Planning a C-Section? Make it the best possible! {San Diego Bradley Method® Instructor}

{From the Birth Book, by Dr. Sears}

Medically necessary reasons to have a Cesarean section birth include: (aka: Hard indications)

• Placenta Previa
• Placental abruption
• Active genital herpes at time of delivery
• Prolapsed umbilical cord
• Transverse position of the baby
• Health complications in the mother (ex: Severe toxemia, uncontrolled Diabetes)

Medical reasons often given for a c-section that given proper advice and support, mothers can often circumvent: (aka: Soft indications)

• Failure to progress (uterine dystocia) - usually this reason is given when the medical staff is impatient and has called your "time up!" It is the doctor's "failure to wait."
• CPD (Cephalopelvic Disproportion) - this means the doctor suspects your baby is too big (macrosomic) to fit through the pelvis. TRUE CPD is unusual and can only be diagnosed in stage 2 of labor if no progress is made after a considerable amount of time spent pushing. 
• Fetal distress - often given as a reason when the External Monitor tracing patterns cause "OB distress". Certain patterns on the EFM suggest (but do not prove) that the baby may not be getting enough oxygen - and most doctors are not willing to gamble on it being a false alarm. {Side note: the EFM has not improved maternal and fetal outcomes in the USA, it has only increased our Cesarean rate to an astounding high of 34%}
• Repeat cesarean birth - these account for 30% of all cesareans, even though 70-90% of women who have previously had a c-section can safely deliver their next baby vaginally.
• Breech presentation - the breech baby can be safely delivered naturally if a trained midwife or OB is in attendance. Breech presentation is a variant of normal, and can be safely delivered vaginally.

How to Avoid a Cesarean:

1.              Choose your birth attendants and birth place wisely. Choose a care provider and place of birth that is most likely to give you the best and safest birth. The most likely place for a Cesarean to happen is the hospital (34%) and least likely is home (5%) or a Birth Center. If you choose an OB, ask for their % rate of C-section – if it is over 15% consider choosing another doctor. Their VBAC rate should be 70% or higher. Do they support walking in labor and various methods of pushing? These are important options to consider.

2.              Bring a birth buddy. Your chance of Cesarean in a hospital birth is decreased by 50% if you hire professional labor support (doula).

3.              Think upright. Back-lying is the position for a cesarean. The more time you spend on your back in labor, the more likely you will need a cesarean. Research has shown that laboring upright increases uterine efficiency, shortens labor, dilates the cervix better, and allows your labor to progress more comfortably and efficiently. Freedom of choice in laboring positions is your best ticket to a vaginal birth.

4.              Take a walk. Research has shown that walking helps labor progress and is good for the baby.

5.              Use electronic fetal monitoring and interventions wisely. EFM can be your friend or foe. Studies have shown no difference in infant outcome whether EFM or fetoscope is used. The studies also found that mothers who had continuous EFM were TWICE as likely to have a cesarean birth. However, if your doctor suspects a complication, the EFM might save you from a surgical birth by showing the doctor the baby is not bothered by a long labor.

6.              Consider the epidural carefully. This intervention can lead you to more interventions and end up in cesarean delivery. It takes away your friend, gravity, as you spend all your time on your back. Epidurals reduce uterine efficiency, often leading to the use of pitocin. In some instances, they can be useful for a very long labor in which the mother gets exhausted and can not relax enough to dilate.

7.              Take your time. Birth, like sex, shouldn’t be rushed. Don’t feel pressured to give birth in a hurry because of others’ convenience or timetables. Often a mother’s “failure to progress” is really the obstetrician’s “failure to wait.” There is no evidence that a long labor is harmful to the baby. If you are planning a hospital birth, it is best to labor as long as possible at home.

8.              Use discernment about “managed” births. A pregnant woman, screened for normalcy and certified by ultrasound to be near term, books her birth near her due date. She enters the hospital in the morning, gets a pitocin drip to get things going and an epidural to keep from hurting. Her labor is chemically stimulated, electronically monitored, and technically managed. Before you sign up for this new way of birthing, consider the probability that a disproportionate number of these births will be mis-managed and will wind up in the operating room.

9.               Lobby for legal letups. While some indications for cesarean birth are absolutely black and white, others are shades of gray, requiring a judgment call by the physician. The fear of a lawsuit is likely to cloud a physician’s judgment and lead him into a “take-no-chances” mind-set, which leads to the operating room. It often takes more discernment to decide NOT to do a cesarean than it does to cut.

10.           Remember your vulnerability. Plan ahead. Learn about true indications for cesarean and options for the gray areas. Having a professional labor assistant helps. After exhausting all your alternatives you can participate in the decision about surgery with no blame, regrets, or scars in your birth memory.