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How to Avoid an Unnecessary Cesarean
The Public Citizen Health Research Group in Washington, D.C. has estimated
that half of the nearly one million cesarean sections done every year in the United States are medically unnecessary.
That is, with more appropriate care during pregnancy, labor and delivery, half of the cesareans could be avoided. Clearly there are times when cesareans
are very necessary. However, cesarean delivery presents increased risks to both mothers and babies, and if those
risks can be avoided, both mothers and babies will benefit. The following suggestions are things you can do to help avoid an unnecessary cesarean.
By preparing throughly, you can help insure that your birth experience is as healthy and positive as possible.
- Read and educate yourself. Attend classes, groups and workshops inside and outside of the hospital environment.
- Research and prepare a birth plan. Submit copies to your hospital or birth facility, doctor or midwife, and labor support persons.
- Interview more than one care provider. Ask key questions, see what their responses are and how your probing influences their attitudes. Are they defensive or pleased by your interest?
- Ask your care provider if there is a set time limit for labor and second stage pushing. See what he/she feels can interfere with the normal process of labor.
- Tour more than one birth facility, note their differences, and ask about their cesarean rate, VBAC (Vaginal Birth After Cesarean) protocol, etc. Become aware of your rights as a pregnant woman.
- Find a labor support person. Interview more than one, look for someone who has attended several births and has background experience with normal, non-interventive birth. A recent medical journal article showed that female labor support can significantly reduce the need for a cesarean.
- Help ensure a healthy baby and mother by eating a well-balanced diet. Eating foods rich in protein, vitamins and minerals can prevent complications in pregnancy, labor and delivery. Salt restriction is not recommended during pregnancy. Salt food to taste.
- If your baby is breech, ask your care provider about "tilt-position" exercises, external version (turning the baby) and vaginal breech delivery. You may want a second opinion.
- If you have had a prior cesarean, seriously consider and explore the option of VBAC. According to the October 1988 VBAC guidelines from the American College of Obstetricians and Gynecologists, VBAC is safer in most cases than a scheduled repeat cesarean and up to 80% of women with prior cesarean sections can go on to deliver their subsequent babies vaginally.
- Stay at home as long as possible. Walk and change positions frequently. Labor in the position most comfortable for you. Remember, squatting can help. Do not labor or birth flat on your back as the weight of your baby on the vena cava (a major blood vessel in the mother's abdomen) can decrease the blood supply and oxygen to your baby.
- Continue to eat and drink lightly, especially during early labor. The uterus is a muscle, and like all muscles, it must be nourished to work effectively.
- Avoid pitocin augmentation for a slow labor. If your labor is progressing slowly, you may want to try nipple stimulation. Nipple stimulation and loving caresses may also get your labor going when you are past your due date. Remember, delivering past your due date and/or a slow labor may be normal for you.
- If your bag of water breaks, don't let anyone do a vaginal examination (to avoid the risk of infection), unless medically indicated for a specific reason. Discuss with your care provider about how to monitor for signs of infection.
- Recent studies have shown that the routine use of continual electronic fetal monitoring contributes to an increase in cesareans without related improvements in fetal outcome. Request the use of a fetoscope or perhaps just an initial monitoring strip upon admission to your birthing facility.
- Epidurals and other anesthesia can slow down labor and can cause complications for the mother and baby. If you do have an epidural and are having trouble pushing effectively, let the epidural wear off and then resume pushing.
- Do not arrive at the hospital too early. If you are still in the early stages of labor when you get to the birthing facility, instead of being admitted, walk around the hospital or go home and rest.
- Find out the risks and benefits of routine and emergency procedures before you are faced with them. When faced with any procedure, find out why it is being used in your case, what are the short and long term effects on your baby, and what are your other options.
- Remember, nothing is absolute. If you have doubts, trust your instincts. Do not be afraid to assert yourself. Accept responsibility for your requests and decisions.
Copyright© 1992, International Cesarean Awareness Network