10 Best Ways to Avoid a Cesarean Section

1. Understand the true risks associated with cesarean section:  With a national cesarean rate of nearly 34% percent, it would be easy to assume that surgical delivery of a baby is a piece of cake. While the surgical technique has been perfected over recent decades, Cesarean delivery is not a benign procedure.  Some of the more common risks of C-sections are:

• prolonged pain and recovery from birth
• lifting restrictions for several weeks after baby’s birth
• delayed skin-to-skin contact between mother and baby after birth
• delayed initiation of breastfeeding

Other unpleasant side effects associated with cesarean section include:

• wound infection
• wound dehiscence
• injury to internal structures like accidental cut in the bowel or bladder
• chronic C-section scar endometriosis
• decreased option for vaginal birth in subsequent pregnancy, depending on type of incision used in the first Cesarean delivery, and hospital/provider regulations on VBAC (vaginal birth after cesarean)

2. Choose a maternity care provider and birth setting with low C-section rates: With our nation’s Cesarean rate ever-rising, one of the best ways to reduce a woman’s individual chances of delivering by Cesarean is to give birth in a location, and with a provider, that maintain low C-section rates. In the United States, there is no federal mandate for universal reporting of birth-related medical interventions. With the exception of a few states that do require this, the only way a pregnant woman can find out the Cesarean rate of her provider/birth place is to directly ask.

3. Talk openly and often with your maternity care provider about your desire to avoid a C-section.  Not only do all patients have the legal right to informed consent  prior to receiving medical treatment, but they also have the right to informed refusal. Barring any dire circumstances that require a Cesarean delivery for the life or well-being of mom and/or baby, talking with your maternity care provider early and often about your desire to avoid a Cesarean delivery is important. Being on the same page with your doctor or midwife can then allow you to move forward with brainstorming ideas for keeping your risk of Cesarean section low.

4. Arrange ahead of time for a skilled labor support person who will be comfortable supporting you through labor and birth:  Because Cesarean sections often occur as a manifestation of a cascade of interventions, taking steps to minimize the number of interventions during birth is important. Studies have shown that women who birth with a trained labor support person decrease their chances of requesting pain medication and, ultimately, the incidence of undergoing a cesarean delivery.

5. Download and read Childbirth Connection’s What Every Pregnant Woman Needs to Know about Cesarean Section

6. Let your labor start on its own (avoid labor induction): Initiation of labor by use of medications like misoprostol (Cytotec) or synthetic oxytocin (Pitocin) creates a more intense pattern of uterine contractions without the natural “on/off” mechanisms that accompany the production of endogenous oxytocin. Also, when labor inductions are initiated in a woman whose body is not ready for labor her chances of failing the induction, and ending up delivering by Cesarean, are greater. 

7.  Labor at home for as long as possible before relocating to your chosen place of birth: The mammalian processes of labor and birth are strikingly similar—whether talking about dogs, cats, or humans.  Like other intimate experiences, labor (and birth) progresses more smoothly when experienced in a quiet, private environment. Being at home as long as possible also allows the woman to access familiar ways of coping with discomfort including lying in her own bed, bathing in her own bath or shower, taking a walk in her own yard or neighborhood and having access to her favorite high nutrition foods. Additionally, the longer a woman waits to transfer to her birth place of choice, the less likely she is to experience a cascade of interventions which can ultimately lead to a C-section.

8. Try as many non-pharmacological pain-coping methods as possible before opting for an epidural: Because the early use of epidural analgesia in labor (prior to 4cm cervical dilation) is associated with increased incidence of Cesarean section, women are encouraged to use alternate pain-coping mechanisms for as long as possible. Non-pharmacologic pain coping techniques might include:

• rhythmic movement & vocalization during contractions
• frequent position changes
• massage by a loved one or doula
• hydro therapy (warm bath/shower)
• meditation/visualization
• sacral (low back) counter pressure
• environmental changes (aromatherapy, relaxing music, low lighting…)
• alternate use of hot/cold packs

9. Avoid continuous (versus intermittent) electronic fetal monitoring: From The Official Lamaze Guide:  “Three decades of research show that EFM doesn’t improve birth outcomes.  When EFM is used during labor, no fewer babies die and no fewer have problems at birth.  However, more women have cesarean when EFM is used.”

Instead of being continually connected to the EFM (which limits a woman’s movement during labor and is often known to vary in interpretation from one maternity care provider to another), laboring women are recommended to request intermittent fetal monitoring with a hand-held Doppler device.

“Compared with the intermittent use of Doppler, the routine use of continuous EFM increase the likelihood of needing an instrument delivery or a cesarean, but does not reduce the incidence of problems for your baby (like admission to the neonatal intensive care unit, low Apgar scores cerebral palsy and death).”  

10. If you have already had a C-section in the past, seek a maternity care provider and birth location which supports VBACs. Approximately 70 percent of women planning a vaginal birth after cesarean (VBAC) are able to successfully accomplish this goal. The risk of uterine rupture during a vaginal birth after cesarean is 0.5 percent compared to a woman’s risk of uterine rupture without a scarred uterus (0.07%).  Contact your local chapter of ICAN for more information and support.

Kimmelin Hull, PA, LCCE, has been a Lamaze Certified Childbirth Educator since 2005 and is the Community Manger for Lamaze International’s Science & Sensibility research blog site. She is a physician assistant and is the author of A Dozen Invisible Pieces and Other Confessions of Motherhood. Kimmelin has also written freelance articles for regional and international parenting magazines, and maintained her own blog site, Writing My Way Through Motherhood and Beyond since 2008. A member of Montana Childbirth Collective, Kimmelin has participated in numerous community education, normal birth and gentle parenting advocacy events. A mother of three, Kimmelin and her husband raise their family in the beautiful Rocky Mountain town of Bozeman, Montana.