Are You A First Time Mom Wanting to Avoid an Unnecessary C-Section? Read This Post.
America’s c-section rates are too high - even USA Today recently reported on the problem (birth workers have been talking about it for a very long time). In one 2019 study the article mentions, women who had c-sections were 80% more likely to have complications than those who birthed vaginally. Furthermore, the fact that c-section rates are so disparate between hospitals (60% or more at some hospitals!) shows that we are facing differences in how client care is managed, not a huge number of women needing c-sections. There are needed c-sections. Not a single person I know wants to dispute that. I am overwhelmed with gratitude at the way science and medicine have worked to improve outcomes in so many situations where surgery saves lives. But shouldn’t we also be excited about the possibility of reducing our need for a birth process that cuts a woman open, which can also save lives?
One way, of course, is to help mothers with c-sections have vaginal births with subsequent children. VBACs, as they are called, are wonderful too. But something that would also help would to be to stop a c-section from happening in the first place, making any VBAC plans unnecessary & helping a woman’s postpartum recovery be better right away. With that goal in mind, I’ve put together this list of options that could help make a difference for your birth outcomes!
1) Consider Using A Midwife As Your Care Provider - One study of over 20,000 women found that those who used hospital midwives were 30% less likely to need c-sections for their first births, and 40% less likely to need c-sections for later births. Another study in New York found that midwife-assisted births were less likely to result in c-sections and episiotomies.
Does this mean all OBs aren’t good care providers? No. It’s really a matter of training. As OB Dr. Neel Shah says, “this debate is not about the superiority of midwives over doctors…” - it’s that OBs are trained surgeons (which we need!). Dr. Shah again - “you can either either try to rewire the OB, or avoid the OB unless you really need one…”. Midwives are trained to care for normal, physiological birth - which comes with its own special set of skills. And they know when to rely on their team member OBs. I’ve seen this in action & it’s such a good relationship!
Maybe a midwife isn’t available to you. There are so many excellent OBs who embrace the fact that a woman’s body is made to birth babies! It’s fine. But take your time choosing one - ask friends who have had positive births about their providers, for instance. And ask a provider if they routinely offer inductions at 39 weeks ~~ many do, and though one study seems to indicate this is better than inducing at later times, other research says that 1/4 of first time inductions end in c-sections, which are not favorable odds.
2) Exercise ~ Sometimes it’s easy to put the blame on our medical system or doctors and ignore the very real things we can be doing on our own to help our bodies. This is one of them. Birth is an arduous physical process. We can’t “practice” it, but we can keep our bodies strong. In fact, one study found that women who exercised consistently in pregnancy were 20% less likely to need c-sections and also tended to have smaller babies. (For the connection on hard physical work & birth, check out this post on confidence in birth…)
3) Skip Continuous Fetal Monitoring In Labor ~ Continuous Fetal Monitoring (CFM) is technology that was introduced to try and reduce the rate of babies born with cerebral palsy because of distress in labor (that was the reason given; it was actually never was tested before being sold to the medical community). It is now routinely used by most American doctors even though research has shown no reduction in cerebral palsy births and has shown that “continuous CTG was also associated with increased numbers of caesarean sections and instrumental births…” (source). This does not mean baby is ignored in birth! Intermittent fetal monitoring is used as an excellent assessment tool.
4) Skip Routine Cervical Checks At Prenatal Appointments - Knowing how much you’re dilated doesn’t actually help give a strong indicator of how eminent labor is. Some women can go from 1-9 CM in just a couple of hours. There hasn’t been a lot of research done on whether cervical checks make a difference or not, but some of the scant research indicates it could cause your water to break before the onset of labor. Again, this may not be the case ~ but there are no clinical benefits to routine checks, and there could be a risk.
6) And, Yes, Hire A Doula. We make a difference. A Cochrane review found that a trained support person outside of a woman’s normal support network could improve birth outcomes. A 2015 study found that first time mothers who had a doula present experienced less anxiety & less pain in childbirth than those without doulas (source). And in yet another study, done between 1988-1992, 25% of women without a doula had c-sections compared to only 13.4% of the women with doula support. Yes, the difference was that dramatic. And in that case, this difference was observed for doulas who only provided support in labor. Considering the fact that most doulas today offer prenatal education and on-call support for before you even arrive at the hospital, I suspect the difference would be even more dramatic now!