December 8, 2011

Trying to Avoid A Cesarean Birth

The World Health Organization recommends that the cesarean section rate should range between 5-10% for a healthy outcome for both mother and baby. So why is the national rate hovering over 30%, and what can be done to help lower this sky rocketing epidemic?

There are a variety of ways a woman can help reduce her chances of giving birth via cesarean section:

Low Risk Women Should Go To Low Risk Care Providers.
The vast majority of women can be categorized as “low risk” pregnancy so it would make sense for these women to align themselves with a care provider that caters to this population. Those that are indeed “high risk” (i.e. twin births, those with pre-existing health conditions, gestational diabetes, etc.) should be under the care of a “high risk” doctor. What happens when the low risk woman uses a high risk doctor? Well, the high risk doctor is probably not going to change the way he or she practices medicine, and will likely be more aggressive with the usage of routine interventions. High risk care providers may also follow a stricter labor and delivery schedule. Find out the statistics of your care provider- What is the c-section rate? What kind of schedule does he/she expect you to labor around? If you are not high risk, why should you be treated as if you were?

For more ideas of figuring out if you and your care provider are a good fit, check out The 5 questions to ask your care provider BEFORE your birth

Low Risk Women Should Go To Low Risk Educated Places Of Birth
This is a similar philosophy to picking the right care provider: picking the right place to birth. If the hospital mainly cares for high risk women that are often receiving a lot of interventions, the nursing staff may be unfamiliar with techniques to support a woman that is choosing a natural birth or does not need some of the interventions a high risk woman may require. There may also be an unfamiliarity of what a natural birth looks and sounds like, as well as a lack of patience for an unmanaged labor.

To better understand the differences in birthing facilities, please read, Where You Birth DOES Matter.

Educate yourself
Because of the nonchalant attitude and public acceptance of c-sections, the seriousness of the surgery is often glossed over. I believe if more women were educated about the potential risks involved in undergoing this procedure, fewer women would agree to a c-section and take more aggressive steps to avoid the possibility of one.

For a bigger picture of the risks vs the benefits of a cesarean, check out To Cesarean or Not To Cesarean

Get Educated Support
Since most well meaning partners do not know the ins and outs of labor and delivery, it can be very helpful to have an educated labor supporter that can offer you guidance and advice during the process. A well trained labor support doula can provide support and help steer you away from interventions and procedures that may be more routine than necessary.

Here is a little more information about how incorporating the help of a doula helps lower your chances of cesarean birth.New Study: Doula Care Lowers Cesarean Rate

Stay Home As Long As Possible

Staying home (and comfortable!) as long as possible is another way to decrease your chances of having a c-section. This is also another place where having a trained set of eyes watching you labor may help determine when it is time to head into the Birth Center or hospital, and when you haven’t quite turned the corner into active labor. Many care providers have a formula as to when they would like you to come to the hospital. It is likely the 5-1-1 or 4-1-1 rule. Meaning that the laboring mother should experience contractions 5 minutes apart, lasting for 1 full minute for 1 full hour! Once the laboring mother is admitted onto the Labor and Delivery floor, she is “on the clock” and a certain level of progress is expected to occur in a timely manner. If this progress is not met, it is likely that medical interventions will take place to move labor forward.

Avoid Unnecessary Interventions

Introducing routine interventions is a slippery slope. While there is no definitive formula, there is an increased likelihood that one intervention leads to another, and to another, and so forth. This is called the ‘cascade effect of intervention’. What may seem benign, such as artificially breaking the water or continuous fetal monitoring, can soon spiral out of control eventually leading to a cesarean birth.

It has become routine practice in many hospitals that women in active labor receive continuous EFM. According to Lamaze International, routine continuous electronic fetal monitoring (EFM) provides no benefit for babies and increases the risk of cesarean for mothers. The American College of Obstetricians and Gynecologists (ACOG) recommends that for healthy, low risk women, fetal heart rate be monitored with a fetospcope or Doppler every 30 minutes in active labor and every 15 minutes during pushing. The World Health Organization (WHO) encourages intermittent manual listening and warns that EFM is often used inappropriately.

There is a fair amount of research supporting the link between labor induction and the rise in the cesarean rate. When a woman is induced, she will more likely need the support of the epidural which decreases the mother’s ability to actively move around. Movement during labor can help encourage the baby into an optimal birthing position, create more effective contractions and make labor pains more tolerable. Along with the epidural comes the need for continuous EFM, which may offer false positive readings of fetal distress.

Avoid Epidural For As Long As Possible
While there are conflicting studies about the effect of epidurals and cesarean births, it is fair to say that once the epidural is in the picture, so are a lot of other interventions that can interfere with an easeful progression of labor: lack of movement, continuous EFM, bladder catheter, oximeter, blood pressure cuff, continuous IV drip and the need for pitocin.

One way to prolong taking the epidural is to learn pain management techniques. There are a variety of methods that can be incorporated into labor like, massage, counter pressure, focusing on the breath, the use of mantras or visualizations, taking a shower or bath, moving or rocking on a birth ball, just to name a few.

For those interested in non-pharmaceutical pain management, please read, 7 Tricks Of The Trade to Help You Have a Better Labor

I hope these ideas are helpful in supporting you through a happy and healthy birth!

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