Most women plan to give birth vaginally, yet more than one in three babies are born by cesarean section in the United States. There are many things you can do prenatally and in labor to help to lower your risk of cesarean. This topic is very important to me and I have lots of information to share here and in next week's post.
Start by asking your provider what his or her cesarean rate is, and compare that to others in your area. The World Health Organization says a cesarean rate of ten to fifteen percent is optimal; rates above that increase the risk for mother and babies. While very few American providers have rates that low, the American College of Obstetricians and Gynecologists (ACOG) came out with new recommendations for obstetricianslast year in which they strongly urge obs to lower their cesarean rates to make birth safer for mothers and babies.
We’ve long known that cesareans increase the mother’s risk due to higher rates of infection, hemorrhage, and the risks of anesthesia. Newer research is also focusing on the risks to cesarean born babies, including higher rates of allergies and asthma. This may be because they don’t have the opportunity to be colonized by their mothers' vaginal fauna. Cesareans can also initially complicate breastfeeding and require a longer recovery time. Having a cesarean increases the chances that a woman's next baby will also be born by cesarean, and the surgical risks increase with each cesarean birth.
“I would absolutely recommend other women to seek a Vaginal Birth After Cesarean (VBAC), and I'd certainly recommend birthing vaginally." says Jennifer Heller, a mother I spoke with who has had given birth twice vaginally and once by cesarean. Her cesarean was medically indicated and she has no regrets about it, but she told me "At a very visceral level, experiencing my body give birth vaginally to a baby has empowered me in ways I don't even fully understand. Not to mention the recovery was so much easier!”
One of ACOG’s recommendations for how providers can lower cesarean rates is to work with doulas. A doula's presence has long been known to lower the rates of interventions including cesareans. She can suggest labor positions and techniques, answer questions and provide reassurance, and help your partner to support you. Women who birth with doulas are more likely to delay or avoid an epidural, which reduces their cesarean risk. A doula's presence is calming; the calmer you are in labor, the less likely it is that your labor will stall or your baby will go into distress. While doctors, midwives, and nurses are usually on shifts, your doula is a familiar face you can count on to be at your labor, and she’ll be there for the entire time. She can come to your home in early labor if you want her to, go to the hospital with you (the car ride is often a challenging time in labor) and be with you until you are settled in your postpartum room.
I asked Liz Libby, who birthed twins by cesarean and went on to give birth to her third baby vaginally, how having a doula made a difference at her vaginal birth. She told me “having great birth support is really important, and my doulas got me through a lot. I'm not sure I could have done it without them.” Ask your friends and family with young children if they can recommend a doula, seek suggestions from your childbirth educator, prenatal yoga instructor, or midwife, or check out doulas certified with CAPPA and DONA.
In its statement ACOG changed the definition of active labor, saying that now it doesn’t start until six centimeters dilation. This change means women should be staying at home in labor longer. The more established your labor is when you come into the hospital, the less likely you will be sent home or given drugs such as Pitocin to speed up your labor. Labor induction doubles a mother and baby’s risk of cesarean, so ACOG is also encouraging providers not to do any non-medical inductions before forty-two weeks.
In next week's post, I'll have suggestions on how to care for yourself prenatally to reduce your risk of cesarean. I'll also share information specifically for moms who want to VBAC, birth vaginally after previously giving birth by cesarean.