More and more women in the United States (and around the world) are having cesarean births. A study from the Yale University of Medicine showed two main reasons for the rise: more C-sections in first-time moms and lower rates of VBAC (vaginal birth after cesarean).
For your first baby, what can you do to reduce your chances of an unnecessary cesarean birth? We've identified 10 areas where you can be proactive and try to avoid a C-section.
This point is number one for a reason – it's critical. In most practices, you could have any one of several doctors or midwives. You get whoever is on call when you go into labor. It's helpful to know your practice's cesarean rates.
The labels "obstetrician," "family doctor" and "midwife" don't necessarily tell you what you need to know about your provider's philosophy. Some doctors practice more like midwives, and some midwives practice more like a stereotypical doctor. Will they have a toolbox of natural techniques or only medical tools to help you if your labor is complex?
If you're not sure which doctor or midwife to choose, ask a doula. Doulas see all kinds of births with many different practices, and they will be happy to make a recommendation of a provider with a low cesarean rate and good bedside manner. If you find out that your provider is not supportive, it is never too late to switch, even if you are just a few weeks or even days before your due date.
Simply put, doulas make birth better, and there's research to prove it. A meta-analysis of studies shows that women who use a doula are 26 percent less likely to have a cesarean birth, among other dramatic benefits.
Having continuous support from a friend of family member can be helpful too, but the best results come when women hire an outside doula, according to a recent Cochrane Review.
What exactly is the doula magic? The research hasn't pinpointed it, but it may be the unique combination of physical, emotional, and informational support, plus gentle advocacy makes a huge difference. Doulas help women feel safe and comfortable so the hormones of labor can work at optimal levels, positioning ideas and tricks can help babies work their way out, and evidence-based information and help communicating with the medical staff can help women have their best chance inside a system that doesn't really promote natural birth.
It's not so much that you need to know a lot about giving birth, but many women (and men) need to undo what society has taught us about birth. Independent classes are usually longer and more in-depth, with more interaction and less lecture. A good instructor can help increase your confidence in your body and help you trust in the normal birth process.
An independent Lamaze-certified instructor will base her class on the six Lamaze Healthy Birth Practices, a wonderful resource that lays the groundwork for the best possible birth. Another benefit of an independent class is that your teacher works for you. She can teach you how to advocate for yourself within the system, without having to worry about what doctors, administrators or anyone else might think.
As a first-time mom, some studies show that simply walking in the door for an induction of labor doubles your risk of a cesarean. Avoiding induction is never more important than with a first baby. But if you must be induced for a medical reason, call on your natural childbirth instructor and your doula to help you with tips to keep it as normal and natural an experience as possible, even with the unexpected circumstances. If mom and baby are not in immediate danger, low-and-slow inductions can result in a better chance of a vaginal birth, but you'll need great support on the journey.
Your independent childbirth instructor will teach you how to recognize active labor. If you follow the common hospital recommendation to "come in when contractions are five minutes apart, at least a minute long, for at least an hour," most women having their first baby will be very early in labor. The intensity of contractions is a much better guide than the timing. The more hours you are at the hospital before your baby is born, the higher your risk of intervention (including a cesarean).
Research is a bit mixed, and not all studies have been high quality. But still, the best evidence available does seem to show that epidurals, especially when women get them early in labor, do increase the cesarean rate in first-time mothers. Childbirth Connection is a great resource for information on the benefits and risks of epidurals.
There are rare times, of course, when getting an epidural can actually help a woman have a vaginal birth, if she simply doesn't have the strength to go on. Every labor is different. But an epidural also makes it harder for a baby in a bad position to move into a better one, it limits your ability to move, and it requires a lot of other interventions (IV, continuous monitoring, bladder catheter, etc.). Your doula and your independent childbirth class may give you enough natural tools so that you won't even need the drugs. Most women don't.
Get these books, and read them cover-to-cover.
It's hard to do this alone, you need support! Even with the best doula, your partner is still an integral part of your birth journey. Penny Simkin's book "The Birth Partner: A Complete Guide to Childbirth for Dads, Doulas and All Other Labor Companions" is a great place to start. Be sure your partner attends that independent childbirth class with you – sometimes partners benefit even more than moms from that information and support.
It's possible, with the right support, to have a great first birth in the hospital – even a vaginal birth without pain medication. But the current cesarean rate in the United States is 32 percent, according to the Centers for Disease Control. Many studies have shown similar results, which makes out-of-hospital birth at least worth considering.
Your body works. Birth works, in all its complex and wonderful variations. Surround yourself with knowledgeable support, of course, in case you encounter any rare and unexpected complications. But truly... trust your body.