.”
When you're active and upright, you're working with your body and gravity. You're helping your baby move down into the pelvis – he's got to pull off some wriggles, twists and turns before he is born. Working with him will ease his passage. Being immobile makes things more difficult.
Your uterus also contracts forwards. This is why many women naturally lean forward during contractions, it just feels natural. Lying down is also one of the most physiologically dysfunctional positions to give birth in. Your pelvis can widen up to 40% more when you are squatting. Also, when you lie down, you're bearing the weight of your uterus and baby, which may result in compression of major blood vessels. This may reduce the blood and oxygen supply to your baby. If this happens, your baby may go into fetal distress.
#7: Surround Yourself With The Right People
Not only do you need a supportive cheersquad around you during pregnancy, but in the birth room too.
The people who you surround yourself with impact on your thoughts, beliefs and confidence going into birth. There are always plenty of people willing to spew their horrific birth stories over anyone who will listen — ideally the first pregnant woman who crosses their path.
The birth experiences of those around us can impact on what we think birth will be like and what we think is possible. So if you start hanging around positive, uplifting people, you'll start to look forward to the birth, and believe in yourself. Join birth support groups or birth forums that have a supportive vibe.
The birth environment is no different. Be careful who you invite into your birth circle. You don't get another chance at giving birth, so the people who are there can either make or break your experience.
Make sure your primary care provider is in alignment with the birth you want, and make sure the people you choose to support you are going to be a great support and have relevant experience. Make sure your partner feels well prepared.
You may have the loveliest of friends, but if none of them have had a vaginal birth, then they haven't experienced what it takes to get through ten centimetres of birth intensity. They may end up holding your hand in sheer terror, seeing you struggle through your toughest moments, without a clue of what to do.
Mothers (and sometimes fathers-to-be!) can crumble seeing their loved one in pain, and may insist on pain relief in an attempt to take it all away. But labouring women do not need to be saved. They need to be supported and cheered on. Only if the labouring mother decides she wants a c section (or if medically necessary) should she end up with one. Not because the people around her are falling apart and have no tools in their toolbox to help her.
Here are 5 tips for choosing the right (non-trained) birth support people.
Believe it's entirely possible to have a rewarding, normal birth — because it is. It can be difficult during a time where so few women are having wonderful, normal birth experiences. But this is only because there is so much fear, misinformation and a lack of good support. Many women don't make choices that back up the outcome they seek.
You don't have to be one of those people who tells their birth horror story for years to come. Even if you do wind up needing a c-section, you'll have less trouble coming to peace with it when you know you did everything that you could, and you were well prepared.
- Goer, H (2014). Does Inducing Labor Increase The Risk Of Cesarean Surgery. International Doula, Volume 22, Issue 2.
- Declercq et al. (2013). Listening To Mothers III Survey and Report.
- Centers For Disease Control and Prevention. Recent Trends in Cesarean Delivery In The US.
- Gibbons, L, et all. (2010). The Global Numbers and Costs of Additionally Needed and Unnecessary Caesarean Sections Performed per Year: Overuse as a Barrier to Universal Coverage.
- Lawrence, A (2013). Maternal positions and mobility during ﬁrst stage labour.