Preventing Cesarean Birth

What is a cesarean section?

A cesarean section is a surgery done to deliver your baby through your abdomen. The number of cesareans done in the United States has gotten too high in the past several years, and a vaginal birth is the safest for most women and their babies.

Why are cesareans done during labor?
Very rarely, a cesarean is done because there is an emergency health problem for you or your baby. The most common reason for a cesarean is that labor is not going as fast as expected. Your contractions may not be strong enough, your cervix may not be dilating (opening), or your baby may not be moving down the birth canal. If your health care provider suggests you need a cesarean because your labor is not going fast enough, ask if you have other options. If your baby’s heart rate is doing well, there is likely no medical reason to have a cesarean birth.

Why should I try to avoid a cesarean?
You are more likely to have health problems after a cesarean than after a vaginal birth. These include severe bleeding, infection, more pain, and a longer recovery time. Having a cesarean may prevent you from holding your baby in the first hour after birth and also makes it harder to start breastfeeding. You are more likely to be unsatisfied with your birth experience, which can lead to anxiety and depression. Your baby can have problems breathing after birth. Rarely, your baby can be hurt or cut during the surgery.
Having a cesarean can cause you to have health problems later. If you get pregnant again, you can have problems with your placenta and severe bleeding, which might require a hysterectomy (removal of the uterus). You may have to have cesareans for all future births, and the health risks are worse each time you get pregnant after having your first cesarean. For all these reasons, a cesarean should be done only if it is needed to protect your health or your baby’s health.

What can I do during my pregnancy to prevent having a cesarean birth?

    • Find a provider who has a low cesarean rate. Providers have different cesarean rates for low-risk women.
    • Ask about your provider’s cesarean rate before you choose. Midwives often have the lowest rates of intervention. A rate of 15% or lower for women who are low risk and having their first baby is best.
    • Find a birth place that has a low cesarean rate. Cesarean rates vary a lot in different birth settings. Women who are low risk and plan to give birth in out-of-hospital birth centers and at home have the lowest cesarean rates. Do your homework!
    • Talk to your provider about your preferences. Discussing your desires for birth with your provider prior to labor is important. This gives you the opportunity to find out how they will work with you to help you have a vaginal birth. If you are not comfortable with your provider’s answers, you have time to find a provider who supports your goals.

Do not have your labor induced unless there is a medical reason. Induction of labor can significantly increase your chance of cesarean birth. If this is your first baby, the chance of cesarean birth can be twice as high with induction compared with going into labor spontaneously. This is true until you are at least a week beyond your due date.

© 2012 by the American College of Nurse-Midwives
Preventing Cesarean Birth
Journal of Midwifery & Women’s Health
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