How to Reduce Your Risk of a Cesarean Birth
Robin Elise Weiss, Ph.D. | Feb 15, 2018
The cesarean section, also known as a c-section, is a life-saving surgery that happens just before or during the process of labor. It is performed via an incision in the abdominal wall and uterus to remove the baby from the uterus rather than have it pass through the vagina. Read on to learn about why cesarean sections are performed and how to reduce your risk.
How many cesarean births are there?
The cesarean section is the most commonly performed surgery in the United States. Approximately 32 percent of all babies are born via cesarean, meaning about 1.2 million cesarean sections are performed yearly. With cesareans, a simple wound infection occurs about 2-7 percent of the time. That means an increase of 26,000-91,000 cases of infection. The amount of cesarean births and infections takes a toll — in terms of the patients’ health, costs incurred, and the resources at the hospital level.
Why would you want to reduce the number of cesarean births?
There are many complications that can occur during this surgery for both the mother and the baby. These can include increased risk of infection and blood clots for the mother and an increased risk of breathing problems for the baby, including increased likelihood of going to the neonatal intensive care unit (NICU). When the benefits of this surgery outweigh the risks, it is appropriate, but many times, this surgery may be performed when other options might be safer, including to simply wait.
Choose a provider with a low cesarean rate
The provider you choose may influence whether you have a cesarean. Certainly, there are things that come up that can result in a cesarean no matter who your provider is, but a provider with a lower cesarean rate may not be as quick to jump to cesarean as the first line of defense. One study found that having an obstetrician with a lower patient volume made women more likely to have a cesarean. If you are low-risk, you may consider a provider who specializes in low-risk births, like a midwife.
Choose a place of birth with a low cesarean rate
The place you give birth will also influence how you give birth. Some hospitals have a very high cesarean rate, while others have a lower cesarean rate. While mothers who give birth in birth centers and at home have lower cesarean rates, this is also attributable to their low-risk status and provider. While quality score information, including cesarean rates, may be available for hospitals, many women don’t report engaging with this information as they make their choices.
Avoid induction of labor
About one-quarter of all births are induced, meaning labor is started artificially via a number of methods. Some studies show an increase in cesarean delivery rate when induction is done, while others tease out the data to show it’s more related to specific things like the dilation of the cervix at the time of induction, pregnancy complications, maternal age, and more. However, induction is sometimes a direct cause of cesarean— for example, if there is fetal distress due to the induction method.
Hire a doula
A doula is a trained person who is an addition to your pregnancy care team. While they don’t perform medical tasks, the comfort measures, labor support, and information they provide before, during, and after your birth have been shown to reduce the risk of cesarean birth. Most doulas are hired by individuals, but some hospitals also have doula programs within their walls. Ask at your hospital tour what they offer or for recommendations for local doulas to help lower your risk of a cesarean.
Stay home as long as possible
When you’re in labor, most people wind up going to the hospital well before active labor. The earlier part of labor is best done at home where you are more comfortable in your own surroundings. It is recommended that you not be in the hospital or birth center until you are in active labor, or about 6 centimeters dilated. Getting to the hospital and staying before that mark may increase your risk of cesarean delivery.
Use intervention, like water breaking, wisely
There are many ways that hospitals and practitioners can intervene in the birth process. Each type of intervention has a specific purpose and timing. When used for specific reasons, they are worth the risks. However, some become problematic when used on everyone. A great example is breaking your water in labor. Doing this without specific need in a specific moment may increase the risk of cesarean delivery. Risks are not limited to this example; other interventions can also increase the risk.
Get a second opinion
If you are being told that you need a cesarean and it is not an emergency, even before labor begins, you have the option of getting a second opinion. A cesarean birth is a major surgical procedure that has long-term ramifications for you and your baby. Taking the time to get another opinion may yield more options to try before surgery, or it may confirm that a surgical delivery is your best option.
Consider a vaginal birth after a cesarean
If you have had a previous cesarean birth, you may believe that you absolutely have to have a cesarean for all future births. Yet, having a vaginal birth after a cesarean (VBAC) has been shown to have many benefits for mother and baby. Talk to your doctor or midwife about whether you are a good candidate for a VBAC so that you can avoid another cesarean. Each additional cesarean incurs more risks for you and baby, including placental issues, blood loss, uterine rupture, and prematurity.