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Preventing the Unnecessary Cesarean

After the third straight year of rising cesarean rates, the American College of Obstetricians and Gynecologists (ACOG) has issued a press release stating that they are requesting that practitioners and hospitals evaluate their cesarean rates in different manners. Considering the added risks of surgery to the birthing process, including increased infection rates and mortality rates for mom, and potential problems for the baby as well, it's best saved for the situations where it is truly necessary.

This may raise questions in your mind about how you can avoid becoming a cesarean statistic. If so many are unnecessary how can you ensure that you avoid the unnecessary surgeries?

Choosing Your Practitioner

Before you get pregnant or early in your pregnancy interview your doctor or midwife about their cesarean rates. Ask them specific questions about when they would intervene with surgery, when surgery would become appropriate prior to labor, and about their vaginal birth after cesarean rates (VBAC).

More Questions to ask your practitioner:

  • Do you have limits on the length of labor? Pushing stage?
  • How do you feel about laboring at home in early labor? Is it encouraged?
  • When do you do inductions? Is there a policy for the length of gestation?
  • For what reasons would you do a cesarean prior to labor?

Do you feel comfortable with their answers? Are their numbers well within the guidelines set forth by different organizations as being appropriate? The Healthy People: 2010 benchmark for the year 2010 is 15.5% for first time cesareans. In 1996 the rate was 17.9%.

Choosing Your Place of Birth

Having your baby in a facility that has a lower primary cesarean rate (rate for first time cesareans) is of great benefit. All hospitals and birth centers are required to give you this rate. Ensure that the number you are getting does not include repeat cesareans. You should be able to obtain this information from the hospital administration office.

For those choosing a birth center or home birth, talk to your practitioners about their rates of transport and how many of those transports wind up having surgery. Generally speaking, these numbers will be lower because they are working with a lower risk population, and use fewer interventions.

Choosing Your Support People

Cesarean rates for women who choose professional labor support are much lower. According to some studies as much as half the rate of their non-supported counter parts. In their statement ACOG says, "The continuous presence of nurses or other trained individuals who provide comfort and support to women in labor may lead to lower rates."

A doula, or trainer labor support person, is someone that you hire to be with your throughout labor. Her only focus is the physical and emotional support of you and your partner. This can also help reduce the epidural rates, which may increase cesarean rates inadvertently.

Knowledge & Advocacy

Be prepared. It's not just for Boy Scouts anymore. Be educating yourself on different birthing techniques and interventions you can save yourself some fear and potentially an unnecessary surgery. Childbirth classes can give you many great coping skills for labor to increase your comfort, decrease the need for medications and interventions and the fear that many women feel. It will also leave you in a better space to make decisions should interventions be needed.

For example, the use of electronic fetal monitoring, while designed to save the lives of babies, has been shown to actually increase the cesareans rates without the benefit of saving the lives it set forth to save. ACOG recommends that low risk women not be continuously monitored, but that the use of intermittent monitoring be used instead for this group of women.

If a cesarean became appropriate it would also provide you with the knowledge base to make decisions about the surgery. Knowing what to be prepared for is also helpful in these cases.

Birth plans should also be discussed as a communication tool between you, your practitioners, the staff at your place of birth and your support people.

Other Resources

Cesarean Prevention Resources
Cesarean Resources
Birth Plan Resources
Doulas: Professional Labor Support

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Photos courtesy of Robin Weiss.

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