Things a Careprovider Can Do to Avoid Unnecessary Cesareans

by Pamela Udy

With the emphasis on a woman’s desire to choose how she gives birth, how does an OB empower women with the knowledge to make responsible decisions? By encouraging a woman to prepare for her labor and delivery, you are helping to ensure she has a healthy and positive birth experience. Birthing women should be aware of the benefits and possible risks of each intervention and should be informed of the cascade effect that often accompanies interventions. Women have the right to informed consent, as well as informed refusal.

Before Labor

When a woman comes to you for care the first time, or is pregnant for the first time, sit with her (fully clothed) in your office and discuss any concerns, expectations, and questions.
Provide her with a reading list.
Provide her with a birth plan to be filled out and discussed. Sign and submit copy to birth place. Be sure she is realistic and optimistic.
Provide her with a copy of International Childbirth Education Association’s "The Pregnant Patient’s Bill of Rights and The Pregnant Patient’s Responsibilities".
Provide her with a doula or provide a referral list so she can hire one herself.
Discuss nutrition with the pregnant woman. Encourage her to eat a well-balanced diet. Provide her with guidelines on eating foods rich in protein and vitamins.
If her baby is breech, discuss vaginal breech delivery. Discuss ways of turning the baby.
Discuss when to arrive at the birthplace. Discuss what she can do in early labor, to encourage labor without overly tiring herself (walking, light eating, rocking, tub).
If she has had a prior cesarean, sincerely encourage her to have a vaginal birth after cesarean. It is important to dispel any doubt she has that she could not have a vaginal birth. Play an active role in encouraging her.

During Labor

Encourage her to walk and labor in the position most comfortable for her. Remember that squatting can help bring her baby down. Laboring or/and birthing flat on her back is not recommended. It can decrease blood and oxygen supply to baby and the mother has to work harder to push her baby uphill.
Encourage her to continue to eat and drink lightly, even during labor. The uterus is a muscle and like all muscles, it must be nourished to work effectively.
Avoid Pitocin for a slow labor. If her labor is progressing slowly, you may want to encourage her to try nipple stimulation and loving caresses.
To avoid risk of infection, limit the number of vaginal exams done after her water breaks. Discuss with her how to avoid an infection and how to monitor for signs of infection.
After an initial monitoring strip upon admission, only occasional monitoring is necessary. Continual monitoring contributes to an increase in cesareans without related improvements in fetal outcome.
Epidurals and other anesthesia can slow labor and can cause complications for the mother and baby. Educate the mother about the risks involved and all the interventions that come with anesthesia. If the mother is having trouble pushing effectively, let the epidural wear off and then resume pushing.
Discuss with your patients natural pain relief measures such as: massage, reflexology, relaxation, guided imagery, hot/cold packs, shower or tub, birth ball, positioning, hypo birthing, and other comfort measures.
Discuss risks and benefits of routine and emergency procedures before they are encountered. When faced with the possibility of any procedure, discuss with the patient why it is being offered, what the short and long term effects are on the baby and herself and what the other options are.
If a cesarean is necessary, explain things that are happening, focus on the mother, reassure her.
A woman should first hear about the option for VBAC even before the first cesarean is done — "I am sorry that things aren’t going as we had planned. A cesarean seems to be what needs to be done for this birth because____ . You have every reason to believe that you can have a vaginal birth next time. I plan to do a low transverse incision because that will be strongest and safest for future births. We’ll talk more about this at your postpartum visit. "
Remember birth is your job, but this birth will be a life-changing event for the mother.

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International Cesarean Awareness Network