I’ve mentioned before my own ignorance about transformation and c-section. So having come out of that tunnel vision still leaves me with the feeling that the basic system of maternity care doesn’t really support women to healthy birth.
Next week, I’m interviewing an OBGYN on my radio show. He’s very receptive to different ideas, although it’s clear he is a conventional doctor, with beliefs common to the medical profession. I contacted him after reading his blog where he was writing about the causes of escalating rates of cesarean section. He thinks this is a problem (that’s a good start) and he names his opinions for the cause of the 31.8% rate. I think he’s wrong about some of it. But I’m listening because he is looking- and so many doctors aren’t.
(Here is why I am impressed with him: He is open-minded. Although he stated that he believes hospital birth is safer than homebirth, he was willing to consider his opinion might not be fact, but just perception, based on his only experience with homebirth: hospital transfer when it doesn’t work out. When we talked about that, he admitted that this might affect his perception of the safety of homebirth despite statistics- that it is tough to wrap your mind around something that doesn’t reflect what YOU SEE firsthand. He doesn’t see the successful homebirth stories. It takes more effort to be open when what you see doesn’t match the studies.)
So, I’ve been brushing up on my own research and reading what the data shows are the main culprits. We’re going to hash some of it out on the show. But it’s only an hour long show. I know we won’t cover everything because this could be month-long conversation if we had the time. So I want to list on the blog what you can do to lower your risk of surgical birth if you are pregnant.
1. Carefully choose your care provider. Make sure you feel like a partner in your care, that you feel comfortable asking questions, and that your care provider listens to and respects your values, needs and goals.
2. Ask questions about cesarean section well in advance of your labor. Ask for examples/reasons your provider might suggest surgery. Ask what happens if a situation came up where you disagree and refuse surgery or want a second opinion. Ask for examples of non-urgent situations/health concerns that might increase your risk of cesarean. The more prepared you are, the less likely you will feel pushed into something/out of control/dis-empowered if you really do need a c-section.
3. If a c-section is recommended, ask questions: specifically why it is recommended; what benefits it is expected to offer; whether the expected benefit is greater than the risks associated with major abdominal surgery; and what other options exist for your situation. You have the right to this information as part of your right to informed consent. If you are not in labor when surgery is recommended, consider a second opinion, and definitely do some research about the condition or issue cited as the reason.
4. If you’ve already had a c-section, ask for a VBAC. If your doctor/provider does not provide this service, it is important they understand the demand is still there. Consider contacting another care provider if VBAC is important to you. I also recently discovered a doc who was willing to travel to provide VBAC to women in areas it is not available in hospitals.
5. Educate yourself about common reasons given for c-section.
a. Failure to progress– ways to overcome/avoid:
- Ask your provider in advance: how long is too long? so you can see if this idea/perception fits your individual needs.
- Move around during labor. Ask in advance about your freedom of movement during labor at your chosen birth location.
- Avoid interventions (like epidurals) that prevent you from standing/walking around to keep labor moving.
- Wait to go to the hospital/birth center until you are in active labor (having trouble concentrating or focusing during contractions).
- Eat during labor- keep up your energy during this “endurance challenge” so you can get to the end. You don’t run a marathon without eating and labor is like a marathon. Ask in advance about the “rules” and about informed refusal of any “rules” that prevent you from eating when you are hungry. (Then be sure to bring your own food with you!!)
- Hire a doula for personal support and help trusting your body.
b. Changes/concern about fetal heart rate.
- Ask for intermittent (rather than constant) fetal heart rate monitoring. Shown to be just as effective when used by diligent care providers, it also allows you more freedom to move. (Care providers can listen with a Doppler Device from anywhere in the room.)
- Attempt to avoid synthetic oxytocin (like Pitocin) which causes more intense uterine contractions and may affect the baby’s heart rate.
- Ask in advance about options for additional testing to check on the baby if there is concern about heart rates.
- Ask about moving to a different position and checking the heart tones again if there is concern.
c. Breech position
- Ask about options for turning a breech baby, including acupuncture, acupressure, breech tilt, external cephalic version (with an experienced provider- ask your provider about their experience. You may consider consulting someone with more experience for this aspect of your care if your provider is not familiar or has limited experience).
- In my opinion, the safety of vaginal breech birth is largely dependent on the skill and experience of your care provider- so ask at the beginning of your relationship about their experience with this and willingness to offer vaginal birth as an option for a breech presentation.
6. Avoid Elective Induction of Labor
- Except in the case of maternal health conditions (i.e. diabetes, preeclampsia, unterine infection) or when baby is not growing normally, reasons for induction of labor are generally not medical. Ask your provider why induction is suggested; ask about the risks/benefits of waiting for labor to begin naturally; research on your own the risks/benefits mentioned by your provider.
- Know that if your cervix is “unripe” (long and closed) you are at increased risk of a failed induction, followed by c-section.
- Know that medications to “ripen” your cervix (like misoprostol/prostaglandin E1/Cytotec) used during an induction are not FDA approved and may seriously harm you or your baby. There has been no safety testing and there is reason to be concerned. Ask your provider about the medications he/she plans to use and do your own research before you consent.
- Risk of a “big” baby: Only 30% of pregnant women believed to be carrying a big (over 8lbs13oz) baby actually give birth to a big baby. Ask your provider about risks/benefits. (I was told “they don’t grow more bones in the last 2 weeks, just more fat” and fat is squishy.)
- Post-term pregnancy (past 42 weeks): When calculating due dates, there is a 2 week margin of error (Lamaze International), so talk to your provider about options to delay/prevent induction, such as monitoring baby 2x per week, amniotic fluid level checks, etc.
- When water breaks but no contractions (PROM): Ask about waiting for labor to begin spontaniously, discussing/watching for symptoms of infection.
7. Choose a midwife for your care. Women who choose midwifery care have lower rates of cesarean section and higher rates of satisfaction. I’m not saying doctors are “bad.” In fact most are fabulous people. But outcomes are better for mothers and babies when women choose care from a midwife (Coalition for Improving Maternity Services http://www.motherfriendly.org). Reasons women under midwifery care have lower c-section rates seems to relate to the care choices- less use of induction, intermittent monitoring of fetal heart rate, encouraged freedom of movement, women encouraged to eat during labor, less need/use of pain medication. So the methods that get the best results could certainly be employed by doctors too.
I’m NOT anti-doctor. Doctors are needed for women with high risk pregnancies and for emergencies- definitely. Having a care provider who understands you are an individual, that one size doesn’t fit all (or if it does, it is a hand-off approach), who is receptive to questions & takes time to answer them- ALL of THEM, is more important than the title of the professional you choose.
If you want to lower your risk for cesarean surgery, you have to educate yourself and be prepared to ask a lot of questions. If you made it to the end, congrats. Please comment and add your thoughts to the equation.