Guest post by Dr. Poppy Daniels, OB/GYN
- Choose a provider/facility with a low cesarean rate – Midwives have lower cesarean rates: the Midwives Model of Care has a more holistic approach to prenatal care, familiarity and patience with longer labors, and the fact that midwives are not surgeons. Many OBs & hospitals have lower than average cesarean rates, information about which can often be found online or by asking directly.
- Hire a doula – A doula is a trained labor assistant whose primary purpose is to support the laboring women. This physical & psychological support is critical in helping women to stay encouraged to continue, even in the face of long labors, which is why studies have shown that doulas are associated with lower cesarean rates.
- Be active in labor – Utilizing different positions & strategies in labor: standing, walking, swaying, dancing, birth balls, water therapy (whether shower or birth tubs) are more helpful than lying flat on your back on a continuous fetal monitor. Intermittent fetal monitoring or wireless monitors enable women to be more active.
- Avoid “soft” reasons for induction – Many reasons that women are induced are not truly evidenced-based & may increase the likelihood of cesarean: presumed macrosomia (“big baby”), mild blood pressure elevation without evidence for pre-eclampsia, being 39 or 40 weeks pregnant, or patient TOP (tired of being pregnant). Women who start inductions with an unfavorable cervix may be more likely to end up with a cesarean.
- Prepared childbirth classes – The more education moms and dads have about childbirth, the more likely they will be able to advocate for themselves during the ups and downs of unpredictable labor. Community-based childbirth classes are usually more focused on the physiology of labor & birth than hospital-based classes which can sometimes favor discussions of interventions to expect (IVs, epidurals, cesareans). While epidurals in the active phase of labor do not increase the risk for cesarean, epidurals in the latent phase (now defined as before 6 cm) can.
- Stay home as long as possible & ask for more time – Parents, especially first-time ones, can be excited about the latent phase of labor and go in very early in the process, increasing the likelihood of interventions. However, women who break their water & have an unknown station, are GBS positive, have bleeding or significant pain may need to go in sooner rather than later. Simply giving women more time once in the hospital has been shown to reduce the cesarean rate.
- Eat before you go in. – Despite mounting evidence that starving pregnant women in labor does more harm than good, many hospitals haven’t changed their policies and still limit moms to liquids & ice chips. Not getting fuel before a marathon is a bad idea for runners and a bad idea for pregnant women. Maternal exhaustion and hypocaloric intake can lead to an inefficient/low energy pushing, potentially increasing the risk for cesarean.
- Exercise, prenatal chiropractic, massage & acupuncture. – Pregnancy can cause many changes to the musculoskeletal system from lumbar lordosis to sciatica to carpal tunnel syndrome. Regular moderate exercise and other holistic treatments are beneficial to keep women loose, limber and prepared for the physicality of labor.
- Choosing a healthy diet and controlling blood pressure/blood sugar – Women with excessive weight gain in pregnancy, hypertension, and gestational diabetes are much more likely to end up with a cesarean delivery.
- Avoid listening to bad advice & “birth horror stories” from friends & family – Labor & birth is as much a head game as it is a physical challenge. Surround yourself with positive people who believe in your ability to have an empowered birth rather than naysayers who may mean well but undermine your confidence.
- If your baby is breech, consider finding a chiropractor trained in the Webster technique, doing exercises outlined in Gail Tully’s Spinning Babies, or find a physician with experience performing external cephalic version or vaginal breech delivery. If a cesarean is unavoidable, discuss your desires for VBAC or a larger family with your OB before surgery, if possible.
Poppy Daniels is an Obstetrician/Gynecologist in private practice in Ozark, MO. You can follow her on Twitter @drpoppyBHRT.